Health seeking behaviour of women in response to infertility: a case study of women attending gynaeocological and obstetric clinic at Muhimbili Medical Centre, Dar es Salaam.

The problem of infertility is feared in the world. In Tanzania the symbolic dimensions of woman's role as procreator continues to be valued. Thus, individuals and families are adaptive, pragmatic and pluralistic in pertaining to health seeking behaviour in response to infertility depending on time and circumstance. The general objective of this study was to understand the health seeking behaviour of women in response to infertility, to identify factors which influence health seeking behaviour and to understand who makes decisions in the households in response to treatment options. Methodological triangulation was used in order to cross validate the information on health seeking behaviour from the infertile women. Therefore ethnographic methods such as participants observation, in-depth interview, illness narratives and documents were used. Furthermore small scale quantitative study was conducted with 50 infertile women and 20 questionnaires were administered to the health professionals at the clinic and 20 husbands/patners of infertile women. The study found out from both quantitative and qualitative method that despite of the different socio-economic, cultural and education level four out of five of the respondents were quite familiar with the infertility problems. Also symptoms of infertility were identified after getting married or being sexually active without showing any sign of pregnancy. The perception of the severity of infertility differed. Women who were married for a duration of one year and above perceived infertility as a very serious health problem. On the other hand, women who had a marriage of less than a year perceived infertility as not a very serious problem. This is because they had not lost hope for conceiving. Husbands or partners who had a marriage for a duration of less than a year perceived infertility as a very serious health problem. This is because they had anxiety of being fathers. On the contrary, husbands who had a marriage for a duration of between two and ten years without their wives getting pregnant perceived infertility as no longer a very serious health problem. This is due to husbands getting involved in extra marital relations and hence got children outside the wedlocks. Also findings indicated that no single explanation of the causes of infertility was given. Instead, different causes of infertility were mentioned by the respondents such as bewitchment, lower abdominal pains during and after menstruation, frictions with close relatives, Will of God and inheritance from grand parents. On the opinions, attitudes and feelings about infertility, the findings showed that society holds prejudiced views of infertile women and is generally condemnatory. The infertile women on the other hand interpreted society's attitudes, feelings and opinions about infertility as hostile and rejecting and fear for the continuation of their marriage and old age insecurity. Furthermore, the findings on the health seeking behaviours of women in response to their infertility problems showed that the infertile women recoursed to four main patterns of treatment options, namely selfmedication, traditional healers, modern allopathic medical practitioners and religious healers. These patterns were resorted to either serially or simultaneously. The recourse to the above patterns of treatment options was influenced by socio-economic and cultural factors, health care delivery-related factors and availability of alternative health care resources within the locality. Findings showed that socio-cultural factors influenced the way respondents responded to their health condition, the way they defined and constructed infertility, the belief system about the etiological notions on infertility such as witchcraft, parents complaints, unfulfillment of bride price and Will of God. The study showed clearly that lay referral system, social stigma attached to infertility, past experience or habit and the low position of women in the society played a great role in influencing their health seeking behaviour. In addition, the findings showed that infertile wives were not involved in making decisions on the choice for therapies in response to their infertility. Husbands as heads of households had final say in all matters pertaining to fertility in the household. Based on the findings, the study called for immediate radical changes on the part of health educators, practitioners, administrators and policy makers. Also the study suggested the need to transform not only individual behaviours, but also society as a whole and systems of care delivery and systems of education. This is because, as already shown, health seeking behaviour in response to infertility is influenced more by the therapy management groups than individual patients. Finally the study called for further detailed studies on the experience of poor infertile women in the rural communities where there are no health facilities so as to expand the boundaries of our populations of interest. The present findings suggest that we need to explore more direct ways of capturing the effects of attitude on the health care providers. Related factors and availability of alternative health care resources within the locality. Findings showed that socio-cultural factors influenced the way respondents responded to their health condition, the way they defined and constructed infertility, the believe system about the etiological notions on infertility such as witchcraft, parents complaints, unfulfillment of bride price and Will of God. The study showed clearly that lay referral system, social stigma attached to infertility, past experience or habit and the low position of women in the society played a great role in influencing their health seeking behaviour. In addition, the findings showed that infertile wives were not involved in making decisions on the choice for therapies in response to their infertility. Husbands as heads of households had final say in all matters pertaining to fertility in the household. Based on the findings, the study called for immediate radical changes on the part of health educators, practitioners, administrators and policy makers. Also the study suggested the need to transform not only individual behaviours, but also society as a whole and systems of care delivery and systems of education. This is because, as already shown, health seeking behaviour in response to infertility is influenced more by the therapy management groups than individual patients. Finally the study called for further detailed studies on the experience of poor infertile women in the rural communities where there are no health facilities so as to expand the boundaries of our populations of interest. The present findings suggest that we need to explore more direct ways of capturing the effects of attitude on the health care providers.