Community perceptions of infertility in terms of interpretation, causes, health - seeking behavior and social consequences in Bardiya district, Nepal.

Thesis Report.

SUMMARY: An estimated 50 to 80 million men and women globally suffer from difficulty to conceive (WHO, 1991). Until now health planners have mainly focused on overpopulation, and infertility is considered as a king of "natural check" on population growth (inhorn M. & Buss K.1994). After the 1994 International conference Population and development (ICPD) in Cairo, prevention and treatment of infertility are considered basic elements of Reproductive Health care (RH), and all men and women should have the right of access to this care. However the knowledge on perceptions, beliefs related to infertility and its social and individual consequences is insufficient (Jejeebhoy J., 1998). In Nepal, some statistical data of infertility exist, but no data of social and individual consequences of infertile men and women. This study was designed to elucidate men and women's description of living without children and traditional meaning of 1childlessness, and to describe cultural beliefs about the recognition, causes, treatment of infertility, and the impact on perceived health status and psycho-social consequences. The rational of the study was to provide the database for the planning and implementing of preventive and curative programs in infertility for the Reproductive Health (GTZ) project in Nepal. The study is descriptive and explorative in nature using predominantly qualitative methods. The study was carried out between the 8th of May and 8the of June 2001. It was conducted out among married men and women aged 20 years and above in Bardiya District, western part in Nepal. During the period of study, a total 68 individuals were interviewed, including eleven semi-structured individual in-depth interviews, six Focus Group Discussion and one Spontaneous Group discussion. The richest cases from individual interviews (one from woman, and one from man) were used as case studies. Key-informants' interviews (total 15) were conducted with local traditional healers, medical officers from Bardiya District, trained health workers, gynecologists, and a chief of the Family Planning Divission of the Ministry of Health. The study was completed with a reviewing of documents. Infromants were identified through previous context according to specific background (age, sex, religion, cast, socio-economics status) characteristic in order to present the different strata of the population in Bardiya district. All the interviews were recorded, translated in English, transcribed, and analyzed using the methods of qualitative analysis. The findings of this study illustrate the socio-cultural aspect towards infertility in a patriarchal Hindu dominated society. Community members described the ability to bear as impotent value. Children are the socio-economic insurance in old age and secure the continuity of generations. The most common term to define infertility for both men and women is "barren" (Banja). There is no difference in terms of primary and secondary infertility. However, having only daughters is nearly as bad as primary infertility. This is because the traditional Hindu society believes that only burial and cremation by the hand of a son gives the eligibility to enter into heaven. Both men and women perceived supernatural power, such as, witchcraft and the will of God as leading causes of infertility. Very few people believe on biomedical causes of infertility. Only one participant mentioned STDs as a possible cause of the male infertility. Unsafe abortions were not perceived by respondents as causes of infertility.