Quality of marital relationship, partner violence, psychological distress, and resilience in women with primary infertility

Abstract

Background: Primary infertility is an emerging public health problem associated with immense social stigma and adverse mental health consequence. The impact associated with infertility different from culture to culture. There is a paucity of qualitative research in Indian culture. Hence we aimed to explore the quality of marital relationship, psychological distress and resilience in a sample of women with primary infertility.Methods: A cross sectional single group mixed design was used. Sample comprised of 30 adult women, in their late twenties, diagnosed with primary infertility- female factor, by practicing gynaecologist; recruited from a renowned infertility hospital in Bangalore. The participants were assessed on marital quality scale, domestic violence questionnaire, depression anxiety stress scale-21, and Connor Davidson resilience scale after obtaining written informed consent. Data analysis was carried out using descriptive and inferential statistics.Results: Findings indicate high rates of intimate partner violence (47%) in the sample. Poorer quality of marital relationship was associated with higher levels of psychological distress and lower resilience. Women who experienced violence were more likely to report poor quality of marital relationship, higher levels of distress, and lower resilience than women who did not. Experience of at least one form of intimate partner violence emerged as a significant predictor of psychological distress.Conclusions:The need for prevention and intervention service for infertility is at its peak. The findings of the present research have implications in mental health assessment and intervention in this vulnerable group of women.

<p>Women and Infertility in a Pronatalist Culture: Mental Health in the Slums of Mumbai</p>

“…Despite the fact that infertility affects both men and women fairly equally, [7][8][9] in many societies, the woman is most often blamed when she does not get pregnant, resulting in mental health distress, stigma, discrimination, social exclusion, and abandonment. 2,[10][11][12] Infertility is associated with lower quality of life, marital discord, 13 with greater psychosocial consequences for women. 3,14 Additionally, infertile women with poor social support, high sociocultural pressure to have children (especially sons), maladaptive coping (ie, emotion focused/avoidance), prior trauma or mental health disorders, and overinvolved family members, are at particularly high risk for distress, including depression, and anxiety.…”

“…5,13,15,21,22 Furthermore, in traditional patriarchal societies such as many found in India, a woman's status and value is inextricably linked to her fertility. 5,10,12 Although allopathic infertility treatment and reproductive technology is readily available in India, it is not equally available to all due to the expense and time-intensive nature of treatment. 3,12,23 Sarkar and Gupta 3 found that while roughly 80% of infertile women in India sought treatment, 33% of these treatments were classified as traditional treatments or religious rituals.…”

“…5,10,12 Although allopathic infertility treatment and reproductive technology is readily available in India, it is not equally available to all due to the expense and time-intensive nature of treatment. 3,12,23 Sarkar and Gupta 3 found that while roughly 80% of infertile women in India sought treatment, 33% of these treatments were classified as traditional treatments or religious rituals. In the Indian social context, women who cannot seek treatment or find treatment ineffective, may be at particularly high risk for mental health consequences.…”

“…5 Studies in other pronatalist cultures have indicated that women without children are perceived more negatively than those who have children, and among infertile women, perceived community pressure to have children is associated with distress. 24,25 Yet research on culturally specific infertility distress and the mental health sequelae of infertility in India is lacking, 3,12,23,26 particularly among low-income women. Therefore, the purpose of this study is to assess mental health among a sample of Mumbai slum-dwelling women with a history of infertility.…”

“…This was contrary to anticipated results, and previous studies indicate an increased rate of emotional, physical, and sexual violence reported by infertile women. 12,15,16,46 However, in traditional Indian culture, a certain level of domestic violence towards women is accepted as the norm, 12 and it may be that infertilityrelated domestic violence was taken in stride on that account. On the other hand, while care was taken to conduct the structured interviews with adequate privacy, the women may have feared being overheard.…”