Socioeconomic Status and Women’s Mental Health and Wellbeing in Male-Factor Infertility Marital Circumstances: A Scoping Review

Abstract

Background: Infertility is established where frequent intercourse and non-contraceptive use over 12 to 24-month periods do not result in live births. It is an underemphasized global public health challenge occurring mostly in countries with the highest fertility rates. Infertility can be female- or male-factor-based, combined, unexplained, or impaired. Fertility research emphasizes socio-cultural beliefs, patriarchy, insufficient distinctions between masculinity and virility, etc., as impacting women’s mental health and wellbeing. Conversely, research, policies, and interventions underemphasize the male-factor as central to reproduction. This is counter-productive for their female counterparts in the reproductive equation and contributes to gaps in reproductive health literature. Male-factor infertility, a sensitive, long-neglected public health issue caused by genetic and environmental factors, constitutes 20% of infertility cases globally. The biopsychosocial impacts of childlessness on women in male-factor infertility circumstances are almost equally deleterious across social groups and regions. Objective: To present a scoping review of evidence on the extent to which reproductive health literature recognizes socioeconomic status as central to women’s mental health and wellbeing in male-factor infertility circumstances. Methods: Literature was mapped across five databases (MedlinePlus, Google Scholar, PubMed, ScienceDirect and Publons Web of Science) without restrictions to geographical regions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist-2018 was the review protocol. Results: 12 out of 2582 screened articles met the eligibility criteria. The impacts of childlessness on women in male-factor infertility circumstances are similar across regions, but aggravated by socioeconomic circumstances, particularly in low- and middle-income countries (LMICs) and societies that emphasize childbearing. Women with relatively high socioeconomic statuses and access to New/Assisted Reproduction Technologies (NRTs/ARTs) enjoy better mental health and wellbeing. Discussion/Conclusion: The Social Determinants of Health (SDHs) provided the analytical framework. The socioeconomic status influences the quality of the women’s overall wellbeing in male-factor infertility circumstances, with implications for access to and affordability of New/Assisted Reproduction Technologies (NRTs/ARTs) and other related male-factor infertility treatment options. The deleterious impacts are more for those who are unable to afford the fertility treatments. Asides this socioeconomic context of infertility, a politico-legal context exacerbates the suffering of women in male-factor infertility circumstances, through policy gaps that exist in the provision of interventions to cater to the needs of socioeconomically disadvantaged women.