University of Ghana http://ugspace.ug.edu.gh
 
SCHOOL OF NURSING AND MIDWIFERY  
COLLEGE OF HEALTH SCIENCES  
UNIVERSITY OF GHANA  
 
HEALTH SEEKING BEHAVIOUR OF WOMEN WITH 
INFERTILITY IN SOKOTO STATE, NIGERIA 
BY 
AHMADU GRACE ISIYAKU 
10701730 
 
 
 
 
 
 
 
JULY, 2019 
 
 
 
University of Ghana http://ugspace.ug.edu.gh
HEALTH SEEKING BEHAVIOUR OF WOMEN WITH 
INFERTILITY IN SOKOTO STATE, NIGERIA 
BY 
AHMADU GRACE ISIYAKU 
10701730 
 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSTITY 
OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE 
REQUIREMENTS FOR THE AWARD OF MASTER OF 
SCIENCE IN NURSING DEGREE 
 
 
 
 
 
JULY, 2019 
 
 
 
  
i 
 
University of Ghana http://ugspace.ug.edu.gh
DECLARATION 
 
ii 
 
University of Ghana http://ugspace.ug.edu.gh
 
DEDICATION  
I dedicate this piece of research work to my late father Mr. Gweba Kamso for the proper 
upbringing and solid foundation he gave me despite all challenges of life.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
iii 
 
University of Ghana http://ugspace.ug.edu.gh
ACKNOWLEDGEMENT  
My profound gratitude goes to God for enabling me to successfully complete this program 
in good health and sound mind.  
With a grateful heart, I sincerely appreciate Dr. Florence Naab and Dr. Mary Ani- 
Amponsah for devoting time despite their schedules to equip me with necessary knowledge and 
skills to carry out the research successfully.  I cannot thank you enough for the guidance and 
constructive criticism that impacted positively in my study. I am indebted to the Dean Prof. Lydia 
Aziato, the entire faculty members and the non-academic staff of School of Nursing and 
Midwifery, University of Ghana for their shower of love, advice and hospitality during the course 
of this course. The truth is, your all practically made it happened from admission down to the 
completion of the course, I appreciate all the efforts.  
I sincerely appreciate my lovely husband Dr. Isiyaku Ahmadu and children Abba, Jinkai, 
Saratu, Suleiman and Cecilia for their patience and support throughout the course of my studies.  
Thanks to all my in-laws and family members (the Gweba’s) for being there for my nuclear family 
in my absence. 
I thank the management of Usmanu Danfodiyo University Teaching Hospital for releasing 
me to upgrade my educational status. Special thanks to all the women that participated in this 
study. I sincerely appreciate my colleagues 2018/2019 MSc/Mphil class for being such a 
wonderful course mates. Your encouragements and critiques have been useful in polishing my 
person. 
 
 
  
iv 
 
University of Ghana http://ugspace.ug.edu.gh
CONTENTS 
DECLARATION ............................................................................................................................................... ii 
DEDICATION ................................................................................................................................................. iii 
ACKNOWLEDGEMENT .................................................................................................................................. iv 
CONTENTS ..................................................................................................................................................... v 
LIST OF ABBREVIATIONS .............................................................................................................................. ix 
LIST OF TABLES .............................................................................................................................................. x 
LIST OF FIGURE ............................................................................................................................................. xi 
ABSTRACT .................................................................................................................................................... xii 
CHAPTER ONE ............................................................................................................................................... 1 
INTRODUCTION ............................................................................................................................................. 1 
1.1 Background of the Study ................................................................................................................... 1 
1.2 Statement of Problem ............................................................................................................................. 6 
1.3 Purpose of the Study ............................................................................................................................... 7 
1.4 Objectives of the Study ........................................................................................................................... 8 
1.5 Significance of the Study ......................................................................................................................... 8 
1.6 Research Questions ................................................................................................................................ 9 
1.7 Operational Definition of Terms ............................................................................................................. 9 
CHAPTER TWO ............................................................................................................................................ 10 
THEORETICAL FRAMEWORK/ LITERATURE REVIEW ................................................................................... 10 
2.1 Justification of Theoretical Framework ................................................................................................ 10 
2.1.2 Conceptual Framework .................................................................................................................. 13 
2.1.3 Application of the Theory of Help Seeking Behaviour ................................................................... 13 
2.2.0 Literature Review ............................................................................................................................... 14 
2.2.1 Symptoms Salience of Infertility among Women .......................................................................... 15 
2.2.2 Life Course Factors of Women with Infertility ............................................................................... 16 
2.2.3 Individual and Social cues among Women with Infertility ............................................................ 18 
2.2.4 Enabling and Predisposing Factors Leading to Health Seeking Behaviour among Women with 
Infertility.................................................................................................................................................. 21 
2.2.5 Perceptions of Women with Infertility towards Seeking Medical Help ......................................... 23 
2.2.6 Health Seeking Behaviour of Women with Infertility .................................................................... 24 
v 
 
University of Ghana http://ugspace.ug.edu.gh
2.3 Summary of Literature Review ............................................................................................................. 26 
CHAPTER THREE .......................................................................................................................................... 28 
RESEARCH METHODS .................................................................................................................................. 28 
3.1 Research Design .................................................................................................................................... 28 
3.2 Research Setting ................................................................................................................................... 28 
3.3 Target Population.................................................................................................................................. 29 
3.6 Sampling Techniques and Sample Size ................................................................................................. 30 
3.7 Sample Size Determination ................................................................................................................... 30 
3.8 Data Collection Tools ............................................................................................................................ 31 
3.9 Pretesting of the tool for data collection .............................................................................................. 31 
3.10 Procedure for Data Collection ............................................................................................................ 32 
3.11 Data Analysis ....................................................................................................................................... 33 
3.12 Trust Worthiness ................................................................................................................................. 34 
3.13 Ethical Considerations ......................................................................................................................... 35 
CHAPTER FOUR ........................................................................................................................................... 37 
STUDY FINDINGS ......................................................................................................................................... 37 
4.1 Participants’ Demographics .................................................................................................................. 37 
4.2 Organisation of Themes ........................................................................................................................ 39 
4.3 Symptoms Salience ............................................................................................................................... 40 
4.3.1 Delay in Conceiving ........................................................................................................................ 40 
4.3.2 Desire to have Children .................................................................................................................. 42 
4.3.3 Trying to Conceive.......................................................................................................................... 44 
4.4 Life Course Factors ................................................................................................................................ 46 
4.4.1 Childbirth as a Norm ...................................................................................................................... 47 
4.4.2 Age as a Push Factor ...................................................................................................................... 49 
4.4.3. Lack of Children as a Push Factor .................................................................................................. 50 
4.5 Individual and Social Cues ..................................................................................................................... 51 
4.5.1 Social Values .................................................................................................................................. 51 
4.5.2 Societal Support ............................................................................................................................. 55 
4.5.3 Social Pressure ............................................................................................................................... 60 
4.6 Enabling and Predisposing Factors ....................................................................................................... 64 
4.6.1 Resource and Support .................................................................................................................... 64 
vi 
 
University of Ghana http://ugspace.ug.edu.gh
4.6.2 Treatment Beliefs ........................................................................................................................... 68 
4.7. Perception about Infertility .................................................................................................................. 72 
4.7.1 Knowledge of Infertility ................................................................................................................. 73 
4.7.2 Treatment Outlets .......................................................................................................................... 76 
4.7.3 Medical Treatment Expectation .................................................................................................... 78 
4.8. Health Seeking Behaviour .................................................................................................................... 82 
4.8.1 Decision Making ............................................................................................................................. 82 
4.8.2 Seeking Medical Help ..................................................................................................................... 85 
4.8.3 Seeking Other Treatment Sources ................................................................................................. 87 
4.8.4 Acceptance and Adherence to Treatment ..................................................................................... 89 
4.9. Emerging Theme .................................................................................................................................. 91 
4.9.1 Psychological Experiences .............................................................................................................. 91 
4.9.1.1 Feeling stressed up ................................................................................................................. 91 
4.9.1.2 Being depressed ...................................................................................................................... 92 
4.9.2 Women’s Plea for Help .................................................................................................................. 94 
4.9.2.1 Advice to women .................................................................................................................... 94 
4.9.2.2 Men understanding ................................................................................................................. 95 
4.9.2.3 Government assistance ........................................................................................................... 96 
4. 10 Summary of the Findings ................................................................................................................... 98 
CHAPTER FIVE ........................................................................................................................................... 100 
DISCUSSION OF FINDINGS......................................................................................................................... 100 
5.1 Participants’ Demographics ................................................................................................................ 100 
5.2 The Symptoms Salience of Women with Infertility ............................................................................ 101 
5.3 Life Course Factors of Women with Infertility .................................................................................... 102 
5.4 Individual and Social Cues among Women with Infertility ................................................................. 104 
5.5 Enabling and Predisposing Factors Leading to Health Seeking Behaviour among Women with 
Infertility.................................................................................................................................................... 107 
5. 6 Perceptions of Women with Infertility towards Seeking Medical Help ............................................. 109 
6. 7 Health Seeking Behaviour of Women with Infertility ........................................................................ 111 
5.8. Emerging Themes ............................................................................................................................... 114 
5.8.1 Psychological Experiences ............................................................................................................ 114 
5.8.2 Women’s Plea for Help ................................................................................................................ 114 
vii 
 
University of Ghana http://ugspace.ug.edu.gh
5.9 Summary of Discussion of Findings..................................................................................................... 115 
CHAPTER SIX .............................................................................................................................................. 117 
SUMMARY, IMPLICATION, LIMITATION, RECOMMENDATION AND CONCLUSION .................................. 117 
6.1 Summary of the Study ........................................................................................................................ 117 
6.2 Implication of Findings ........................................................................................................................ 119 
6.2.1 Nursing Practice ........................................................................................................................... 119 
6.2.2 Policy Formulation ....................................................................................................................... 120 
6.2.3 Future Research ........................................................................................................................... 121 
6.3 Limitations of the Study ...................................................................................................................... 121 
6.4 Recommendations .............................................................................................................................. 121 
6.4. 1 Ministry of Health ....................................................................................................................... 122 
6.4.2 UDUTH and SHS ........................................................................................................................... 122 
6.4.3 Non-governmental Agencies........................................................................................................ 122 
6.4.4 Nurses Researchers ...................................................................................................................... 123 
6.4.5 Religions Bodies/Groups .............................................................................................................. 123 
6.5 Conclusion ........................................................................................................................................... 123 
REFERENCES .............................................................................................................................................. 125 
APPENDICES .............................................................................................................................................. 131 
Appendix A: Introduction Letters .......................................................................................................... 131 
Appendix  B: Consent Form .................................................................................................................. 133 
Appendix C: Interview Guide ................................................................................................................ 134 
Appendix D: Acknowledgement of Application for Ethical Clearance .................................................. 136 
Appendix E: Ethical Clearance and Administrative Approval from UDUTH .......................................... 137 
Appendix F: Ethical Clearance and Administrative Approval from SHS ................................................ 138 
 
viii 
 
University of Ghana http://ugspace.ug.edu.gh
LIST OF ABBREVIATIONS  
 
HSG: Hysterosalphygography 
ICMART: International Committee for Monitoring Assisted Reproductive Technologies 
IVF: Invitro Fertilisation 
SHS: Specialist Hospital Sokoto 
TPB: Theory of Plan Behaviour  
UDUTH: Usmanu Danfodiyo University Teaching Hospital   
WHO: World Health Organisation 
 
  
ix 
 
University of Ghana http://ugspace.ug.edu.gh
LIST OF TABLES  
 
Table 4.1 Demographic characteristics of the study participants ……………………………37 
Table 4.2 Themes and subthemes…………………………………………………………….38 
  
x 
 
University of Ghana http://ugspace.ug.edu.gh
LIST OF FIGURE  
 
Figure 2.1: Conceptual Framework of Help Seeking…………………………………………13 
  
xi 
 
University of Ghana http://ugspace.ug.edu.gh
ABSTRACT 
 
Children are highly valued in the African culture. As a result, women with infertility experience 
devastating suffering. Women are often left alone to go through the burden and complex decision 
making process of health seeking because it is seen as a woman’s problem. The main aim of the 
study is to explore the health seeking behaviour of women with infertility in Sokoto State Nigeria. 
Explorative descriptive design which is a qualitative approach was employed.  Ethical clearance 
and administrative approval was received. A purposive sampling technique was used to recruit 
fourteen consented participants who were interviewed using semi structured interview guide. The 
study findings revealed that the women that sought for help to conceive were married, educated 
young elderly women. The women were able to identify infertility because they paid attention to 
their duration of marriage and unproductive sexual intercourse, years of last childbirth and 
repeated miscarriages. Regardless of the women’s financial status and social support (advice, 
prayer, emotional financial) from significant individuals, the women were committed to seeking 
for medical help to conceive. The women believed that infertility is caused by biological and 
supernatural components. As a result, the women sought for help to conceive at both medical and 
faith-based outlets. The women did early and late medical seeking. They also patronised multiple 
health institutions starting with the private clinics for privacy. However, the women were 
psychologically traumatised due to social pressure (neglect by husbands, blame, humiliation and 
stigma) and the ordeal of infertility. Additionally, the women found infertility treatment to be 
expensive. It is recommended that government and relevant agencies should assist in ensuring 
treatment is subsidised and empower women to improve access to fertility related treatment.   
 
 
KEY WORDS: Infertility, Behaviour, Childless Women, Health Seeking, Help Seeking.
xii 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER ONE 
INTRODUCTION 
This chapter presents the background of the study, statement of problem, purpose of the study, 
objectives of the study, research questions, significance of the study and operational definition of 
terms   
1.1  Background of the Study 
Infertility is a worldwide reproductive public health challenge, affecting 48.5million couples  
with 34million under 60years aged women childless due to prolonged maternal morbidity which 
is more common in the middle income world and graded the 5th severe worldwide disability (Cui, 
2010; Dierickx et al., 2019; Mascarenhas, Flaxman, Boerma, Vanderpoel, & Stevens, 2012; 
WHO., 2011). Despite the devastating reproductive health challenges of infertility, it is still one of 
the ignored reproductive health challenge and low in the health priority list in the world especially 
in the low income world (Cui, 2010).  
Infertility is a reproductive system illness characterised by inability to attain a clinical 
pregnancy after 12months or more of consistent uninterrupted sexual intercourse (World Health 
Organisation - International Committee for Monitoring Assisted Reproductive Technologies 
(WHO-ICMART, 2009). Infertility is the inability of childbearing age women (15-49years) at risk 
of achieving pregnancy to become pregnant after two or more years of productive trial (WHO, 
2018). Infertility is the failure of childbearing age women (15-49years) to become or stay pregnant 
within five years of exposure to pregnancy (Rutstein & Iqbal, 2004). Collectively the above are 
the respective biomedical, epidemiological and demographic definitions of infertility indicating 
1 
 
University of Ghana http://ugspace.ug.edu.gh
minimum waiting time before seeking for medical help to get pregnant. Medically, Primary and 
secondary infertility are basically the main types of infertility. Primary infertility occurs where 
there was no history of previous conception in a woman that fail to conceive or bear a child while 
secondary infertility is failure of a woman to become pregnant after previous ability to conceive 
or  carrying a pregnancy to a live birth (Mascarenhas et al., 2012).  
Globally, the prevalence of infertility among women is high with substantially low health 
seeking behaviour recorded. About 15% of couples within the childbearing age are affected by 
infertility with women accounting for about 9-10% prevalence globally (Boivin, Bunting, Collins, 
& Nygren, 2007; Cui, 2010; Mascarenhas et al., 2012; WHO, 2018). Basically, it is reported to be 
underestimated and there is no significant decrease for the past twenty (20) decades (Mascarenhas 
et al., 2012; WHO, 2018). Worldwide, 72.4 million women are infertile with lifetime prevalence 
of 6.6% to 26.4% and 40.5 million seeking for infertility treatment with 32.6million (45%) not 
seeking for medical help to conceive in all the countries (Boivin et al., 2007). Secondary infertility 
was found to be more prevalent among women within the age range of 20-44years while primary 
infertility is more in younger women less than 25years (Cui, 2010; Mascarenhas et al., 2012; 
WHO, 2018).  
In the high income nations, parenting is undeniably sought after (Chin, Howards, Kramer, 
Mertens, & Spencer, 2015).  Prevalence of infertility among women in Britain is about 12.5% and 
more than half sought for medical help to conceive (Datta et al., 2016).  In Portugal, 7% of the 
women demanded for medical help  to conceive out of which 71% were clinically diagnosed of 
infertility (Correia, Rodrigues, & Barros, 2014). In Canada, 3 in 4 couples with female partners 
aged 18-44years reported actively trying to get pregnant however, only 15% reported seeking help 
to become pregnant (Bushnik, Cook, Hughes, & Tough, 2012).  
2 
 
University of Ghana http://ugspace.ug.edu.gh
Racial disparity to the prevalence of infertility and health seeking behaviour among women 
with fertility problem was noted even in the high income countries.  In Georgia, childlessness was 
found to be higher among the white women (84%) than the black women (73%) out of which 67% 
white and 32% black women show variation in actively trying to get pregnant (Chin et al., 2015).  
Similarly, Greil, McQuillan, Shreffler, Johnson, and Slauson-Blevins (2011), also report that black 
and Hispanic women in the U.S. delay in seeking medical help to conceive and are less to demand 
for medical treatment for infertility.   
Despite the significance placed on childbearing, the medical demand for infertility services is 
still an issue. The global medical help seeking for infertility is about 58% even in nations that 
provide generous access to medical care; an example is the level of access in Denmark is similar 
to that of Gambia (Boivin et al., 2007). In USA, 34% of women with infertility do not demand for 
help to conceive (Slauson-Blevins, McQuillan, & Greil, 2013).The issue of infertility revolved 
around secrecy and privacy in both the high and middle income society such that it becomes 
culturally improper to ask why a woman is not pregnant (Petitpierre, 2018).   
Infertility in the middle income nations raises distinct and difficult problems beyond those 
acknowledged by high income countries. Middle income nations have the highest prevalence of 
infertility in places like Asia, Middle East, North Africa and Sub-Sahara Africa (Mascarenhas et 
al., 2012). About 8% married women in India are presently infertile (Saha et al., 2015). In most of 
the middle income regions, fertility is given maximum importance as part of the tradition and/or 
religion; thus,  infertility goes beyond failure to bear a child but is seen as a betrayal or sin (Cui, 
2010; Li et al., 2017). Infertility is prevalent and a grave concern to couples specifically to women 
with the assumption that the affliction is not clearly represented (Petitpierre, 2018). 
3 
 
University of Ghana http://ugspace.ug.edu.gh
 WHO (2018) reported that male factor contributes to about 50% infertility cases yet women 
are mostly afflicted with great consequences of the disease.  Women from China, India, Nigeria, 
Ghana suffer both social and psychological trauma ranging from anxiety, stress, depression, social 
isolation, stigmatisation, marital problems, and being seen as sinners (Bukar, Audu, Usman, & 
Massa, 2012; Kussiwaah, 2016; Li et al., 2017; Naab, Brown, & Heidrich, 2013; Whitehouse & 
Hollos, 2014). This implies that the social and psychological consequences in turn adversely affect 
the health of the infertile women. 
In most Sub-Saharan African (SSA) cultures, marriage is normative for childbearing and 
giving birth is a sign of a blessed marriage (Naab, 2014). However, there is a misconception that 
infertility is basically the fault of the woman posing a complex gender specific problem (Ola, 
2014). Hence, childlessness in SSA signifies misfortune for the couple, frustration for families 
because emphasis is placed on continuity of lineage (Cui, 2010). The specific distress among 
women includes serious economic challenge, humiliation, ban from family and community 
tradition, divorce, depression, murder and suicide (Kussiwaah, 2016; Naab et al., 2013; Petitpierre, 
2018). The prevalence of secondary infertility was reported to be more than primary infertility 
(Bukar et al., 2012;  Naab et al., 2013; Oladeji & OlaOlorun, 2018; Panti & Sununu, 2014)  and 
common among 25-49years old women (Cui, 2010). Most of the infertility cases in the middle 
income countries are due to infections (WHO., 2011). It is therefore, sad to note that little attention 
is given to the preventive measures of infertility (Hampton, Mazza, & Newton, 2013). 
In Africa, medical demand for infertility still remains an issue. In most Africa nations, 
treatment is mostly directed towards women because infertility is viewed as a disease of women 
(Tabong & Adongo, 2013a). In Ghana, it is believed that infertility is caused by social and 
biological factors such as bewitchment, disobeying social norms, use of contraceptive and abortion 
4 
 
University of Ghana http://ugspace.ug.edu.gh
(Tabong & Adongo, 2013b). Thus, women with infertility sought for help to conceive based on 
their perception of the disease from spiritualist, traditional healers and medical treatment (Tabong 
& Adongo, 2013b). It was also reported that some men are not supportive of medical help, as they 
feared being diagnosed as infertile or because they have fathered a child elsewhere (Gerrits, 2012). 
Hence, serving as a discouragement for health seeking to some women and in case of female factor 
infertility, no medical treatment might be sought (Gerrits, 2012).  Generally, there is also the 
problem of limited information on the availability of biomedical care of infertility to the public 
especially in the less developed nations (Gerrits, 2012).  
In Nigeria, being an African nation, fertility is a vital issue and the situation is not different 
from those seen in other Sub-Saharan societies. The prevalence is high in some states with more 
than half (54.8%) of the women in Anambra afflicted with childlessness (Okafor, Joe-Ikechebelu, 
& Ikechebelu, 2017).  Nationwide, offspring are treasured for social, cultural, religious and 
economic motives as such barrenness frequently leads to psychological, social, and economic 
burden, especially for women (Whitehouse & Hollos, 2014). The health challenges caused by 
infertility on women with fertility problem in Nigerian is devastating as the prevalence of 
psychiatric morbidity is said to be around 39% and 42.9% (Awoyinka & Ohaeri, 2014; Ikeako, 
Iteke, Ezegwui, & Okeke, 2015; Upkong & Orgi, 2006). It is evident that childbearing does not 
only have an important influence on the woman’s social status in the family and society but her 
health as well.  In Southern Nigeria, infertility is believed to be caused by predestined supernatural 
problems, problem of women, a threat to man’s lineage and spiritual attack by witchcraft (Okafor 
et al., 2017). The burden of childlessness is confined to the socio-cultural background as it affects 
the opinions of individuals towards medical help seeking. 
5 
 
University of Ghana http://ugspace.ug.edu.gh
Health seeking behaviour is a complex process (activity) characterised by multifaceted 
factors like age, marital status, parity,  literacy level of the individual, family’s financial resources, 
religion, social support and individuals’ perception of infertility (Slauson-Blevins et al., 2013; 
White, McQuillan, Greil, & Johnson, 2006). Women  with infertility in Nigeria, attribute the 
disease to cultural, spiritual and biomedical aetiology (Bukar et al., 2012; Lawali, 2015). This 
implies that despite the importance attached to fertility and the burden of childlessness, women 
seek for help from alternative medicine with only few accessing medical care.   
The burden of infertility on women and the complexities involved in treatment decision 
making makes it imperative for the researcher to explore the health seeking behaviour of women 
in Sokoto state using the theory of help seeking behaviour as an organising framework. 
1.2 Statement of Problem  
Children are highly valued in Nigeria; the Northern part not an exception and the suffering 
associated with infertility is overwhelming. Childless women are ill-treated by husbands and in-
laws. As a result women go through many traumas both psychologically and socially such as 
anxiety, depression, stigmatisation, divorce (Lawali, 2015). In addition, high oxidative stress status 
was found among women with infertility in Sokoto (Panti et al; 2018).  More so, the study by 
Upkong and Orgi (2006), also revealed that women’s experience is devastating as lack of support 
from husband also predicted depression and anxiety for most Nigerian women.This is more evident 
in a predominately Muslim society where gender disadvantage poses threat to the women’s health 
psychologically (Qadir, Khalid, & Medhin, 2015).  
The place of early identification and prompt treatment of the predisposing conditions to 
infertility cannot be over emphasised. In the Northern Nigeria, infertility health seeking is delayed 
as 40% of women with infertility seek for medical care after three years of not being able to 
6 
 
University of Ghana http://ugspace.ug.edu.gh
conceive out of which 50.4% used traditional medication (Bukar et al., 2012). This shows that 
delay in seeking care can be attributed to so many factors in the health decision process and the 
delay might also expose the women to other advance health consequences.  
Secondary infertility accounted for the majority of cases 52.7% in Nigeria (Bukar et al., 
2012; Oladeji & OlaOlorun, 2018). In Sokoto, studies have reported prevalence of infertility as 
15.7% with secondary infertility as the common type with 67.2% (Panti & Sununu, 2014).  
Secondary infertility as the main indication for hysterosalphingograhy (HSG) in Sokoto with 
54.9% with 58.3% abnormalities seen in the cervix, uterus and fallopian tube was also reported 
(Danfulani, Mohammed, Ahmed, & Haruna, 2014). 
 More so, Panti and Sununu (2014), revealed that 42.9% of the infertility cases were female 
related out of which 78.8% had history of preceding genital diseases. According to Panti and 
Sununu (2014), early health seeking and prompt treatment of the genital infections might reduce 
the prevalence of infertility in the State. Studies by researchers in the region and beyond have 
provided a lot of insight on the prevalence, common types, causes and consequences of infertility 
(Danfulani et al., 2014; Dyer, 2008; Lawali, 2015; Panti & Sununu, 2014; Panti et al; 2018).  
However, little is known about the health seeking behaviour of the women with infertility. This 
prompted the researcher to explore the health seeking behaviour of women with infertility in 
Sokoto state. 
1.3 Purpose of the Study  
The main aim of this study was to explore the health seeking behaviour of women with 
infertility in Sokoto State Nigeria. 
7 
 
University of Ghana http://ugspace.ug.edu.gh
1.4 Objectives of the Study 
The objectives of the study were derived from the constructs of the theory. The specific 
objectives of the study were to:  
1. Determine the symptoms salience among women with infertility. 
2. Describe the life course factors of women with infertility 
3. Explore the individual and social cues among women with infertility 
4. Identify the enabling and predisposing factors leading to health-seeking behaviour among 
women with infertility  
5. Assess the perception of women with infertility towards seeking medical help 
6. Explore the health seeking behaviours of women with infertility  
1.5 Significance of the Study  
The results from this study would provide the picture of the factors influencing the health 
seeking behaviour of women. This would give an understanding of the complex process involved 
in health seeking. The information may also help planners and agencies for maternal and 
reproductive healthcare to strategy how to assist the women seek the appropriate medical care. The 
information from the study would assist health practitioners appreciate the complexity in health 
decision making thereby informing them to treat each woman demanding medical services 
holistically and uniquely as individual. The findings would also sensitise and enlighten the women 
on the availability and accessibility of medical infertility services in the community and beyond. 
The study would be an addition to the body of knowledge serving as a reference material for further 
studies. 
8 
 
University of Ghana http://ugspace.ug.edu.gh
1.6 Research Questions  
1. What are the symptom saliences of women with infertility in Sokoto? 
2. What is the life course factors influencing the health seeking behaviour among women with 
infertility in Sokoto? 
3. What are the individual and social cues influencing the health seeking behaviour among 
women with infertility in Sokoto? 
4. What are the enabling and predisposing factors leading to health-seeking behaviour of 
women infertility in Sokoto?  
5. What are the perceptions of women with infertility towards seeking medical help in Sokoto? 
6. What are the health seeking behaviour of women with infertility in Sokoto? 
1.7 Operational Definition of Terms 
Health seeking behaviour: looking for medical treatment 
Help seeking:  seeking for treatment 
Sought for help: looked for treatment 
Infertility: being unable to become pregnant after all trials  
Women: a female of childbearing age (18 to 50yers) 
 
  
9 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER TWO 
THEORETICAL FRAMEWORK/ LITERATURE REVIEW  
This chapter looks at the review of the related literature under the following major 
headings: the theoretical framework and the review of empirical literature, which were organised 
based on the specific objectives of the study.   
2.1 Justification of Theoretical Framework 
Theory gives comprehension that leads to conceptual and operational definition of terms 
in research thereby improving the consumption of research. The development of nursing science 
is based on theoretical framework built via vigorous process from practice and replication via 
scientific inquiry (research) by analysis and development of concept and theories (Bousso, Poles, 
& Cruz, 2014).  Theoretical models help to organise research and the extension of knowledge by 
providing both direction and impetus; hence make research findings meaningful and generalizable 
(Fawcett & Desanto-Madeya, 2012). Thus, it becomes imperative to use a theoretical model to 
guide the entire research process for better understanding of the research problem.   
About three different theoretical frameworks on behaviour were reviewed. The first is the 
Theory of Health Belief Model (HBM) generated by social psychologists Rosenstock, Hochbaum, 
Kegeles & Levegethal in 1950 in order to better comprehend the reasons behind the failure 
experienced by the screening programs for tuberculosis (Carpenter, 2010; Rosenstock, 1974). The 
theory was later amended to include the role of self-efficacy and other emerging evidence in the 
field of psychology in relation to decision making and actions in 1988 (Glanz & Bishop, 2010; 
Glanz, Rimer, & Viswanath, 2008). The model has gained a lot of recognition as it is the best and 
largely used psychological health behavioural theory in health research (Glanz et al., 2008). The 
10 
 
University of Ghana http://ugspace.ug.edu.gh
theory is largely used to predict different changes in the health related behaviours (Glanz et al., 
2008). The theory postulated that health behaviours are influenced by perceived susceptibility, 
perceived severity,  perceived benefits or barriers to actions and self-efficacy (Rosenstock, 1990). 
This implies that the perception of the severity of the disease has influence on the individuals’ 
health behaviour. The constructs of the theory focused basically on the effect of perception on 
health behaviour; of which the researcher was not interested.  
The second is the Theory of Planned Behaviour (TPB) that was developed by social 
psychologist Ajzen in1991. This was derived out of the initial reasoned action (Ajzen, 1991). The 
theory has largely been use as a model to give understanding of different behaviours in which the 
individual has ability to exert self-control (Ryan & Carr, 2010). The health belief model postulated 
that a particular action towards a behaviour in respect to specific question is likely to predict that 
behaviour (Ajzen, 1991). The TPB beliefs that behavioural change is stimulated by three variables 
namely individual’s attitude,  subjective norms and perceive behavioural control (Ajzen, 1991).  
This indicates that TPB detailed the individual’s conscious decision to exert self-control in respect 
to all kinds of behaviour as explained by the conceptualised constructs. Hence, this theory helps 
health professionals to appreciate and influence people to promote healthy behaviour. The 
variables in this theory are also not of interest to the researcher. 
The Help Seeking Behaviour Conceptual Framework is the third theory reviewed. The 
theory was found most suitable to guide this study because it is exclusively meant for infertility 
looking at the peculiarity of the health challenge. 
 
 
 
11 
 
University of Ghana http://ugspace.ug.edu.gh
2.1.1 Theory of Help Seeking Behaviour  
The theory of help seeking behaviour was developed in 2006 by sociologists White, 
McQuillan and Greil (White et al., 2006). The theory drew from the behavioural model of health 
service utilisation by Andersen 1968 with the view to provide a framework for help seeking and 
cognition process of symptoms (White et al., 2006). The model also examines the effect of 
symptoms salience, life course cues, individual and social cues, predisposing and enabling factors 
on the perception of problem which in turn triggers help seeking. The itemised constructs were 
conceptualised by the theorists as follows. 
Symptom salience is perceived as a significant determinant of perception and it shows how the 
symptoms affect daily life (White et al., 2006). For infertility, symptom salience can be represented 
by consciously and actively trying to conceive plus the strength of the individual’s intention 
towards childbirth.  
Life course cues are vital variables for assessing not being able to conceive as a fertility challenge 
and for help seeking behaviour as well. The variables include age, parity and marital status because 
marriage is a normative for childbearing. 
Individual cues have to do with the individual’s attitude based on the significance attached to 
motherhood and religiosity as aim in life. These also impact on perception and help seeking for 
fertility impairment.    
Social cues are other important factors that influenced perception and seeking help. These are 
perceived approval for medical treatment, partner’s perceived fertility intention, perceived stigma 
of infertility and experience, and support of friends and family.  
Enabling conditions are determinants that motivate seeking help like resource (income and health 
insurance), educational level and social support. 
12 
 
University of Ghana http://ugspace.ug.edu.gh
Predisposing conditions are also seen as motivators such as having a trusted personal doctor, 
knowledge of symptoms and treatment, medical anxiety and belief in the safety and efficacy of 
biomedical solution. 
Perception of the problem is actually influenced and established by some of the above mentioned 
items like seeing symptom as biomedical, health belief and belief in medical treatment.  
2.1.2 Conceptual Framework  
 
 
 
Symptom Salience 
 
 
 
 
 
Life Course Factors 
 
 
 Perception of a Sought medical help 
 problem 
 
 Individual & Social 
 Cues 
 
 
 
 Enabling & Predisposing 
 Factors 
 
 
Figure 1: Conceptual Framework of  Help Seeking by White et al. (2006). 
 
2.1.3 Application of the Theory of Help Seeking Behaviour 
Symptom salience: Women with the desire to give birth might actively put efforts in trying to 
conceive e.g going online for health information or in-person consultation or both. 
13 
 
University of Ghana http://ugspace.ug.edu.gh
Life course cue and enabling condition: Educated aged (>35years) women with good family 
income without children are more likely to seek for medical help to conceive. 
Individual cue: Women who have no children with more conservative value like intention to have 
children because of the motherhood and religiosity value are most possible to pick and pay 
attention to signs of fertility problems. 
Social cue: women without children and with the desire to conceive, perceived signs of infertility, 
with positive reasoning about the treatment, good family or friends support and partner’s desire 
for a child are most likely to demand for medical attention immediately (on time). 
Predisposing condition: women with positive health attitudes, positive belief in biomedical 
solutions, and have trusted personal doctor are likely to demand for medical treatment or their 
doctor might identify and raise the issue of the fertility impairment to those that are reluctant. 
Likewise, those with treatment anxiety, do not have regular doctor, and do not have knowledge of 
the medical symptoms are less likely to seek for medical treatment for their fertility problem. 
2.2.0 Literature Review 
The University of Ghana Legon-Accra database search engine which was complimented 
with Open Athens database resources were used to carry out the online search. Academic search 
Elite, Cumulative Index to Nursing and Allied Health Literature, Medical Literature Online, 
Pubmed, ScienceDirect EBSCOhost, Proquest, JSTOR, Springer Link, Elsevier, Wiley Online 
Library and Taylor & Francis online databases were explored to retrieve literature because these 
databases are health and professionally focused.  Specific databases associated to field of search 
and a small scale academic search can be limited to specific professional databases (Coughlan, 
Cronin, & Ryan, 2013).  
14 
 
University of Ghana http://ugspace.ug.edu.gh
The search was guided by the use of measures that includes: basic keywords (infertility, 
behaviour, women, childless, seeking, and help-seeking); Boolean operators (‘AND/OR’) to 
combine words through the advance search. The criteria (English language, year of publications, 
peer reviewed and source type) were used in order to give focus and ensure timely search.  
Keywords used in databases consist of words put in the literature by databases compilers and 
authors which allow keywords to retrieve topics central to the piece of literature than any words 
that appeared in the articles (Aveyard, 2014; Jesson, Matheson, & Lacey, 2011). Search for 
relevant specific articles cited and referenced (reference tracing) by other authors was also 
incorporated into the digital search. The scope of the relevant literature reviewed were from the 
year 2006 to 2019 because infertility is a peculiar area not often studied thus the classical 
references.     
2.2.1 Symptoms Salience of Infertility among Women  
Women desiring to get pregnant are able to identify delay in conceiving and make effort to 
seek for help to get pregnant. Indicator of symptom salience include delay in conceiving which 
was identified by the monthly menstrual flow indicating lack of conception, desire to have children 
and actively trying to conceive (White et al., 2006).  In a Gambia study by Dierickx et al. (2019), 
the finding revealed women were able to perceive infertility after unproductive 1-2 years of 
unprotected sexual intercourse with their husbands and miscarriages within the same period. The 
study furthers shows that women took cognisance of the short period (3-6months) living together 
with their husband without pregnancy (Dierickx et al., 2019).  
Similarly, Bunting, Tsibulsky, and Boivin (2012),  highlighted that desiring to get pregnant 
is seen in making some conscious effort to achieve pregnancy (take some actions e.g tracking 
ovulation)  as an indication of the willingness to seek for help. In a study carried out in USA on 
15 
 
University of Ghana http://ugspace.ug.edu.gh
N=1352 women, women with infertility trying to conceive were related to higher odds of in-person  
health seeking (consulting a doctor) (Slauson-Blevins et al., 2013). It was reported that use of 
allopathic treatment was more among educated women living in the city with 73% compare to 
62% of women not educated and living in the rural area (Sarkar & Gupta, 2016). These show that 
the desire to have children enable women to identify the delay in conceiving and also influences 
actively trying to conceive. 
2.2.2 Life Course Factors of Women with Infertility 
Reports have shown that lack of children in marriage predisposes to marital disharmony.  
In Africa, customarily, married couples are expected to become parents (Dierickx, Rahbari, 
Longman, Jaiteh, & Coene, 2018).  Childbirth cements marriage and children are seen as the chain 
that bond marriages (Mumtaz, Shahid, & Levay, 2013; Tabong & Adongo, 2013b).  The women’s 
role traditionally in Africa is to give birth to children for her husband and in-laws (Mumtaz et al., 
2013; Tabong & Adongo, 2013b). Therefore, children are expected after marriage to bring peace, 
stability in marriage and as prove of womanhood (completeness) (Dhont, 2011; F Naab, 2014; 
Roomaney & Kagee, 2016). Hence, marriage without children weaken marriage ties, it is viewed 
as a curse, incomplete without God’s blessing, a big problem and couple cannot be viewed as a 
family by the community (Mumtaz et al., 2013; Naab, 2014; Tabong & Adongo, 2013a). Thus, 
they push to seek for help to get pregnant in order to have peace and stability in their marriages. 
The ultimate dream of marriage is to have children as a result, those women without 
children are not happy in their  marriages since they went into marriage with the hope of becoming 
mothers (Dhont, 2011; Tabong & Adongo, 2013a). Sadly, some in-laws disrupt the peace in homes 
of these women, women are denied full membership of husband’s family,  their role in the family 
16 
 
University of Ghana http://ugspace.ug.edu.gh
is unsecured or even divorced (Dhont, 2011; Tabong & Adongo, 2013a). As a result, women with 
infertility feel life has been unfair to them because of the fear of reaching old age without children.  
Equally, in a study carried out in high and low income countries the finding shows that 
being married, years of marriage and marriage without children are related to high health seeking 
of consulting a doctor (Dhont et al., 2010; Johnson & Johnson, 2009). The findings in a study 
conducted in India on 720320 households revealed that older married women (>35years) with 
fertility problem, living in the city and belonging to Muslim or Hindu religion did more health 
seeking (Sarkar & Gupta, 2016). There is high help seeking for infertility treatment among older 
women (Bushnik et al., 2012; Datta et al., 2016; Naab et al., 2013; White et al., 2006). The high 
level of health seeking might not be unrelated to the value attached to childbirth both customarily 
and religiously.  
In Canada, 77% of couples whose wives were within the age of 18-44years had at a certain 
time in their relationship tried to conceive (Bushnik et al., 2012). In Britain a study carried out on 
N = 8315 women and N=5742 men, showed that older married women age 35-44years were more 
likely to seek for medical care with 58.0% than the younger married women age 16-25years with 
32.6% (Datta et al., 2016). It further reveals that women who had their first baby at 35years or 
above were more at seeking for medical help to conceive with 74.6% than childless women below 
35years with 58.7% (Datta et al., 2016). In addition, in Canada, women without any child within 
the age of 35 to 44years were twice (63%) more likely to sought medical help to get pregnant than 
younger women with infertility (30%) (Bushnik et al., 2012).  
Furthermore, in quantitative and qualitative studies conducted in Ghana. The findings 
revealed that majority of the women sought for help to conceive were  married,  within the age of 
30-39 years (Kussiwaah, 2016; Florence Naab et al., 2013) and the duration of infertility was 2-
17 
 
University of Ghana http://ugspace.ug.edu.gh
12years and large number (11/14,12/14) had no children at all (Donkor, Naab, & Kussiwaah, 2017; 
Kussiwaah, 2016). Likewise, in Gombe, Northern Nigeria, religion, educational level and number 
of children influenced the health seeking behaviour of women and that women with at least a child 
were more likely to delay in seeking help to conceive (Bukar et al., 2012). However, Sarkar and 
Gupta (2016), argues that women with secondary infertility did more health seeking with 
approximately 6% as against women with primary infertility with 2%.  The difference in the two 
studies could be associated with the demographic characteristics of the participants and the 
diversity in the geographical location. Collectively, it is evident that older women without children 
and with higher cultural value did more of health seeking to conceive.  
2.2.3 Individual and Social cues among Women with Infertility 
Attitude of women with infertility about the condition and social support triggers health 
seeking. Women are usually the first to present in the hospital for treatment of infertility and are 
willing to be exposed to extensive investigations too (Naab & Kwashie, 2018). Children in the Africa 
culture are valued for continuation of family name and as gifts from God (Naab, 2014; Tabong & 
Adongo, 2013a). Hence the belief that God is the giver of children to make women complete. Appears 
to be a social cue. In addition, significance of parenthood is a motive for high treatment seeking for 
infertility (Johnson & Johnson, 2009) and support from significant others triggers may health seeking. 
Women who had advice and encouragement from spouse, family and friends, did more of a consulting 
doctor for help than online help seeking (Slauson-Blevins et al., 2013). The finding in a qualitative 
study by Naab (2014), on N=15 African women revealed that family members’ support influences 
medical help seeking. In addition, support from family and friends help to  reduce stress in women 
with infertility (Kussiwaah, 2016).   
18 
 
University of Ghana http://ugspace.ug.edu.gh
More so, it was reported that the health seeking behaviour of women with  infertility in the 
Northern Nigeria is motivated by husbands, family, friends, financial empowerment and other 
medical condition (Bukar et al., 2012; Lawali, 2015). Meanwhile other women were harshly treated 
by their mother in-laws (Tabong & Adongo, 2013a). Similarly some of the participants reported self-
encouragement and true acceptance of fate was a motivator to rely on a support system and focus on 
the future (Tabong & Adongo, 2013a).  Equally, Dierickx et al. (2019), support that despite the 
secrecy adopted initially by the women, they later realised that social network were significate 
resources to health seeking. This demonstrates that health seeking was possible because the women 
received social, emotional, sometimes financial and verbal recommendations from family, friends 
and the community members. Nevertheless, some studies argue that black women were less supported 
by family and friends but the white women had more social support (Chin et al., 2015; Greil et al., 
2011). Furthermore, report shows that financial support of husbands decreases when treatment is 
ineffective (pregnancy not achieved) and the women continue with the treatment when husbands no 
longer pays the hospital bill (Dierickx et al., 2018). Thus, the women are willing to give off all their 
possession in order to conceive (Dhont, 2011). This describes the importance women place to 
childbearing and the extend they can go in health seeking for infertility. 
In Africa, medical demand for infertility still remains an issue. In most Africa nations, 
treatment is mostly directed towards women because infertility is viewed as a disease of women as 
such some men disassociate themselves from the treatment (Dhont et al., 2010; Mumtaz et al., 2013; 
Naab, 2014; Tabong & Adongo, 2013b). Thus the men always refuse to do any health seeking or 
even to do the test requested on account of their wives’ health seeking for fear of being diagnosed 
infertile (Mumtaz et al., 2013). Additionally, it was  reported by some participants in Naab (2014) 
study that men exclude themselves from the problem of infertility; as such refusing to follow their 
19 
 
University of Ghana http://ugspace.ug.edu.gh
wives to the hospital for medical check-up. Similarly, Dierickx et al. (2019), opined that regardless 
the diagnosis women were more at high chances of health seeking than men. It is evident that some 
women are left with the burden of health seeking which further complicates treatment. 
Nevertheless, report have it that perceived stigma of infertility was associated with higher 
online health seeking to avoid the stigma than doing no health seeking (Boivin et al., 2007; Bunting 
et al., 2012; Slauson-Blevins et al., 2013). Women with infertility carry more of the ordeal of 
stigmatisation and they are stigmatised by other women that have children (Dhont et al., 2010; 
Dierickx et al., 2018; Roomaney & Kagee, 2016).  Women stated that they are stigmatised more than 
people living with HIV (Dhont, 2011). In Ghana, women with infertility are not allowed to related 
with other people’s children because they are seen as witches who have finished their unborn children 
and could harm other children as well (Tabong & Adongo, 2013a). In Tanzania women with infertility 
are viewed as useless and those with primary infertility suffer more because they are tag ‘completely 
barren’ (utasa) and those with secondary are considered may ‘yet conceive’ (ugumba) (Hollos & 
Larsen, 2008). Collectively, this further reveals that the impact of infertility is dreadful ranging from 
personal suffering to community repercussions. 
More so, Infertility is seen as exclusively a woman’s problem and women were often blamed 
and abused for the cause of infertility by either by their husbands, neighbours and the community 
(Dhont et al., 2010; Dierickx et al., 2019; Mumtaz et al., 2013; Naab & Kwashie, 2018; Tabong & 
Adongo, 2013a).  Making coping with infertility difficult (Dhont, 2011). Even where the men were 
medically informed about their condition (Naab & Kwashie, 2018). This is so in Africa culture 
because there is no couple infertility as the man is a near perfect being and the woman is always the 
infertile (Mumtaz et al., 2013; Naab, 2014).  In addition, the misconception has penetrated the health 
system as women are often the first to be tested in medical treatment whenever couples’ are finding 
20 
 
University of Ghana http://ugspace.ug.edu.gh
it difficult to conceive because infertility is perceived to be associated with women (Naab & Kwashie, 
2018).  
The complexity involved in health seeking for infertility by women cannot be over 
emphasized. Sadly, infertility can also be as result of male factor but some women find it difficult to 
convince their husband to go for test as such spend a lot of money for expensive treatment that might 
not be necessarily useful (Dierickx et al., 2019). Interestingly, some women in Ghana are found of 
shielding their husbands by accepting the blames when asked about their delay in conceiving by 
friends and family members (Naab & Kwashie, 2018).  
It appears the social pressure the women suffer exposes them to psychological, social, 
physical and emotional ill health (Mumtaz et al., 2013; Roomaney & Kagee, 2016). Report revealed 
that women are often depressed when they are humiliated by friends or colleagues in their home and 
at their places of work (Donkor et al., 2017). Furthermore, it was reported in Rwanda that women are 
always depressed and feel hopeless/worthless (Dhont, 2011). In Southern Nigeria, lack of support 
from husbands, age, not having any child at all and feeling stressed up are predictors of depression 
(Upkong & Orgi, 2006). This shows that the ordeal of infertility is among the devastating experiences 
an African woman can encounter in her life. 
2.2.4 Enabling and Predisposing Factors Leading to Health Seeking Behaviour among 
Women with Infertility  
Treatment belief, education, resources and support are the determinants that trigger health 
seeking. Studies reported there is high help seeking for infertility treatment among women with high 
education and high family income or good paid jobs than women with low education and low family 
income (Bushnik et al., 2012; Datta et al., 2016; Dhont et al., 2010; White et al., 2006). Similarly, a 
study  has reported that women with high income 63% had modern treatment and 22% had no modern 
21 
 
University of Ghana http://ugspace.ug.edu.gh
treatment likewise, among the low income women, 34% had modern treatment and 36% had no 
modern treatment (Sarkar & Gupta, 2016). Furthermore, Johnson and Johnson (2009), opined that 
that family income was 11-14% more likely to stimulate consulting a doctor. In addition, studies 
conducted in Ghana,  stated that health seeking was done by educated women who have completed 
at least one form of formal education (secondary & post-secondary education) and the women were 
gainfully employed with a monthly earning (Kussiwaah, 2016; Naab et al., 2013). Nonetheless, 
irrespective of their financial status, couple invest in the treatment of infertility (Dierickx et al., 2018). 
Evidently, smaller proportion of women that are between the high and low socioeconomic 
levels (marked as inequalities) did no health seeking (Datta et al., 2016). However, study by Dierickx 
et al. (2019), argues that women in both urban and rural areas spend their life savings to achieve 
pregnancy. The types of medical treatment received depend on what their savings could afford 
(Dierickx et al., 2019; Tabong & Adongo, 2013a). Due to the huge difference in the financial level 
of these women, treatment was mostly accessed in the public sector, although expensive too because 
the test and drugs were bought outside the public health centre (Dierickx et al., 2019).  Infertility also 
adds to the financial burden of the family regardless of the woman’s financial status (Dierickx et al., 
2018; Tabong & Adongo, 2013a). Collectively, it implies that the negative impact of infertility cannot 
only affect the psychological and social wellbeing of an individual but economic aspect inclusive. 
Likewise, the study of Slauson-Blevins et al. (2013), revealed that  positive attitude towards 
biomedical solution were related to higher likelihood of in-person health seeking only or both (in-
person and online) than doing no health seeking. More so, the perception of treatment for safety and 
efficacy largely trigger health seeking with little above half score (53%) than negative belief for short 
and long term (physical and mood effect) (Bunting et al., 2012).  
22 
 
University of Ghana http://ugspace.ug.edu.gh
The study by Bunting et al. (2012)  further revealed that positive treatment belief was seen 
among  younger women with infertility who have been trying to get pregnant for less than 12months 
and are living in the Urban area. The study further reported negative treatment belief among women 
with university education, well paid jobs  and who have been trying to conceive for more than 
12months after consulting a doctor (Bunting et al., 2012). More so, it was argue that black women 
had less belief in medical solution to infertility but the white women had more faith in the medical 
solution to infertility (Chin et al., 2015; Greil et al., 2011).  
2.2.5 Perceptions of Women with Infertility towards Seeking Medical Help 
There seems to be various beliefs on the causes of infertility which influence the type of 
health seeking women pursue. Few of the women believed medical diagnosis as cause of infertility 
and others created their diagnosis mentioning witchcraft and God (Dhont et al., 2010). In West 
Africa (Nigeria and Gambia), infertility is believed to be caused by predestined supernatural 
factors (spiritual attack by witchcraft, evil spirits and God (Dierickx et al., 2019; Okafor et al., 
2017). Similarly, it was reported that some community sees women with infertility as witches who 
are paying their debt with their unborn children (Dierickx et al., 2019; Tabong & Adongo, 2013b). 
In addition, infertility is believed to be caused by natural/biological factors from the woman e.g. 
myoma, unsafe abortions, use of contraceptives, stress which cause miscarriage and infections 
(Dierickx et al., 2019; Tabong & Adongo, 2013b). This implies that the burden of childlessness is 
confined within the socio-cultural background which also influences the perception of individuals 
towards treatment seeking. However, despite the belief and knowledge about the cause of 
infertility, the perceived cause is altered due to prolonged nature of their infertility, side effects 
and treatment ineffectiveness (Dierickx et al., 2019). 
23 
 
University of Ghana http://ugspace.ug.edu.gh
The perception of a disease is opined to influence the type of centres women patronise for 
help to conceive. As a result, treatment seeking is mostly based on women’s perception of the  
disease (Okafor et al., 2017). Furthermore, large population of infertile couples sought for help to 
conceive from traditional and spiritual other than the medical (Johnson & Johnson, 2009). In West 
Africa for instance, it is believed that infertility is caused by cultural, spiritual and biomedical 
(natural) components (Bukar et al., 2012; Dierickx et al., 2019; Lawali, 2015). As a result, women 
with infertility in West Africa sought for help based on their perception by going to faith-based 
healers, traditional healers and medical treatment and some combined the treatment outlets (Bukar 
et al., 2012; Dierickx et al., 2019; Lawali, 2015; Naab et al., 2013; Ola, 2014; Tabong & Adongo, 
2013a).  
2.2.6 Health Seeking Behaviour of Women with Infertility 
Infertility and fertility impairment related diagnosis are part of complex interplay 
predisposing factors impacting on the health of women as observed by fast increasing body of 
knowledge (Hanson et al., 2017). However,  globally, 55% of couples with infertility demand for 
medical treatment in the high and low income countries (Boivin et al., 2007). In addition, women 
are usually the first to go for medical help seeking (Dhont et al., 2010; Mumtaz et al., 2013) and 
to do various testing including the invasive type and treatment which are expensive (Mumtaz et 
al., 2013). Likewise, it was reported that all urban and rural women in these studies accepted the 
medical treatment and continue to seek for help to conceive for up to 20years (Dierickx et al., 
2019; Mumtaz et al., 2013).  However, some participants blamed health professionals for not 
prioritising on their fertility needs by ignoring their fertility related distresses and not providing 
them assisted reproductive technology (Roomaney & Kagee, 2016).  
24 
 
University of Ghana http://ugspace.ug.edu.gh
There is poor health seeking attitude among women with infertility. In the study of Johnson 
and Johnson (2009) in USA on 219 women, 56.8% couples sought for medical help to conceive, 
the couple did investigations and followed treatment but 30.9% did no health seeking. In addition,  
about 34% of women in USA did not seek for medical help for their infertility problem, 9% went 
online for health information on infertility, 32% consulted health professional and 25% did both 
(McQuillan, Greil, Shreffler, & Bedrous, 2015; Slauson-Blevins et al., 2013). Similarly, according 
to Bunting et al. (2012), demand for medical advice to conceive is similar for both high and low 
countries with 75% and 70% respectively. The similarity in the health seeking behaviour for both 
high and low resource countries was also reported by Boivin et al. (2007) but the percentage is 
higher in the latter study.  Collectively, health seeking behaviour for infertility is still a concern in 
both the high and middle income countries. 
Likewise, it appears that women delay before seeking care. Women start seeking for 
medical health seeking at least 5years or beyond of infertility (Dhont et al., 2010). Studies have 
reported that African women with fertility problem delay for 2-3 years before consulting a doctor 
(Bukar et al., 2012; Chin et al., 2015). However, Mumtaz et al. (2013), reported that some women 
were advised to seek for help for infertility as early as 3months after marriage and that mother in-
laws are always the decision makers for medical help seeking, indicating a level of family pressure 
on the woman.  In the middle income nations (India & Nigeria), about 40% of the women with 
infertility sought for medical treatment to get pregnant, while others opted for alternative options, 
traditional and faith-based methods  (Bukar et al., 2012; Ola, 2014; Sarkar & Gupta, 2016). 
Similarly, traditional source is the first to be visited (Dhont et al., 2010). These women health 
seeking behaviour was influenced by lack of awareness, culture and because the medical treatment 
was expensive.  
25 
 
University of Ghana http://ugspace.ug.edu.gh
In a study by Naab et al. (2013),  among 203 women with infertility in southern Ghana, the 
findings revealed that of all the women seeking help to conceive, 76.6% sought for medical 
treatment, 8.9% went for  traditional herbs and 1.6% used both. Collectively, health seeking 
behaviour is influenced by symptoms salient, life course cues, individual and social cues, enabling 
and predisposing conditions and perception of the problem. Which in turn influenced the when to 
seek for help, type of help to sought for, acceptance and adherence to the treatment accessed (Greil, 
McQuillan, & Sanchez, 2014; Greil et al., 2011; McQuillan et al., 2015; Slauson-Blevins et al., 
2013; White et al., 2006). 
2.3 Summary of Literature Review 
The literature review was able to review relevant studies on the health seeking behaviour 
of women with infertility. The studies used were retrieved through a focused online search and 
reference tracing. The health seeking behaviour of women with infertility is said to have no 
significate difference between countries with  high income and good access to medical treatment 
and those with low or middle income and poor access to medical care (Boivin et al., 2007). In the 
reviewed studies in Nigeria, Ghana and USA, health seeking behaviour is said to be largely 
influenced by factors like age, marital status, parity,  literacy level of the individual, family’s 
financial resources, religion, social support and individuals’ perception of infertility (Bukar et al., 
2012; Lawali, 2015; Naab, 2014; Slauson-Blevins et al., 2013; White et al., 2006).  Women with 
high socioeconomic status show good health seeking behaviour (Bukar et al., 2012; Lawali, 2015; 
Slauson-Blevins et al., 2013; White et al., 2006). The vast number of the studies reviewed used 
quantitative approach but the study intends to use qualitative study in order to give an in-depth 
understanding of the level of health seeking behaviour. It was also noticed during the review that 
some authors did not use theoretical framework to guide the study. The current study however, 
26 
 
University of Ghana http://ugspace.ug.edu.gh
plan to use the conceptual model of Help Seeking Behaviour  by White et al. (2006), to guide the 
study. 
  
27 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER THREE 
RESEARCH METHODS 
This chapter gives an explanation of the methods used to achieve the objectives of the 
study. The chapter discussed the research design, research setting, target population, sample and 
sampling technique, instrument for data collection, method of date collection, method of data 
analysis, trust worthiness and ethical consideration.  
3.1 Research Design 
An exploratory descriptive design, which fits within a qualitative approach, was employed 
to explore the Health Seeking Behaviour of Women with infertility in Sokoto State. The qualitative 
design allows for discovering of meaning and revealing various realities; however, generalisation 
is not the main focus (Polit & Beck, 2010). The design further emphasised the need for rigor in 
choosing a research setting with the high potential of providing rich data that will give an in-depth 
understanding of the phenomenon at hand (Polit & Beck, 2010). The design also allows for detailed 
investigation and understanding of the health seeking behaviour of women with infertility.  
3.2 Research Setting  
Nigeria is located at the Western Coast of Africa. The country currently has 36 states which 
are subdivided into six Geopolitical Zones with Abuja as the Federal Capital. It is also operating a 
Democratic government using a federal system of administration (federal, state and local 
government) and has 3arms of government (the executives, legislative and judiciary).  
Sokoto state with the slogan; Seat of the Caliphate is located at the extreme North Western part of 
Nigerian between longitudes 4°8'E and 6°54'E and latitudes 12°'N and 13°58'N. Sokoto 
28 
 
University of Ghana http://ugspace.ug.edu.gh
city is the capital of Sokoto State which was created by General Murtala Mohammed on 3rd 
February 1976. It is an urban town, approximately 25,973 square/kilometres in land mass with a 
population of 3,696,999 with an estimated population of 4,886,888 projected for 2015 
(Commission, 2006). The inhabitants of the state are predominantly Muslim and of Hausa, Fulani. 
Other minority ethnic groups include the Zabarmawa and Tuareg who also speak Hausa as a 
common language (Commission, 2006).The state is bordered to the West by Benin Republic, the 
North by Niger Republic and the East by Zamfara State, Kebbi State to the South-East.  
Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto was established on 
2nd May 1980 and located along Garba Nadama road, Gawon Nama area, Wammako Local 
Government Area of Sokoto State. The Specialist Hospital Sokoto (SHS) came to be in 1991 
during the regime of General Ibrahim Badamasi Babangida.  The choice of these hospitals was 
made because they are the only main public healthcare facilities serving as a referral centres to 
primary and secondary health centres in Sokoto, Kebbi, Zamfara states and the neighbouring Niger 
Republic. The hospitals are made of several departments and units. The Obstetrics and 
gynaecological department comprises of gynaecological ward, lying ward, antenatal clinic and 
ward, MVA room, ultra sound unit, labour ward, fertility research unit and gynaecological clinic. 
The fertility research unit and gynaecological clinic run from Mondays to Thursdays in UDUTH 
and on Tuesdays in SHS. The hospitals (UDUTH and SHS Sokoto) were used as the site for 
recruitment of the research participants. 
3.3 Target Population 
The target population for this study were all women with infertility attending the 
gynaecological clinic of UDUTH and SHS Sokoto for infertility treatment.  
 
29 
 
University of Ghana http://ugspace.ug.edu.gh
3.4 Inclusion Criteria 
Women within the child bearing age of 18-50years married or are in a cohabiting for more 
than one year.  Women who can speak in English or Hausa language diagnosed of either primary 
or secondary infertility. Women on initial or follow up visit were included in the study.  
3.5 Exclusion Criteria 
Post-menopausal women, women who had permanent sterilization and whose partners have 
permanent sterilization were excluded from the study.  
3.6 Sampling Techniques and Sample Size  
Purposive sampling is a non-probability sampling technique known as judgemental 
sampling. It  is described as a method that allows for the selection of a subset from the entire 
population based on the researcher’s knowledge of the topic under study (Grove, Burns, & Gray, 
2012; Polit & Beck, 2010). In addition, it is also based on the researcher’s judgement of 
participants that will provide rich relevant information typical of the population under study 
(Grove et al., 2012; Polit & Beck, 2010). Similarly, purposive sampling allows the researcher to 
develop criteria that represent the characteristics of the target population and intentionally select 
based on the predetermined criteria (Basavanthappa, 2011).Therefore, a non-probability purposive 
sampling technique was employed to recruit the consent participants to participate in the study. 
The technique allows and guide in the selection of women with the experience of infertility.  
3.7 Sample Size Determination 
Qualitative study is not concerned with sample size. However, the sample size is 
determined when there is saturation of data (redundancy) because qualitative study deals with 
participants’ characteristic that will produce information that will give an in-depth understanding 
30 
 
University of Ghana http://ugspace.ug.edu.gh
of the problem at hand (Basavanthappa, 2011; Grove et al., 2012; Polit & Beck, 2010).  As such 
the researcher will recruit participants with the predetermined criteria that will give relevant data 
until data saturation level is achieved. Consequently, at the fourteenth participants, data saturation 
was reached given rise to a sample size of fourteen (14) women with infertility. 
3.8 Data Collection Tools  
Semi structured interview guide was used to give focus and direction to the pattern of the 
in-depth face to face interview in order to extract relevant information from the participants (Polit 
& Beck, 2010). More so, the instrument used for data collection was adequate enough to elicit 
information that will produce answers to the research questions (Burns & Grove, 2010; Parahoo, 
2014). The interview guide was developed based on the objectives of the study and literature. The 
semi structured interview guide was made of open ended questions divided into two sections 
(section A-participants’ socio-demographic data and section B-questions on health seeking 
behaviour of the women); see appendix C for sample of the interview guide. 
3.9 Pretesting of the tool for data collection 
Pretesting of a research tool ensures the accurateness of the tool to obtain anticipated 
responses and also to aid in amending the tool prior to its administration to the recruited 
participants (Brédart, et al; 2014) the semi structured interview guide was pretested at Women and 
Children Welfare Hospital Sokoto on two women who came for infertility treatment. The piloting 
was done to ensure that the questions asked will be comprehensive and to determine practical 
usage. Questions that were not cleared were reframed. Rectifying the gaps identified helped to 
improve the instrument and provided assurance for its practical usage. It is important to note that 
the pilot data was not included in the study.  
31 
 
University of Ghana http://ugspace.ug.edu.gh
3.10 Procedure for Data Collection 
An introductory letter (appendix A) from School of Nursing and Midwifery University of 
Ghana and research proposal were used to request for ethical clearance and administrative approval 
from the Health Research Ethics Committee of UDUTH and SHS Sokoto. Furthermore, an office 
was requested from the in-charge of the gynaecological clinic in order to ensure privacy and 
favourable environment for the interview. 
Ethical clearance and administrative approval were obtained (appendices E & F) from 
UDUTH and SHS ethical committee. With the assistance of the midwives working in the 
gynaecology clinic of the study areas, the clients’ files were used to identify suitable participants. 
Then the consented participants were recruitment for the study based on the predetermined criteria 
after introduction of self and establishing rapport. The participants’ phone numbers and home 
addresses were taken with their permission for follow up.  The participants that gave their consent 
were interviewed at a scheduled time, venue and day convenient for each of the participant. Eight 
(8) participants were interviewed in the assigned office at the gynaecology clinic and 6 participants 
were interviewed at their respective homes. Verbal and written consent (tick consent form) 
(appendix B) were requested from the participants after explanation of the purpose and benefits of 
the study. The study participants’ permission was also sought to audio record and take notes of 
observation that cannot be recorded by the tape in order to retain relevant information.  
The interview which lasted for about 30-45munites was conducted in English and Hausa 
(predominate local dialect) language. The data collection was done within two weeks. The 
researcher personally conducted the interview utilising the guide. The thoroughness that was 
applied in the data collection process is to help reduce potential bias to the results of the study that 
32 
 
University of Ghana http://ugspace.ug.edu.gh
might be introduced by untrained personnel used for data collection (Parahoo, 2014; Polit & Beck, 
2012). 
3.11 Data Analysis 
The researcher used the thematic content analysis style described by (Vaismoradi, Turunen, 
& Bondas, 2013). In using this style, the researcher assumes a position of an interpreter by reading 
through the data, making meaning out of segments which are used to develop major and subthemes 
(Vaismoradi et al., 2013). Data generated was manually and electronically managed. Translation 
of interview conducted in Hausa language was then followed by transcription of the data by the 
researcher. Pseudonyms were given to represent each participant conforming to their transcripts. 
The transcribed notes were prudently and intentionally read through, comparing it with the audio 
tape recorded over time again and again to ensure consistency.  
To ensure integrity of the information, the recorded tape and transcribed documents was 
vetted the supervisor.  Field notes, field journal of dates, time and place of interview sessions were 
well-kept. Coding was done and the corresponding codes were used to bring out the comprehensive 
meaning and understanding. Codes were categorised to connect patterns and structures to form 
major themes and subthemes. Quotes were used to support the main themes and subthemes which 
were logically organized beneath the six constructs derived from the conceptual framework and 
study objectives including the two main themes that emerged. The transcripts and field notes were 
securely kept in files under lock and key under the researcher’s guard. The audio files from the 
interviews were pass-worded in the researcher’s laptop. Only the researcher and supervisor have 
accessible to the data.  
33 
 
University of Ghana http://ugspace.ug.edu.gh
3.12 Trust Worthiness 
According to Prion and Adamson (2014), rigor is the principle that underpins the being 
sure of the data collection, analysis and interpretation (methods) as truthful. It was also supported 
by Tobin and Begley (2004), that methodological rigour in qualitative research underpins the 
acknowledgement of the method as a systemic scientific process.  Collectively, rigour establishes 
the integrity and fitness of the method used in carrying out the study. Trustworthiness is essential 
in assessing the value of a qualitative research (Johnson & Rasulova, 2017).  However, they also 
warn that qualitative research should be evaluated on the basis of research ethics and respect for 
participants. The research used the criteria for evaluating trustworthiness as highlighted by Lincoln 
and Guba (1985), (pioneers of qualitative research) to ensure the robustness of the study. The four 
criteria are credibility, transferability, dependability and confirmability. 
Credibility: This is concerned with how well the information presented represents the 
participants’ factual data (Lincoln & Guba, 1985). In addition, demonstrating the value of data and 
the interpretation (Lincoln & Guba, 1985; Prion & Adamson, 2014).  In a way of ensuring that the 
findings and interpretation are valid, the researcher established rapport with the participants before 
the interview in order to promote trust. Then during the face to face in-depth interview, field notes 
taking was done to include gestures that cannot be captured by the recorder. This was used for 
summary and transcription of the interview. The summary was in turn used to seek for clarification 
from each participant based on the data coded and meaning given to the codes in summary of the 
interview.  
Transferability: Allows for the application of results of the study to another population in a 
different but similar background or setting (Lincoln & Guba, 1985; Prion & Adamson, 2014). As 
a result, the comprehensive description of the methods with attention payed to the setting and 
34 
 
University of Ghana http://ugspace.ug.edu.gh
participants used was done. This was done to help the reader decide on the possibility of replicating 
the method on another population with different context but similar characteristics.  
Dependability: This is demonstrated through auditing of researcher’s record notes of data, 
procedures, judgement and findings by other inquirers (Lincoln & Guba, 1985; Prion & Adamson, 
2014). Thus, member checking was done; a step by step rigour of the methods (data collection, 
analysis and interpretation) was incorporated in the report to give complete understanding of the 
process. Then, the findings were subjected to verification through member checking and review 
of the reports by experts in the field. 
Confirmability: Is the objectivity and agreement between two or more individuals in the 
establishment of the truth that interpretations are derived from the data (Tobin & Begley, 2004). It 
also demonstrates that the data and interpretation of the findings are from the participants’ not the 
researcher’s perspective (Lincoln & Guba, 1985; Prion & Adamson, 2014). Therefore, the data 
and interpretation of findings were subjected to the study participants and supervisors’ review in 
order to reduce researcher’s potential subjectivity.  Furthermore, the proposal, field notes, field 
journal, audio records, coding record and note analysis were kept as audit trail for any independent 
auditor for verification to help in making decision about the data. 
3.13 Ethical Considerations  
There are ethical consequences in all the phases involved in nursing research process. It 
ranges from the decision to research or not, selection of topics, design and dissemination of 
findings (Burns & Grove, 2010; Parahoo, 2014). In addition, the  research ethics committees are 
there to ensure that the participants rights’ are protected (Burns & Grove, 2010; Parahoo, 2014). 
Thus, researchers are expected to be conscious of this and follow the outlined principles to enhance 
ethics in research.  
35 
 
University of Ghana http://ugspace.ug.edu.gh
The researcher obtained ethical clearance and administrative approval from the Research 
Ethics Committee of UDUTH and SHS Sokoto on presentation of an introductory letter from 
School of Nursing and Midwifery University of Ghana and a research proposal. With the assistance 
of the nurse in charge of the gynaecology clinic, explanation was given to the recruited participants 
on the purpose and benefit of the study. Emphases were made on voluntary participation and that 
participant is free to opt out at any level of the research or stop the researcher at any level of the 
interview. The study participants were also educated that consent covers tape recording of the 
interview, notes taking of observations that cannot be recorded by the tape, description and 
reporting of the findings.   
The study participants were assured of confidentiality of all the information given during 
the interview. As such, the tape recorder and notebook were constantly under lock and key when 
not in use and transcript and computed information were pass-worded. Participants were informed 
not to use their names or any form of identification. Even on the field note taking, only coding/ 
pseudonyms was used in order to eschew the real identification of the participants thereby ensuring 
anonymity. An office in the gynaecological ward was used to ensure privacy for those interviewed 
conducted in the hospital. The participants were guaranteed of no harmed throughout the study. 
Then, the participants were requested to indicate their consent by ticking a box on the consent 
form.   
  
36 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FOUR 
STUDY FINDINGS 
The chapter presents the research findings. Using the theoretical model adopted, the 
findings were presented into six thematic areas with subthemes and two other themes with five 
subthemes that emerged from the data analysis. The demographic characteristics are presented first 
followed by the themes.  
4.1 Participants’ Demographics  
The study participants were all women within the age range of 22-45years. The participants 
were married with different years in marriage and 5 participants were in polygamous marriage. A 
large number (n=8) were Muslims with 6 participants being Christians. Half (7) of the participants 
were predominantly Hausa Fulani by tribe, 4 from Northcentral and 3 were Igbos from the 
Southeast, all resident in Sokoto. Among the 14 participants, 10 had no child at all, 2 had 1child 
each and 2 had 2 children each but still consider themselves as having fertility problems. All the 
participants completed some form of formal education out of which 10 had tertiary education and 
4 had finished secondary school. Eight (8) of these participants were working, 3 were engaged in 
small trading while the remaining 3 were housewives. The family monthly income also varied 
among participants from low (< N100, 000) to middle income (>N 200,000) while 2 participants 
chose not to speak on the family monthly income. See details in the Table 4.1 below: 
 
 
 
37 
 
University of Ghana http://ugspace.ug.edu.gh
Table 4.1 Demographic Characteristics of the Study Participants 
 
Variables  Frequency Percentage 
(N=14)  (100%) 
Age (years)   
20-29 3  22 
30-39 9  64 
40 above years 2 14 
Marital status  All married 100 
Duration of marriage (years)   
1-5  4 28 
6-10  7 50 
11-15 - - 
16-20 3 22 
Duration of infertility (years)   
1-5                                                                             6    43 
6-10 2 15 
11-15 3 21 
16-20 3 21 
 
Parity   
None  10 72 
One 2 14 
Two    2 14 
Educational status   
Primary school 0 0 
Secondary school 4 29 
Diploma  4 29 
Degree  6 42 
Religion   
Islam  8 57 
Christianity  6 43 
Family income    
< N100, 000 3 22 
> N 100,000 – 200, 000 3 22 
> N 200,000 – 300,000 0 0 
> N 300,000 – 400,000 1 7 
Do not know spouse income but participants earn   
<100,000 5 35 
Refuse to respond on income 2 14 
Overall participants  14 100 
 Source: Transcribed data (2019). 
38 
 
University of Ghana http://ugspace.ug.edu.gh
4.2 Organisation of Themes  
The findings were organised into Six (6) major themes and seventeen (17) subthemes 
which were derived from the conceptual framework used for the study and two (2) main themes 
and five (5) subthemes emerged from the data analysis given a total of eight (8) main themes with 
twenty-two (22) subthemes. These themes and subthemes are presented below in Table 4.2 
Table 4.2 Themes and Subthemes  
S/no.                           Themes Subthemes  code 
  Theoretical      Emerged 
1 Symptoms             - • Delay in conceiving SS 
Salience • Desire to have children 
• Trying to conceive 
 
2 Life Course - • Childbirth as a norm LCF 
Factors  • Age as a push factor 
• Lack of children as a 
push factor   
3 Individual and - • Social values/beliefs ISC 
social cues  • Societal support  
• Social pressure 
  
4 Enabling and - • Resource and support EPF 
predisposing • Treatment beliefs 
factors 
5 Perception about - • Knowledge of infertility  PAI 
infertility  • Treatment outlets  
• Medical treatment 
expectations  
6 Health seeking - • Decision making  HSB 
 behaviour   • Seeking for medical help   
  • Seeking other sources of  
  treatment  
  • Acceptance and  
  adherence to treatment  
    
7 Psychological • Feeling stressed up   
 experience • Being depressed PE 
    
   
• Advice to women 
8 Women’s plea for help WP4help 
• Men understanding 
 
• Government assistance 
Source: Transcribed data (2019). 
39 
 
University of Ghana http://ugspace.ug.edu.gh
4.3 Symptoms Salience 
According to the participants’ symptom salience refers to the obvious happenings around 
them that made them take cognisance of their infertility and prompt them to start seeking for help 
to conceive. This was explicitly expressed by the women as how they were able to detect symptoms 
by themselves. Some of the women compared themselves with women they got married same time 
with who have children. Others took cognisance of how long they have been married and having 
unprotected sexual intercourse. They expressed their desire to have children in various ways. For 
some, children provide companionship; some want more children because it is not bad to do so 
and others want to deliver for their husbands. Symptoms salience was described as delay in 
conceiving, desire to have children and trying to conceive.  
4.3.1 Delay in Conceiving 
  The women accentuated delay in conceiving as an aspect of symptoms salient that initiated 
their looking for help to conceive. For these women, not being able to be pregnant for the period 
they have been living together with their husbands and having frequent unprotected sexual 
intercourse without results were described as delay in conceiving. 
Recounting delay in conceiving; Kyauta shared that she patiently waited and observed the year 
passed by after marriage without pregnancy. But she observed as some other women got pregnant 
immediately after marriage; 
Since I married, I have not gotten pregnant o, we waited for one year after marriage. After 
one year there was nothing you know? But I observed that some people got pregnant 
immediately, some six months and some even one year after marriage (Kyauta, 33years)  
 
Izatu expressed that she has not used any contraceptives to delay pregnancy and she has been 
having frequent sexual intercourse with her new husband for two years, still no pregnancy; 
After the divorce with my ex-husband then I married this present husband, I have never 
done family planning and we have been together for the past two years but up till now, I 
have not conceived (Izatu, 35years). 
40 
 
University of Ghana http://ugspace.ug.edu.gh
 
Gomma and Vida (all pseudo names) narrated that they were able to identify their delay in 
conceiving as they observed the women they got married together with and the ones that even got 
married after them giving birth; 
I saw all the ladies we got married the same time, everyone has given birth and even those 
ones that married after my marriage have all delivered. They have their own children but 
nothing is happening to me. It makes me think that I have a problem (Gomma, 25 years). 
 
Some women that I got married before them, I saw them giving birth to 2-3 children, so I 
do feel it. I knew something is not normal. What is wrong with me? Is my own different? 
(Vida, 31years) 
 
Alheri shared how she observed the symptom of delay in conceiving few months into her marriage 
as she expected immediate conception. She impatiently went to the hospital but was advised to 
wait longer which she patiently did for 3years yet no pregnancy; 
I went to hospital after some months myself. So they said we should not worry if there is 
problem either from my husband or me, they will know after 3years. So we were patient 
and managing with our lives like that till after the 3years (voice down) but still no 
pregnancy (Alheri, 39years). 
 
Amal expressed that she noticed the symptom of delay in conceiving few years after marriage. 
Although there were times she used to think she was pregnant but investigations usually reveal no 
pregnancy; 
I noticed that when I, let’s say I have spent 2-3 years after my first marriage. So, I noticed 
maybe sometimes I will miss my menses for 2-3months then I was thinking I was pregnant. 
I went for ultrasound or some test but I was told it was not pregnancy (Amal, 45years) 
 
Tumba a mother of one child expressed that she perceived the signs of delay in conceiving when 
her child turned three years old plus the two repeated miscarriages;  
I conceived 3 months after my marriage but the pregnancy got aborted [pause] so I had 
miscarriage. A month after the miscarriage, I conceived again and that is the living child 
I have now who is six years old. After that I conceived twice but all the pregnancies got 
41 
 
University of Ghana http://ugspace.ug.edu.gh
aborted, I think [pause] (closed eyes) and I think am having this issue of not conceiving for 
more than a year now almost two years. I didn’t put it to cognisance until my child reached 
three years. That was when I started perceiving may be something is wrong, for me not to 
be able to conceive (Tumba, 33years) 
 
Similarly, expressing delay in conceiving, Vida reported not able to conceive after her first and 
only delivery of 7years ago which was followed by two miscarriages. She also complained of not 
knowing the cause of the delay in conceiving;  
I have a baby quite alright, she is 7years old and I had two miscarriages. Since then [pause] 
I did not take in again. I feel it is not normal but I don’t know the cause of it (Vida, 
31years). 
 
Narrating her delay in conceiving, Hannah lamented that she got pregnant but lost the baby in the 
womb and never conceived again since 5years ago; 
The first one that I have that one died in 2013. I took in but the child died inside the 
womb….…… since then I never conceived again (Hanna, 33years). 
 
These were the ways the women described their symptoms salient as delay in conceiving which 
helped them to identify their fertility problems as they could not conceive despite the time living 
together with their spouses. Their intentions to have children helped them to be able to perceive 
that they were experiencing infertility. 
4.3.2 Desire to have Children 
As part of symptoms salient, the women emphasized that their desire to have children or 
more children motivated their help seeking. The women who had no children at all, desire to get 
their own children while those with 1 or 2 also desire to have more children.  These intentions to 
give birth were described in various ways. 
 Alheri narrated that it is good to have companionship in the form of a child. For that reason, she 
has even adopted children: 
42 
 
University of Ghana http://ugspace.ug.edu.gh
 Yes, I thought of having a child. My sister, it is good to have children as companion at 
home, one person cannot help herself even right now, I have adopted children with me 
(Alheri, 39years). 
 
For Igge, desire to have her own children as she shares her happiness when she started normal 
menstruation because she sees it as a correction of the cause of her infertility:  
Yes, I am interested, I desire to have my own children (smile, giggle) I was very happy 
when I saw my menses coming regularly because they use to say, it is only when you are 
menstruating that you will get pregnant. That is why I was so happy (Igge, 22years). 
 
Other participants with at least a child or husband having children with other wives emphatically 
expressed their desire to have children as below:  
Every woman would want to have a child of her own. We are not saying other means of 
having children are not okay. They are but you would want to have a child of your own 
(Tumba, 33years). 
 
Vida recounted that she desires to have more children because it is not a bad thing and she likes 
children but she is sad because she did not get the needed support for health seeking from her 
husband:  
Yes, I thought of having more children but the only thing that does make me sad is my 
husband. It is not bad to have more children [pause] that is why I like having children. 
(Vida, 31years). 
 
Izatu shared her yearning to have children for her new husband since her ex-husband took the two 
kids they had together away and staying without children is disturbing her, as such, she wants to 
give birth.  
Yes, since I married this man, it is two years now but I am still not pregnant and I want to 
have children with this man that I married. And my previous husband took all the kids away 
and the thing is disturbing me.  I want to also have my own children with this my husband 
(Izatu, 35years). 
 
43 
 
University of Ghana http://ugspace.ug.edu.gh
The women desired to have children is another aspect of the salient symptoms expressed 
by the women. The women intent to have their own children and for some more children because 
it is not a bad thing as children are good companions at home. The intention to conceive made the 
women to try various ways to conceive.  
4.3.3 Trying to Conceive 
Trying to conceive was described as another feature of salient symptoms by the women. 
This subtheme shows how the women went about looking for help to conceive. Large number of 
the women tried to conceive by visiting the hospital to see health professionals for solutions to 
their infertility when they observed the delay in conception. They did some investigations and 
some had fertility enhancement drugs while some even had surgeries done.  
In trying to conceive, Azume described the several efforts made to sustain all the pregnancies she 
had to term by seeing doctors and adhering to treatment regimen but all efforts were unsuccessful; 
Several times, several times I thought and desire to have a child of my own that is why I 
kept trying to sustain the pregnancies. I went for all the tests and adhered to doctors’ 
instruction but still the pregnancies refused to reach term (Azumi, 43years).   
 
Kyauta narrated that after waiting for one year; she actively tried to conceive by consulting a 
doctor. She explained that the doctor she consulted was recommended by her husband because he 
does not have time to wait for her turn in the tertiary hospital:  
He is the one, he was using that clinic before I came, and he now said we should go to that 
clinic. You know, I am a new person here and my husband is working here, he now said he 
will not have time, in (hissed)UDX they use to waste time that is better we go to clinic that 
he will go and come back so that he will be able to go to his place work (Kyauta 33years). 
 
Another woman describing actively trying to get pregnant reported how she and her husband have 
been visiting the hospital, doing investigations for some time now. She reported that the result was 
said to be normal but she is still not pregnant: 
 
44 
 
University of Ghana http://ugspace.ug.edu.gh
Sometimes we use to think am pregnant but at the end of the month there is nothing. We 
have been going to SHX hospital together with him looking for how to conceive. They kept 
doing tests for me and even him. They said there will say there is no problem but it is two 
years now but am still not pregnant (Izatu 35years) 
 
Adasa described her hospital experience in actively trying to conceive. She mentioned series of 
tests conducted revealed normal womb. However, she was placed on some drugs to continue taking 
until she gets pregnant which she did but later stopped:   
I have been to the hospital, trying to conceive. Series of [ehh] tests have been carried on 
me like all these [ehh] scanning, plus other tests after that one shows normal womb. They 
then placed me on this thing (close eyes) some drugs that I should continue taking until am 
pregnant. I took for some time but no pregnancy, so I stopped the drug because I was afraid 
the harm of continues taking it (Adasa 35years) 
 
Likewise, Charis shared a parallel experience of how she enthusiastically tried to conceive after 
marriage by going to the hospital. She had series of investigation done and drugs given but yet 
with all the interventions she did not conceive up till the time she relocated;  
So, and since I married that 2016 October I have been trying to conceive with all the 
intervention still, I even did all the tests, my husband did his test too which was okay. So 
the first [ehh] test I did show a tube was blocked (smiles) and that I also have [ehh] ovarian 
cyst [ehh] which was extracted by laparoscopy in FXG hospital in January 2018. So since 
then, I have been taking drugs nothing has [pause] happened till I left Gusau to Sokoto 
(Charis 36years) 
Still in trying to conceive, some of the participants shared their trying to conceive hospital 
experiences where they had some investigations and treatment.  Tumba described that she tried to 
conceive by going to the hospital where she did some investigation, was placed on diet, drugs and 
even had surgery to remove fibroid;  
I now say let go to the hospital since I could not find solution online. Let me go for other 
investigations that may determine abi, show them the whole issue with regards to my 
reproductive system. So that was why I went for all those unpleasant tests one was very 
painful (voice lowered down) couple with the expensive price. So, possibly they are saying 
it is the fibroid that is obstructing the lower part of the uterus and so, I had to go for surgery 
again. They booked me for surgery, few months after the HSG.  Thank God the surgery 
was successful, [aaa] they said I should wait again and see (Tumba, 33years). 
45 
 
University of Ghana http://ugspace.ug.edu.gh
As a health professional, Sonia reported a parallel experience of enthusiastically trying to conceive. 
She recounted that she had HSG, TVS, surgery and even went a step further to do artificial 
insemination; 
I have been coming to the hospital, I have been seeing the doctors, and they sent me for 
several investigations. I did 2 HSG, the first one before the surgery and after the surgery, 
they sent me for the second one (Lowered voice pitch further) likewise my husband which 
he did sperm analysis and they didn’t identify anything. Even Dr. XXX [name mentioned] 
there was a time she gave me this type of drug, I can’t remember the name, she gave me 
six sachets of the pack of all these drugs. TVS transvaginal for follicular tracking you will 
do it like (knock table twice) 3-4 times in a month to know when you are really ovulating. 
I attempted on one and one with the doctors there they did this collecting of the sperm to 
inject, I have (hissed) forgotten the procedure here (looked up, silent, trying to recollect 
the name of the procedure) artificial insemination (Sonia, 34years). 
 
In summary, symptom salience for these women is being able to identify their fertility 
problem based the on common knowledge that having unprotected sexual intercourse over time 
with spouse should lead to pregnancy. Their desire to have children prompted the women to go for 
medical treatment. In addition, trying to conceive by consulting with health professionals for 
treatments of infertility was also done as initial treatment or after failed trying of alternative 
responses.   
4.4 Life Course Factors  
The life course factors were associated with cues that trigger these women to actively seek 
for medical solution to infertility. The women highlighted that it is normally expected that a woman 
should deliver after marriage. Some were able to point that children are the joy of marriage and 
they make the woman to be accepted by her in-laws. Others stated that children are gift from God 
that help in performing some spiritual rites like praying for their parents when they are dead. Other 
women mentioned their age and lack of children were push factors for seeking treatment for 
46 
 
University of Ghana http://ugspace.ug.edu.gh
infertility. The women described their life course factors as childbirth as a norm, their age and lack 
of children as push factors for trying to have their own children. 
4.4.1 Childbirth as a Norm 
Childbirth as a norm was emphasized as part of life course factors by these women. The 
women described that it is customarily expected that every woman should give birth immediately 
after marriage. Most of the women too expected immediate conception. As such, it became a worry 
for most of the women when they could not conceive after marriage.  
This is how Sonia described childbirth as a norm. She was overwhelmed with her inability to 
conceive after marriage since conception is customarily after marriage. She expressed the duration 
of her infertility as a condition she is suffering since childbirth.    
Okay [tau] (high pitch voice) what do I say? (silent) after marriage, which is the normal 
thing, (lowered voice pitch) woman after marriage is expected to be pregnant but since 
after marriage I have not conceive not even saying that I was, maybe there was a 
miscarriage; even since birth let me just put it like that I have not been pregnant before 
(Sonia, 34years). 
 
Alheri, in narrating childbirth as a norm recounted that her in-laws expected immediate conception 
after marriage since she and her husband were faithful to each other before marriage;   
When we got married his people were expecting that immediately we got married, we will 
have a child because we did not live a wayward life…..  Not knowing that after getting 
married I started having this, I face the challenge (Alheri, 39years). 
 
In expressing childbirth as a norm, one of the women lamented how she became disappointed after 
marriage for not conceiving because she never thought that she would be married for up to 3years 
without getting pregnant; 
I got married 3years ago, 2016 December, sorry 26th March 2016 by the 26th of this month 
it will 3years now. Sincerely, since when I was 7 months in marriage, I was not happy 
because since I got married I desire to have my children. I never thought I will be married 
for 3years without getting my own child (Yar-Buga, 27years). 
 
47 
 
University of Ghana http://ugspace.ug.edu.gh
In expressing childbirth as a norm, Kyauta recounted the many years she has spent in marriage 
without having a child; 
I have been married since 2012, this month is the 7th years now. (Lowered voice) I do not 
have any children despite all my effort (Kyauta, 33years).  
 
Izatu expected immediate conception after marriage because it is customarily expected as she 
shared her experience of infertility in her second marriage;  
I got married 2008 had two children before I was divorce… I was in my parent house for 
one year before I remarried. Since I married this man, it is two years now but am still not 
pregnant. He has five children with his first wife. You see, I need children of my own with 
him (Izatu, 35years). 
 
Childbirth as a norm in marriage was expressed by Amal, a 45year old woman who lamented for 
not conceiving in her first marriage of 17years. She also shared how she had to remarry after her 
first husband died in anticipation of getting pregnant but no pregnancy came in her two years of 
marriage;  
 “My first marriage, which was [pause] married 17years ago, so my husband died 5 years 
ago, so I even re-married. Now am married two years ago that is my second marriage but 
still I did not have any issue” (Amal, 45years). 
Charis viewed childbirth as a norm because to her, children are the joy of marriage since a child 
makes a woman gain acceptance by her in-laws; 
I married October 2016 and since then am having difficulty in conceiving. Like the first 
month, the second month that I got married, there was nothing like [ehh] pregnancy, so I 
went to the clinic.….  I want to have my own children because [pause] (high pitched voice) 
children, they are the joy of marriage because any marriage you are into without a child 
even your in laws, that is your husband’s family members, they will not consider you as 
part of the family till when you have a child (Charis, 36years). 
 
Gomma equally narrated how she is now having problems with her in-laws that once loved her. 
She related her lack of childbirth after marriage to be responsible for the problem she is 
experiencing with her in-laws because she was loved by her in-laws before the infertility issue 
unfolded. This was how childbirth as a norm was described by her; 
48 
 
University of Ghana http://ugspace.ug.edu.gh
Initially when we got married, my in-laws love me because we are somehow related with 
my husband by blood; we are from the same family. So they love me and I don’t have any 
problem with them but the problem I am experiencing with them now is related to my 
inability to give birth. That is what is bringing the misunderstanding between us (Gomma, 
25years). 
 
The participants have expressed their concerns on one of the life course factors which is childbirth 
as a norm. They shared how lack of children in their marriage is affecting their marital 
relationships.  
4.4.2 Age as a Push Factor 
Age is another life course factor that prompted some women to seek for medical help to 
conceive. Only Alheri and Azumi in this study explicitly paid significant attention to their age as 
a push factor.  
Alheri feared that menstruation has a time bound as such it can stop at any time with aging, that 
was her description of age as a push factor; 
What motivated me was that [ee] as I am, am going to 40 now. Let’s say, give me 2years 
or 1year, let me 1year because by May I will be 39 [pause] according to the date given to 
me right from my childhood. So, am considering my age is going. Tau! Menstruation have 
limit….. So, it can stop at any time [pause], so that is my fear (Alheri, 39years).   
 
Similarly, Azumi seems overwhelmed with her age which is the push factor that makes her to still 
see the need to seek for conception; 
I think am aging now at [pause] 43 to 44years. I cannot remain like this; I am trusting God 
let me not stay the like this. I am [pause] maybe is my destiny (Azumi, 43years)  
 
The women’s life course factors was described as their age which serves as the push factor to their 
seeking for medical treatment because they believe menstruation is limited to time and ceases with 
aging.   
49 
 
University of Ghana http://ugspace.ug.edu.gh
4.4.3. Lack of Children as a Push Factor  
Lack of children, expressed as life course factors was a driving force for the women to seek 
for help to conceive. Some women have never been pregnant; they do not have children at all and 
their need for at least a child prompts their health seeking.  
This was how Charis expressed her lack of children and her eagerness to have a child by relating 
her infertility to a condition from her childhood; 
And since my youth, since I started my menstruation since I came to my puberty age, I 
never got pregnant before talk more to do any abortion. So, that was the first pregnancy I 
had after 2years of treatment and I lost it (Charis, 36years) 
 
According to Hannah, lack of children has influenced her to still search for children by going to 
see doctors after losing the first pregnancy; 
The first one that I have that one died in that 2013, I took in but the child died inside the 
womb.  I went to hospital in 2015 and I went to see doctor at that my clinic side because I 
did not conceive again (Hannah, 33years). 
 
Lack of children is a serious prompt to health seeking for infertility even among women with at 
least one child. Tumba, shared her experience about lack of children as a push factor that is making 
her try all her possible best to conceive; 
A month after the miscarriage, I conceived again and that is the living child I have, he is 6 
years now. I have tried and I am trying all my own possible means to be able to conceive 
and the thing, the efforts are just being proven abortive (Tumba, 33years). 
 
Likewise, some women shared their experience of lack of children as a reason to seek for treatment. 
Adasa and Izatu still desire to have more children because of their present husbands as such they 
went to the hospital for treatment; 
This is the eight years in marriage. Then I have two kids, although one because I have one 
before the marriage before the present husband. That is out of this marriage and then I 
had one and since then I have not gotten another one. I have been to the hospital, done 
series of [ehh] investigations after which they now placed me on (close eyes) clomid which 
I took not until last December I became, I got pregnant and I lost the pregnancy last month. 
The pregnancy was almost three months plus (abi) then I lost (Adasa, 35years).  
  
50 
 
University of Ghana http://ugspace.ug.edu.gh
Now I have two kids alive, one boy and one girl. Since I remarried I have never conceived 
is two years now but am still not pregnant that was why we kept going to the hospital with 
my husband (Izatu, 35years). 
 
In a nutshell, life course factors prompted the women to seek for help to conceive. There is a quest 
for acceptance by in-laws or happy marital life since childbirth is a norm; ages of the women, lack 
of children were what prompted these women to seek for help to conceive.  
4.5 Individual and Social Cues 
These cues were defined by the women’s beliefs and societal value attached to childbearing 
such as their partners’ need for children, pressures (stigma, mocking and blames) experienced from 
families and the society due to infertility. To some, encouragement from families, friends and 
neighbours were their motivating factors to seek for help to conceive. The women described 
individual and social cues as social values, societal support and social pressures.  
4.5.1 Social Values   
This subtheme defines childbirth according to the participants as a very important standard 
for womanhood and the community as a whole.  The social value of childbirth as cues to health 
seeking for infertility was described by the women as a form of continuation of lineage, gifts from 
God and an act of service to God as children are instruments used to perform some religious rites. 
They equally reported that their husbands’ intention for childbearing was quite helpful in 
enhancing their health seeking to conceive.  
Some of the participants in reporting the social value of childbirth as cue to health seeking; stated 
without mixing words that childbirth ensures continuation of the family. For Tumba, she 
confidently recounted that childbearing is a thing of joy because her parent gave birth her and she 
would also want to give birth to another. She added that she wants her child to represent her when 
she is dead; 
51 
 
University of Ghana http://ugspace.ug.edu.gh
[silent] (staring the roof) [mmm] (She maintained eye contact as she responded) 
childbearing to me, it is a thing of joy because [increased voice pitch] I came to the world 
through somebody and I would also want to bring somebody to the world through me. And 
you know, I would want somebody to at least, even if I am not there somebody will be there 
for me; as in having somebody to represent me if I am not alive (Tumba 33years).   
 
Equally, Vida a mother of one naturally likes children and she wants more children because as the 
first child of her family that has no male child; she has to continue with her father’s lineage and to 
immortalise his name. That was how she expressed her social value of childbirth; 
I like having children. We are not much in our family. My father doesn’t have a male child, 
am the first born and we are only three. So, I feel like having children so that my father’s 
name will continue. At least if they see my children, they will say, (ha!) this child is a 
grandchild to Mr XXX [mentioned father]. Even me I like having children, I just like 
children naturally (Vida 31years). 
 
Few the participants of this study both Muslims and Christians in describing their shared value for 
childbirth viewed it as gift from God, instrument for religious rites and as an act of service to God. 
These were described this in different forms below. Kyauta stated that the social value of children 
in Islam is to intercede for their parent after death, so she wants to have her children so that she 
would not be forgotten and to benefit from that aspect of the religious ritual when she dies;  
Okay, I am a Muslim, you know, if one has children now, maybe something will happen to 
me and I know I leave something. And I know that I have someone that will be praying for 
me when I leave, someone will be praying for me. But now if I leave after one year, no 
matter, my sister, my mother, [pause] my brother after one year, two years they will forget 
about me. But my own children can never forget about me [wave the index finger to 
demonstrate ‘never’] and they will be praying (Kyauta, 33years). 
 
Alheri recounted the social value of children that motivated her to seek for treatment. She stated 
that having children and training them well is an act of service to God. That was why she held to 
the teaching of being faithful and avoiding youthful risky behaviours that might expose her to 
52 
 
University of Ghana http://ugspace.ug.edu.gh
infertility before marriage.  She also adopted children when she could not conceive to do service 
for God as she waits on Him to bless her with pregnancy; 
 
 
 I was taught that as a lady if you get married if you have ever done anything abortion 
when you are youth, when you get married, you will not [eeh] you might not have baby. I 
said God forbid that teaching (stroke the thumb and middle finger together) was in me 
preventing me not to go against it, against whatever that will make me not have 
babies…….. I have adopted children with me instead for me not to do anything for God 
because even I have my biological child today is still for God. Whosoever I train is for God 
(Alheri, 39years). 
 
Still expressing their social value as a cue that stimulated health seeking, Tumba a mother of one 
and a devoted Muslim shared that her religion encourages and cherishes childbirth. According to 
her, she is not against other means of having children. However, she wants to have more children 
of her own; 
 It is not that we are saying other means of having children they are not okay, they are but 
I would want to have more children of my own.  Couple with the fact that my own religion 
Islam, where childbirth is encouraged and cherished (Tumba, 33years) 
 
Some women narrating the shared value of childbirth expressed that it is a gift from God. As such 
they have accepted their fate and will wait patiently on God but will not challenge God since he is 
the giver of children. Responses from Hannah, Amal and Yar-Buga have shown that they belief in 
God’s plan and have decided to wait on God even as they seek for medical help to conceive; 
As a Christian I will not ask God question why that I didn’t have a child. He knows 
everything, God time is the best, when it is God’s time, then God will give me a child 
(struggled with words all through and started crying again) (Hannah 33years). 
 
If God says I will have, I will have and if God says I will not have, no matter what I do, I 
will not have it (silent). I have a strong belief that whatever God says it will happen, 
certainly it will happen because is God that gives and takes that is my own (Amal 45years). 
 
Am a Muslim and you know, children are; is just that they are gift from God, I love and 
desire children. So, I am waiting on God’s time (Yar-Buga 27years).  
53 
 
University of Ghana http://ugspace.ug.edu.gh
Narrating their husbands’ social value for childbirth; some of the participants attributed that their 
zeal to seek for medical help to conceive was borne out of their husbands’ intention to have 
children and the support gave to them. Yar-Buga testified that her husband wants more children 
and constantly encourages her to go for follow up even when she does not want to go despite the 
five children he has with her co-wives; 
Honestly he wants more children even when I was coming for check-ups, if he noticed I 
have taken a while without visiting the doctor, he encourages me to go see doctor and give 
more explanation we might be lucky to get another way out. Even yes, last year they asked 
him to bring his sperm for test and they did and the doctor said there was no problem seen. 
He has five children already with the other two wives (Yar-Buga 27years). 
 
Izatu recounted that her husband is worried because he values children. She also stated that he is 
eager to have more children with her and he gets excited when her period delays. But whenever 
she sees her menstruation and she becomes sad, he always comforts her; 
The thing is also disturbing him.  You know, when a woman is about to menstruate towards 
the month end; a lady will be having some feelings as if she is pregnant, I use to have such 
feelings. I then use to tell him that I want to eat some things. That usually makes him excited 
thinking is pregnancy. But after two days or when the menstruation comes, he is usually 
not happy and when am crying, he is always worried, and then he will tell me to stop crying 
because that is the way God wants it (Izatu 35years).   
 
 
In addition, Amal had a parallel experience as she recounted her husband’s social value for children 
by showing his desire for children. She shared that he has been praying for them to have their own 
children and supported her all through the treatment they had;  
His also wants to have children. [tau!] He has been praying; always praying that one day 
we will have our own children. He has been involved and really helpful; we did all the 
investigations required of us all (Amal 45years). 
 
The social value story is similar to that of Sonia’s whose husband also desires to have his own 
children and has been supportive in all the treatment seeking. But lately, she is not sure of his 
intentions because of the pressure they are receiving from his relatives;  
54 
 
University of Ghana http://ugspace.ug.edu.gh
[tau] (high pitch of voice) he desires to have his own child though is not forth coming 
[hmm] he is doing what he can do. Most of the time he will be doing, let us wait on God, 
[m] if they say we should come to the hospital, he will follow me.  He has been trying and 
he has been patient with me (high pitch of voice) but honestly [gaskiya] I don’t know what 
it is in his mind. [ehh] I don’t know what is in his mind for now because of pressure from 
his people (Sonia 34years). 
 
In a nutshell, the social value for childbirth described as part of individual and social cues were 
expressed by the women’s beliefs on childbirth, their husbands’ intention to have children and the 
support. These were sources of encouragement to the women in seeking for help to conceive.  
4.5.2 Societal Support   
The societal support is another aspect emphatically described as individual and social cues. 
This was expressed by the participants as the encouragement received in the form of advice, 
prayers and companionship from family members, friends and neighbours. Others are colleagues 
at work place and significant others that motivates medical health seeking.  
 The women described that the support from their families, friends and neighbours came in the 
form of advice and prayers. They shared that advices and prayers were reassuring and builds their 
hopes up as described by Tumbar and Igge; 
I have friends, I have families and my husband to some extends, he is supporting me.  It is 
just that he refused to go for the tests. They have been supportive and they are praying for 
me because that is what they have been saying. That they support me [pause] as in when 
we are discussing and talking about not being able to conceive; all they use to say is that 
I should not lose hope since the doctor says that my womb is now okay. That I am not 
having any condition that can stop me from conceiving that I should still have hope that I 
will still have more children. So, they have been supportive and is encouraging” (Tumbar 
33years). 
 
The truth is, I did not have any problem with anybody. My family and friends, every one of 
them advised me to go to the hospital that it might be possible the irregular menses is the 
cause of my inability to conceive. Even my husband doesn’t have problem, my friends too 
said I should go to the hospital, I don’t have problem with anyone (Igge 22years). 
 
Another woman expressing the support received, explained how her first husband was very 
supportive as quoted below; 
55 
 
University of Ghana http://ugspace.ug.edu.gh
Gaskiya [low voice pitch] my first husband supported me very well. He has always 
supported me well. Especially my first husband, he took me for all that Shiradkor stitches 
he is the one saying they should do that Shiradkor stitches so that the pregnancy will stay 
but later [kuma] I will bleed and they will just remove the stitches (silent) (Azumi 
43years). 
 
Two of the participants described how their husbands’were patience with them and gave them full 
support needed to follow up with medical treatment from one health centre to another as narrated 
by Charis and Kyauta; 
He has been supportive of me because all the tests he did in FGX hospital; he also did in 
YBX hospital. When I came to UDX hospital Sokoto they said he will still repeat it because 
they want to have their own report, he should do it here. So, he came down from Gusau to 
this place, he did it and all the three results were okay (Charis 36yeras). 
 
My husband has been trying in supporting me because anything that they say we should to 
do, that maybe someone said we should go to do this [pause] to the hospital. [ma] He use 
to follow me but he said UDX hospital he doesn’t have time because UDX hospital they 
use to waste time but all the first hospital we went from the beginning; we use to go 
together. He did the test they asked him to do in UDX we are waiting for the result to be 
out (Kyauta 33years). 
Sonia emotionally expressed that the challenges experienced due to infertility is a great lesson for 
her and she has decided to be strong to support herself because of the lessons learnt. More so, she 
mentioned that her husband and friends were supportive too. This was how she expressed the social 
support received;  
[emm] what keeps me moving [pause]. Life with infertility has taught me many lessons, 
honestly as a lesson I have learnt from life. Myself number one (tears fill her eyes). I have 
made up my mind to be strong with the help of my husband and my friends were all 
supportive. (giggle, smiled) [ehh naw] this one, what I am going through with infertility is 
a big lesson abi? [ehmm] [hissed] (silent) (Sonia 34years). 
The women also expressed how their families were of immerse encouragement to them in effort 
to support socially. They made emphasised on the reassurance received from their in-laws on the 
need to continue waiting on God and the assurance that they believe they will have their children 
one day. An example was shared of gifts received from an in-law as a way of showing their concern 
as explicitly described by Charis and Kyauta;  
56 
 
University of Ghana http://ugspace.ug.edu.gh
My husband family were of help to me although he is not from a big family, they are just 
three in the family and the father is late. But honestly, the mother [pause], sometimes she 
is the one that will even call me; she kept encouraging me that was the reality. She will call 
me, she will encourage me that I should not worry that everything will be okay, even his 
sisters, even the sister two days ago sent me 500-naira airtime. So, his family used to 
encourage me, they have never done anything that will discourage me. They will call me 
to say I should not worry, like my mother in law anything she called; she will say that she 
hopes I am not disturbed? That it is God that gives children, that I should not worry, that 
she has that believe that I will have, that her son will have his own child. So, in my own 
family honestly, my mum is disturbed.  My dad is late but my mum, she is disturbed because 
sometimes she even told me that if I want, even though I did not have a child. That my 
sister’s and brother’s children that, I can pick one and take care of them. That is even if 
God said that I will not have a child (Charis 36years). 
 
My parent did not give me any problem and my mother in-law too up till now she did not 
give me any problem. Like my mother in-law now she was good to me, I don’t know o 
maybe she is doing eye service but she has not reacted anything or disturbed me up till 
now. Anytime that she sees me, she will tell me that we should wait for God’s time (Kyauta 
33years). 
 
Another woman reported how her family supported her through her ordeal, empathised with her 
and reassured her that they were praying for her because they were also not happy about the 
infertility; 
My family showed me concern, they felt it with me and they were praying along with me. 
So his people were not happy that upon his service to God, and my people also upon my 
service to God. We will be like this, what should be the circumstances? (hhh, (breath out). 
So, that is the aspect they care for o verbally (Alheri 39years). 
 
Likewise, Gomma narrated that her family members were supportive too by encouraging her that 
she will be pregnant someday. They encouraged her to be strong in her faith even if she will be 
childless for life because God favours women He denies childbirth;  
My own family are telling me that everything is from God, that even the heart to be patient 
is from God. If I don’t get pregnant now, I will become pregnant one day and if I don’t get 
pregnant at all, God favours the women He denies childbearing (Gomma 25years) 
 
 
57 
 
University of Ghana http://ugspace.ug.edu.gh
In sharing her experience of social support as a cue to medical help seeking; Yar-Buga recounted 
how her elder sisters constantly encouraged her to go to the hospital. They even kept checking to 
be sure she was being attended to by the right clinic in the hospital, seeing a gynaecologist and 
demanded for feedback; 
My family they were supportive. We are many in my family, more of females, most of them 
are married, and we are the small children among them. They show their concern by 
calling weekly or monthly asking if I have gone to the hospital again and the outcome. 
Showing their concern and worries based on my inability to conceive up till now. Their 
advice is always, go to the hospital. And they also ask the specific unit I went if is gynae or 
another department until I reassure them that I saw the gynaecologist. Even my in-laws 
are doing their best (Yar-Buga 27years).  
 
Another participant describing her social support experience, whose aunty is also concerned about 
her situation kept advising her and insisting to know if she has visited the hospital for the fertility 
problem;  
My aunt has been advising me because my issue is also disturbing her. She kept asking if I 
have gone to the hospital concerning my difficulty getting pregnant that is two years now 
and they have not heard anything.  I told her that we are doing our best (Izatu 35years). 
 
Still describing the social support, the women had, in forms of reassurance and help from their 
neighbours and friends, a woman described how her neighbours rallied around her even when she 
was sick, caring for her implying that she is pregnant until she told them that she not pregnant as 
quoted below; 
My relation with people is okay, I have good neighbours that are elderly, we are the young 
one around and they have all given births. There was one I met with pregnancy, now she 
has delivered the second one (bow down her head). They all encourage me. Even when am 
just sick, they all will come to the house taking care of me thinking I am pregnant until I 
told them it was not or it is confirmed in the hospital that am not pregnant. I have told you 
about my neighbours they are also the friends I have around (Yar-Buga 27years). 
 
58 
 
University of Ghana http://ugspace.ug.edu.gh
Similarly, Amal expressed that her social support came from friends who always call or come 
around for update on her treatment seeking and suggesting that she should continue with following 
up hospital treatment; 
Friends will come or call to ask me if I gone to the hospital again and ask for the feedback. 
That is the only thing and since I know I have done whatever is necessary (knocked the 
table) what will I say? Prayers that is my only thing my faith in God is my only strong hold 
(silent) (Amal 45year). 
Contrary, not all the women had the full support needed from their husbands, family and friends. 
Gomma, Hannah and Tumba reported ordeal of lack of full support from their husbands because 
their husbands refused to do the tests requested which makes things difficult for them and makes 
them feel neglected; 
He sometimes shows his worries because I am yet to give birth but often he neglects me. It 
was only once when I told him that the doctor insisted he should come, that he was forced 
to come along with me to the hospital. Since then whenever I want to go to the hospital, he 
does not support in anyway and he refused to be tested. He does not want me to talk about 
the test or even tell him that the doctor wants to see him again. He does not want to hear 
all those things, Am the only one that is seeking for treatment for the problem and I am not 
happy (Gomma 25years). 
 
My Oga tried after the second surgery; they gave my husband a test to go and do but my 
Oga [Lowered her voice] refused to go and do the test. He said he will not do the test (eyes 
full with tears) (silent) (Hannah 33years). 
 
Though he was supportive morally and financially as I earlier mentioned but he refused to 
be tested. You know, on seeing the doctors, may be the gynaecologists, the series of 
investigations given to you. For you to be able to do them because some investigations are 
not just for you alone; they will ask your partner to do it. So, in most cases you will be the 
only person going for the investigations and the doctor will be looking for, asking for your 
partner’s own because your partner is not ready to cooperate to go for same investigations 
in order to help the issue. Then you will have some difficulty that may possibly expose you 
to more extensive tests because during my own, they gave me some tests all that high vagina 
whatever, all those cervical whatever, all those tests that are somehow not [em] 
comfortable on taking the samples. But just for my partner to go for only one test (shows 
the index finger), he refused to do it [shows sad face]. Still am the only person going for 
the treatment (emphasised with hand gesture) my husband is not going for anything 
(Tumba 33years) 
59 
 
University of Ghana http://ugspace.ug.edu.gh
Equally, Vida lamented on how her husband completely neglected her without any form of support 
in her suffering and looking for solution to the infertility. She recounted that she finds the treatment 
path a lonely one but however, she is bent on seeking medical help for the infertility; 
…That is why I come to the hospital to see if there is problem, I believe they will solve it 
for me by God’s grace because I feel am alone, I’m the only one looking for treatment 
[pause] because there is no support from my husband. He did not support me in anyway. 
So, I am here, he did not even support me because when I told him am going to the hospital, 
he said, he doesn’t care if I like I should go. (Silence, head down then crying, crying, 
crying, crying) (Vida 31years). 
 
In summary, societal support as a cue received by these women came in the forms of advice, 
prayers, continuous checking for updates on the progress of treatment and partner’s 
companionship. Not all the women got supported or had the full support needed by their husbands, 
families, friends and neighbours. However, almost all the women had experienced one form of 
social pressure or the other.  
4.5.3 Social Pressure  
Social pressure was expressed by the participants as a feature of individual and social cues. 
The women experienced pressures in the form of lack of support from the husband, stigmatisation, 
ridicule from other women and the women being accused for infertility both from the family and 
the public. Some of the women described that the ordeal of the pressure forced them to go seeking 
for treatment in order to prove a point because of the way they were being blamed for the cause of 
the infertility by their husbands, in-laws and some people in the community. Vida, narrating her 
ordeal mention that her husband explicitly blamed her for the infertility. She lamented how it hurts 
her badly. According to her, the husband further challenged her to allow him try getting other 
women pregnant. That was what prompted her to seek for help in the hospital in order to get treated 
if at all she is truly the one with the problem;   
 
 
60 
 
University of Ghana http://ugspace.ug.edu.gh
Whenever I bring that issue [pause] he will not say anything again. To the extent [pause] 
there was a day, he told me that the problem is from me [pause].  So, it pains me [pause] 
he said the problem is from me (pointed self) [silent for long but struggle to continue] that 
the problem is from me and I really feel the pain. [pause] that [ehh] if I think that he has a 
problem, let him go and test with another woman outside to show me that he doesn’t have 
a problem; that I am the one that has problem. All what he knows, he doesn’t have problem 
that am the one that has the problem. Like for me, anytime I travel home, they are expecting 
to see me with another baby but they will see me with same baby that I have before. Even 
though if they did not tell you, they say action speaks louder than voice but sometimes I 
don’t care. There was a day that my sister in-law told me that I have to give them another 
baby not only this one that they want. So, I feel pain. (hissed) So, I am here on my own, to 
try to see how [pause] the result is. If the problem is from me, then I will treat it, and if it 
is from him, then I will go and clear myself that the problem is not from me (Vida 31years). 
 
Tumba a mother of one child, also bitterly shared her ordeal of the social pressure experienced. 
She narrated that being in a polygamous marriage where the other woman gives birth coupled with 
her religion that values children, people were insinuating that she deliberately caused the infertility 
by using contraceptives. She shared that her husband also blamed the infertility on her and refused 
to do his test; hence her health seeking in order to prove them wrong; 
Being married in a polygamous setting and my own religion, some people will be   thinking 
that it is you that is not interested in having children. Yes, because somebody even told me 
[aa] that possibly we are doing one kind of family planning that is the reason I was not 
able to give birth to another child again, which is not true.  [Pause] I am trying all my own 
possible means to be able to conceive and the thing the efforts are just being proven 
abortive. So you know, even with the way maybe among your family or your husband’s, 
you know, outsiders are blaming you, (lowered voice pitch) you would want to prove them 
wrong. Now, had it been he went for the test even if it is once, at least I will know that the 
problem is with me alone, he is not having any issue.  But he is still claiming that since he 
can have two kids with my co-wife, that he doesn’t have any problem, am the one having 
the problem (voice lowered down) (Tumba 33years). 
 
Gomma shared the pressure she was experiencing in her two years of marriage where her in-laws 
refused to give her any support but blamed her for the infertility by comparing her with other 
women that gave birth. She reported that the pressure is worrisome as if they do not belief that 
children are gifts from God; 
  
61 
 
University of Ghana http://ugspace.ug.edu.gh
I did not get any help from my husband’s family but they were only complaining of my 
inability to conceive. That since I came for marriage up till now they have not heard of 
anything in respect to getting pregnant and delivery. And other people that got married 
before and after her have all have children but nothing from her. While His people often 
talk to him but few of them met me face to face to talk to me about the issue. Saying what 
is the problem, that up till now you have not given birth? I use to feel bad and I use to feel 
as if they don’t belief in God that is why they are disturbing me like that. Don’t they know 
that God is the giver of everything? I use to feel bad and it use to worry me a lot (Gomma 
25years). 
The story was not different for Amal and Igge who lamented their experience of the social pressure. 
They reported that they were accused for the cause of infertility by in-laws and society. However, 
they were encouraged by the support of their husbands;  
My in-laws before the diagnosis, my in-laws were saying since I am a working class woman 
that maybe I have done something to prevent the pregnancy before the diagnosis. So, later 
on after the diagnosis again, they said maybe I am the one that has the problem [pause] 
since I cannot bear a child and my husband refuse to marry again. That is where the 
problem started I was having some issues with them. But am not always worried because 
my husband is supporting me in the treatment (Amal 45years) 
 
Honestly, sometimes I don’t feel anything because I know God is the giver. I hardly feel 
anything but when any woman deliberately does things to show me that I didn’t give birth 
then it used to hurt me. Yes, and also insinuating that I took drugs because I don’t want to 
give birth now, thinking I planned it and that is what people use to think, yes (silence). 
Everybody, especially my in-laws and it also hurts me when some of the people were 
disturbing me, insinuating that I did not conceive since I got married thinking I did family 
planning because I don’t want deliver on time. Sometimes, am not bordered because my 
husband is not disturbing me but supporting to go to the hospital (Igge 22years). 
Kyauta a primary school teacher lamented how some of her colleagues humiliated her when it 
comes to issue related to children. With an example she narrated pressure at the work place where 
her behaviour is being scrutinised as being cruel because she is childless anytime she disciplines 
children that misbehaved. Her contributions to issues of children are regarded as invalid because 
she is inexperienced in that area such that she should not be accepted; 
You know, sometimes maybe if you talk, they will say maybe because you don’t have 
children. One day, maybe all these small, small children, some maybe they offend you or 
they did something bad and you beat them. Even if they do not talk, you will see some 
parents’ reaction maybe because you do not have a child that is why you are being hard 
on their children. Or something happen you talk; like one of my colleague, the other day 
they were talking about “ela-ela” [skin infection on children]. I now told her that there is 
one medicine that they can to use. She said that I don’t have the experience; I did not know 
62 
 
University of Ghana http://ugspace.ug.edu.gh
the medicine. And that thing [high voice pitch] pained me. When I came to my class I 
shaded tears (Kyauta 33years). 
 
Hannah reported societal pressure experienced in the form of stigmatization. She explains further 
that some of the mothers do not want women with childlessness to touch their children or even 
their children’s items. Insinuating that they are cursed or might harm their children;  
From my experience, you know, we that are women with infertility; those women that born 
children, some of them, they don’t like women like us that have never given birth and 
[pause] that we are praying that God should give us a child. Some of those mothers do not 
like us to carry their children or to touch their anything. This is because they think that we 
have problem or will do anything harmful to their children but for inside my mind or inside 
our mind we don’t have such plan (Hannah 33years). 
Vida recounted her experience of the societal pressure; that it sometimes makes her depressed and 
feels that God does not recognise her spirituality like He does for others. This she expressed with 
an example of how her neighbour mocked her as quoted below; 
Sometime, I think that [hmmm] God doesn’t answer my prayer like others because there is 
one of my neighbours that said if she wants to get pregnant this month she must get it. 
Sometimes I feel as if I should not go out to mingle with people like that.  I feel I should 
stay at home; it is like my own is different. So [hissed] [lowered voice pitch] I pray to God, 
I fast but nothing (silent, put head down) (Vida 31years). 
 
Charis narrated a parallel experience of societal pressure that even strained her good relationship 
with her neighbour because of the way her neighbour mocked her. She stated that her neighbour 
comes out in the compound to play with her child by making it an obvious exhibition to spite her;  
I use to have good relationship with people before the diagnosis. But after the diagnosis, I 
still have the good relationship but sometimes, maybe some people they will be doing 
somethings to me deliberately maybe is because am not pregnant that is why they are doing 
that so that I will get angry. [ehh] Like sometimes, because there was an issue that [en] 
one of my neighbour like that used to stay inside her room. So when she gave birth, so, I 
noticed anytime am around, so she will be playing with her baby outside [very high voice 
pitch] I don’t know if she does it when am not around. But if am around she will just carry 
the baby, she will be shouting, she be saying my baby, my baby playing with her child that 
is if she noticed am outside. So, because it was after the diagnosis if I saw her doing that, 
I will feel maybe she is doing it because of me. So because of that my relationship with her 
was not [lowered her voice] was not good honestly (Charis 36years). 
By way of summary, individual and social cues (social value and social support) identified by 
these women were sources of encouragement while the societal pressure caused them 
63 
 
University of Ghana http://ugspace.ug.edu.gh
psychological trauma. In addition, individual attitude towards childbirth, their husbands need for 
children, husbands’ support and the support of significant others (families and friends) were the 
strong positive cues for some of the participants. Even where these women were faced with social 
pressure of all kinds, the challenge pushed the women to seek treatment for infertility.  However, 
both the encouragement and trauma prompted them to seek for medical solution to the infertility 
issue. 
4.6 Enabling and Predisposing Factors 
This is defined by the participants as the financial resources and educational literacy levels 
of the women that empowered them to seek for medical treatment of infertility. Aside affordability, 
others prompting factors were awareness and beliefs on the importance, safety and effectiveness 
of medical treatment as against any alternative options. However, the women acknowledged that 
their access to treatment is limited to what they can afford. Yet they still choose the hospital 
because they believed in its safety and effectiveness. The enabling and predisposing factors 
described by these women were resources and support, and treatment beliefs.   
4.6.1 Resource and Support 
Resource and support were emphatically expressed as enabling and predisposing factors 
for the women. This defines financial capability to afford treatment and the literacy level of the 
woman to help discern the choice of treatment in health seeking. More than half of the women had 
tertiary education and are working class women. Although some of them had NHIS, they reported 
that it only covered few less expensive investigations and treatment (drugs and surgery) was not 
inclusive which made them to seek for financial support from their husbands because infertility 
treatment is expensive. Fortunately for some that are not working, they testify that their husbands 
were supportive but it is not easy on the family finances. However, the experience was different 
64 
 
University of Ghana http://ugspace.ug.edu.gh
with some women that had no financial support from their husbands, government but are paying 
for the treatment from their life savings.  
Describing resource and support as enabling factors; Tumba a working class woman reported that 
her family income is not very bad because they can afford to pay their bills without much stress. 
As such she paid for majority of the expensive treatment that the NHIS did not cover; 
 
Family income [pause] I think to say is okay to some extent as in we can provide almost 
all we need without too much difficulty. Although I have NHIS I paid for some of the tests 
because the NHIS only covers I think, high vaginal whatever and all those minor 
investigations that are not expensive they accept NHIS. But with all those imaging test 
NHIS does not cover it. In fact, because where they asked me to do the tests are not 
accepting NHIS and where they accept NHIS, the machines are not functional, so I had to 
pay myself (Tumba 33years). 
 
Regardless of one’s financial status, infertility treatment puts pressure on the family economic 
resources. Sonia who works in the very hospital she is accessing care, recounted that she did not 
use her NHIS because most of the investigations were done outside the hospital. She explained 
that it was easy for her to access some treatment because she could afford it but she was not able 
to afford invitro fertilisation that was later suggested to her;  
No, I did not use NHIS because most of the investigations I went for were not here that you 
can say let me use the NHIS. And with the NHIS they will just be toasting you up and down.  
While the HSG, follicular tracking all of those was done in private hospital. But the doctors 
here, you know all of them are hocked up in different hospitals so after here we schedule 
how to go there and do the investigations with TVS all of them, was outside. TVS 
transvaginal for follicular tracking you will do it like (knock table twice) 3-4 times in a 
month to know when you are really ovulating. Me, it was easy for me because I am working 
but I know some people they cannot afford it even the HSG, they cannot afford it and other 
investigations. Some will even say I should go for that invitro fertilization but it is expensive 
and not everybody that can afford it (Sonia, 33years). 
 
The experience related to the challenges of the enabling factor of using NHIS and personal 
payment of hospital bills for infertility treatment was not different in other state. Charis expressed 
that she started the treatment in a neighbouring state before relocating to Sokoto. But her NHIS 
65 
 
University of Ghana http://ugspace.ug.edu.gh
could only cover for less expensive investigation and could not even used the NHIS to access 
treatment in Sokoto as quoted below; 
I have NHIS but I did not use it here. I only used it in Gusau, even the Gusau [ma] like all 
that hormonal profile is not among the NHIS this thing; because all those expensive tests 
and some of the drugs are not among the NHIS. So I bought them outside. When I did the 
hormonal profile I paid almost ten thousand naira plus because they said is not among the 
NHIS this thing. Then when I came here Sokoto, they said that my NHIS can only access 
care in Gusau hospital (voice down) they cannot use it so all the service here I paid for 
them. My husband use to support me and even because is only the two of us. There is no 
any support from any other place. Is only if I collect salary, I will do my test and even him 
if I sees that I cannot maybe be able to pay some tests; he will then assist that is it (Charis, 
36years). 
 
Describing resource and support as enabling factor to treatment seeking; some women described 
how they struggled to pay for treatment with their family income without assistance from 
anywhere (social or government). Although, the burden is huge for the family income, they still 
manage to access treatment. Amal, Izatu and Hannah recounted that they are doing their best to 
access the treatment they can afford;  
If you look at it in that perspective, no matter how much we earn since we have other people 
that are still under us that we have to take care like our parents, our junior brothers and 
so on, with such burden I don’t think we have much to go for [clap hands] so much medical 
expenses. Though we have tried many times and it was only me and my husband that were 
paying for the treatment. In short we have done all my medical check-ups (low voice pitch) 
is just that, it is not yet time (Amal, 45years). 
 
We went to use his NHIS but they didn’t allow me that he needs to get us registered. That 
he should produce our passport photograph for registration and that it takes time before it 
is out. And now, we are doing these investigations, we cannot wait for the NHIS card. We 
are just using what God gave us but we are not getting any support from anybody. When I 
stopped business, the money I gathered I starting selling things at home. Honestly, initially 
when we started attending the SHX hospital, we have spent money. I kept going for 
imaging, they kept writing for me drugs and I was taking. They wrote for me some test 
which I usually do outside SHX hospital. We’ve been doing test, N10,000, N 11,000, N 
7,000 but up till now nothing happened that was why he said we should change to UDX 
and see. So that was where my trading money went, he brings and I bring. And now, you 
see, he is the only one paying because I don’t have the money now. And he can’t use his 
NHIS card for me; he is the only one that can use it (Izatu, 35years). 
 
 
66 
 
University of Ghana http://ugspace.ug.edu.gh
Even the first operation that I did, none of them helped me. They didn’t support me with 
anything. It was only me and my husband that looked for the money and did everything. 
[ehh] My Oga is trying but he does not have that plenty amount of money because the last 
surgery, that I did, it was with my money that I used to do everything. That was why I went 
for this second one I didn’t tell anybody (Hannah, 33years). 
 
Vida lamented lack of financial support from anywhere even from her husband and that makes her 
unhappy. Nonetheless, she was committed to using her life savings from her trading to commence 
treatment to the extent she can afford; 
 
 
I am not working, yes am not working, am a trader, I sell iris potatoes. Is the like money I 
have that am using for the treatment because my husband did not help me with anything. 
Where the money finish, I will stop there. I am not happy, I feel am alone (silent, tearing 
then nodded her head). I don’t have anybody to support me, because like the money that I 
have, that is the one that I am using whenever it finishes [pause] [lowered voice pitch] I 
will stop anywhere the money finish, I will stop (Vida, 31years). 
 
Alheri reported that though the church (social agent) is trying and paying their bills because they 
are church workers. They are still limited to the access of treatment for infertility because of funds 
and the treatment is expensive. That was how she described resource and support as quoted; 
Though previously in some hospitals when we were at Kaduna, they wrote drugs for my 
husband after tests but the drugs were costly. He bought and took for some time then he 
said he will not take again; he cannot continue there is nothing wrong with him. We are 
people for the public, [ehh] church workers, so they care for us. People care for me most 
especially, people care for me and they have been trying to pay our bills. [mm] And now, 
they gave me tests that I am supposed to might have done it last week and the drugs they 
wrote, we were unable to get it. But we don’t have enough money (giggle) we don’t have 
enough money that is the challenge we have. That is what is holding it, if not I would have 
done that one now (Alheri, 39years). 
 
Yar-Buga narrated that it is only her husband who is paying her hospital bills because her take 
home at the end of the month is nothing to ride home about. Her expression of resource and support 
is shared in this way; 
67 
 
University of Ghana http://ugspace.ug.edu.gh
For all the investigations and medications, me and my husband have received so far; 
nobody supported us. It was only my husband that was paying the bills because my part 
time work does not pay much (Yar-Buga, 27years).   
 
For Gomma, her husband has stopped paying her bills. However, her parents want her to continue 
with the treatment. As such they offered to continue paying her hospital bills because she is not 
working. She obliges because of her awareness of the importance of hospital treatment. That was 
how she shared experience of resource and support;  
Even when my husband stopped paying the hospital bills, my father starting paying since I 
am not working. They are always encouraging me never to get tired of going to the hospital. 
Another thing that motivated me to continue visiting the hospital is that; you know when 
one is ill; it is good to visit the hospital to lay your complaint and take treatment. Thank 
God we have this awareness that if one is sick, it is good to visit the hospital see doctor 
and take the prescribed treatment. We are not hinder from going to the hospital (Gomma 
25years). 
Sonia a medical professional, delayed treatment but had no choice than to visit the hospital when 
lack of pregnancy and symptoms of comorbidity persisted. Her description of resource and support 
were her literacy level that prompted her health seeking; 
From knowledge I have, [pause] pregnancy did not come, and with the initial problem I 
told you. Because then I used to hear people that with fibroid one can still conceive but the 
bleeding, pregnancy was not coming and the bleeding did not stop. So, I had no option 
than to come to the hospital (Sonia 36years). 
In summary, financially it was not easy for these women even with those that had social support, 
government support to some extent and a family income to back up. Nevertheless, even those that 
are single handily paying their hospital bills for infertility were committed to continue with 
treatment as long as they can afford because of the awareness that hospital treatment is better. 
Their treatment beliefs were another motivator that made them continue to strive to access 
treatment for infertility.  
4.6.2 Treatment Beliefs 
Treatment belief was another way the participants described enabling and predisposing 
factors. The women’s treatment beliefs were defined basically as the reasons behind the confidence 
68 
 
University of Ghana http://ugspace.ug.edu.gh
and trust the participants have in medical treatment that made them do the health seeking. The 
women believed in the safety and effectiveness of medical treatment that was why they choose the 
hospital for solutions to their infertility problems. They also emphasised that they will continue 
with the medical treatment because that is the only place they can trust and go for solutions. 
Conversely, other women stopped a particular treatment, refused a certain treatment suggested by 
the doctor for some reasons nonetheless; they still preferred to continue with medical treatment 
than do otherwise.  
Reporting on treatment belief; Tumba and Izatu narrated that they cannot vouch for traditional 
medicine because it can be harmful. Since they do not know the content, mode of action and the 
information were not online for them to check. They recounted that they strongly believe in the 
safety of the medical treatment because investigations were always carried to identify the problem 
which is good. They mentioned being comfortable with the medical treatment they had so far 
because even when they checked online they found that those were the right treatments for 
infertility and they did not experience any side effect as described by Tumba and Izatu; 
 I have never used any treatment channels because I belief hospital is the only place that I 
can seek remedy to my being unable to conceive. I don’t know the content of all the 
traditional concoctions and I cannot say how they work. And there is no means for me to 
google and see how they work, so I just feel like the only remedy is for me to go and see 
doctor. The hospital treatment is okay, because whatsoever they place you on with this 
global whatever they are having, if you google to look at it, you will see that they are the 
remedies to the inability to conceive. And I am not having any side effect or any problem 
to any of the treatment, so, is okay. And that is the only reason am sticking to their 
instructions because I believe this is the place that I can seek remedy to my being able to 
conceive (Tumba 33years). 
 
I went to the hospital because visiting the hospital is the proper thing to do. When I went 
they requested for some tests. They first did those tests to check if there is anything wrong 
with my system that is preventing me from conceiving and to also check if he has any 
problem that is preventing him from impregnating me. You see, that means going to the 
hospital is good because they were able to identify the issue since his result was normal 
maybe the problem is from me though the first result was normal and now is the second 
tests that they want me to do. Which means going to hospital is relevant. Instead of staying 
69 
 
University of Ghana http://ugspace.ug.edu.gh
at home and be doing self-medication or taking native medicine [pause] one is just killing 
oneself because you don’t know what will happen to you (Izatu 35years). 
Vida having tried self-medication and faith base; she then realised that she cannot treat what she 
does not know since she did not test herself before the self-medication and even faith requires a 
genuine action. She reported going to the hospital because she beliefs the health professionals in 
the hospital were trained to identify and treat disorders. That was Vida’s narration of treatment 
belief; 
[tau!] God said, if we stand up, He is going to help us. That is one thing that I hold. I said, 
as far as they prayed for me and there is no problem, I believe every problem have solution. 
Because you cannot just treat what you don’t know like the one I did for toilet infection. Is 
not that I tested it to know that I have the toilet infection, I just said let me try it, so that is 
why I come to the hospital. Yeah, like this toilet infection tablet I bought it with the one that 
they put in the vagina too. So, I bought all these things.  I was thinking maybe by using 
public toilet may be [pause] I just try to do one or two thing is a friend that advise me to 
come to the hospital and [pause] I know they were taught about it and they have learnt 
many things about health, that is their area of work. So, I said, as far as they know more 
about it, let me come, I believe they will help me. So, if they will give some medicine here 
for treatment, maybe, if it is a problem, they will figure out the problem then I will know 
yes, this is the cause of it (Vida 31years). 
Likewise, Charis reporting treatment belief shared that she chose the hospital because she believes 
health professionals have the ability to identify and treat health issues but staying at home will not 
help one to identify the problem or solution. More so, she has seen people that had similar problem 
of infertility treated in the hospital and they now have their children. She also testifies of the 
improvement she now feels in her system that were not there before; 
I chose the hospital because, if they do any, maybe through them, they will discover some 
problem.  Maybe there is some problem that within me I have. Maybe I have problem in 
my womb that I am not aware but by attending the clinic, going to the hospital, they will 
identify the problem. Maybe sometimes is just a minor something that they will just give a 
drug everything before you know, you will conceive. But if you do not go to the hospital, 
you are staying at home, you will not know. Where the problem is coming from but by 
visiting the hospital you will know where the problem is from. I was really encouraged to 
visit the hospital because I have seen some people that have some similar issue with me; 
that through the hospital intervention they conceive, they achieve their pregnancy. And 
also, like as am visiting the hospital, am noticing some, there is some improvement that I 
am seeing in my body which is not there when am, when I have not started the clinic 
(Charis 36years). 
 
70 
 
University of Ghana http://ugspace.ug.edu.gh
Similarly, Igge and Alheri shared how they were also encouraged by the testimonies of other 
people with similar issues of infertility that was rectified in the hospital and that was why they 
visited the hospital too. This was how they described their treatment belief;  
I went to hospital because I have seen a lot of people that were not able to deliver for many 
years and when they went to the hospital it worked out for them and I expect to also be 
pregnant like others. So, presently we are only doing some tests. He started giving me some 
drugs then later he started giving me some tests for me and my husband to do (Igge, 
22years). 
 
[mm] I think [ehh] I have testimony of some people that have gone to the hospital, through 
check-up like that and other treatment [ehe] they were able to get pregnant and delivered 
children. Like [ee] I don’t know that somebody if the problem is on the man, that if maybe 
where the cell that can [pause] produce child cannot drop, it means there is a blockage. 
And if they can be able to get the sperm [pause] this thing, the living cell and inject to 
woman’s womb, she will be pregnant. Tau! I think that is good too because I heard that in 
the hospital (Alheri, 39years). 
 
Reporting contrary experience, Amal who has been experiencing infertility for the past 17years, 
in expressing her treatment belief narrated that she has tried all the recommended treatment. She 
mentioned stopping clomid because she had side effects and she also refused the treatment of 
invitro-fertilisation as it requires her to get a donor plus the cost which she cannot afford. Amal 
thinks it is just not yet time, as described below;  
 
Most of the drugs even gave me side effect like that clomid when I was taking it, it gave me 
side effect, my menstruation ceased. Then when I stopped, the menstruation came back 
normal. So, the consultant it was Dr. XXX [name mentioned] she removed the clomid from 
my drugs then she stared giving me some injections. In short, I have tried all that she can 
give me to the extent there was nothing much she can do (silent). The last treatment 
alternative was IVF which I have not tried because of the donor they told me that I have to 
get a donor. You know, initially they said that there is no much egg; that the egg is not 
growing [pause] as required. So doing the IVF is better but they now said that I have to 
get another egg donor (lowered her voice) which I don’t like (shake her head). Even if I 
want to try, how I am sure it will work and you know, it is expensive (Amal, 45years). 
 
Sonia a medical professional with 6years infertility, sharing her treatment belief has a parallel 
experience; which she stated that she has adhered to all the recommended treatment and the 
medical personnel empathized and did their best for her. She reported going extra miles to even 
71 
 
University of Ghana http://ugspace.ug.edu.gh
do artificial insemination which did not yield results. Now she has some doubt about the 
effectiveness of invitro fertilizer that was recommended to her; 
(Giggle) [tau!] They have tried o, the treatment, [pause] surgery, they have been following 
me up and they have been showing me care and love. They put themselves in my shoes.  
Even Dr. XXX [name mentioned] there was a time she gave me this types of drugs, I can’t 
remember the name, she gave me six sachets of the pack of all these drugs. So, I will say 
they have tried. Yes, she gave me some of the India supplements which I took but nothing, 
because she is among the people that I use to see. She gave me some, they have been trying 
[pause] I can say is not their fault [m] and I have done my best [mm] (smiled). The Doctors 
even suggested IVF but [pause] when I thought over it, I was like, if now they say there is 
no problem [pause] the tube are potent, menstruation comes when due, you ovulate and 
still is not working, my husband is okay. So, invitro is it the one that will work? That is the 
question I use to ask myself, I have not even thought of going for it, so I don’t know because 
if these ones have not, I doubt if I go; it will work. The truth of the matter, me I have not 
made up my mind or think of going there since this one that there is no problem nothing is 
working, I don’t know if it is that one that will work and it is very costly. Though, I 
attempted on one and one with the doctors there they did this collection of the sperms to 
inject, I have (hissed) forgotten the procedure here [pause] [ehe!] artificial insemination 
(Sonia, 36years). 
 
By way of summary, the enabling and predisposing factors prompted the health seeking by these 
women. The women had various treatment beliefs that predisposed them to health seeking. 
Resources and support enabled the access of medical treatment they believed in and the ones they 
can afford. Nevertheless, few women having tried medical treatment over time now doubt the 
effectiveness of some treatment options. 
4.7. Perception about Infertility 
The participants’ defined the perception of infertility as what the women and the society 
belief causes infertility which was highlighted as natural/ biological, spiritual and social factors. 
The knowledge of infertility was associated with the treatment outlets utilised by the women which 
also impacted the women’s expectations of treatment. Perception of infertility was expressed by 
the women as knowledge of infertility, treatment outlets and medical treatment expectations.  
72 
 
University of Ghana http://ugspace.ug.edu.gh
4.7.1 Knowledge of Infertility 
The knowledge of infertility was expressed by the participants as the beliefs on the causes 
of infertility which is also an aspect of the perception of infertility that prompted help seeking for 
infertility as described by the women.  
Few of the participants believed that infertility occurs naturally from God since He is the one that 
gives children and can also be as a result of a biological dysfunction of the system. They held to 
the outcomes of the investigations in the hospital and their beliefs despite other people’s suggestion 
that their fertility problem might be spiritually related. As such they ignored their advice on 
traditional medicine or sacrifice which they believed is harmful and against their religion as 
recounted by Azumi, Kyauta and Adasa;    
Some people are saying it is spiritual, some are saying it is this and that, you know how 
people are? Some are saying is spiritual and some are saying maybe someone did 
something to me that is why but I don’t belief in such things. So, what I believe is hormonal 
as the doctor explained because I went for hormonal test, they said I have oestrogen related 
problem. You see, I don’t belief in that spiritual thing (Azumi, 43years). 
 
 Some of my colleagues in the office because I don’t have many friends, I do not know 
anyone. In my working place, they will just call me and advise me that; like one lady [ma], 
she stayed for 5years before given birth. One day, she said that I should go to one man that 
is herbalist that gives all these herbs. I now told her no, I won’t go and that it was her own 
time to give birth that was why [pause] that when my times reach, [ me ma] I will have my 
own. I said, I’m very grateful but I will not go to that man. You know, I did not belief in the 
native doctor because some of their medicines use to damage something in someone’s body 
so, I do not want it and my religion again is against it. I don’t know, is before I use to think 
about the condition, I use to even cry [ma] cry but now, since I realise everything is from 
God. I just put faith in God, if God say I will have it, then I will have it. But you know, if 
God did not allow, nobody can give [pause] so, I belief in God, if God say I will have then 
I will have it (Kyauta, 33years). 
 
I and my family were worried, so disturbed that [pause], some of them were even saying 
that I should go and collect native medicine. Then I said no, [pause] so they were saying 
all sort of things, I said no. Some said go and do sacrifice but I refused since my faith is 
against it, the result of the test show that I don’t have problem and I have delivered before 
(Adasa, 35 years). 
Gomma expressing her perception of infertility narrated that it is from God because God allows 
illness at the same provide cure. Same as He gives children at His own time; 
73 
 
University of Ghana http://ugspace.ug.edu.gh
You know, all illness comes from God and before God brought down illness, He first of all 
brought down the solutions. So, childlessness is also from Him because He is the one that 
allows a woman to give birth (Gomma, 25years). 
 
Another woman described the knowledge on the cause of infertility as generally held in her 
community especially against the educated women. She narrated that her community believed that 
infertility can be caused by a distortion in the natural functioning system of an individual. That is 
influenced by the effect of some social factors such as, unsafe abortion at youthful age and use of 
contraceptives. The woman also shared her own perception too which she said can be natural as a 
result of a disorder. She recounted her ordeal that she believed the cause was fibroid then after she 
had surgery and all the hormonal test reading normal then her focus on the cause of the infertility 
shifted to her husband that refused to be tested as expressed by Tumba;   
You know, some have the perception that when a lady was not married and she had 
committed illegal abortion maybe once or twice that it can cause infertility. So, they have 
that kind of perception. Since you are a learned person, maybe you pass level of secondary 
school, tertiary institution. They attach all those [eeh] negative perceptions of abortion 
and use of family planning as cause of infertility with this class of women that are having 
difficulty to conceive. However, I cannot say the only thing after they diagnosed me of that 
fibroid, I now felt maybe is because of that fibroid then after the surgery not happened. But 
my own thing is, had it been because am still telling myself, that had it been my husband 
went for the test that they asked him to do, may be it would have helped us. Because for 
them now, I don’t have any issue because fibroid is not there, all the hormonal test I did 
everything is reading normal (Tumba, 33years). 
 
Recounting her community knowledge of infertility, Alheri narrated that she was taught that 
abortion resulting from a risky health behaviour can cause infertility and she held to that teaching 
initially but now she finds it difficult to believe it;  
I was taught that as a lady if you done abortion in your youthful age, when you get married, 
you will not give birth. I said God forbid that teaching. Even people that live a wayward 
life, they started telling us, some will say I have aborted for how many times [pause] and 
see me I have children. I started thinking again, for a lady to keep herself till she gets 
married, can it bring problem of infertility? (hissed) I was confused (Alheri, 39years). 
 
74 
 
University of Ghana http://ugspace.ug.edu.gh
One of the participants Charis a bachelor’s degree holder, explicitly recounted her knowledge on 
the cause of her infertility as being caused by witchcraft as she believed someone has bewitched 
her that was why she was infertile since the follicular tracking indicates the presence of a mature 
ova severally but she is still not pregnant after all the attempts;  
My perception [ehh] about difficulty conceiving is that, I feel maybe there is somebody 
behind it so, because that is my perception because even all the vagina scan I did, I did 
this [emm] follicular tracking, so they will even tell me [aa] there is matured egg, this egg 
will be release at a certain time but still nothing will click. So I feel, my perception was 
that maybe there was somebody behind it (Charis, 36years). 
 
Alheri expressed her belief on the cause of infertility as a spiritual one that comes in the form of a 
dream but with physical implication. She described her experience as she relates it to the meanings 
attached to dreams in her culture and Christendom. She recounted that she has experienced the 
manifestation of her dreams associated with her difficulty getting pregnant as interpreted. 
Quotation below; 
If I dream about children and pregnancy, the interpretation God gave me is that I will be 
faced with challenge in real life. Initially, I used to be happy that I was pregnant in the 
dream as such expecting to be pregnant in the physical. Not knowing that it is challenge 
that might come my way. I have dreamt it so many times and I have seen the interpretations. 
When I even shared with some mature Christians too, they told me that if one dreams of 
fruits, then it is a sign of child. Like in my culture, if you dream snake moving or one 
stepped on it, then it is a sign of child coming to you. If you dream of [ehh] yam or cassava, 
it is a sign of child too. If you dream that you are pregnant or deliver, that it is not good, it 
is going to be challenges that will come. And if you come to Christendom, if narrate these 
dreams, some people will have their different meaning. They will tell you that snake is an 
evil spirit [giggle] (Alheri, 39years).  
 
In a nutshell, the participants believed that infertility may be caused by biomedical, 
natural/biological, and social factors. These women’s and significant others (their social network) 
beliefs are basically associated with the type of treatment outlets they patronized for solutions to 
infertility. 
75 
 
University of Ghana http://ugspace.ug.edu.gh
 
4.7.2 Treatment Outlets 
The treatment outlets of the participants were described as where they went looking for 
solution for their infertility. The treatment outlets is said to be influenced by the perception of 
infertility as believed by the women and that of significant social network of the women. Majority 
of the women went for medical treatment and used prayers houses (faith-based) since they believe 
it is like any other illness God allows to befall human beings but it can also be as a result biomedical 
factors. While those who thought that social factors were the causes of infertility, there were others 
who utilised medical treatment outlets for solution to their infertility.   
Some women even with their perception of infertility being caused by biomedical factors; were 
out of desperation influenced to utilize other treatment outlets by significant people. As such, they 
used the medical treatment outlet in combination with spiritual outlet (prayer houses) seeking for 
help to conceive when all investigations revealed no abnormality in the reproductive system. 
Adasa narrated that she decided to use the faith-based outlet by going for prayers when the results 
of the investigations carried out on her in two different hospitals she patronised were normal and 
she does not know the cause of her infertility; 
I don’t know the cause of this delay in conceiving, so I was told that I should go for 
investigations so that I will know whether there is (silence) if there is any problem with my 
[ehh] womb.  The first hospital that I went, they did for tests and placed me on clomid, it 
was UDX here and nothing happened. Later [ehh] somebody then directed me to doctor 
XXX (name mentioned) hospital he too did [ehh] some series of investigations, everything 
was normal then he placed me on clomid again. Then we even decided to start going for 
prayers because the results were normal. I started going for prayers because after the test 
showed normal [ehh] womb and tubes they didn’t do anything again but said I should 
continue on clomid till something happened (Adasa, 36years). 
 
Similarly, sharing her experience on treatment outlets; Charis stated that she concurrently used 
both medical and faith-based treatment outlets. She did the concurrent treatment seeking because 
she was desperate and her husband wanted them to avoid the surgery. As such, they decided to 
76 
 
University of Ghana http://ugspace.ug.edu.gh
patronize faith-based healers even when she doesn’t believe in it coupled with her perception that 
her infertility was caused by somebody that is bewitching her;  
I did not stop the hospital treatment even when I was going for prayers because they 
diagnosed me of ovarian cyst. It was when I was even booked for the surgery; I was booked 
for the surgery, so that was when my husband said I will not do the surgery. So that was 
why we now went to that Mercy land for prayer because I was pushed. So, I do use prayer, 
and I use to pray that anybody behind my infertility that God should expose the person. 
[Voice lowered down] and the person should leave me (pause, wave hands again) to have 
my own children (silent) (Charis, 36years). 
 
Alheri describing her 17years of treatment outlet experience shared that she utilised two treatment 
outlets. She recounted that as she was told that it was too early to detect infertility at few months 
of marriage, her husband encouraged them on using faith-based since he is a pastor. But as the 
years passed by, people advised them not to limit themselves to only faith-based but to try the 
medical treatment too as described below;  
Okay, after I discover that I was not getting pregnant few months after marriage, I went to 
hospital but was told to wait a bit.  As I married a man of God, he doesn’t what anything 
sorrow. He said we should leave everything to God and the bible tells me that we should 
be happy always. [ehh] That was why we are fighting it through prayer (giggles), we have 
been praying. But when we started opening up to some of the people that we know, that we 
do not have children; they all advised us not to stop. That we should not leave things like 
this that was why we started coming to the hospital again (Alheri, 39years).   
 
Another woman believes infertility can be naturally caused because it is only God that gives 
pregnancy that was why she chose the hospital as she is praying and trusting God to conceive. She 
recounted that the investigations she did were normal and she was also placed on medication;  
 
So, I belief in God, if God say I will have then I will have it. That is why am going to the 
hospital and they told me that there is no problem; there is no problem with my womb. 
They just gave me one drug that I should be taking it, after one month that I should come 
back to the hospital. So everything is from God (Kyauta, 33years). 
 
Gomma sharing her treatment for help seeking said she patronised medical treatment and even 
visited more than one hospital. She expressed further that tried the traditional medicine and 
supplements because she believes achieving something in life is about trying one’s luck; 
77 
 
University of Ghana http://ugspace.ug.edu.gh
 
And you can’t say because you were not success with the initial treatment that does not 
mean you will never be healthy or you can’t be successful with other subsequent treatments. 
That is why I changed hospital when the drugs I was given affected my menses because 
everything about life has to do with luck. I also used tradition medicine my mother’s friend 
gave and MACA supplements (Gomma, 25years).   
 
Sharing similar experience of treatment outlet, Sonia, a health professional lamented that her 
eagerness to get pregnant made her to combine three treatment outlets (medical, faith-based and 
traditional) because she was under pressure and she wanted to avoid blames that might come when 
she rejects their cultural practice. She narrating a weariness ordeal that she has tried all suggested 
medical treatment except invitro fertilization and they also went for prayers and has used 
traditional herbs given to her by her in-laws based on their culture; 
[Tau] (High pitch of voice) We desired to have our own children but none was forth coming 
[hmm]. We have waited on God, met men of God prayer [m] we went to places. The 
hospital did all tests and tried several treatments except invitro fertilization. [Tau] Like 
you know, this [ehh] relative something the immediate family put pressure that we should 
go and let do this things traditional medicine then me I am from Igbo, Igbo land there are 
some herbs that they will to give you, all the stuffs and I still did (knocked on the table) as 
requested to avoid blame. [Tau] (Lowered pitch of voice) all these we tried but nothing, 
no pregnancy, I am honestly tired (Sonia, 34years). 
 
The majority of the women utilized only the hospital for treatment seeking for infertility while the 
rest used as their initial treatment outlet before venturing into other outlets over time.  Among the 
few that used the more than one outlet; they apparently maximised the medical treatment and faith-
based. This is because they believe infertility is naturally caused, can occur as a result of distortion 
in one's system and even where they think it is spiritual, they believed God has the solution. Some 
patronised more than one treatment centres while others were forced to do incredible things against 
their wish due to eagerness to get pregnant and avoiding social pressure. 
4.7.3 Medical Treatment Expectation 
Medical treatment expectation is another aspect of perception of infertility that contributes 
to health seeking which the participants were able to express as the women’s anticipation of the 
78 
 
University of Ghana http://ugspace.ug.edu.gh
outcome of treatment. In describing this, some of the women shared that they anticipate conception 
soon, while others are not sure of what to expect. However, they were motivated and hopeful that 
the result of the investigations done will reveal what the cause of the infertility is. Some of the 
women were highly optimistic as they were expecting conception very soon based on the treatment 
they have received so far.  
Tumba narrated that she was hopeful because the possible cause of her infertility (Myoma) has 
been resolved since she had surgery and she was not on any contraceptives as she has read could 
delay pregnancy. She expressed her anxiousness to conceive as she kept counting the duration of 
treatments and months gone after surgery but then she prayerfully and enthusiastically emphasized 
that she expects to conceive very soon as she trusts in God;  
I have been going through this treatment for [pause] more than a year now. I still have 
hope, am expecting to conceive very soon. Am just hoping and trusting in God with the 
treatment and the doctor said I should just continue (clap hands twice) and I should be 
praying may be possibly because of the operation I had I will be able to conceive if at all 
is the fibroid that is not allowing me to conceive again. So, now am just waiting for God’s 
time. I [pause] am even praying before this month ends. I am praying that God should help 
me so that I will conceive.  This is the third or almost the fourth month after the fibroid 
operation and ideally, the way I read it, immediately after the operation if at all one is not 
using any family planning method, one will conceive immediately but still (few seconds 
loss of voice, force the words out) I am still not pregnant [accompanied by hand gesture to 
show nothing happen]. I don’t know the thing, but doctor said that I should wait there is 
still time, I cannot say that we are not having hope of conceiving that we still have the 
chance (Tumba, 33years). 
 
Equally, Kyauta has high expectations that she is going to conceive with the medical intervention 
she is currently getting in this present health institution. She expressed that the previous health 
institutions she visited, none tested her husband. Nonetheless, here she and her husband had several 
investigations carried. Hoping that when the results are out, the problem will be identified and 
treated; 
 
79 
 
University of Ghana http://ugspace.ug.edu.gh
You know all the hospital that we went initially, it was only me that they were investigating 
they did not talk about my husband, do you understand? Is when we went to ZFX, ZFX 
asked us to do one test, from that time we did not go again. But now when I started UDX 
many tests I did not do in those two hospitals were written for me and I did all. Many tests 
that my husband was not asked to in those hospitals before, he has done them. So, when 
the results are out that is the time that we will come, and they will know the person that 
have problem and treat that person. So, I am expecting that in sha Allah [smiled, ha] I will 
get pregnant with this treatment (Kyauta, 33years).  
 
The experience is not different for Charis as she was also optimistic in her expectations of 
conceiving very soon based on the medical treatment she is getting here. She reported that she 
keeps to her follow up appointments because she likes their drugs and encouraging attitude. More 
so, she stated that she is certain she will conceive again because the few months’ treatment in this 
hospital made her conceived but she lost it unlike the previous hospital that she has attended for 
two years without pregnancy;  
Honestly, my expectation is pregnancy, [ehh] my expectation is that am sure that I will 
conceive because it was even when I started here in this hospital that I got pregnant but 
loss it. I have been going there for almost two years nothing. But honestly, just the few 
months, I started here with their drugs and the way they were even encouraging me. 
Honestly, to even made me happy and gave me that zeal to be even attending the clinic till 
I finally got pregnant that [ehh] November and unfortunately (lowered pitch of voice very 
down) I had miscarriage (became quiet and put head down) (Charis, 36years). 
 
Alheri sharing her medical treatment expectation; she relates her anticipation in relation to her 
perception of infertility as she reported that based on the dreams she is currently experiencing of 
somebody giving her sweet fruits and corn (seed) in the dream. She believes that with the medical 
treatment she is receiving presently that she was going to conceive by God’s intervention because 
God is the one that gives children and even gives people the knowledge to help; 
What I want to say, since we came to Sokoto here, I have been dreaming about fruits, I 
have been dreaming about seed [masara] that they are giving me. Even not quite long, 
somebody gave me one fruit like that I know the fruit in our local place, white, whitish in 
it, if you remove it is whitish and very sweet. Somebody gave me too that I should link it 
and (low voice) I was linking it. So, I have belief that with the medical help we are getting, 
God is going to bless me. I belief in God because even if man wants to do anything for you, 
to help get solution, he is not the one, is God that put that knowledge there. So, is to believe 
80 
 
University of Ghana http://ugspace.ug.edu.gh
in God that God can do anything, everything that He wishes me to have.  I trust that God 
is going to bless us with this hospital treatment (Alheri, 39years). 
 
Furthermore, some of the participants that started medical treatment not quite long had high 
expectations of getting pregnant soon. As they were encouraged with the outcome of some of the 
investigations, results were normal which indicates a positive sign that there is nothing that can 
prevent conception as expressed by Yar-Buga; 
 Why am motivated and hopeful is because they all the other tests I did were normal. There 
was no problem with the result of the investigations I have done so far. If that God wishes 
because there nothing anybody can do when it is not yet time. I hope to conceive but 
supposing they identify a problem; I would have said maybe the problem caused my delay 
in conceiving. Anywhere I will go is just advice and prayers. Even the hospital does not 
have the final solution to the difficulty getting pregnant but they can guide, advice and they 
can treat since they have the knowledge and things will work out well God’s willing. Since 
there was no any ailment that is preventing me from conception; I know is all about time, 
I am patient and will continue to solicit for prayers from parents, family and friends which 
will never go in vain by God’s grace I will also conceive (Yar-Buga, 27years). 
  
Even some of the participants that had been medical treatment for more than fifteen years despite 
their diagnosis were still hopeful. As they wait and depend on God for conception because they 
see their case as a difficult situation based the report they had from doctors from different hospitals. 
This was how Azumi and Amal described their medical expectations;  
I went to ZFX and I went to UDX Hospital, all the doctors told me the same thing that the 
problem is hormonal. Hormonal [pause] problem is not easy to treat, it is not like 
somebody that have incompetent cervix or somebody that has this thing, what do they call 
it, like all those that have ovarian cyst or fibroid; that can be removed and the woman may 
get pregnant but me, hormonal problem is very difficult to correct. Have accepted my fate 
and am trusting God, that is the only thing because am not having any difficulty in getting 
pregnancy but the only thing is that am having difficulty sustaining the pregnancy to reach 
9months for delivery (Azumi, 43years). 
 
It is just that it is not the right time [pause] because I have tried all the treatment at SHX, 
ZFX and UDX except one even the consultant said that it is not yet time because the egg 
that is not maturing. For is me, it is not God’s time yet. I am just praying and waiting for 
God’s time. if God says I will have, I will have and if God says I will not have, no matter 
what I do, I will not have it (silent) (Amal, 45years). 
  
81 
 
University of Ghana http://ugspace.ug.edu.gh
In summary, the women expressed their perception of infertility. They were able to describe that 
infertility could be caused naturally as God wishes, due to a disorder like fibroid (biological) and 
socially due to abortion or use of family planning. Others believed that it could be spiritual 
referring to bewitchment or diabolical. Despite the women’s knowledge of infertility and the 
influence of significant others, the women mostly utilised the medical and faith-based treatment 
outlets which they did concurrently. This is because they believed that it is only God that gives 
children. Nonetheless, few of the women used herbal medicine to fulfil cultural practices and avoid 
blames. Regardless of the duration of treatment and years of infertility, the women reported high 
expectation of conceiving with the current medical treatment.   
4.8. Health Seeking Behaviour 
   The health seeking behaviour of these participants was defined as the complex process 
involved and the experiences attached to choosing treatment for infertility. They mentioned some 
consultation and negotiation with relevant individuals on advice about treatment seeking. They 
also highlighted medical seeking and changing medical treatment institutions when they could not 
get results (pregnancy). The health seeking behaviour of these participants was described as 
decision making, seeking for medical help, acceptance and adherence to treatment.  
4.8.1 Decision Making 
Decision making was one of the health’s seeking behaviour steps the women went through. 
The process involved advising oneself, sought and got advice from people and negotiated with 
their husbands before using the medical treatment outlet.  
Some of the women recounted that when the idea of seeking for medical treatment came to mind, 
they consulted their husbands for consent but were undecided to consent because of various 
reasons as described below. 
82 
 
University of Ghana http://ugspace.ug.edu.gh
Sharing her experience of decision making, Izatu narrated that when she told her husband about 
the need to seek for medical help to conceive, he was reluctant because he does not have money. 
She stated that she made efforts to convince him that the initial visit might just require 
investigations which they can do later when he gets paid;   
We were just discussing with him in the room then I brought the issue of the need to go to 
the hospital for solution to my difficulty getting pregnant. He said he doesn’t have the 
money. I encouraged him that we should just go for the first visit, because I belief they will 
just request for tests which we can do later when you get your salary [pause] you see the 
hospital is better honestly. We were just sitting down when I suggested that (Izatu, 
35years). 
 
Likewise, Tumba reported how difficult it was for her to gain approval to seek for medical 
attention. She narrated consulting her sister about her delay in conceiving who advised her to go 
for medical treatment. That gave her the courage to inform her husband and seek for consent but 
he was hesitant and told her just to wait patiently. She recounted that since he did not give her any 
genuine reason and she could not find any reason why she should not seek for medical treatment, 
she then started visiting the hospital without further delay. This was how Tumba described her 
decision making step; 
[mmm] It was not easy sha, to say the truth because even, before your family will accept 
you to go to the clinic for seeking health services, it was a thug of war. Because some will 
say that is just that you are not patient, you are not trusting God, you cannot wait for God’s 
time for you to conceive. You see [pause] [mmm] initially when I discussed with my elder 
sister she said I should go and see doctor. That was the first thing she told me. I then 
discussed with my husband, (lowered voice pitch) and he said we can wait on God for some 
time to see if the thing didn’t work then. And [hissed] from there now, as I observed for 
few months and there is nothing to say that [hissed] is really genuine that is stopping me 
from seeing doctor, I just started seeing doctor on that without wasting time (Tumba, 
33years).   
 
Hanna narrating her experience of self-decision making process. She described her ordeal where 
she went to the hospital 2015 two years after losing her first pregnancy but was not able to see the 
doctor because her file was missing. She further explained that it took another year, 2016 for her 
to revisit the decision for medical treatment through the prompting, advice and assistance of a 
83 
 
University of Ghana http://ugspace.ug.edu.gh
church member (nurse) that was working in the same hospital that was aware of her problem. Her 
quotation below; 
I decided own my own to go to the hospital in 2015 because since after the baby died in 
side my womb I did not go to the hospital check about myself or anything. [ehh] In 2016 
there was one nurse that helped me, I went to UDX hospital because the woman works in 
UDX and (looking absent minded) we attend the same church. Then she asked me what 
happened because she noticed that after the first pregnancy I lost she did not see me with 
pregnancy again. She asked me, what happened? I told her how I went to hospital in 2015 
but could not see doctor due to missing file. I told the nurse, and then the nurse said she 
will help me and find the file. So, she gave me a date because she wanted me to see Dr. 
XXX [name mentioned] and I went (Hanna, 33yrs). 
 
Still on the decision making step of treatment seeking, Adasa and Vida narrated that they were 
advised to seek for medical treatment by people close to them on consultation with them about 
their problems of infertility. So, they chose the medical treatment as expressed by Vida and Adasa; 
I was advised to come to the hospital by that my friend. I went to my friend and complained 
to her that this is what is going on. So, she now said okay she knows someone in here in 
UDX that [ehh] that I should come so that we can go and meet the doctor and then do some 
tests maybe the problem will be identified from the result. That is why I come to the 
hospital. It was a friend that advise me to come to the hospital and I chose to come [silent] 
(Vida, 31 years) 
  
My superior where I was working before and others advised me that to go for test. Even 
from my husband side [pause] advised to me seek for help. I thought of [ehh][pause] visiting 
the hospital before (knock the table twice) my superior advised me.  She said that I should 
go and visit the (knock the table twice) hospital to check if there was problem so that urgent 
action will be taken before it gets worst. So, when I went and they did the tests but they 
couldn’t find anything [pause] because everything was just normal (Adasa, 35years). 
 
Even some women that have tried and stopped the medical treatment recounted their decision 
making process that they were advised to recommence medical treatment because it is effective. 
Alheri and Gomma shared that they have decided to try the hospital treatment again based on 
people’s advice and recommendation; 
We have stopped going to the hospital for quite sometimes now and we have been praying. 
But since we came here (Sokoto) some of our church workers that are doctors, you know 
how they do their work, so some of them now stood for us. So they stood for us and someone 
told me also that it can be done medically. So, it is this medical aspect that I am processing 
now. So, since we came in here now that they are giving us assurance that medically we 
84 
 
University of Ghana http://ugspace.ug.edu.gh
can get child. We now said [tau] let’s see what God can do to that. It is not us that choose 
the hospital now, like some of them people I told you today, they are the ones that are 
processing it. Like they joined me with them, then another woman also took me to a private 
clinic because they asked me to do a test (Alheri, 39years). 
 
I am back to the hospital because my parents advised me. That is why am in the hospital 
to get the treatments and they said they have the solution because there are treatments to 
the conditions. Thank God I am in my parents’ house now for treatment and they said they 
must summon him to come and be tested too (Gomma, 25years). 
 
The women’s decision making aspect of health seeking behaviour was influenced by relevant 
individuals. Even those that initially got tired of pursuing medical treatment without result have 
decided to give it another try. However, some women were persistent and decided to seek for 
medical treatment even when their husbands were reluctant.  
4.8.2 Seeking Medical Help 
The health seeking behaviour of these women was furthermore described as seeking 
medical help. They expressed seeking for medical help to conceive early while others delayed in 
their medical help seeking late. Visiting multiple health institutions was a health seeking behaviour 
reported by these participants.  
Some of the participants sharing their experience on seeking medical help to conceived narrated 
that they eagerly went to the hospital few months after marriage and trying to conceive without 
result. However, they were told to go back home and keep trying and to come back after a year 
when nothing happens because it was too early to detect any fertility problem which they obeyed 
as expressed by Yar-Buga and Alheri;  
…As such 7 months into the marriage I went to see the doctor and she advised me to be 
patient till after one year of marriage because she cannot be able to identified if I have 
problem or not till after one year. When I completed the one year, I went back to the 
hospital (Yar-Buga, 27years).  
 
I went to hospital after some months’, so they said we should not worry if their problem 
either from my husband or me, they will know after 3years. So we were patient and 
managing with our lives like that till after few years (voice down) but still no pregnancy 
(Alheri, 39years).  
 
85 
 
University of Ghana http://ugspace.ug.edu.gh
The early medical help seeking experience was not different for Charis. She went to the hospital 
earlier than expected too but was asked to come back after a year. However, she was too eager and 
could not wait for a year. So, she decided to visit another clinic, started the treatment which she 
later stopped before returning back to the hospital after a year.  
I went to the gynae clinic in FMX hospital after like 3 months of marriage when I saw that 
there was nothing like pregnancy, I went there. They now told me that I should go till after 
1 year [pause] before they will know what they will do. So I went to another health centre, 
the doctor said that my husband should do sperm analysis and he gave me clomid when 
the result of the test came out. I took the drug for sometimes but later stopped and then I 
went back to FMX hospital after 1year (Charis, 36years). 
 
Nonetheless, on the contrary, few of the women described delayed in medical help seeking to 
conceive as expressed by Azumi and Adasa;  
I didn’t rectify it early, because by that time maybe there is immaturity in me or something, 
if I get abortion, then later just after 2months I will get pregnant again then it will be 
aborted, I did not border [give dam] about such. I said maybe time will come and the 
pregnancy will stay. That is the only thing [mm]. But later when I realise the thing is 
becoming habitual, it refused to stop. That was why I started going other clinics to some 
doctors there (Azumi, 43years). 
 
I started going to the hospital after like two years of marriage and there was delay in 
pregnancy. My husband’s relative became worried and I too was disturbed. That was how 
I went to the hospital where they did some tests and started giving me drugs (Adasa, 
35years). 
 
Majority of the participants regardless of their years of infertility and duration of their help seeking 
to conceive visited multiple health institutions. The women usually started from the private clinic 
and secondary health institution before changing to the tertiary health institution for better care as 
described by Kyauta, Yar-Buga and Charis; 
I now started clinic in SCX hospital Dr XXX (mentioned name) said he will wash my womb 
or what? He did it for me first time then the second time he said he want to do it, I said I 
will not do it. I now left that hospital from that clinic SCX someone told that I should go to 
clinic ZCX, they did many test for me and you know that ZCX is very expensive. Why I 
stopped is that when she did that many tests, she used to give me drugs then she used to do 
that TVS or what are they calling it? So, when she told me that we should be praying, I 
now said [tau!]. Why should I be wasting my money again? But now when I started UDX 
hospital many tests I did not do in those two hospitals, is what they wrote it for me now 
86 
 
University of Ghana http://ugspace.ug.edu.gh
and am are doing it and many test that my husband did not do, we are doing it now too 
(Kyauta, 33years) 
 
The first time I went to SHX hospital. They did many tests for me and I was told that they 
have not identified anything that will prevent me from giving birth. So, last year I changed 
hospital and came here to UDX hospital and did all investigations too and they also told 
me that they didn’t see any problem too (Yar-Buga, 27years) 
 
I have been trying to conceive without result with all the intervention still nothing 
happened. I even did all the investigations; my husband did sperm analysis at a private 
clinic at Gusau where I started treatment before changing to FMX hospital Gusau. I even 
had laparoscopy in FMX that is January 2018. So since then, I have been taking drugs, 
they placed me on clomid 50mg, 100 to 150mg nothing [pause] happened still. When I 
came to [ehh] Sokoto State for studies, I started attending clinic at UDX hospital. So, when 
I attend the clinic here, they repeated the tests I had at Gusau again.  So, after the tests, I 
was placed on clomid. I did this [emm] follicular tracking, so they will even tell me [aa] 
there is matured egg, this egg will be release at a particular time (Charis, 36years). 
 
In seeking for medical help to conceive, majority of the women were anxious to be pregnant. As 
such they went to the hospital earlier than medically expected for diagnosis that is before twelve 
months of frequent unprotected sexual intercourse. Few women however, did a late help seeking 
after at least two years of waiting for pregnancy. It was interesting to note that vast majority of the 
women visited more than one hospital for medical treatment regardless of their years of infertility.  
4.8.3 Seeking Other Treatment Sources 
This is defined as other options the women patronised in order to achieve pregnancy. The 
participants tried to conceive by doing self-medication, others patronised traditional medicine 
outlets and spiritual outlets prior to or along with medical treatment to conceive.   
Few of the women tried to conceive by seeking other possible treatment options such as online 
consultation, self-medications and visiting prayer houses. Others use of alternative medicines to 
solve fertility problem prior to actively trying to conceive.  
Tumba narrated her seeking for other treatment options to conceive experience by frequent 
googling of the internet for solution online based on symptoms she perceives;  
87 
 
University of Ghana http://ugspace.ug.edu.gh
I google internet every now and then to be able to say if, okay let me see, if I’m perceiving 
this, could it be because of this? If am feeling this? Could it be because of this? I pull, I 
think in so many dimensions to be able to fish out the reason why I was not able to conceive 
and I couldn’t lay my hands on one reason (Tumba, 33years). 
In seeking other treatment options to conceive; Vida shared doing a self-medication for infection 
and also patronised the prayer houses prior medical treatment; 
….So, I went and did self-treatment of infection and other things to see may be I will get 
pregnant again and there is no any sign of anything.  I went for prayers, I met the pastor 
and told him my problem and he prayed for me but (giggle, smile) the funniest thing is that 
any pastor I met and prayed for me, he will tell me that there is no problem with me that 
my children are on the way, that is it. But later I started going to hospital when I did not 
get pregnant (Vida, 31years). 
Another woman reported seeking other treatment options to conceive by prayers and even used 
oral contraceptives as advised by a friend without checking with her husband or even reading the 
instructions for use: 
I have adopted children with me, my uncle’s child, sister in-law’s child and my younger 
sister’s child. [Tau!] (Pointing to a girl in the room) this one was 3years before they gave 
her to me. My belief is that [emm] as am waiting on God and we have been trying to 
conceive through prayer (giggles) through prayers. And based on friend’s advice I even 
went and requested for oral pill and they gave me, as they gave me, when I came I didn’t 
ask my husband, I didn’t even check the small paper for me to read and know the procedure 
of taking as am anxious getting pregnant. I started taking it, I don’t even follow the 
procedure, I it daily for up to a month still nothing no pregnancy (Alheri, 39years). 
Gomma shared her experience of seeking other treatment sources to conceive by using various 
alternative options; like vitamin supplements and traditional medicine which even affected her 
regular menstruation: 
I have used a traditional medicine that is mixed with honey which was brought to me by 
my mother’s friend. And I also took ‘MACA’ because of the problem of infertility and 
menstruation. Even when I took that one, it only corrected my menses but up till now I did 
not get pregnant. The traditional medicine I took now spoilt my menses again, that is why 
I then went to the hospital (Gomma, 25years) 
 
In narrating her experience of using alternative treatment sources, Sonia a health professional 
lamented that she went out of her way to visit prayer houses, use local herbs all in effort to conceive 
and avoid blames:  
88 
 
University of Ghana http://ugspace.ug.edu.gh
…We went and met the man of God to pray for us. Then me, I am from Igbo. In Igbo land, 
there were some herbs they gave me to [pause] put in water and boil. All these stuffs, I went 
ahead (knocked the table) to attempt in order to avoid blame, [tau] (lowered pitch of voice) 
which we have tried severally but still. [hmm] that time (hissed) [hey] I have forgot the 
name of this, all the Edmark company, they have all these supplements, I took that one 
before finally settling for hospital treatment (Sonia, 34years). 
Some women sought for alternative options prior to medical treatment seeking to conceive. 
However, others combined the alternative options of going to prayer houses with medical 
treatment seeking. 
4.8.4 Acceptance and Adherence to Treatment 
The women in defining acceptance and adherence to treatment as part of their health 
seeking behaviour expressed persistence in follow up care and sticking to medically recommended 
treatments/instructions. Some of the women in adhering to treatment have done virtually all that 
they were instructed to do. They were so determined that they accepted all the recommended 
treatment even where there were some medical difficulties. They explicitly mentioned that they 
are sticking to medical treatment and doctor’s instruction because they desperately need to 
conceive as described by Hanna and Tumba 
[ehh]when I went for tests, (lowered her voice) they said the mouth of the womb is close. 
So, I was told to meet my doctor to open the mouth of the womb for the test. I met Dr. XXX 
[name mentioned] who tried with other doctors but could not see the mouth of the womb. 
So, [ee] November in 2017 I had the first this operation and immediately I was sent to do 
the test. When I went for the test, I was sent back to my doctor that the womb is closed 
again.  Dr. XXX [name mentioned] took me to the theatre in December 2018 and I had the 
second operation. After the operation, the doctor confirmed that the place was opened. I 
confirmed it too because my period before (shake her head) but now, the thing is flowing 
well more than the way it used to be (Crying but still talking) my period even comes with 
thick clot. My next clinic day will be next month and I am preparing to go because I have 
not started taking medicine. They said if I start seeing my period, I will start taking the 
medicine so that will help me (Hanna, 33years).  
 
When my husband refused to do his tests, I then decided to follow the doctor instructions 
to do more tests that may determine [abi] tell them the whole issue with regards to my 
reproductive system. So, that was why I went for that HSG (voice lowered down) which 
was very painful and expensive. I did test twice because they could not see the first result 
89 
 
University of Ghana http://ugspace.ug.edu.gh
in my file. So, the result showed that the fibroid was bigger because of the drugs I took and 
the fibroid was removed. The doctor said we should just increase the frequency of meeting, 
(clap hand), we should take high something diet, I am doing all the doctor have instructed. 
So I just feel like the only remedy is for me to continue seeing doctor. And that is the only 
reason am sticking to their instructions (Tumba, 33years). 
Charis narrated her treatment acceptance and adherence experience. She stated that the previous 
hospital protocol and attitude of the healthcare providers made her loose her initial zeal for medical 
treatment. She also recounted regaining her zeal by adhering to treatment in this present hospital 
she was now accessing treatment. Quotation from Charis below; 
Honestly in my hospital FGX, sometimes I feel discouraged to go for my clinic days because 
of the time wasted in waiting. You see, [tau!] when go early say at12noon, nobody will 
attend to you until around 1pm or 2pm before they will start. The doctors usually come to 
the gynae clinic exhausted after finishing with those women in ANC. So, attention is no 
paid to your concerns. A doctor once said I go for IVF after asking for my age. That it was 
the only solution [pause] I should just go for IVF. Honestly it is difference [pause] in UDX 
[sha] I don’t know maybe because of their manpower here than the FGX hospital. So, here 
I don’t know whether it is also the same doctors that still run ANC and Gynae clinic same 
day. But here they are faster that was why I have never missed any of my clinic days.  But 
honestly when I was attending FGX hospital, sometimes (hissed) I don’t go since I will only 
go and suffer without good attention to my concerns (waves the right hand) (Charis, 
36years). 
 
Adasa experience of acceptance and adherence to medical treatment was different. She reported 
that she stopped taking the pregnancy enhancing drugs the doctors prescribed to her because there 
was no follow up investigation while she was taking the drugs and no time limit. When she read 
the side effects of the drugs, it made her stop but even when she changed treatment institution, 
same treatment principle was applied as expressed below; 
There was no monitoring; they just placed me on the drugs after the tests that I should 
continue taking it till when something happen. I said [ha] how long will I continue to be 
taking this thing and there is no check-up? So they did not check me, as in to do even 
ultrasound to see what is going on, nothing like that. I say no I can’t continue that was how 
I stopped the drugs after one month of taking it. I then changed to Dr XXX hospital. He 
also placed me on the same drugs clomid, folic acid and all these haematinics. I read you 
need to be checking when taking all these things [pause] to see if anything is going wrong 
but there was nothing like that. He just said I should continue taking it [pause] till I am 
90 
 
University of Ghana http://ugspace.ug.edu.gh
pregnant. So, I said no, this thing is not done like that. So, I stopped taking the drug because 
I was afraid of the side effects I read and since the results showed normal womb, I decided 
to go for prayers (Adasa, 35years)  
In summary, the women had good health seeking behaviour because majority did an early medical 
seeking and were able to return to the hospital the appropriate time. Though few did late medical 
help seeking and small number patronised other treatment options too prior to medical treatment 
or in combination. What was worthy of note was that the women accepted and adhered to medical 
treatment against all odds from decision making process to challenges encountered during the 
medical treatment. 
4.9. Emerging Theme 
The two themes psychological experiences and women’s plea for help emerged during the data 
analysis but could not be categorised under the theoretical framework.  
4.9.1 Psychological Experiences    
The psychological experiences as explained by the participants were their emotional feelings in 
respect to the infertility. The women emphasized that the condition is disturbing, they feel 
overwhelm and feel inner sadness deep within them.  The psychological experiences were 
described as feeling stressed up and being depressed. 
4.9.1.1 Feeling stressed up 
Feeling of being stressed up was an aspect of the psychological experiences these women 
went through due to their ordeal of infertility. The women expressed that the symptoms were 
manifested in the form of crying, feeling bad and sad over birth related events.  
Some women said since they were diagnosed of infertility, whenever they are discussing about the 
condition, they cannot help but cry. Hanna emotionally recounted that all she does was cry when 
she talks about her condition even when she is discussing with the doctors. She further stated that 
91 
 
University of Ghana http://ugspace.ug.edu.gh
she was not like this before but crying has become part of her system because it was the only way 
she could express the burden of what she is going through as quoted below; 
I don’t know (silent) I can’t control the tears that is how it use to do me to show the 
weighted of how I feel. [pause] That is how, the thing is even Dr. XXX [name mentioned] 
now knows me with the cry (silent). For this thing, for this cry, the thing is, in my body. 
When I am talking to somebody like this, I will even just start crying sometimes. That is 
why any time I went to hospital if they talk like this issue, that you are asking me about, 
[ehe] (still crying and talking) tears will come out of my eyes but I was not like this before 
(Hanna, 33years). 
Kyauta, narrating how her feeling of being stressed up, she recounted that she feels bad when her 
menstruation comes and also cries over any event associated with childbirth for the past 3-4 years. 
Most time or anytime I see my menses, I use to feel bad or like if I get the news that someone 
has delivered, all these things, makes me feel bad and cry (smile and was silent). For 3years 
to 4years now all I do was I cry but the cry is reducing (Kyauta, 33years). 
 
Tumba, expressing her feeling of being stressed up, emphatically and explicitly lamented that she 
feels overwhelmed with so many pressures and she has to tolerate them all as described quoted; 
The things on you are huge and too much.  You bear the cost, you bear the pain of 
treatment, and you bear the side talks from people. The issue that people are discussing 
that you are not able to conceive, you are wasting your husband’s money, you are wasting 
your husband’s time? You know because maybe some people believe that you are the 
reason why you are not able to conceive which is not true (Tumba, 33years). 
 
Feeling stressed up was a psychological experience the women went through which was described 
as feeling bad and crying to show the gravity of how they are suffering. 
4.9.1.2 Being depressed  
The women described being depressed as a psychological experience. Majority of the 
women expressed that they were not happy and they feel this sadness within them. 
Narrating being depressed, Charis lamented that she feels depressed to the extent that even the 
encouragement she has around does not help. She described signs of insomnia as she finds it 
difficult to sleep at night. As such she is generally not happy because she feels she ought to have 
her own children even with her late marriage as quoted below; 
92 
 
University of Ghana http://ugspace.ug.edu.gh
Honestly am not feeling happy because sometimes even with all those encouragements and 
sometimes I will feel depressed, sometime I will still feel (pause, close eyes) am depressed. 
Sometimes even in the night I will just wake up, if I start thinking, I will just be depressed. 
So, honestly, generally (lowered pitch of voice down) I’m not happy about my situation 
(squeeze the forehead) because am feeling by now, I should have my kids. And even though 
I have late marriage but at least since 2016 by now I should have had even one child on 
my laps but no child. The issue of this fibroid (smiling weirdly) is even what is bordering 
most (Charis, 36years). 
Adasa and Sonia emotionally reported that it is not a good experience at all because it was 
emotional. It makes them think and sometimes they lack words explain how they feel because they 
feel unhappy deep within them. This was how they expressed their feelings of being depressed;  
It was not easy because it was an [pause] (closed eyes) emotional [pause] (closed eyes) 
[ehh] thing, how will I put it? It wasn’t easy because I was not feeling well, I was not happy 
within me. Especially when I am alone, maybe you know, the kind of thoughts that will 
come to a person’s mind, I thought of all sort of things. That was just the thing but it wasn’t 
easy [shake head and made a sound with the mouth]. It was not a good experience (Adasa, 
35years).  
 
[hmm] I can’t explain o, (shake head) I least expected this, I don’t know how to [pause] 
gaskiya I don’t know how to explain because the situation [tears in the eye] [tau] [hh] I 
don’t know the word to use but is not a palatable one (silent) [fighting tears] (Sonia, 
36years). 
 
Izatu shared her psychological experience of being depressed. She stated that she was not happy 
because of her polygamous setting because the co-wife has children. Although, nobody was 
pressuring her but she was just not happy with her inability to give birth as described below;  
Honestly, I am not happy, look at the way I am. You know we are two wives; she has her 
own children though I know they are also my own children since he is my husband and he 
loves me. We have never had issue on children, all his children whatever I do to them, it 
never disturbed him. I discipline them the way I want if they do anything wrong, it is not 
as if there is any problem but my fertility problem is disturbing I want to also have my own 
children. I am sad, am not happy honestly (Izatu, 35years). 
Tumba narrated that she is not happy with her condition of delay in conceiving. She also recounted 
that she is the only person that knows how she feels because it is right inside her. Despite her 
family support she feels sad. Her description of being depressed is below;   
Am not happy (frowns face, look sad, became quiet and bow the face down). Even with the 
support from my family, I feel sad inside. In fact, psychologically you will be passing 
93 
 
University of Ghana http://ugspace.ug.edu.gh
through (lowered voice pitch) something that you are the only person that will say it out. 
Nobody can just look at you face and say this is what she is feeling or she is comfortable 
because she is not having a child. Or she is living a comfortable life, or she is free that 
nobody is disturbing her or this and that, is not true, every woman wants to have a child of 
her own (Tumba,33years). 
 
In summary, the women expressed their psychological experience which they described as feeling 
stressed up characterised by feeling bad and crying due to pressure of the whole situation. While 
the feeling of being depressed was characterised by lack of sleep at night, thinking, being unhappy 
and sad, all these resides within them. 
4.9.2 Women’s Plea for Help 
The women defined this as their concerns about infertility and how to help women ease the 
suffering that comes with infertility. The participants describing their plea for help made emphasis 
on advice to women, men understanding and government assistance.  
4.9.2.1 Advice to women 
The participants in expressing their plea for help emphatically advised women with 
infertility issues to seek for medical help and that it should be done on time. Large number of the 
women admonished women with infertility to visit the hospital in order to get a proper and timely 
intervention on their infertility problem. Kyauta and Igge encouraged women to go to the hospital 
with their husbands as couples for treatment, even when they are praying and waiting patiently on 
God. This was how they expressed their advised to women;  
I want advise them to go to the hospital, they should continue praying, I do not have 
anything to give out. They should go to the hospital; they should check the husband and 
the wife. They should pray and if it did not come; they should continue praying and going 
to the hospital (Kyauta, 33years). 
 
[tau] what I want to add here is to advice anybody that has spent up to 2years without 
getting pregnant to go to the hospital for check-up. Since some delay can be due to some 
problems while sometimes is from God because is not yet time until when it is time then 
God will allow you to conceive (Igge, 22years). 
 
94 
 
University of Ghana http://ugspace.ug.edu.gh
Amal with duration of 17years of infertility confidently advised women with infertility to go for 
proper medical investigation because they might be lucky to get pregnant after treatment if their 
problem is resolvable. She narrated that because she is still expectant, she does not mean others 
might not conceive too. Her expression of advice to women; 
I want women with infertility to always visit the hospital, I want them to go to the hospital 
and have a proper check-up. Some may have minor problem which can be easily corrected. 
If they go, they might become pregnant because I have not gotten does not mean that 
somebody would not get. So, I advise them to go for total check-up (Amal, 45years). 
Azumi using herself as an example advised women to look for solution of their infertility from the 
hospital on time. She stated that she did not try to rectify her infertility problem on time. So, she 
wants others to correct that aspect and do the right thing;  
The only thing, I want to advise women to rectify their problem of infertility as early as 
possible. For me, I didn’t rectify the problem earlier, [pause] it was late when I started 
treatment [mm]. Try as early as 16, 17 to 20 years let them identify any female problem 
that may affect pregnancy and delivery [mm] so that maybe it can be easily treated [mm] 
(Azumi, 43years). 
The women’s pleas were expressed by advising other women experiencing infertility and were 
presently not treatment to go for medical treatment. Some of the women also shared their personal 
experiences to solidify the enlightenment as they wouldn’t want any woman to go through similar 
experience.  
4.9.2.2 Men understanding 
An aspect of these women’s plea for help was drawing men’s’ attention to their plight. 
Some of the women shared their experience and advised that men should be involved and be 
supportive of their wives in seeking treatment for infertility.  
Vida a mother of one child stated that it is better for a couple to reach a consensus if the husband 
does not need more children and that treatment should be done as a couple rather than apportioning 
blames. This was her expression about women’s plea for men’s understanding on infertility issues 
as narrated below;  
95 
 
University of Ghana http://ugspace.ug.edu.gh
I think if a woman is going through all these things, the husband is supposed to support 
her. It is not only the mother that will enjoy the child when the child becomes somebody 
life. Like for me, my husband doesn’t care, is not good like that. Everybody like children, 
if you don’t like children, you tell your wife. That you only need one child then everything 
will be okay, and then your wife will know that yes, this is what you want not to push blame 
on [pause] each other. Even if it is the husband that has the problem, you stay together 
and make sure you treat it together not to push blame to one another. I think that is the 
only thing I have to say (Vida, 31years). 
  
Similarly, Gomma in expressing her plea for men’s understanding recounted that issue of infertility 
requires treatment as couple not as a lonely or private thing for women. Identification of the 
problem is clearer when they are examined as a couple;  
I just have one thing to say.  It is very important for men to make effort to encourage their 
wives by following them to the hospital. All the investigations that will be carried out, they 
would also want to test the man in order to identify where the problem is. If they don’t 
know where the problem is, they won’t be able to know who has the problem between the 
husband and wife (Gomma, 25years). 
The participants pleaded for men’s understanding in supporting couple’s treatment and the need 
for negotiation and agreement in respect to childbirth rather than allocating blames. 
4.9.2.3 Government assistance 
Government assistance is another aspect of the women’s plea which they defined as the 
need for the government to intervene in the plight of the women with infertility because the 
treatment is extremely expensive. The women requested for assistance in the form of subsidising 
the cost of treatment and empowering women with infertility to enable them access the treatment 
they have accepted.  
Vast number of the participants’ based on their treatment experience wish to expressed 
their heart felt plea to the government to assist women with infertility by reducing the cost of 
investigations and drugs because they are expensive. These women narrated that they have met 
with many women that cannot afford some treatment though they were able to afford some form 
of the investigations. They reported that subsidising the cost of treatment will encourage women 
to do more health seeking for infertility as described by Sonia, Charis and Tumba;   
96 
 
University of Ghana http://ugspace.ug.edu.gh
[emm] most of the investigations I did, like this TVS to know when you are really ovulating, 
you will do it like 3-4 times in a month.  So it is not easy, we need government or some 
people that can come and help the women. This is because most of the women there is 
minor, had it been they came for medical check-up or there was medical assistance they 
would have been pregnant. Maybe it was minor problem but due to economy but if we will 
have the government that will come in to assist financially or with all these drugs, all this 
hormonal, these supplements it will be a good one, it will help us. [emm] Some people if 
they do it for them, it may work for them. But majority can’t afford it but if we have 
government or organisations that can help us, I think it will be better (Sonia, 36years). 
 
Honestly anything patterning [ehh] infertility, like to seek help for infertility, the way I am 
seeing it all over because of all the hospitals I have gone to so far, honestly is expensive 
even the drugs compare to other [pause] illness. If the government lessen things or give 
support especially to women with infertility, it will help them. Maybe in times of all this 
infertility drugs and tests because if you look at it, most of the infertility drugs that will 
help women are expensive. They cannot even afford it; some of the tests are very expensive 
too. Some women can benefit from it but because of it is expensive, they will be discouraged 
(Charis, 36years). 
 
If you look at the treatment of not being able to conceive, they are very expensive [pause] 
and they are extensive in nature. So, women with infertility cannot avoid all the tests. I 
think, if the government are not helping, the issue of not being able to conceive will still be 
something, a topic of discussion. When you come to see doctor, you have decided that you 
will seek medical advice or medical help for your issue of not being able to conceive. First 
consultation, you are being given investigations alone, ordinary tests worth N30,000 naira 
just first consultation, it is not everybody that can afford it.  And the tests they are going to 
give you are not going to be the last or are not going to be just the final tests that you are 
going to do. So, I think if the government can come in and help with these tests some, even 
if not all. If they cannot remove all the expenses, they should reduce them to some extent 
that at least the person coming for the tests will be able to pay for it. Because those tests 
are not easy, is it the pain of the procedure you will bear with or the money that you are 
going to look for that you don’t have? So, I think maybe government, possibly the 
government should have a way to help if they can. They should help in one way or the other 
to reduce the suffering women are passing with regards to not being able to conceive 
(Tumba, 33years). 
 
 
Another participant pleaded with the government and relevant individuals to assist in empowering 
women with infertility with skills, so that they can access the treatment of infertility. This, she 
asserts it is necessary because some men are not supportive of their wives and the women are 
suffering without help. This was how Izatu expressed her plea for government assistance; 
 
97 
 
University of Ghana http://ugspace.ug.edu.gh
Of a truth, there are a lot of women that need to be helped because some women want to 
have their babies but their husbands don’t care it and the women cannot afford treatment. 
There are a lot of them like that, some their husbands have the money but don’t want to be 
identified with infertility and they will refuse to support or assist their wives. So, am 
pleading on the government, the women and their families to help establish them with skills 
or a trade that will empower them to take care of their hospital bills in respect to difficulty 
getting pregnant. Some women their husbands don’t care, some men don’t care if their 
wives give birth or not it doesn’t disturb them but the thing keeps disturbing the women. 
As such am advising women to look for a trade and if the government can empower them, 
that will be fine. That is my advice (Izatu, 35years). 
 
In a nutshell, the women’s plea was described as a request for women with infertility to embrace 
timely medical treatment, men to get involved in the issues of infertility and government to reduce 
the cost of treatment. The participants were passionate in their plea as some used their situations 
as an example to give awareness for things to be done better.  
4. 10 Summary of the Findings 
This empirical study has revealed that the women with infertility in Sokoto state had good 
health seeking behaviour and their attitudes were modified by complex processes.  A total of eight 
(8) main themes and twenty-two (22) subthemes were reported that shows the complex experiences 
of women with infertility in health seeking. The participants’ experiences were grouped into 8 
main themes as follows: symptoms salient, life course factors, individual and social cues, enabling 
and predisposing factors. Others are perception about infertility, health seeking behaviour, and 
psychological experiences and women’s plea for help.   
All the women and some of their husbands too indicated their intention and eagerness to 
have their own children or more children. This made it possible for some of the women to easily 
identify the symptoms based on the delay in conception despite frequent unprotected sexual 
intercourse over a period of time. It also became apparent for the women to seek for help to 
conceive in order to be happy in their marriage, play their womanhood role in marriage and to be 
able to perform their service to God. 
98 
 
University of Ghana http://ugspace.ug.edu.gh
The participants had the support of their husbands, family, friends and significant others. 
The supports were financial, advice and companionship which they reported was useful in 
encouraging them to do more health seeking. However, some women were not fortunate enough 
to benefit from such support but that challenged them to seek for help for their predicaments by 
using their life savings. The societal pressure was also another challenge that made the women to 
do more health seeking in order to erase the wrong perception the society has about their condition. 
However, few were pressured to the extent of going out of their ways to fulfil cultural practice by 
using herbs given to them to avoid blames.  
The participants had this awareness about the causes of infertility and their belief in the 
effectiveness of medical treatment prompted their health seeking behaviour. This was evident 
because large numbers of the participants accepted and adhered to the treatment. The women 
reported that they have done all their prescribed investigations and were currently on treatment 
and expect conception very soon. Conversely, two of the participants who were on treatment for 
quite long though were hopeful but doubted the effectiveness of the IVF that was suggested to 
them and were reluctant to try.  
Finally, the women expressed that infertility affects the women psychologically causing 
stress and depression that makes them unhappy and emotionally unstable. As such, they urged 
husbands to be responsive to issues of infertility. They also stated that the medical treatment for 
infertility needed to be commenced as soon as possible for it to be effective. They advised women 
with delay in conceiving to look for timely medical help and that government should subsidise the 
treatment because it is expensive and not all women can afford the treatment.  
  
99 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER FIVE 
DISCUSSION OF FINDINGS  
This chapter presents the detailed discussion of the major findings of this study in 
association with the existing relevant literature pertinent to the Health Seeking Behaviour of 
Women with Infertility. The discussion is presented according to the major themes and subthemes 
which were based on the objectives of the study. The women detailed demographic characteristics 
preceded before the discussion on the themes. 
5.1 Participants’ Demographics   
The demographic characteristics of these women were essential findings of this study 
which reveal that all the 14 participants were married out of which 5 were in a polygamous 
marriage and the duration of infertility was 2-20years. The women were within the ages of 22- 
45years out of which majority (9) were within 30-39years. All the women were formally educated; 
10 had tertiary education and 4 had secondary education. The women were empowered financially 
since 8 of the participants were gainfully employed and 3 were small scale traders. This study is 
in agreement with the characteristics of the women in Ghana that sought for help to conceive where 
majority of the women were within the ages of 30-39years,  married, formally educated and 
gainfully empowered as established (Kussiwaah, 2016; Naab et al., 2013).  This implies that 
educational level, economic status and age of women are life cues that prompt health seeking 
behaviour. 
In this study, majority (10/14) of the women were diagnosed of primary infertility while 4 
had secondary infertility as also seen in (Kussiwaah, 2016) where primary infertility had 12/14. 
The congruency in the studies might not be unrelated to the similarities in the setting (West Africa) 
100 
 
University of Ghana http://ugspace.ug.edu.gh
of the study. Similarly, the participants were predominantly Muslims 8/14 and 6/14 were 
Christians. This finding is in agreement with the study of Sarkar and Gupta (2016) in India where 
majority of the participants belong to the Muslim faith. The corroboration in the two studies might 
not be unrelated to the belief found in the predominant religion in the area. 
5.2 The Symptoms Salience of Women with Infertility 
Symptoms salient were the events around the women that made them recognise their 
infertility problem and stimulated them to seek for help to conceive. This study indicates that the 
women took cognisance of their delay in conceiving; desired to have their own children which in 
turn initiated the trying to conceive. In consistent with this finding, is the study by White et al. 
(2006), where pointer of symptoms salient were delay in conceiving, desire to have children and 
actively trying to conceive. This indicates that the women were able to identify the delay in 
conceiving because of their desire to conceive. 
This study finding reveals that the women desired to have their own children, thus were 
able to recognise the delay in conceiving due to the duration of frequent unprotected sex with their 
husbands without getting pregnant over the period of 1-2years. This finding is in similar lines with 
some of the results obtained in Gambia where women were able to identify infertility by failure to 
achieve pregnancy after regular unprotected coitus over a period of 1-2years (Dierickx et al., 
2019). More so, the similarity found in the studies could be associated with the value placed on 
childbirth in Africa. The women in this study also took note of the short time delay (as early as 3-
7months) that turned into years of marriage without pregnancy which they compared with other 
women who had children. For mothers with at least one child, the delay to conceive was identified 
based on the age of their last child and repeated miscarriages. This findings concurs that short 
period (3-6months), long period (1-2years) unproductive coitus and miscarriages were viewed as 
101 
 
University of Ghana http://ugspace.ug.edu.gh
infertility by the participants in Dierickx et al. (2019). This finding is however, contrary to the 
study conducted in USA by White et al. (2006), which noted that the women recognised delay in 
conceiving by monthly menstrual flow showing lack of conception. The difference in the events 
used by the women to identify delay in conceiving might be due to the disparity in the study context 
and level of reproductive awareness.   
This current study shows that all the women desired to have their own children because 
they like children and see children as source of companionship. As such large number of the 
women consulted with the doctors where they had some tests, ovulation tracking, drugs and 
invasive surgical procedures with conscious effort to conceive. This conforms with the study of  
Bunting et al. (2012) where women were said to have tracked ovulation, used drugs and had 
artificial insemination as conscious efforts made to conceive. Consequently, it does also agree with 
the study of Slauson-Blevins et al. (2013), that women trying to achieve pregnancy were associated 
with high likelihoods of consulting a doctor.  
5.3 Life Course Factors of Women with Infertility 
Life course factors in this study were those indicators that stimulated health seeking 
behaviour in these women. This study finding shows that in the Nigerian tradition, immediate 
conception is customarily expected after marriage as a symbol of womanhood (blessing of 
marriage), joy of marriage, and reward of faithful premarital life and license for acceptance by in-
laws.  As a result, lack of immediate conception after marriage provoked concerns in these women 
that prompted help seeking to conceive. This study finding concurs with some part of the study by 
F Naab (2014) which reported that in Africa children are normally expected in marriage to ensure 
completeness (womanhood) and stability of marriage. Furthermore, as a norm in Africa, women 
were expected to fulfil the fundamental role of procreation  or risk loss of benevolence from  
102 
 
University of Ghana http://ugspace.ug.edu.gh
husband’s family (Dhont, 2011; Tabong & Adongo, 2013b). This explains why some of the women 
in this study were overwhelmed and disappointed with advancing years of marriage without 
children as the norm entails. 
 The women in the current study felt life was unfair because they were denied blesses of 
marriage which led to rejection from in-laws (Mumtaz et al., 2013; Naab, 2014; Tabong & 
Adongo, 2013a) studies also established similar findings that women are unhappy in marriage. The 
finding of this study further reveals that majority of the women that sought for medical treatment 
to conceive were married for some years without children. Thus, agreeing with many studies that 
marriage, years of marriage without children is a concern that motivates high likelihood of 
treatment seeking to conceive (Bushnik et al., 2012; Dhont et al., 2010; Johnson & Johnson, 2009). 
This shows that years of marriage without children have similar effects on the health seeking 
behaviour of women in middle and high income nations. 
In terms of age as push factor, the result obtained from this present study gave an explicit 
expression of age as an indicator to treatment seeking to conceive. Few (2/14) of the women in 
this study revealed that they were in apprehension because of their advanced age since they knew 
that menstrual cycle ceases with aging hence, the help seeking to conceive. This finding 
corroborates with several studies which noted that older married women do more help seeking to 
conceive (Bushnik et al., 2012; Datta et al., 2016; Naab et al., 2013; White et al., 2006).   
Similarly, part of the current study was consistent with studies that observed  that women 
with primary infertility did more help seeking to conceive (Bukar et al., 2012; Kussiwaah, 2016). 
This was however, inconsistent with the study of Sarkar and Gupta (2016) which established that 
majority of the women that sought for medical help to conceive in India had secondary infertility. 
This difference might be related to lack of awareness as infertility was higher among women who 
have not attended formal school (Sarkar & Gupta, 2016). It is also possible that the incongruities 
103 
 
University of Ghana http://ugspace.ug.edu.gh
might be as a result of the definitions of primary and secondary infertility used in the two studies. 
Sarkar and Gupta (2016), definition of primary infertility refers to individuals who have never 
been pregnant but this study also included inability to carry a pregnancy to live birth as defined by 
(Mascarenhas et al., 2012). Likewise, secondary infertility for this study is failure to conceive after 
previous live birth (Mascarenhas et al., 2012). 
5.4 Individual and Social Cues among Women with Infertility 
Societal support is very essential in prompting health seeking for infertility because of the 
value the society places on childbearing. Children are highly treasured in the African culture as 
they are considered as gifts from God, instrument for continuation of lineage and religious ritual. 
This is because children are also required to continue praying for their parents after their demise 
in the Muslim religion. This finding relates with (Naab, 2014; Tabong & Adongo, 2013a) that 
reported that children are God’s gift as symbol of blessing of marriage, seen as instrument for 
spiritual rites and for continuation of the family name.  
The place of societal value for children and the husband support in childbearing cannot be 
over emphasized and encourages help seeking to conceive. The result of this study reports that the 
support women received from their husbands, family and significant others in form of advice, 
prayers and sometimes financial were encouraging and promoted help seeking to conceive. In 
similar lines, findings about the encouragement on help seeking as a result of societal support was 
also established in many studies (Bukar et al., 2012; Dierickx et al., 2019; Lawali, 2015; Naab, 
2014; Tabong & Adongo, 2013a). The notion that women who had encouragement from family, 
husband and others have high odds of consulting a doctor in person than doing an online health 
seeking was also found in (Slauson-Blevins et al., 2013).  
104 
 
University of Ghana http://ugspace.ug.edu.gh
More so, another finding in this current study reveals that self-motivation and the 
acceptance of fate were essential in keeping the women hopeful and trusting their support in help 
seeking to conceive. Self-encouragement and acceptance of fate prompted relying on support and 
focus to their future was reported in Ghana (Tabong & Adongo, 2013a).Worth noting was the 
support committed by the women’s family (parents) to continue payment of treatment where 
husbands have stopped due to prolonged treatment without pregnancy. In similar lines, husbands 
were likely to stop financial support where treatment takes longer duration but the women often 
continued with the treatment (Dierickx, 2018). This shows that the women are determine and 
derive inner strength to continue health seeking alone where need be. In addition, the similarities 
noticed in the above studies were not surprising because of the shared Africa cultural belief where 
men are considered sacred and complete. As a result, women are often blamed for 
infertility(incomplete) and the male factor ignored. It was also obvious that childbirth as a norm 
identified in this study was among the reasons that stimulate health seeking by these women 
regardless of all odds. Thus, it becomes imperative to intensify public enlightenment on couple 
infertility, especially male factor in order to promote male involvement in treatment seeking for 
infertility.  
However, not all the women were fortunate to have been completely supported through 
their ordeal. The result of this study revealed that some women had financial and emotional support 
from their husbands however their husbands refused to be tested.Women were hardly able to 
persuade their husbands to go for investigations (Dhont et al., 2010; Dierickx et al., 2019; Mumtaz 
et al., 2013). Thus exposing thewomen to further expensive and extensive clinical investigations. 
Smilarly,this report supports that women spent heavily on treatment that might be unnecessary as 
also seen in this present study (Dierickx et al., 2019). In addition, this present study revealed that 
treatment for seeking for infertility was a lonely path for some women as as they continue treatment 
105 
 
University of Ghana http://ugspace.ug.edu.gh
even when their husband and other relevant individuals completely disengaged themselves from 
issues related to infertility. In consistent with this present finding, studies (Naab, 2014; Tabong & 
Adongo, 2013b) have reported that men disassociate self from infertility and allow women to go 
through the ordeal of infertility alone. 
Another major finding of this study was that women suffer the social consequences of 
infertility as they were humiliated, stigmatized and  blamed for infertility in diverse ways by their 
husbands, family and the community; this is congruent with several studies (Dhont et al., 2010; 
Dierickx et al., 2018; Hollos & Larsen, 2008; Roomaney & Kagee, 2016). The finding of this study 
also reveals that the women in their places of work were being ridiculed as inexperienced with 
issues of children as such their advice were shun and ignored. Furthermore, some mothers do not 
allow the women to touch their children insinuating that the women were evil and might harm their 
children. Similar to the study in Ghana where the women were accused of being witches thus, 
prevented from relating with people’s children for fear of the children being bewitched (Tabong 
& Adongo, 2013a). Some husbands in this current study accused their wives of being infertile and 
the society also accused the women of voluntarily causing their infertility by using 
contraceptiveswhich is congruent with the studies in (Dhont et al., 2010; Dierickx et al., 2019; 
Mumtaz et al., 2013). Fortunately, the social consequences though traumatising, became a driving 
force that trigger health seeking by some of the women in order to put an end to the suffering. 
This study discovers that the strong trauma caused by the humiliation, stigmatization and 
accusations prompted the treatment seeking to conceive as a defense by the women to unblemished 
themselves. In similar lines, stigma motivates women to do more health care seeking to conceive 
irrespective of the judgement (Dierickx et al., 2019). Nevertheless, this is incongruent with the 
report that women go online than doing health seeking for infertility due to stigma (Boivin et al., 
2007; Bunting et al., 2012; Slauson-Blevins et al., 2013). The disparity observed in the studies 
106 
 
University of Ghana http://ugspace.ug.edu.gh
might be related to the geographical location, orientation and access to informational technology 
facility. 
5.5 Enabling and Predisposing Factors Leading to Health Seeking Behaviour among Women 
with Infertility  
Treatment seeking for infertility is driven by multiple factors, resource and treatment 
beliefs inclusive. In this present study, vast numbers (8/14) of the women were working class 
women who had tertiary education and others (3/14) were gainfully empowered (trading). The 
findings of this study explicitly revealed that the literacy level of the women helped them to 
identify that they have fertility problem and prompted health seeking to conceive. In congruency 
with these current findings, several studies established that educated women with good 
earnings/family income do high medical seeking for infertility than those with low education and 
income (Bushnik et al., 2012; Datta et al., 2016; Naab et al., 2013; White et al., 2006). However, 
the findings further revealed that women acknowledged that the treatment of infertility is 
expensive.  
More so, some investigations and drugs were accessed outside the government hospitals. 
Sometimes the women were limited to complete access of some treatment (HSG, IVF, drugs) 
because of their income (Dierickx et al., 2019; Tabong & Adongo, 2013a). Meanwhile the NHIS 
was not very useful since most of the investigations and drugs were accessed outside the public 
hospitals. In line with the present finding, it was reported that women complained of the expensive 
nature of the treatment and that certain test and drugs were not accessed in the public hospitals 
(Dierickx et al., 2019; Tabong & Adongo, 2013a). There is the need for the healthcare system to 
consider subsidising and integrating consistently basic infertility investigations in the public health 
facility. 
107 
 
University of Ghana http://ugspace.ug.edu.gh
It was interesting to note that the women with meagre earnings were also committed to 
accessing medical treatment using their life savings base on their affordability. Sadly, accessing 
certain treatment was delayed due to shortage of funds. Similar finding was reported, where 
women used their life savings for treatment of infertility (Dierickx et al., 2019) and sometimes 
even experienced delay in treatment because they were limited by funds (Dierickx et al., 2019). 
This shows that despite the economic challenges, women are ready to go the extra miles to seek 
for help to conceive. Therefore, the commitment of the women with meagre earnings to use their 
savings to seek for treatment that is considered expensive even to women with sound financial 
status is quite commendable. 
The safety and effectiveness of medical treatment is motivator to health seeking for 
infertility.  The result of this present finding point that majority of the women opted for orthodox 
medical treatment because they believe that the medical professionals were adequately trained to 
identify and treat diseases. Others chose medical treatment because it was the only place that has 
solution to their infertility since they cannot vouch for traditional concoctions. The women 
believed traditional concoctions can be toxic to the body. More so, the women reported that there 
was no information on the constitutions and mode of action even in the internet. Some of the 
women have experiences of other women with infertility that had their fertility restored through 
medical treatment. These findings concur with the studies that established that safety and the 
effectiveness of orthodox medical treatment largely prompt health seeking (Bunting et al., 2012). 
Likewise, this present findings concur with Slauson-Blevins et al. (2013) that positive treatment 
behaviour was associated with high possibility of consulting a doctor than going online health 
seeking or doing both than doing no health seeking. This implies that the women in the studies 
mentioned above demonstrated positive treatment belief for medical treatment because of its 
108 
 
University of Ghana http://ugspace.ug.edu.gh
efficacy and safety. However, this finding disagrees with the aspect that medical treatment seeking 
is more among younger women accessing treatment for less than 12months (Bunting et al., 2012).   
Conversely, some women claimed that they rejected IVF treatment because of various 
reasons such as doubt for its effectiveness since they have tried all the treatments suggested to 
them. Failed previous artificial insemination and the use of donor egg were other reasons for the 
rejection.  In similar lines, educated women who have been on treatment for more than 1year were 
more likely to develop negative treatment belief (Bunting et al., 2012). It is evident therefore that 
treatment belief can be influenced by the non-effectiveness of previous treatments as reported by 
Dierickx et al., (2019).        
5. 6 Perceptions of Women with Infertility towards Seeking Medical Help 
Socio-cultural background of the individuals’ often influences their perceptions on the 
causes of infertility. This current study discovered that infertility is believed in the community to 
be caused by natural/biological and supernatural (spiritual) components. Natural/biological factors 
where there are problems (disorder) within the women that prevent conception e.g myoma. Or 
where there is a distortion in the normal functioning of the reproductive system as caused by 
abortion and use of modern contraceptives methods.  In consistent to this findings, studies reported 
that the belief  that risky health behaviour (unsafe abortion) and the use of modern contraceptives 
were responsible for creating issue in the womb and causing infertility (Dierickx et al., 2019; 
Tabong & Adongo, 2013b). 
Equally, some of these women believed infertility is caused by supernatural component. 
By God because He is the provider of children and others believed it is caused as a result of 
manipulation of evil people/spirits (e.g witches) in the spirit realm in order to inflict pain to the 
women. Studies in Africa established that socially, infertility is believed to be caused by 
109 
 
University of Ghana http://ugspace.ug.edu.gh
supernatural (spiritual) factors e.g bewitchment to destroy peoples lineage or the women are 
paying debt using their children in the womb (Bukar et al., 2012; Dierickx et al., 2019; Lawali, 
2015; Okafor et al., 2017; Tabong & Adongo, 2013b). Only the participants in Dhont et al. (2010) 
believed the part that infertility is caused by God since He is that giver. The disparity in the spiritual 
belief might be related to the study areas because in Northern Nigerian the residents are 
predominately Muslim who strongly believe that everything in life is destined from God. However, 
(Dierickx et al., 2019), argued that prolonged state of infertility, ineffectiveness and side effect of 
treatment can modify the perception of the condition. This was explicitely expressed by few of the 
participants. The interesting part was that the cause of infertility was reported from being 
biological to being an attacked by evil spirits and this was reported by participants who were 
medical personnel. This is of medical concern as it goes to show that there are barriers to health 
seeking that needs eradication. 
 The belief on the cause of infertility and the significant social network of the women were 
highly related to the treatment seeking behaviour of the women. The finding of this current study 
shows that majority (9/14) of the women patronised the medical treatement centres and faith-based 
healers for solution to their infertility. This was possible because the women believed that 
biomedical component causes infertility, also that God is the provider of everything. Thus, the 
promptness to use those two treatment outlets. In Africa, women seeking treatment for infertility 
frequently use either of the three treatemnt oulets (medical, faith-based and traditional) and some 
use the outlets simultaneosly (Bukar et al., 2012; Dierickx et al., 2019; Lawali, 2015; Naab et al., 
2013; Ola, 2014; Tabong & Adongo, 2013b). This similarity might be due to the similarities in the 
soci-cultural background of the settings.  
There are little diversities in the women’s treatment expectations. Majority of the women 
in this current study expected conception since they have done all the required investigations and 
110 
 
University of Ghana http://ugspace.ug.edu.gh
adhered to the suggested treatment. Those who were at the  early stage of treatment were hopeful 
that the outcome of the tests done might be helpful in the identification of the cause of the infertity 
for prompt treatment. Other women in this study expected divine visitation from God to conceive 
since they believed they have exhauted all recommended treatment they can afford. The women 
also believed that except God intervenes, there is nothing anyone can do because everything 
happens according to God’s timing, and that even medical treatment cannot alter that.  
 
6. 7 Health Seeking Behaviour of Women with Infertility 
Health seeking to conceive is a complex process that entails consulting and negotiating 
with husbands, family and friends before internalising advice to take action. In this present study, 
majority of women were advised to go for medical treatment by husbands, close family, friends 
and intimate medical professionals who noticed the delay in conceiving. Even where some 
husbands were reluctant to consent to medical treatment but want to wait patiently on God, the 
women still took the decision to access medical treatment. Contrary to the study that demonstrated 
that mother in-laws often make the decision for medical treatment seeking (Mumtaz et al., 2013). 
The difference in the findings might be related to the demographic characteristics of the 
respondents. This shows that women with social support were always the first to seek for medical 
treatment for infertility.    
The participants in this present study were educated and empowered to make               self-
decision even where their husbands were reluctant to consent. However, few had contrary counsel 
from siblings, friends and in-laws to use alternative treatments like supplements, traditional herbs, 
faith-based, fetish sacrifice and even self-medication (infection treatment & contraceptives). 
Consequently, the women heed to the advice and used mainly medical and faith-based treatment. 
111 
 
University of Ghana http://ugspace.ug.edu.gh
This is not surprising because the belief of significant others on the causes of infertility also 
influenced the choice of place where these women sought help to get pregnant.  Few (3/14) women 
however, combined medical, faith-based and traditional herbs treatment methods similar to the 
report in (Bukar et al., 2012; Naab et al., 2013; Ola, 2014; Sarkar & Gupta, 2016) with the 
exception of fetish sacrifice. In addition, some of the women used medical treatment as initial 
treatment and did early health seeking. On the contrary, it was demonstrated that women accessed 
medical treatment after failed efforts from alternative sources typically traditional source is the 
first to be visited (Dhont et al., 2010). The demographic characteristics and beliefs of the 
participants might be the reasons for the disparity.  
Utilisation of medical treatment by the participants regardless of educational level in this 
study was done earlier than medically necessary. This was because of the customarily expectation 
of immediate conception after marriage and the women’s desire to have children. Some women 
did medical treatment seeking at 3-7 months after marriage without pregnancy. But they were 
medically advised to continue trying until at least 1year without pregnancy. Keeping to this current 
finding, (Mumtaz et al., 2013) reported that 3months after marriage women were pushed to sought 
for medical treatment to conceive. Some women waited patiently and returned to the hospital after 
1year of trying without pregnancy.  
However, some were too anxious to wait for a year as such, accessed the private clinic and 
faith-based healer before returning to the public hospitals after some years. The study also 
discovered that few of the women did late medical seeking after at least 2years without pregnancy; 
the finding is similar to that of some studies (Bukar et al., 2012; Chin et al., 2015). Though, this 
finding disagrees with the years of delay as seen in the study of Dhont et al. (2010) which reported 
that women delayed for at 5years of infertility before seeking for medical treatment to conceive. 
This disparity in the years of delay might be related to the time taken by the women to access 
112 
 
University of Ghana http://ugspace.ug.edu.gh
alternative sources as reported in the contrary study. More so, it was also reported that lack of 
awareness and cost of treatment influences health seeking (Naab et al., 2013).   
In terms of using other treatment sources, it was observed that few (5/14) of the women 
initially sought for help to conceive through alternative treatments by doing self-medication and 
online health seeking. This is in agreement with the report by Slauson-Blevins et al. (2013) that 
some women avoided consulting with a doctor in person but  did online health seeking. Other 
forms of alternative treatment used were supplements, faith-base and traditional medicine. 
However, few women combined both medical and faith-based treatment. This information 
corroborates with that in several studies (Bukar et al., 2012; Naab et al., 2013; Ola, 2014; Sarkar 
& Gupta, 2016) that reported that women trying to conceive utilise either only medical or in 
combination with alternative treatment. The similarity in the studies might possibly be because of 
the value attached to alternative medicine in both Africa and Asia culture. 
Further interesting findings of this study was that more than half of the participants 
accessed at least two healthcare facilities for treatment with the initial centre being a private clinic. 
Reasons include husband’s choice, verbal referral by friends, avoiding the cumbersome protocols 
in the public hospitals. Other reasons for those that patronised other public hospitals as initial 
centre were; bad attitude of health professionals and lack of treatment satisfaction since there was 
no pregnancy. Treatment of infertility might possibly take a long period (20-25years) before 
conception is achieved (Dierickx et al., 2019).  
 
  This present study reveals that the women were committed to accepting and adhering to 
treatment because of treatment satisfaction and also has confirmed online that treatment was 
appropriate. Other reasons were that the women have not experienced any side effects and were 
satisfied with the attitude of the health professionals. However, few (3/14) stopped certain drugs 
113 
 
University of Ghana http://ugspace.ug.edu.gh
because they experienced side effects. Studies have reported participants’ acceptance and 
continuation of medical seeking for up to 20 years (Dierickx et al., 2019; Mumtaz et al., 2013).  
5.8. Emerging Themes  
Two important themes emerged during the analysis which is psychological experiences and 
women’s plea for help. 
5.8.1 Psychological Experiences  
Infertility is a complex condition that affects the mental health of women. This study 
records that women are overwhelmed as a result of the ordeal of infertility causing them to be 
stressed up, as established in Dhont et al. (2010). Lack of concentration, feeling bad and crying 
over almost everything especially issue related to childbirth were the symptoms the women used 
to describe being stressed up.  
Further findings of this study was the psychological effect of infertility which was 
explicitly expressed as depression, similar to the findings on the population of several studies 
(Dhont, 2011; Donkor & Sandall, 2007; Kussiwaah, 2016; Lawali, 2015; Mumtaz et al., 2013; 
Roomaney & Kagee, 2016). The women mentioned having sleepless nights, always thinking, 
unhappy within them and sad. Some of the women claimed that they social support from their 
husbands, friends and close family, they are still worried. This indicates that infertility is a bad 
experience that affects women’s psychological wellbeing and requires more than social support to 
improve the women’s mental health. Hence, medical counselling for these women is of paramount 
importance.   
5.8.2 Women’s Plea for Help 
The plight of infertility is a complicated issue that has diverse aspect to it. The women in 
this study found it very necessary to add their voices on how the suffering can be reduced in order 
114 
 
University of Ghana http://ugspace.ug.edu.gh
to prevent traumatic psychological experiences for women with infertility. Even the participants 
who have been on treatment for more than fifteen years passionately admonished other women 
with infertility to make haste and visit the hospital for early diagnosis and speedy treatment. This 
shows that these women were able to recognize that treatment for infertility might take longer 
period than expected.  
Additionally, some of the women were zealous in drawing the attention of men to their 
ordeal. As they plead with the men to view infertility as a couple problem that required men’s 
understanding and participation in treatment. They further assert that negotiation and reaching 
consensus on family size is better than apportioning blames. This also demonstrates that financial 
and emotional support of spouses are not enough because the treatment of infertility requires the 
couple to be fully involved for easy diagnosis and effective treatment.    
Finally, the women also plead with the government to assist in subsidising the cost of 
infertility treatment because infertility treatment is extremely expensive and not all the women can 
afford it, and some men are not supportive of their wives. More so, the women expressed that they 
have met with several women that cannot afford some investigations and drugs. They further 
employ the government and agencies and meaningful individuals to help in empowering these 
women.    
5.9 Summary of Discussion of Findings 
The women desired to have their own children which made it easy for them to recognise 
the symptoms of delay in conceiving (unproductive frequent unprotected coitus, last child’s age 
with repeated miscarriages). The symptoms were identified by some women earlier than the 
medically justified period to qualify for infertility and some after 2years. Thus, the women tried to 
achieve pregnancy by going to the hospital where they were tested, given fertility enhancing drugs; 
115 
 
University of Ghana http://ugspace.ug.edu.gh
some had surgeries and even artificial insemination. Majority of the participants were married 
young adults (30-39years) with no children at all. Meanwhile, customarily children are viewed as 
the binding chain to happy marriage, complete acceptance by in-laws, sign of blessed marriage 
and womanhood. Hence marriage as a normative for childbirth and the aging caused the women 
without children to seek for medical treatment to conceive.  
Advised from husbands, close family and friends encouraged the women to seek for 
treatment. Social pressure (blame, stigma, ridicule) also prompted health seeking by the women in 
order to clear self (flawless). Majority of the women were educated and gainfully employed as a 
result, their awareness of the importance of health seeking to conceive prompted the medical 
seeking. It was also noticed in this studies that regardless of the women’s financial status, they 
were committed to investing and using all their possession for medical treatment. The women 
believed that infertility is caused by natural/biological and supernatural components. As such, the 
women basically accessed the medical treatment and faith-based centres for help to conceived.  
Health seeking by these women was done after consulting and negotiating with husbands, close 
family members and friends. Few women however, did medical help seeking with the agreement 
and support of their husbands. Further, some of the women consulted with the doctor earlier (3-
7months) than the medically expected time and few did late medical treatment seeking after 2years 
of infertility. 
  These women have accepted and were committed to adhering to treatment except for few 
that stopped some medications due to side effect. Interestingly, some of the women patronised 
more than two medical treatment centres. Others were advised by loved ones to use other 
alternative treatment source (faith-based and traditional) which some did simultaneously with the 
medical treatment.  
116 
 
University of Ghana http://ugspace.ug.edu.gh
CHAPTER SIX 
SUMMARY, IMPLICATION, LIMITATION, RECOMMENDATION AND 
CONCLUSION 
The chapter presents the summary of the study, implications of the study, limitations of the 
study, recommendations and conclusion. 
6.1 Summary of the Study 
Worldwide the prevalence and burden of infertility is significantly huge with medical help 
seeking reported from different countries however, little health seeking was recorded in Nigeria. 
What was worse is, none was reported in Sokoto State. Thus, the Help Seeking Conceptual 
Framework was used to guide to the health seeking behaviour of women with infertility in Sokoto 
State. 
The literature review revealed large number of quantitative studies with a considerable 
number of qualitative too. The studies were on the prevalence and causes of infertility, 
psychosocial health of the women and medical seeking experiences of women with infertility. 
Hence, the qualitative explorative descriptive approach was used to give an in-depth understanding 
of the complexity involved in health seeking to conceive.  
Ethical clearance and administrative approval was gotten from UDUTH and SHS hospitals 
(Appendices E & F) upon the presentation of an introduction letter from the University of Ghana 
(Appendix A) and a research proposal. Fourteen women were recruited purposively and face to 
face in-depth interview was employed for data collection with the help of semi structured interview 
guide (Appendix C). Methodological Rigor was ensured during data collection and analysis which 
was done concurrently. Thematic and content analysis were used for data analysis giving rise to a 
117 
 
University of Ghana http://ugspace.ug.edu.gh
total of eight main themes and twenty-two subthemes. The major themes were; symptoms Salient, 
Life Course Factors, Individual and social cues, Enabling and predisposing factors, Perception 
about infertility, Health seeking behaviour, Psychological experience and Women’s plea for help.  
The findings revealed that the women have good health seeking behaviour. The women in 
Sokoto desired to have their own children because they like children and culturally children cement 
marriage and are considered important for religious rites. As a result, the women did medical and 
faith-based help seeking because they believe infertility is caused by either biological (health in 
the woman, abortion and contraceptives) supernatural and components (God or evil spirits). 
Majority of the women strongly believe that it is only God that provides children and that medical 
treatment can only be effective by God’s wish. Thus, the simultaneous medical and faith-based 
(praying and going to prayer houses and waiting on God) treatment. The women sought for help 
to conceive earlier than medically required (3-7months), some late (after 2years) and some visited 
multiple health centres. This was possible because of their eagerness to have children and the 
expectation of childbirth after marriage made them to identify their infertility.  
The women sought for medical treatment even where partners did not consent but partners 
were insistent on waiting on God to conceive. The social support (advice, prayer, emotional 
financial) from husbands, families and friends also motivated the help seeking to conceive though, 
some husbands refused to be tested for infertility. Even women who had no form of social support 
from anywhere were committed to investing in medical treatment to get pregnant because they are 
aware of the significance of medical treatment. Further findings revealed that stigma, humiliation 
and blame prompted medical seeking in order to prove self as not the source of the fertility 
problem. Regardless of the women’s years of treatment, the women have accepted and are 
committed to adhering to treatment until pregnancy is achieved. However, some women accessed 
treatment (tests and drugs) late due lack funds. Few stopped certain treatments due to side effects. 
118 
 
University of Ghana http://ugspace.ug.edu.gh
Others rejected IVF due to the cost and doubted its effectiveness since they had tried all the 
suggested treatments without getting pregnant.  
Finally, the findings also show that infertility causes psychological trauma (stress and 
depression) due to the burden it bears on the woman. More so, it is quite obvious that the women 
find medical treatment expensive regardless of family income. As such plead with government to 
subsidise the cost of treatment and empower women to be independent in affording treatment.  
6.2 Implication of Findings 
The results of this study have the following implications to nursing practice, policy makers and 
research.  
6.2.1 Nursing Practice 
The findings revealed that majority of the women sought medical treatment irrespective of 
the husbands’ refusal to consent. This is an indication of a strong attitude towards health seeking 
that can be further sustained through continuous health education of woman at the health facilities. 
The combination of medical and faith-based treatment outlets was because they believe that God 
is the giver of children and He does that as it pleases Him. That even medical treatment cannot be 
productive (pregnancy) except God wishes. Therefore, it is necessary for medical professionals to 
appreciate the place of spirituality (praying and fasting) in treatment of infertility in order to 
enhance acceptance and compliance to treatment. Prompt medical seeking can enhance early 
identification of health problems and prompt treatment of women.  
Similarly, the use of multiple medical treatment centres for infertility, commencing with 
the private clinics that do not offer specialised infertility treatment can predispose women to 
harmful effects on the reproductive system. Other possible consequences are waste of resource 
119 
 
University of Ghana http://ugspace.ug.edu.gh
and time, delay in health care access, better treatment and prolonged years of treatment can cause 
a change in the belief of medical treatment.   
Further findings show that women continue paying for their treatment with the help of their 
parents where their husbands have stopped paying for the treatment.  Some women stated that the 
burden of treatment is placed only on them because the husband disassociated self from the 
infertility, refused to be tested or give financial support and even blamed the women for the 
infertility. This goes to show the gender lack of awareness of the possible causes of infertility; 
which makes the identification of problem and treatment difficult.  Additionally, this ignorance on 
the part of the men complicates the health of the women because they feel alone and rejected by 
such actions which consequently affects their mental health (stress and depression).    
The acceptance and adherence to medical treatment by these women is a positive sign that 
health professionals can adequately maximise through education to enhance sustainable 
compliance to treatment instruction to the end.  Consequently, it becomes imperative for health 
workers to prepare women’s mind for prolonged waiting since infertility treatment duration 
sometimes takes time up to about twenty years.  
6.2.2 Policy Formulation 
Women have called on government to review the high cost of infertility treatment in order 
to subsidise the charges since affordability limits the access to available treatment.  It was adduced 
from the findings that NHIS does not cover for main treatment of infertility and the public hospitals 
do not carry out some of the investigation requested. It is very important for stakeholders and 
agencies concerned to develop policy that will incorporate the treatment of infertility in the NHIS 
policy, medicine list and treatment access list. Policy by the state and federal government should 
be created that will make all public hospitals capable of providing treatment at a subsidised rate 
for infertility management.   
120 
 
University of Ghana http://ugspace.ug.edu.gh
6.2.3 Future Research  
The findings revealed that seeking for medical treatment is a lonely and private issue for 
some women and husbands blame women for infertility and refuse to be tested although the women 
pleaded for men’s understanding.  There is a need for future studies on the perception of infertility 
among men and the health seeking behaviour of men with infertility in order to assess the men’s 
level of health seeking and create awareness on male factor infertility. One of the emerging themes 
is the psychological experiences of the women. Thus, there is a need to conduct a research on the 
psychosocial effect of infertility to obtain detailed consequences of the burden to the women’s 
mental and social wellbeing. Further study on the psychosocial health or coping mechanism of 
infertility is important too. 
6.3 Limitations of the Study  
Transferability of findings to a similar setting with same characteristics should be done 
with thoughtfulness since the findings of the study are from fourteen participants sampled from 
two major public health institutions in Sokoto State.  Secondly, few (4/14) of the interview were 
carried out in Hausa language (local dialect) which were transcribed into English language. The 
researcher being a native of the north and speaks the Hausa dialect fluently was able to translate 
and transcribe the audio tapes to English language. However, some words that were found to be 
challenging to translate were substituted with words nearest in meaning which was checked with 
participants during member checking.  
6.4 Recommendations  
Recommendations were made to UDUTH, SHS, Sokoto State ministry of Health, Non-
governmental agencies and for nurse researcher based on the findings of the study.  
121 
 
University of Ghana http://ugspace.ug.edu.gh
 
6.4. 1 Ministry of Health 
The Ministry of Health should: 
• Incorporate infertility treatment into its health agenda and special attention paid to the 
access of medical treatment by subsidising cost of treatment or make it free since it is a 
public health condition.  
• Stock facilities with infertility treatment resources such as fertility enhancement drugs, 
equipment for investigations (transvaginal scan and HSG machines). 
• Improve on infertility enlightenment (male factor infertility inclusive) through the use of 
information education and communication system, mass media campaign and public 
seminars. 
• Enact policy that will mandate all hospitals in Sokoto to give women infertility pre-
treatment (counselling) for women that usually present for care in less than 12months  
6.4.2 UDUTH and SHS 
The hospitals should:  
• Equip nurses and midwives through training on infertility management which will guide 
the professionals in educating the women and the provision of quality care. 
• Ensure health professionals to give the women adequate orientation and education on the 
pattern of infertility treatment.  
• Upgrade their infertility treatment resources (drugs, testing kits and equipment) to enable 
quality treatment. 
• Incorporate counselling session to care for women’s psychological health. 
6.4.3 Non-governmental Agencies 
Agencies providing reproductive health services should: 
122 
 
University of Ghana http://ugspace.ug.edu.gh
• Include strengthening public hospitals in the area of improving treatment infertility at a 
subsidised cost noting that infertility has been classified the 5th severe worldwide disability 
by WHO. 
• (Plan International, Integrated Health Program, JHPIEGO/USAID and Women for Health) 
join in educating the populace on infertility as done for other public health conditions. 
• Create programs that will empower women to boost their financial capabilities. 
6.4.4 Nurses Researchers 
Nurse researcher should: 
• Utilise a quantitative approach to measure the health seeking behaviour of women with 
infertility 
• Study the psychosocial experiences of women with infertility in Sokoto State 
• Explore the perception of infertility among men 
• Examine the health seeking behaviour of men in relation to infertility 
6.4.5 Religions Bodies/Groups 
The religious organisations should: 
• Create a psychotherapy unit that would support the psychologically needs of these women 
through counselling 
• Create a society/fellowship group where the women would gather to encourage one another 
• Also explore providing financial support for treatment or empowering the women.  
6.5 Conclusion  
The women irrespective of educational level, religion, financial and social support system 
sought for medical help to conceive because they believe in medical treatment. The women had 
the perception that infertility is caused by natural and supernatural factors. As a result,the women 
123 
 
University of Ghana http://ugspace.ug.edu.gh
sought for help to conceive simultaneously from both medical and faith-based sources. This is 
because in the northern Nigeria people believed that everything (good or bad) is destined by God. 
Thus, it becomes essential for health professionals to pay attention to the reasons for the 
combination of treatment centres and give consideration to spirituality during infertility treatment.  
It was evident that some women did medical seeking earlier (less than one 12months) than 
medically expected for infertility health seeking. When they were sent back home to return after a 
year, some patronised private clinics, visited prayer houses and used close people’s advice for self-
medications.  These avenues have the potential of providing ineffective and harmful treatment to 
women. Therefore, it is imperative to create infertility pre-treatment (counselling) sessions in 
health institutions and at the community level to avoid missed opportunities, late treatment seeking 
and prevent possible harm to women’s reproductive systems. The women were committed to 
accepting and adhering to treatment instructions. This intervention can be enhanced through sound 
education and orientation during the preliminary session of the treatment.  
  
124 
 
University of Ghana http://ugspace.ug.edu.gh
REFERENCES  
Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 
50(2), 179-211. 
  
Aveyard, H. (2014). Doing a literature review in health and social care: A practical guide: McGraw-Hill 
Education (UK). 
 
Awoyinka, M. F., & Ohaeri, B. M. (2014). Depression and coping strategies among women with infertility, 
attending three gynaecological clinics in Ibadan. Journal of Medicine and Biomedical Research, 
13(2), 48-60.  
 
Basavanthappa, B. (2011). Essentials of nursing research: Jaypee Brothers Medical Publishers. 
 
Boivin, J., Bunting, L., Collins, J. A., & Nygren, K. G. (2007). International estimates of infertility 
prevalence and treatment-seeking: potential need and demand for infertility medical care. 
Human Reproduction, 22(6), 1506-1512.  
 
Bousso, R. S., Poles, K., & Cruz, D. d. A. L. M. (2014). Nursing concepts and theories. Revista da Escola de 
Enfermagem da USP, 48(1), 141-145.  
 
Bredart, A., Marrel, A., Abeztz-Webb, Lasch, K., & Acquardo, C. (2014). Interviewing to develop patient-
reported outcome (PRO) measures for clinical research eliciting patirnt's experience. Health and 
Qualit of Life Outcome 12(1),15. 
 
Bukar, M., Audu, B., Usman, H., & Massa, A. (2012). Health seeking behaviour of infertile women in 
Gombe, north eastern Nigeria. Tropical Journal of Obstetrics and Gynaecology, 29(1), 83-87.  
 
Bunting, L., Tsibulsky, I., & Boivin, J. (2012). Fertility knowledge and beliefs about fertility treatment: 
findings from the International Fertility Decision-making Study. Human Reproduction, 28(2), 
385-397.  
 
Burns, N., & Grove, S. K. (2010). Understanding Nursing Research-eBook: Building an Evidence-Based 
Practice: Elsevier Health Sciences. 
 
Bushnik, T., Cook, J., Hughes, E., & Tough, S. (2012). Seeking medical help to conceive. Health reports, 
23(4), 1A.  
 
Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting 
behavior. Health communication, 25(8), 661-669.  
 
Chin, H. B., Howards, P. P., Kramer, M. R., Mertens, A. C., & Spencer, J. B. (2015). Racial disparities in 
seeking care for help getting pregnant. Paediatric and perinatal epidemiology, 29(5), 416-425.  
 
Commission, N. P. (2006). Population and housing census of the Federal Republic of Nigeria. Priority 
tables, 1.  
 
125 
 
University of Ghana http://ugspace.ug.edu.gh
Correia, S., Rodrigues, T., & Barros, H. (2014). Socioeconomic variations in female fertility impairment: a 
study in a cohort of Portuguese mothers. BMJ open, 4(1), e003985-e003985. 
doi:10.1136/bmjopen-2013-003985 
 
Coughlan, M., Cronin, P., & Ryan, F. (2013). Doing a Literature Review in Nursing, Health and Social Care: 
SAGE Publications: Sage. 
 
Cui, W. (2010). Mother or nothing: the agony of infertility. In: SciELO Public Health. 
 
Danfulani, M., Mohammed, M. S., Ahmed, S. S., & Haruna, Y. G. (2014). Hysterosalphingographic 
findings in women with infertility in Sokoto North Western Nigeria. African Journal of Medical 
and Health Sciences, 13(1), 19.  
 
Datta, J., Palmer, M. J., Tanton, C., Gibson, L. J., Jones, K. G., Macdowall, W., . . . Wellings, K. (2016). 
Prevalence of infertility and help seeking among 15 000 women and men. Hum Reprod, 31(9), 
2108-2118. doi:10.1093/humrep/dew123 
 
Dhont, N. (2011). Clinical, epidemiological and socio-cultural aspects of infertility in resource-poor 
settings. Evidence from Rwanda. Facts, views & vision in ObGyn, 3(2), 77.  
 
Dhont, N., Luchters, S., Ombelet, W., Vyankandondera, J., Gasarabwe, A., Van de Wijgert, J., & 
Temmerman, M. (2010). Gender differences and factors associated with treatment-seeking 
behaviour for infertility in Rwanda. Human Reproduction, 25(8), 2024-2030.  
 
Dictionary, E. (2018). Thesaurus. Grammar Help. In: Oxford Dictionaries. 
 
Dierickx, S., Balen, J., Longman, C., Rahbari, L., Clarke, E., Jarju, B., & Coene, G. (2019). ‘We are always 
desperate and will try anything to conceive’: The convoluted and dynamic process of health 
seeking among women with infertility in the West Coast Region of The Gambia. PLoS One, 14(1), 
e0211634. 
  
Dierickx, S., Rahbari, L., Longman, C., Jaiteh, F., & Coene, G. (2018). ‘I am always crying on the inside’: a 
qualitative study on the implications of infertility on women’s lives in urban Gambia. 
Reproductive Health, 15(1), 151. doi:10.1186/s12978-018-0596-2 
 
Donkor, E. S., Naab, F., & Kussiwaah, D. Y. (2017). “I am anxious and desperate”: psychological 
experiences of women with infertility in The Greater Accra Region, Ghana. Fertility research and 
practice, 3(1), 6.  
 
Donkor, E. S., & Sandall, J. (2007). Soc Sci Med, 65(null), 1683.  
 
Dyer, S. J. (2008). Infertility-related reproductive health knowledge and help-seeking behaviour in 
African countries. ESHRE Monographs, 2008(1), 29-33. doi:10.1093/humrep/den148 
 
Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of 
nursing models and theories: FA Davis. 
 
Gerrits, T. (2012). Biomedical infertility care in low resource countries: barriers and access. Facts Views 
Vis Obgyn Monog, 2, 1-6.  
126 
 
University of Ghana http://ugspace.ug.edu.gh
 
Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and 
implementation of public health interventions. Annual review of public health, 31, 399-418.  
 
Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health behavior and health education: theory, research, 
and practice: John Wiley & Sons. 
 
Greil, A. L., McQuillan, J., & Sanchez, D. (2014). J Health Psychol, 24(null), 1.  
 
Greil, A. L., McQuillan, J., Shreffler, K. M., Johnson, K. M., & Slauson-Blevins, K. S. (2011). Race-ethnicity 
and medical services for infertility: stratified reproduction in a population-based sample of US 
women. Journal of Health and Social Behavior, 52(4), 493-509.  
 
Grove, S. K., Burns, N., & Gray, J. (2012). The practice of nursing research: Appraisal, synthesis, and 
generation of evidence: Elsevier Health Sciences. 
 
Hampton, K. D., Mazza, D., & Newton, J. M. (2013). Fertility‐awareness knowledge, attitudes, and 
practices of women seeking fertility assistance. Journal of Advanced Nursing, 69(5), 1076-1084. 
  
Hanson, B., Johnstone, E., Dorais, J., Silver, B., Peterson, C. M., & Hotaling, J. (2017). Female infertility, 
infertility-associated diagnoses, and comorbidities: a review. Journal of assisted reproduction 
and genetics, 34(2), 167-177.  
 
Hollos, M., & Larsen, U. (2008). Motherhood in sub‐Saharan Africa: The social consequences of infertility 
in an urban population in northern Tanzania. Culture, Health & Sexuality, 10(2), 159-173.  
 
Ikeako, L., Iteke, O., Ezegwui, H., & Okeke, T. (2015). Clinico-demographic indicators of depression 
among infertile women in a tertiary health institution in Awka, South East Nigeria. Br J Med 
Medi Res, 7(11), 921-931.  
 
Jesson, J., Matheson, L., & Lacey, F. M. (2011). Doing your literature review: Traditional and systematic 
techniques: Sage. 
 
Johnson, K. M., & Johnson, D. R. (2009). Partnered decisions? US couples and medical help‐seeking for 
infertility. Family relations, 58(4), 431-444. 
  
Johnson, S., & Rasulova, S. (2017). Qualitative research and the evaluation of development impact: 
incorporating authenticity into the assessment of rigour. Journal of Development Effectiveness, 
9(2), 263-276.  
 
kr Saha, S., Barman, M., Gupta, A., Chowdhury, P. D., Sarker, G., & Pal, R. (2015). Gender preference 
among married women in Kolkata metropolitan slum of India. American Journal of Public Health, 
3(4A), 6-11.  
 
Kussiwaah, D. (2016). Experiences Of Women With Infertility And Their Bio-Psychosocial Management: A 
Study At The Korle-Bu Teaching Hospital. University of Ghana, 
 
Lawali, Y. (2015). Psychosocial Experiences of Women with Infertility and their Coping Strategies in 
Zamfara State, Nigeria. University of Ghana,  
127 
 
University of Ghana http://ugspace.ug.edu.gh
 
Li, H., Lei, J., Xu, F., Yan, C., Guimerans, M., Xing, H., . . . Zhang, D. (2017). A study of sociocultural factors 
on depression in Chinese infertile women from Hunan Province. Journal of Psychosomatic 
Obstetrics & Gynecology, 38(1), 12-20. doi:10.1080/0167482X.2016.1265500 
 
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry (Vol. 75): sage. 
 
Mascarenhas, M. N., Flaxman, S. R., Boerma, T., Vanderpoel, S., & Stevens, G. A. (2012). National, 
regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 
health surveys. PLoS medicine, 9(12), e1001356.  
 
McQuillan, J., Greil, A. L., Shreffler, K. M., & Bedrous, A. V. (2015). The importance of motherhood and 
fertility intentions among US women. Sociological Perspectives, 58(1), 20-35.  
 
Mumtaz, Z., Shahid, U., & Levay, A. (2013). Understanding the impact of gendered roles on the 
experiences of infertility amongst men and women in Punjab. Reproductive Health, 10(1), 3.  
 
Naab, F. (2014). Every month becomes a funeral when they menstruate: African women’s beliefs about 
couple infertility. J Infertility Reprod Biol, 2(3), 92-100.  
 
Naab, F., Brown, R., & Heidrich, S. (2013). Psychosocial health of infertile Ghanaian women and their 
infertility beliefs. Journal of Nursing Scholarship, 45(2), 132-140.  
 
Naab, F., & Kwashie, A. (2018). ‘I don’t experience any insults, but my wife does’: The concerns of men 
with infertility in Ghana. South African Journal of Obstetrics and Gynaecology, 24(2), 45-48.  
 
Okafor, N. I., Joe-Ikechebelu, N. N., & Ikechebelu, J. I. (2017). Perceptions of Infertility and In Vitro 
Fertilization Treatment among Married Couples in Anambra State, Nigeria. African journal of 
reproductive health, 21(4), 55-66.  
 
Ola, T. M. (2014). Gender Dimensions of Seeking Treatment for Infertility in Nigeria. Journal of Research 
in Gender Studies, 4(2).  
 
Oladeji, S., & OlaOlorun, A. (2018). Depression among infertile women in Ogbomosoland. South African 
Family Practice, 60(2), 41-45.  
 
Panti, A., & Sununu, Y. (2014). The profile of infertility in a teaching Hospital in North West Nigeria. Sahel 
Medical Journal, 17(1), 7-7.  
 
Panti, A. A., Umar, A. B., Rabiu, U. A., Saidu, Y., Bilbis, L. S., Shehu, C. E., . . . Hassan, M. Evaluation Of 
Oxidative Stress, Gonadotrophins and Prolactin in Infertile Women. European Journal of 
Pharmaceutical and Medical Research, 5(3),505-511.  
 
Parahoo, K. (2014). Nursing research: principles, process and issues: Macmillan International Higher 
Education. 
 
Petitpierre, E. (2018). Challenges – Addressing subfertility/infertility in developing countries (bulletin). 
Retrieved 3dr November 2018, from World Health Organization 
http://www.who.int/reproductivehealth/topics/infertility/countryperspective/en/ 
128 
 
University of Ghana http://ugspace.ug.edu.gh
 
Polit, D., & Beck, C. (2012). Designing and conducting quantitative studies to generate evidence for 
nursing. Nursing research, 226.  
 
Polit D.F., B., C.T. (2010). essentials of nursing research: appraising evidence for nursing practice (7th 
ed.). piladelphia: lippinctt willians & wilkins  
 
Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising evidence for nursing practice: 
Lippincott Williams & Wilkins. 
 
Prion, S., & Adamson, K. A. (2014). Making sense of methods and measurement: Rigor in qualitative 
research. Clinical Simulation in Nursing, 10(2), e107-e108.  
 
Qadir, F., Khalid, A., & Medhin, G. (2015). Social support, marital adjustment, and psychological distress 
among women with primary infertility in Pakistan. Women & health, 55(4), 432-446.  
 
Roomaney, R., & Kagee, A. (2016). Salient aspects of quality of life among women diagnosed with 
endometriosis: A qualitative study. Journal of Health Psychology, 23(7), 905-916. 
doi:10.1177/1359105316643069 
 
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 
2(4), 328-335.  
 
Rosenstock, I. M. (1990). The health belief model: explaining health behavior through expectancies.  
 
Rutstein, O., & Iqbal, H. S. (2004). Infecundity, infertility, and childlessness in developing countries. 
Demographic and Health Surveys (DHS) Comparative reports No. 9. Retrieved from 
http://www.who.int/reproductivehealth/topics/infertility/DHS-CR9.pdf 
 
Ryan, S., & Carr, A. (2010). Applying the biopsychosocial model to the management of rheumatic 
disease. In Rheumatology (pp. 63-75): Elsevier. 
 
Sarkar, S., & Gupta, P. (2016). Socio-Demographic Correlates of Women’s Infertility and Treatment 
Seeking Behavior in India. Journal of reproduction & infertility, 17(2), 123.  
 
Slauson-Blevins, K. S., McQuillan, J., & Greil, A. L. (2013). Supplementary file for Social Science and 
Medicine article:" Online and In-Person Health Seeking for Infertility"--Table 2. Descriptive 
Statistics of Type of Health-Seeking and Independent Variables.  
 
Tabong, P. T.-N., & Adongo, P. B. (2013a). Infertility and childlessness: a qualitative study of the 
experiences of infertile couples in Northern Ghana. BMC pregnancy and childbirth, 13(1), 72.  
 
Tabong, P. T.-N., & Adongo, P. B. (2013b). Understanding the social meaning of infertility and 
childbearing: a qualitative study of the perception of childbearing and childlessness in Northern 
Ghana. PLoS One, 8(1), e54429.  
 
Tobin, G. A., & Begley, C. M. (2004). Methodological rigour within a qualitative framework. Journal of 
Advanced Nursing, 48(4), 388-396.  
 
129 
 
University of Ghana http://ugspace.ug.edu.gh
Upkong, D., & Orgi, E. (2006). Mental health of infertile women in Nigeria.  
 
Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis and thematic analysis: Implications 
for conducting a qualitative descriptive study. Nursing & health sciences, 15(3), 398-405.  
 
White, L., McQuillan, J., Greil, A. L., & Johnson, D. R. (2006). Infertility: testing a helpseeking model. 
Social Science & Medicine, 62(4), 1031-1041.  
 
Whitehouse, B., & Hollos, M. (2014). Definitions and the Experience of Fertility Problems: Infertile and 
Sub‐fertile Women, Childless Mothers, and Honorary Mothers in Two Southern Nigerian 
Communities. Medical anthropology quarterly, 28(1), 122-139.  
 
WHO-ICMART. (2009). WHO-ICMART Definition Glossary (Glossay). Retrieved from 
http://www.who.int/reproductivehealth/publications/infertility/art_terminology2.pdf  
 
WHO. (2018). Sexual and reproductive health. Retrieved from 
http://www.who.int/reproductivehealth/topics/infertility/definitions/en/ 
 
WHO. (2011). Sexual and reproductive health: disability global picture. Retrieved from 
http://www.who.int/reproductivehealth/topics/infertility/definitions/en/ 
 
  
130 
 
University of Ghana http://ugspace.ug.edu.gh
APPENDICES 
Appendix A: Introduction Letters  
131 
 
University of Ghana http://ugspace.ug.edu.gh
 
132 
 
University of Ghana http://ugspace.ug.edu.gh
Appendix  B: Consent Form 
Title: Health Seeking Behaviour of Women with Infertility in Sokoto State, Nigeria 
Principal investigator: Grace Isiyaku Ahmadu 
Address: School of Nursing University of Ghana Legon, Email: graceahmadu75@gmail.com 
General Information on the Research 
Little is known on the Health Seeking Behaviour of Women with Infertility in Sokoto State. The 
investigation is to discover the experience of women with difficulty getting pregnant in Sokoto in 
respect to the complexity in the decision making process about health seeking. You got the request 
to participate in this study based on your experience of infertility and decision making on health 
seeking. If you are willing to take part in the investigation, there is a need for you to show your 
acceptance verbally and by ticking the box on the consent form before going through an interview 
that will be recorded and observation documented by field note taking. You are free to withdraw 
from the study at any level or stop an interview session when you are not comfortable because 
some questions might bring back unpleasant memories. The interview will be conducted in an 
office at the gynaecological clinic to ensure privacy or at your agreed time, venue and date which 
is expected to last for about 40minutes.  The study is strictly for academic purpose, confidentiality 
will be ensured on all the information given by you and your name or any form of identity is not 
required. You will not be harmed in any way. 
 
Indicate your consent by ticking the box      
If you have any questions, you can contact the individuals below 
Grace Isiyaku Ahmadu (Mrs.) 
MSc. Nursing student 
Department of Maternal and Child Health 
School of Nursing and Midwifery 
P.O.Box LG 43 
University of Ghana, Legon. 
Tel no: +2348035049330 
Email: graceahmadu75@gmail.com  
 
Supervisors: Dr.Florence  Naab PhD, M’phil. BA, RM, SRN, Policy Fellow 
Head of Department of Maternal and Child Health 
School of Nursing and Midwifery 
P.O.Box LG 43 
University of Ghana, Legon. 
Tel no: 0263741717 
Email: florencenaab@yahoo.com or fnaab@ug.edu.gh 
 
Co-Supervisor: Dr. Mary Ani-Amponsah PhD, M’phil,  
Department of Maternal and Child Health 
School of Nursing and Midwifery 
P.O.Box LG 43 
University of Ghana, Legon. 
Tel no: 02443368205    Email: mary.aniamponsah@gmail.com  
133 
 
University of Ghana http://ugspace.ug.edu.gh
Appendix C: Interview Guide 
 Health Seeking Behaviour of Women with Infertility  
Introduction:  
• Welcome the interviewee and thank them for sparing their time for the session 
• Tell them about the study (background, objectives, benefits) 
• Tell them what is involved in the interview plus the topic to be discussed 
• Make emphasis on confidentiality 
• Tell the interviewee about recording of the interview, field note taking and state reasons 
• State that the interview might bring back unpleasant memories 
• Discuss on voluntary participation and the right to stop at any time without penalties 
• Give interviewee time to ask question or concerns 
• Ticking of informed consent form by participant  
• Switch on the audio recorder 
Section A: Socio-demographic Characteristics (life course factors) 
Tell me about yourself  
Probes: 
1. How old are you 
2. What is your level of education? 
3. What is you religion 
4. For how long have you been married?  
5. How many children do you have?  
6. What is the range of the family income like? 
Section B: Symptoms Salience 
Tell me how you got to know that you have difficulty getting pregnant  
Probes: 
1. How do you know that you have fertility problem?  
2. Have you thought of having a child?  
3. What have you done to achieve conception? 
 
Section C: Individual and Social cues 
Please share some of your personal experiences and interaction with people with me 
Probes:   
1. What are your beliefs on childbearing? 
2. What is your partner’s intention on childbearing? 
134 
 
University of Ghana http://ugspace.ug.edu.gh
3. Can you tell me why you chose to visit the hospital for treatment? (perception for medical treatment, 
friends & family support/pressure, failed traditional or spiritual treatment) 
4. How do you think the society look at you from your experience? 
5. Can you describe how you relate with people before and after the diagnosis 
Section D: Enabling and predisposing factors 
What are some of your support systems in this experience of difficulty getting 
pregnant? 
Probe:  
1. What are some of the support system you benefit from?  (government/social) 
Section E: perception towards seeking medical treatment 
What is your experience with looking for treatment? 
Probe: 
1. Who advised you to seek for help in the hospital 
2. What makes you think the hospital has solution to the fertility problem? 
3. How do you feel about the fertility problem? 
4. How do you feel about the medical treatment? (expectation- effectiveness, safety and efficiency) 
       Section F: Health seeking behaviour 
        At what time did you decide to look for help and what prompted this decision? 
Probes:  
1. What is the general situation around your health seeking for infertility? 
2. What were your decision making experience on health seeking to infertility like? 
3. What motivated you to visit the hospital for treatment? 
4. Can you tell me other treatment channels you have used before coming to the hospital? 
5. Is there anything you what to advice on medical health seeking? 
     
 
  
135 
 
University of Ghana http://ugspace.ug.edu.gh
Appendix D: Acknowledgement of Application for Ethical Clearance 
  
136 
 
University of Ghana http://ugspace.ug.edu.gh
Appendix E: Ethical Clearance and Administrative Approval from UDUTH 
 
137 
 
University of Ghana http://ugspace.ug.edu.gh
Appendix F: Ethical Clearance and Administrative Approval from SHS 
  
138