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Difficulties Conceiving and Relationship Stability in Sub-Saharan Africa: The Case of Ghana

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Abstract

Little is known about the relationship between self-identified difficulties conceiving, biomedical infertility, and union instability in Sub-Saharan Africa. Previous research suggests that infertility increases the risk of psychological distress and marital conflict, encourages risky sexual behaviour, and deprives infertile individuals and couples of an important source of economic and social capital. Qualitative research has suggested that there may be a link between infertility and divorce; less is known about the implications of infertility for unmarried couples. In this paper, discrete-time hazard models are applied to 8 waves of secondary panel data from Ghana collected by the Population Council of New York and the University of Cape Coast (pooled n = 10,418) between 1998 and 2004. Results show a positive relationship between perceived difficulties conceiving and relationship instability for both married women and those in non-marital sexual unions; this relationship, however, does not hold for biomedical infertility. Future research should examine this relationship using nationally representative data in a cross-national comparison to determine whether results hold across the subcontinent.

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References

  • Addai, I., & Trovato, F. (1999). Structural assimilation and ethnic fertility in Ghana. Journal of Comparative Family Studies, 30(3), 409–427.

    Google Scholar 

  • Alhassan, A., Ziblim, A. R., & Muntaka, S. (2014). A survey on depression among infertile women in Ghana. BMC Women’s Health, 14(1), 42.

    Article  Google Scholar 

  • Allison, P. (1995). Survival analysis using SAS: A practical guide. Cary, NC: SAS Institute.

    Google Scholar 

  • Amato, P. R., & Rogers, S. J. (1997). A longitudinal study of marital problems and subsequent divorce. Journal of Marriage and Family, 59(3), 612–624. doi:10.2307/353949.

    Article  Google Scholar 

  • Armstrong, A. (1997). Law and the family in Southern Africa. In A. Adepoju (Ed.), Family, population and development in Africa (pp. 183–202). London: Zed Books.

    Google Scholar 

  • Aryee, A. F. (1997). The African family and changing nuptiality patterns. In A. Adepoju (Ed.), Family, population and development in Africa (pp. 78–96). London: Zed Books.

    Google Scholar 

  • Barden-O’Fallon, J. (2005). Unmet fertility expectations and the perception of fertility problems in a Malawian village. African Journal of Reproductive Health, 9(2), 14–25.

  • Bledsoe, C. H. (2002). Contingent lives: fertility, time, and aging in West Africa. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Boerma, J. T., & Urassa, M. (2001). Associations between female infertility, HIV and sexual behaviour in rural Tanzania. In J. T. Boerma & Z. Mgalla (Eds.), Women and infertility in sub-Saharan Africa: A multidisciplinary perspective (pp. 175–188). Amsterdam, NL: KIT Publishers.

    Google Scholar 

  • Booth, A., Johnson, D. R., White, L. K., & Edwards, J. N. (1986). Divorce and marital instability over the life course. Journal of Family Issues, 7(4), 421–442. doi:10.1177/019251386007004006.

    Article  Google Scholar 

  • Box-Steffensmeier, J. M., & Jones, B. S. (2004). Event history modeling: A guide for social scientists. New York: Cambridge University Press.

    Book  Google Scholar 

  • Caldwell, J. C., Orubuloye, I. O., & Caldwell, P. (1992). Fertility decline in Africa: A new type of transition? Population and Development Review, 18(2), 211–242.

    Article  Google Scholar 

  • Casterline, J. (2007). Social learning, social influence, and fertility control (Project description). New York: Population Council and University of Cape Coast.

    Google Scholar 

  • Cox, C. M., Hindin, M. J., Otupiri, E., & Larsen-Reindorf, R. (2013). Understanding couples’ relationship quality and contraceptive use in Kumasi, Ghana. International Perspectives on Sexual and Reproductive Health, 39(4), 185–194.

  • Demographic and Health Surveys. (2015). Statistics compiler. Retrieved from http://www.statcompiler.com/country.cfm?ctryid=14&Ctryname=Ghana#.

  • Desgrees du Lou, A. (1999). Reproductive health and AIDS in sub-Saharan Africa: Problems and prospects. Population: An English Selection, 11, 61–87.

    Google Scholar 

  • Donkor, E. S. (2008). Socio-cultural perceptions of infertility in Ghana. Africa Journal of Nursing and Midwifery, 10(1), 22–34.

    Google Scholar 

  • Donkor, E. S., & Sandall, J. (2007). The impact of perceived stigma and mediating social factors on infertility-related stress among women seeking infertility treatment in Southern Ghana. Social Science and Medicine, 65(8), 1683–1694. doi:10.1016/j.socscimed.2007.06.003.

    Article  Google Scholar 

  • Dyer, S. J. (2007). The value of children in African countries: Insights from studies on infertility. Journal of Psychosomatic Obstetrics and Gynecology, 28(2), 69–77.

    Article  Google Scholar 

  • Dyer, S. J., Abrahams, N., Hoffman, M., & Van der Spuy, Z. M. (2002a). Infertility in South Africa: women’s reproductive health knowledge and treatment-seeking behaviour for involuntary childlessness. Human Reproduction, 17(6), 1657–1662.

    Article  Google Scholar 

  • Dyer, S. J., Abrahams, N., Hoffman, M., & van der Spuy, Z. M. (2002b). Men leave me as I cannot have children’: women’s experiences with involuntary childlessness. Human Reproduction, 17(6), 1663–1668.

    Article  Google Scholar 

  • Farnes, C., Beckstrand, R. L., & Callister, L. C. (2011). Help-seeking behaviours in childbearing women in Ghana, West Africa. International Nursing Review, 58(4), 491–497.

    Article  Google Scholar 

  • Feldman-Savelsberg, P. (2002). Is infertility an unrecognized public health and population problem? The view from the Cameroon grassfields. In M. C. Inhorn & F. Van Balen (Eds.), Infertility around the globe: New thinking on childlessness, gender, and reproductive technologies (pp. 215–232). Berkeley: University of California Press.

    Google Scholar 

  • Fledderjohann, J. (2012). “Zero is not good for me”: Implications of infertility in Ghana. Human Reproduction, 27(5), 1383–1390. doi:10.1093/humrep/des035.

    Article  Google Scholar 

  • Fledderjohann, J., & Johnson, D. R. (2015). Impaired fertility and perceived difficulties conceiving in Ghana: Measurement problems and prospects. Journal of Biosocial Science, FirstView,. doi:10.1017/S0021932015000310.

    Google Scholar 

  • Frank, O. (1983). Infertility in sub-Saharan Africa: estimates and implications. Population and Development Review, 9(1), 137–144.

  • Galhardo, A., Cunha, M., & Pinto-Gouveia, J. (2011). Psychological aspects in couples with infertility. Sexologies, 20(4), 224–228. doi:10.1016/j.sexol.2011.08.005.

    Article  Google Scholar 

  • Gerrits, T. (2002). Infertility and matrilineality: The exceptional case of the Macua of Mozambique. In M. C. Inhorn & F. Van Balen (Eds.), Infertility around the globe: New thinking on childlessness, gender, and reproductive technologies (pp. 233–246). Berkeley: University of California Press.

    Google Scholar 

  • Ghana Statistical Service. (2014). Poverty profile in Ghana, 2005-2013 (Ghana Living Standards Survey No. Round 6).

  • Greil, A. L. (1991). Not yet pregnant: Infertile couples in contemporary America. New Jersey: Rutgers University Press.

    Google Scholar 

  • Greil, A. L., McQuillan, J., Johnson, K., Slauson-Blevins, K., & Shreffler, K. M. (2010). The hidden infertile: Infertile women without pregnancy intent in the United States. Fertility and Sterility, 93(6), 2080–2083. doi:10.1016/j.fertnstert.2009.08.024.

    Article  Google Scholar 

  • Guo, G. (1993). Event-history analysis for left-truncated data. Sociological Methodology, 23, 217–243.

  • Gyimah, S. O. (2003). A cohort analysis of the timing of first birth and fertility in Ghana. Population Research and Policy Review, 22(3), 251–266.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Hollos, M., Larsen, U., Obono, O., & Whitehouse, B. (2009). The problem of infertility in high fertility populations: Meanings, consequences and coping mechanisms in two Nigerian communities. Social Science and Medicine, 68(11), 2061–2068. doi:10.1016/j.socscimed.2009.03.008.

    Article  Google Scholar 

  • Hollos, M., & Whitehouse, B. (2014). Women in limbo: Life course consequences of infertility in a Nigerian community. Human Fertility, 17(3), 188–191.

    Article  Google Scholar 

  • Larsen, U. (2000). Primary and secondary infertility in sub-Saharan Africa. International Journal of Epidemiology, 29(2), 285–291.

    Article  Google Scholar 

  • Larsen, U. (2005). Research on infertility: Which definition should we use? Fertility and Sterility, 83(4), 846–852. doi:10.1016/j.fertnstert.2004.11.033.

    Article  Google Scholar 

  • Leonard, L. (2002). Problematizing fertility: “Scientific” accounts and Chadian women’s narratives. In M. C. Inhorn & F. Van Balen (Eds.), Infertility around the globe: new thinking on childlessness, gender, and reproductive technologies (pp. 193–214). Berkeley: University of California Press.

    Google Scholar 

  • Marchenko, Y., & Royston, P. (2009). Relation between official mi and user-written ice and mim commands. http://www.stata.com/support/faqs/statistics/mi-versus-ice-and-mim/. Retrieved 15 Apr 2011.

  • Meekers, D. (1992). The process of marriage in African societies: A multiple indicator approach. Population and Development Review, 18(1), 61–78.

    Article  Google Scholar 

  • Meekers, D., & Calvès, A.-E. (1997). “Main”girlfriends, girlfriends, marriage, and money: The social context of HIV risk behaviour in sub-Saharan Africa. Health Transition Review, 7(supplement), 361–375.

    Google Scholar 

  • Moreland, S., & Logan, D. (2000). Modeling adolescent reproductive health in Ghana: an application of the ARH Model. POLICY PROJECT. Arlington: The Futures Group International. http://www.policyproject.com/pubs/countryreports/ghanamodel.pdf.

  • Ngom, P., Debpuur, C., Akweongo, P., Adongo, P., & Binka, F. N. (2003). Gate-keeping and women’s health seeking behaviour in Navrongo, Northern Ghana. African Journal of Reproductive Health/La Revue Africaine de La Santé Reproductive, 7(1), 17–26. doi:10.2307/3583341.

    Article  Google Scholar 

  • Okonofua, F. (1999). Infertility and women’s reproductive health in Africa/Infertilité et santé reproductive des femmes en Afrique. African Journal of Reproductive Health/La Revue Africaine de La Santé Reproductive, 3(1), 7–12. doi:10.2307/3583224.

    Article  Google Scholar 

  • Oppong, C., & Abu, K. (1987). Seven roles of women: impact of education, migration and employment on Ghanaian mothers. Geneva: International Labour Office.

    Google Scholar 

  • Osei, N. Y. (2014). Association of Childless Couples Of Ghana (ACCOG). Facts, Views & Vision in ObGyn, 6(2), 99–102.

    Google Scholar 

  • Pearce, T. O. (1999). She will not be listened to in public: Perceptions among the Yoruba of infertility and childlessness in women. Reproductive Health Matters, 7(13), 69–79. doi:10.2307/3775705.

    Article  Google Scholar 

  • Population Reference Bureau. (2015). Total Fertility Rate, 1970 and 2014. http://www.prb.org/DataFinder/Topic/Rankings.aspx?ind=17. Retrieved 31 Oct 2015.

  • Rouchou, B. (2013). Consequences of infertility in developing countries. Perspectives in Public Health, 133(3), 174–179. doi:10.1177/1757913912472415.

    Article  Google Scholar 

  • Salm, S. J., & Falola, T. (2002). Culture and customs of Ghana. Westport, CT: Greenwood Press.

    Google Scholar 

  • Sennott, C., & Yeatman, S. (2012). Stability and change in fertility preferences among young women in Malawi. International Perspectives on Sexual and Reproductive Health, 38(1), 34.

    Article  Google Scholar 

  • Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.

    Book  Google Scholar 

  • Sundby, J., & Jacobus, A. (2001). Health and traditional care for infertility in the Gambia and Zimbabwe. In J. T. Boerma & Z. Mgalla (Eds.), Women and infertility in sub-Saharan Africa: A multidisciplinary perspective (pp. 257–268). Amsterdam, NL: KIT Publishers.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Tabutin, D., & Schoumaker, B. (2004). The demography of sub-Saharan Africa from the 1950s to the 2000s. A survey of changes and a statistical assessment. Population (English Edition), 59(3/4), 457–555.

  • Takyi, B. K., & Broughton, C. L. (2006). Marital stability in sub-Saharan Africa: Do women’s autonomy and socioeconomic situation matter? Journal of Family and Economic Issues, 27(1), 113–132. doi:10.1007/s10834-005-9006-3.

    Article  Google Scholar 

  • Takyi, B. K., & Gyimah, S. O. (2007). Matrilineal family ties and marital dissolution in Ghana. Journal of Family Issues, 28(5), 682–705.

    Article  Google Scholar 

  • Teachman, J. (2011). Modeling repeatable events using discrete-time data: Predicting marital dissolution. Journal of Marriage and Family, 73(3), 525–540. doi:10.1111/j.1741-3737.2011.00827.x.

    Article  Google Scholar 

  • Wilkinson, S. E., & Callister, L. C. (2010). Giving birth: The voices of Ghanaian women. Health Care for Women International, 31(3), 201–220.

    Article  Google Scholar 

  • World Bank. (2015). Ghana. http://data.worldbank.org/country/ghana. Retrieved 31 Oct 2015.

  • Yeatman, S., Sennott, C., & Culpepper, S. (2013). Young women’s dynamic family size preferences in the context of transitioning fertility. Demography. doi:10.1007/s13524-013-0214-4.

    Google Scholar 

  • Yebei, V. N. (2000). Unmet needs, beliefs and treatment-seeking for infertility among migrant Ghanaian women in the Netherlands. Reproductive Health Matters, 8(16), 134–141.

    Article  Google Scholar 

  • Zabin, L. S., & Kiragu, K. (1998). The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa. Studies in Family Planning, 29(2), 210–232. doi:10.2307/172160.

    Article  Google Scholar 

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  1. Department of Sociology, Lancaster University, Lancaster, LA1 4YN, UK

    Jasmine Fledderjohann

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  1. Jasmine Fledderjohann
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Correspondence to Jasmine Fledderjohann.

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Fledderjohann, J. Difficulties Conceiving and Relationship Stability in Sub-Saharan Africa: The Case of Ghana. Eur J Population 33, 129–152 (2017). https://doi.org/10.1007/s10680-016-9401-5

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