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 Table of Contents  
Year : 2014  |  Volume : 11  |  Issue : 2  |  Page : 35-38

Acceptability of child adoption in the management of infertility: A survey of women attending fertility clinics in the tertiary facilities in Lagos

Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria

Date of Web Publication8-Dec-2014

Correspondence Address:
Alero A Roberts
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1595-9587.146497

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Introduction: Infertility is a major social problem with public health relevance in developing countries, with prevalence levels up to 30%. In contrast, the available treatment options for infertile couples are limited. Most times, the cost of this treatment is far beyond the reach of the common man and the success rates recorded with these treatments are minimal. This study was carried out to determine the knowledge, attitude, and practice of child adoption among infertile women attending fertility clinics in the public health facilities in Lagos, and to identify factors that may influence the willingness to adopt among these women. Materials and Methods: A descriptive cross-sectional study was conducted in the three government-owned tertiary fertility clinics in Lagos (namely the Lagos University Teaching Hospital (LUTH), the Lagos State University Teaching Hospital (LASUTH), and the Federal Medical Center (FMC) Ebute-Metta) among 355 infertile women attending these clinics. Results: The majority of the respondents (90.1%) had heard of child adoption before and 28.7% of them had a good knowledge of the processes and legalities involved in child adoption. Almost two-thirds (63.7%) expressed their willingness to adopt, while 58.6% of the respondents felt that an adopted child could never be compared to a biological child. Factors that were significantly associated with the attitude toward child adoption included the level of education of the respondent, their religion, marital status, knowledge of child adoption, and duration of infertility (P < 0.05). Discussion: The high level of willingness to adopt in contrast to the low level of practice among infertile women in Lagos indicates the scope for advocacy and public enlightenment to integrate adoption into the arsenal of management of infertility.

Keywords: Child adoption, Lagos, management of infertility, Nigeria, tertiary health facilities

How to cite this article:
Ezenwankwo FC, Roberts AA, Balogun MR. Acceptability of child adoption in the management of infertility: A survey of women attending fertility clinics in the tertiary facilities in Lagos. J Clin Sci 2014;11:35-8

How to cite this URL:
Ezenwankwo FC, Roberts AA, Balogun MR. Acceptability of child adoption in the management of infertility: A survey of women attending fertility clinics in the tertiary facilities in Lagos. J Clin Sci [serial online] 2014 [cited 2020 Apr 7];11:35-8. Available from: http://www.jcsjournal.org/text.asp?2014/11/2/35/146497

  Introduction Top

The global estimates of infertility report that 72.4 million women are currently infertile, with 40.5 million seeking treatment. [1] Wit h a global prevalence of 9% and local estimates as high as 30.3% there is an increasing tendency toward the use of child adoption as a part of the management of infertility. [1],[2],[3] Infertility, although not in itself a life-threatening condition, carries a large weight of psychosocial morbidity, which complicates its management. Diagnosis and treatment of the reproductive disorders is made more difficult because there are poorly understood social dynamics between the partners and within the immediate and nuclear families. [4],[5] The single performance indicator of successful treatment is the achievement of a viable pregnancy, carried to term, resulting in a live birth. The power of human desire to be parents has been reported in literature and there are varying cultural overtones that influence the attitudes to child adoption. [6],[7],[8],[9],[10] Research done in Nigeria has shown that there appears to be a growing acceptance of child adoption. [3],[11] This survey was carried out to determine the knowledge, attitude, and practice of child adoption among infertile women attending fertility clinics in public health facilities in Lagos, and to identify the factors that might influence the willingness to adopt among these women.

  Materials and methods Top

This descriptive cross-sectional study was conducted among women attending fertility clinics in three tertiary health facilities in Lagos, Nigeria. Using the average prevalence of infertility of 32%, [10] a sample size of 355 was calculated, with allowance for non-responses. The respondents were women of child-bearing age who had failed to achieve a viable pregnancy despite regular unprotected intercourse in the preceding 12 months, but without any other gynecological comorbidity. Semi-structured interviewer-administered questionnaires were used to survey women recruited into the study, sequentially, based on their voluntary informed consent. Data was collected over a three-month period beginning from May 2012. The survey sought information on the sociodemographic characteristics of the respondents, duration of infertility, and the perceptions and practices of child adoption.

Data management

The data was entered and analyzed using the Epi-Info version 3.5.1. Results of the analysis were presented using the frequency distribution tables. Nine questions were used to assess the knowledge of the respondents on child adoption in Lagos State. The knowledge was graded as: 0 - 2 correct answers = poor knowledge, 3 - 5 correct answers = fair knowledge, 6 - 9 correct answers = good knowledge. There were three core questions on attitude. Attitude was graded thus; 0 - 1 favorable answer = negative attitude, 2 - 3 favorable answers = positive attitude. The Chi-square test was used to test the association between the variables and a P ≤ 0.05 was taken as significant.

Ethical consideration

Ethical approval and permission were obtained from the Ethics and Research Committees and the Heads of Department of Obstetrics and Gynecology of the participating hospitals before the study was conducted. Informed consent was obtained verbally from the respondents before the interview, on the basis of assuring complete confidentiality.

  Results Top

Three hundred and fifty five women were surveyed with a mean age of 34.57 ± 5.45 years. Almost two-thirds (64.5%) had tertiary education, 45.9% were of Igbo ethnicity, and three-quarters were Christians [Table 1]. Of those married, 87.0% were in monogamous marriages and 76.5% had been married for less than 10 years. One hundred and sixty-six women (46.7%) described themselves as professionals/skilled workers and 94.9% were in some form of employment. Almost three-quarters of the respondents (267, 75.2%) had been pregnant before; of whom 46.8% (125/267) had reached full term. One hundred and eleven respondents (88.8%) had at least one child who was alive. One hundred and thirty four women (37.8%) had been infertile for >5 years and 56.9% had had previous treatment [Table 2]. Almost all the respondents (90.1%) had heard of child adoption and the most common source of information was 'people or friends' (75%). One hundred and two respondents (28.7%) had a good knowledge of child adoption and its issues. Two-thirds of respondents had a positive attitude to child adoption. Thirty-one respondents had adopted before and 226 (63.7%) expressed willingness to adopt if given the opportunity. Willingness was positively correlated to respondents of older age, tertiary level education, being Christian, and married. Of those willing to adopt, 42.9% were willing to adopt either sex. Significant characteristics associated with those that have ever adopted were, length of duration of infertility, ethnicity other than Yoruba or Igbo, and religion being Muslim.
Table 1: Sociodemographic characteristics of respondents (n=355)

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Table 2: History of infertility

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A bivariate analysis of the sociodemographic characteristics examined that could influence the willingness to adopt found that increasing age of the mother and length of the marriage had statistically significant effects. When knowledge about child adoption practices was graded, it was found that two-thirds of those with a fair knowledge and three-quarters of those with good knowledge were willing to adopt [Table 3]. However, there was no statistically significant association between the previous treatment or duration of infertility and a willingness to adopt. The duration of infertility, ethnicity and religion of the women were statistically significantly associated with whether adoption practice [Table 4].
Table 3: Association between the sociodemographic characteristics of respondents and their willingness to adopt

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Table 4: Association between length of infertility and adoption practice

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  Discussion Top

Expectedly, over three-quarters of the respondents (84%) were 30 years and older, and almost that proportion had attained secondary and post-secondary education. Studies have reported that seeking advice on fertility issues occurs more often among women who are over 30 years and are better educated compared to the women in the community. [12],[13] The majority were also married, Christian, and of Igbo ethnicity. This survey showed that three-quarters of respondents had achieved pregnancy in the past and almost two-thirds had five or less years of infertility, which was comparable to what was obtained elsewhere and underscored the sociocultural perception of the importance of fertility and procreation. [14],[15],[16] Very few women (8.7%) had ever adopted, however, 226 (63.7%) expressed a willingness to adopt, showing a marked increase over other studies that reported 30.7% willing to adopt in Lagos, 17.0% willing to adopt in Ibadan, and 7.2% willing to adopt in Sokoto, although not as high as what was reported in Zaria. [17],[18],[19],[20] The factors that influence the attitude toward child adoption are not different from what has been reported before; largely, a higher level of education, better income, and a longer duration of infertility. [11] The issue of having fulfilled one's role as a woman by getting pregnant and having a child is an overarching theme for women who reported an unwillingness to adopt. [20] However, there are changing characteristics of children awaiting adoption in terms of age and sex of the child, pre-existing morbidities, and the existing extended family; which make it necessary for the staff in infertility clinics to possess the requisite counseling skills to aid implementation of child adoption as a strategy in the arsenal for management. [11],[17],[21] The marked increase in the proportion of those surveyed, expressing their willingness to adopt, is indicative of the scope for utilizing adoption as an interim measure for management of long-term infertility, particularly in cases of 'step-parent' or extended family adoption. [11] Further research is still needed to triangulate the dynamics of decision-making concerning child adoption within the immediate and extended family, as well as, the optimal time for discussions to begin the treatment process.

  References Top

Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: Potential need and demand for infertility medical care. Hum Reprod 2007;22:1506-12.  Back to cited text no. 1
Adetoro OO, Ebomoyi EW. The prevalence of infertility in a rural Nigerian community. Afr J Med Med Sci 1991;20:23-7.  Back to cited text no. 2
Omosun AO, Odeyemi K. Knowledge, attitude and practice towards child adoption amongst women attending infertility clinics in Lagos State, Nigeria. Afr J Prim Health Care Fam Med 2011;3. Available from: http://www.phcfm.org/index.php/phcfm/article/view/259  Back to cited text no. 3
Oladokun A, Arulogun O, Oladokun R, Adenike Bello F, Morhassan-Bello IO, Bambgoye EA, et al. Attitude of infertile women to child adoption in Nigeria. Niger J Physiol Sci 2010;25:47-9.  Back to cited text no. 4
Kamel RM. Management of the infertile couple: An evidence-based protocol. Reprod Biol Endocrinol 2010;8:21.  Back to cited text no. 5
Dyer S, Mokoena N, Maritz J, van der Spuy Z. Motives for parenthood among couples attending a level 3 infertility clinic in the public health sector in South Africa. Hum Reprod 2008;23:352-7.  Back to cited text no. 6
Araoye MO. Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med 2003;22:190-6.  Back to cited text no. 7
Ali TS, Sami N. Adoption practices among couples with secondary infertility in Karachi: A triangulation study design. J Pak Med Assoc 2007;57:55-9.  Back to cited text no. 8
Bharadwaj A. Why adoption is not an option in India: The visibility of infertility, the secrecy of donor insemination, and other cultural complexities. Soc Sci Med 1982 2003;56:1867-80.  Back to cited text no. 9
Dyer SJ. The value of children in African countries: Insights from studies on infertility. J Psychosom Obstet Gynaecol 2007;28:69-77.  Back to cited text no. 10
Adewunmi AA, Etti EA, Tayo AO, Rabiu KA, Akindele RA, Ottun TA, et al. Factors associated with acceptability of child adoption as a management option for infertility among women in a developing country. Int J Womens Health 2012;4:365-72.  Back to cited text no. 11
Stephen EH, Chandra A. Use of infertility services in the United States: 1995. Fam Plann Perspect 2000;32:132-7.  Back to cited text no. 12
Herbert DL, Lucke JC, Dobson AJ. Early users of fertility treatment with hormones and IVF: Women who live in major cities and have private health insurance. Aust N Z J Public Health 2010;34:629-34.  Back to cited text no. 13
Vahratian A. Utilization of fertility-related services in the United States. Fertil Steril 2008;90:1317-9.  Back to cited text no. 14
Tabong PT, Adongo PB. Infertility and childlessness: A qualitative study of the experiences of infertile couples in Northern Ghana. BMC Pregnancy Childbirth 2013;13:72.  Back to cited text no. 15
Rouchou B. Consequences of infertility in developing countries. Perspect Public Health 2013;133:174-9.  Back to cited text no. 16
Ezugwu FO, Obi SN, Onah HE. The knowledge, attitude and practice of child adoption among infertile Nigerian women. J Obstet Gynaecol 2002;22:211-6.  Back to cited text no. 17
Oladokun A, Arulogun O, Oladokun R, Morhason-Bello IO, Bamgboye EA, Adewole IF, et al. Acceptability of child adoption as management option for infertility in Nigeria: Evidence from focus group discussions. Afr J Reprod Health 2009;13:79-91.  Back to cited text no. 18
Nwobodo EI, Isah YA. Knowledge, attitude and practice of child adoption among infertile female patients in Sokoto north-west Nigeria. Niger Postgrad Med J 2011;18:272-5.  Back to cited text no. 19
Avidime S, Ameh N, Adesiyun AG, Ozed-Williams C, Isaac N, Aliyu Y, et al. Knowledge and attitude towards child adoption among women in Zaria, northern Nigeria. Niger Med J 2013;54:261-4.  Back to cited text no. 20
[PUBMED]  Medknow Journal  
Balen R. "You can always adopt": What clinic staff need to know about adoption and fostering? Hum Fertil (Camb) 2013;16:13-6.  Back to cited text no. 21


  [Table 1], [Table 2], [Table 3], [Table 4]


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