Most fertile couple should get pregnant within a year of their marriage with regular unprotected sexual intercourse. Infertility is an important public health problem in many parts of Africa because of its increasing prevalence which ranges from 10% – 20%, in sub-Saharan Africa and its serious societal implications. Child adoption that may be used as an alternative treatment for infertility is not fully explored and added to the management schedule of infertility. The study assessed the knowledge, attitude, and practice of child adoption among infertile couples who attend the infertility clinic (Human Reproduction Research Programme) in University of Benin Teaching Hospital Benin City, Edo State. A descriptive cross-sectional study was used in this study, with a sample of 200 respondents that were selected using the simple random technique. Data were collected using the researcher administered the semi-structured questionnaire and were analyzed using descriptive statistical analysis and presented on tables using frequency counts, percentages, and bar charts. Findings showed that almost all the respondents 194 (97%) were within the age group of 20-49, and 174 (87%) participants were females. Of the 174 female respondents, 112 (64.4%) had been pregnant before (thus had secondary infertility). Few respondents, 21 (10.5%) had good knowledge of infertility while 12 respondents (6%) had good knowledge of child adoption and only 6 respondents (3%) had a good attitude towards child adoption. Conclusively, the result of this study confirms that though some of the respondents are aware of infertility and child adoption, they were less knowledgeable about these issues. The predominant practice of the respondents was that of child fostering, not child adoption as the majority of the respondents had a poor attitude towards child adoption. The government has a significant function in the enlightenment of the masses to combat the negative impact of infertility on the population.
Keywords: Knowledge, Attitude, Practice, Child Adoption, Infertile Couples.
1.1 Background to the Study
Parenthood is a fundamental human need and an essential part of life and the urge to procreate is virtually universal. Most human beings have a desire to become a parent and look after his or her own child. The very desire to becoming a parent is a step in the direction of creating a family. Having children in many cultures is important and not having children is considered a personal tragedy and a curse which may impact on the entire family and even the community (Dyer, 2007). The African society cherish procreation and the woman’s place in marriage remains unstable until she is able to bear children. In most society, a wife has to establish her womanhood through childbearing while the husband has to confirm his manhood in the same way. Children are seen as wealth, pride and strength for the family, with a man’s fortune and power being equated to his descendants (Ezugwu, 2012). In developing countries, where motherhood is so much valued, couples who do not have children face so much problems such as open ostracism, divorce, social stigma, isolation and mental distress (Rutstein, 2014, Aina, 2007, and Ameh, Kene,Onuh, Okohue, Umeorah & Anozie, 2007).
Adoption is the process of legally placing a child with a parent or parents other than those to whom they were born. Adoption under family Law has a restricted meaning, notwithstanding this fact, various authors and legal writers have defined the word “Adoption” in various ways. Sections 12 and 39 of the Adoption Act of 1976 define Adoption thus: “Adoption is the process whereby a court of law irreversibly stops the legal ties between a child and the natural parents or guardians and creates counterpart ties between the child and the-adopters”. Accordingly, adoption is to stop the child’s Legal rights and duties towards his biological parents and the substitution of such rights and duties towards his foster parents (Larry and Chukwu, 2012). Adoption could be open or closed. Open adoption allows identifying information and communication to be between adoptive and biological parents and there is interaction between them. Closed adoption bars all identifying information from being shared between the adoptive parents and the biological (Omosun and Kofoworola, 2011).
It is natural for everyone to have the urge to bear children and it is considered a basic human need so as to continue the existence of the human species (Abubakar, et al 2013). Most fertile couples (90%) should achieve pregnancy within a year of regular unprotected intercourse, and this rises (to 95%) over a period of two years (Padma, 2008). Fertility or the ability to produce children has a positive social value, whereas infertility has a negative value in Africa (Padma, 2008). There is no definition of infertility that is universal, but generally a couple is considered infertile when they are not able to achieve pregnancy after at least twelve months of regular unprotected sexual activity (Sumer.et al, 2011). Infertility can be primary or secondary. The World Health Organization (WHO), using a two-year reference period, defines primary as not been able to conceive despite living together and been exposed to regular unprotected sexual intercourse. Secondary infertility is defined as the failure to conceive after a previous pregnancy (in the absence of family planning and breastfeeding) (Waldenstrom, 2008).
Infertility is a medical problem and also a social problem in our society as most customs see and equate it with as failure on the part of the couple. It is important that everyone has adequate knowledge about infertility so that couples can seek timely medical intervention and most misconceptions corrected (Sumer.et al, 2011). In general, women are seen as virtually the cause of infertility while the men are blameless and so the women are disgraced, isolated, mocked, snubbed and ridiculed. Such humiliations make most women go to varying lengths to get children such as a visit to the hospitals, native doctors such as herbalists and traditionalists’ healers, churches and prayer houses in search of children and solution. Some will go to baby factories buy babies (following a pretense of being pregnant) not caring about the source of the babies. Some will engage in secret extramarital relationships (Ezugwu, 2012). Those who can afford ART go for it but it is very expensive and have a low success rate and if all these fail some may go for adoption (Ezugwu, 2012). Adoption gives infertile couples happiness and also help the adopted children to receive appropriate care from their adopted parents which most of them would have been deprived of.
This study examined the knowledge, attitude and practice of child adoption among infertile couples attending infertility clinic in UBTH in other to know their attitude and how they feel about the practice as an alternative form of infertility management. Parents and couples need to know about adoption as a recommended alternative form of infertility management and also carry out attitude to this knowledge in order to accept these practices following ethical guidelines and the law.
1.2 Statement of the Problem
The National Population Commission (NPC) in Nigeria and the Nigeria Demographic and Health Survey in (2008), stated that the current fertility rate in Nigeria is about 5.7% which is relatively high. However, infertility still affects 20% of Nigerians and is of public health concerns (Oladokun, et. al 2012). Infertility does not affect the physical health of people in the general population but it does impact strongly on the psychological and social well?being of couples (Dimkpa, 2010). Infertility is a source of distress for the couple and they are also exposed to social, psychological, and cultural problems and marriage instability especially in the African culture which places a high premium on childbearing as a societal norm (Forti, 2008). This can lead to the risk of losing their partner, separation and depression (Ameh, et.al. 2007). Owing to the misconception associated with infertility, the women folk bear most of the burden and are often subjected to psychological torture and physical violence (Oladokun, et. al 2012). Family and society look down on couples who are not able to bear children within a reasonable period of time following marriage. Another reason for much importance being attached to the social aspect of infertility is that family name will not be carried forward without a child, especially a male child (Padma, 2008).
As much as children bring joy to parents, their absence also cause conflict in homes. It is an established fact that the importance of children in a marriage and home cannot be overemphasized as their presence means a lot to the parents and guardians. (Padma, 2008). Child adoption serves as a coping mechanism to infertile couples and brings succor to the affected couples but this alternative treatment option has not been fully explored and embraced as a management schedule of infertility (Omosun and Kofoworola, 2011). The overall stability of marriages and the family and solving some of these problems can be through proper health awareness about child adoption as an alternative measure of infertility management. The marginalization and the unfair treatment of childless couples in the society has been a point of concern to the researcher, the physical, psychological, social, cultural and economic problems and marriage instability faced by the infertile couples and also this researcher observation and interaction during her clinical posting at the infertility clinic in UBTH with infertile couples, observed that most of the patients do not have good knowledge about child adoption. It was also observed that a study of this nature has not been conducted in Edo state. These gave the idea to the researcher to explore the knowledge of infertile couples in Benin City on child adoption and their attitude towards the acceptability of child adoption, it will also assess their practice of child adoption as an alternative method of infertility management.
1.3 Significance of the Study
The significance of child adoption among infertile couples cannot be overemphasized as infertility which is a public health problem affecting married couples has the potential to cause breakup in marriage especially in Africa where child birth is a yardstick for marital success (Dimkpa,2010). Also, marriage without children is stressful for couples as there are lots of pressures from members of the family encouraging the husband to marry another because the woman is seen as the cause of the problem (Dimkpa,2010).
Infertile couples are exposed to social, psychological, emotional stress and cultural problems which affect women greatly because they are generally blamed for infertility in many developing countries (Omosun & Kofoworola, 2011) and this may lead to marriage instability which can lead to the risk of losing their partner, separation, and depression.
The significance of this study is that it will create awareness among infertile couples about child adoption and will help to reduce and prevent the breakup in marriages and also help to solve the overall stability of marriages and the family through proper health awareness about child adoption as an alternative measure to infertility management especially for families having psychological and emotional problems. (Dimkpa,2010). Also, the findings from this study will serve as a useful instrument to know about infertile couple’s awareness and a guide for improving their attitude towards child adoption. It will help to identify circumstances influencing attitudes to adoption that will help uncover instruments that can make its general acceptability easy. Furthermore, the process of medical investigations and management for the couple makes the situation worse as there are limited treatment options which are very expensive with low success rates. While receiving these high cost managements the couple believes that there would be a solution and if it does not happen it leads to feelings of helplessness and powerlessness (Abubakar, et al 2013). While some couples succeed with the treatments, others who do not get confused and wonders if becoming a parent is simply not their destiny but the will of God. In African societies, where having children is a must in marriage and a child-free lifestyle is forbidden, many infertile couples are left with the option of child adoption. Although there are advanced facilities to provide successful treatment to many infertile couples, it is certain that not all of them will bear children and these ones would be in extreme need to find ways to cope with infertility. A study carried out by Omosun and Kofoworola in 2011 shows that adoption is one of the coping mechanism and that couples who adopt grieve less about the challenges and have better emotional support than their peers. The study will also give an insight that limited studies have only been conducted in this region on child adoption as an alternative treatment option to provide background information and interventions to promote its acceptability (Omosun and Kofoworola, 2011).
The study will also make recommendations to appropriate authorities on adoption laws as there is no uniform child adoption law in Nigeria despite the Child Rights Act that was enacted in 2003 by the National Assembly which provides for child adoption (Omosun and Kofoworola, 2011).
1.4 Broad Objectives
The aim of this study was to assess the knowledge, attitude, and practice of child adoption among infertile couples attending infertility clinic in University of Benin Teaching Hospitals in Edo State.
1.5 Specific Objectives
1. Assess the knowledge of infertile couples regarding child adoption.
2. Assess the attitude of the clients towards child adoption
3. Determine the level of practice of child adoption among infertile couples
4. Identify the factors that will influence the practice of child adoption among infertile couples.
1.6 Research Questions
1. What is the level of knowledge of child adoption among infertile couples in UBTH?
2. What is the attitude of infertile couples towards child adoption?
3. What is the level of practice of child adoption?
4. What are the possible factors that would affect the practice of child adoption?
1.7 Null Hypotheses
1. There is no significant association between knowledge and practice of child adoption among infertile couples attending HRRP clinic in University of Benin Teaching Hospital.
2. There is no significant association between attitude and practice of child adoption among infertile couples attending HRRP clinic in University of Benin Teaching Hospital.
1.8 Scope of the Study
The scope of this study was delimited to include all infertile couples attending HRRP, UBTH, Edo state, and it focuses mainly on knowledge, attitude and practice of child adoption.
1.9 Operational Definition of Terms
Adoption: the process of placing a child under the parental care of a person who is not the biological parents by law.
Attitude: refers to the opinion or way of thinking of couples regarding child adoption.
Infertile Couple: Two people who are married and are unable to get pregnant after 24months of regular unprotected sexual intercourse without contraception.
Fertility clinic: is a medical establishment or a department of a hospital run by several specialists working in co-operation and Sharing the same facilities and providing treatment for couples and clients who have expressed the desire to achieve pregnancy in all situations of barrenness or infertility of both primary and secondary origin, and Lesbians, Bisexual, Gay and Transgender (LBGT).
Infertility: this refers to the inability of a couple to get pregnant after one year of regular unprotected sexual intercourse without contraception.
Knowledge: it refers to the awareness, fact or experiences known by a couple about child adoption and able to answer the questions correctly.
Practice: It means an action or ways of adoption.