The Silent Suffering: Psychological and Social Impact on Pakistani Women Facing Male-Factor Infertility

Abstract

Objective: To evaluate the psychological burden of male factor infertility on Pakistani women and their lived experience of stigma, family pressure, marital issues and coping strategies.

Methodology: The selected tertiary care hospitals in Islamabad and Rawalpindi, Pakistan, included the gynecology and obstetrics departments, which were included in the cross-sectional convergent mixed method study from January to June 2024. Through purposive sampling 120 female (20-45 years) subjects were selected whose husbands had a clinically diagnosed condition of male infertility. Sociodemographic questions were asked and quantitative data were collected by means of the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Infertility Stigma Scale (ISS). The twenty respondents were selected for in-depth semi-structured interviews in a purposive sampling. Descriptive statistics, independent-samples t tests, and one-way analysis of variance were used for quantitative data analysis, and for qualitative, the thematic analysis was used.

Results: The 120 participants had moderate-to-extremely severe depressive symptoms 75.8% of the time, moderate-to-extremely severe anxiety 79.2% of the time, and moderate-to-extremely severe stress 55.0% of the time. Social experiences involved, were: blame for not being able to conceive, even though the male factor was known (80.8%), refusal by in-laws to accept the husband's diagnosis (54.2%), threats of the husband's remarriage (36.7%) and domestic/emotional abuse (29.2%). The mean depression score and mean stress score was higher in the case of the women of joint families as compared to the nuclear families (p=0.021 and p=0.006 respectively). Housewives had higher anxiety scores than employed women (p=0.047). Four themes from the qualitative analysis emerged, guilt by association, fear of disclosure, social isolation, and desire for autonomy.

Conclusion: For women with male factor infertility, the psychological burden and social stigma can be significant, even though they are not to blame for the cause of the infertility. This burden can be exacerbated by gendered expectations, family structure, and fear of disclosure. Including gender sensitive counselling, psychological support and public awareness for male infertility in fertility services can decrease the stigma and be a step towards shared reproductive responsibility.

Keywords: Male-factor infertility, Infertility stigma, Psychological distress, Women, Pakistan, DASS-21, Reproductive health.