Advancing Understanding and Measurement of Infertility, Related Fears and Stigma, and Associated Consequences in Low-Resource Countries

增进对资源匮乏国家不孕不育、相关恐惧和耻辱以及相关后果的理解和衡量

• 批准号: 10525916
• 负责人: Suzanne O'Dea Bell
• 金额: $ 13.72万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525916
• 关键词: Address; Adverse effects; Africa South of the Sahara; Area; Award; Behavior; Child; Communities; Contraceptive Agents; Contraceptive methods; Country; Couples; Development; Dimensions; Etiology; Exposure to; Fertility; Fertility Study; Focus Groups; Fright; Funding; Future; Goals; Grant; Health; Health behavior; Hospitals; Human; Individual; Infertility; Infertility study; Intervention; Interview; Knowledge; Literature; Location; Longitudinal Studies; Marriage; Measurement; Measures; Mentors; Mentorship; Methods; Modeling; Monitor; Names; National Institute of Child Health and Human Development; Outcome; Perception; Performance; Personal Satisfaction; Population; Poverty; Pregnancy; Prevalence; Prevention; Psychometrics; Qualitative Methods; Reproductive Health; Research; Research Personnel; Research Priority; Research Technics; Research Training; Resource-limited setting; Resources; Role; Sampling; Social Sciences; Social isolation; Suicide; Surveys; Techniques; Testing; Training; Training Activity; Uganda; Uncertainty; United States National Institutes of Health; Unsafe Sex; Variant; Woman; Women' s Health; Work; Writing; advanced analytics; adverse outcome; aged; base; care seeking; career; cognitive testing; emotional abuse; experience; health disparity; improved; indium arsenide; innovation; instrument; low and middle-income countries; low income country; men; motherhood; neglect; physical abuse; population based; prevent; programs; psychological distress; public health priorities; reproductive; secondary infertility; social stigma; unintended pregnancy

PROJECT SUMMARY Infertility – the inability to conceive a pregnancy within 1-2 years – causes intense psychological distress and other adverse outcomes for millions of women and men but remains understudied in low- and middle-income countries. Infertility research is particularly limited in sub-Saharan Africa (SSA), despite findings suggesting SSA has among the highest levels of infertility globally, especially secondary infertility (the inability to conceive a second or higher-order pregnancy within 1-2 years). Infertility estimates in SSA range widely from 2-31% de- pending on location, population, definitions, and assessment method; the broad range of estimates highlights the need for further research to evaluate model assumptions. Besides uncertainty about the extent of infertility, we lack an understanding of the mechanisms contributing to adverse outcomes. Women experiencing the “ag- ony of infertility” are often blamed, causing physical and emotional abuse, marriage instability, poverty, social isolation, psychological distress, and even suicide. These impacts may be exacerbated by fears of infertility and perceived community-level infertility stigma, which have negative impacts on women’s health, health be- haviors, and care seeking. However, existing research on these phenomena are limited. The objective of this training grant is to conduct mentored research to address these knowledge gaps by improving the field’s un- derstanding of infertility levels, stigma, and fears in SSA. This work leverages Performance Monitoring for Ac- tion (PMA) in Uganda, an ongoing, longitudinal study of reproductive aged (15-49) women. I will work with my mentors to achieve three specific aims: 1) Improve population-level infertility prevalence estimation by evaluat- ing infertility measurement model assumptions in Uganda; 2) Understand Ugandan women’s and men’s per- ceptions, fears, and experiences of infertility and its related stigma, and; 3) Identify dimensions of infertility stigma and fear among women in Uganda. Results have implications for both population-based measurement of infertility prevalence and our understanding of infertility stigma and fear, which can inform interventions to reduce them and their impacts on health and well-being. The corresponding training objectives that will enable me to complete the proposed research include various training activities and mentorship in: 1) advanced ana- lytic techniques for the measurement of infertility; 2) qualitative methods; 3) psychometric research techniques; 4) infertility etiologies and relevant conceptual frameworks, and; 5) NIH-grant writing. The proposed research will lay the groundwork for submitting a competitive R01 application in year 4 proposing a mixed-methods lon- gitudinal study of infertility, related stigma and fear, and their impacts in SSA. The complementary research and training will move me toward my long-term goal to become an independent investigator using interdiscipli- nary, mixed-methods approaches to improve the scientific understanding of health disparities in fertility-related behaviors (both fertility prevention and promotion) and outcomes in low-resource settings.

项目概要 不孕症——1-2年内无法怀孕——会导致强烈的心理困扰和 对数百万妇女和男子的其他不利后果，但在低收入和中等收入国家中仍未得到充分研究 尽管研究结果表明，撒哈拉以南非洲地区的不孕不育研究尤其有限。 SSA 是全球不孕率最高的国家之一，尤其是继发性不孕症（无法怀孕） 1-2 年内第二次或更高次怀孕) SSA 的不孕症估计范围广泛为 2-31%。 取决于地点、人口、定义和评估方法； 除了不孕程度的不确定性之外，还需要进一步研究来评估模型假设。 我们对导致不良后果的妇女的机制缺乏了解。 “不孕症的唯一原因”经常被指责，导致身体和精神虐待、婚姻不稳定、贫困、社会 对不孕不育的恐惧可能会加剧孤立、心理困扰，甚至自杀。 以及社区层面的不孕不育耻辱感，这对妇女的健康、健康状况产生负面影响 然而，现有对这些现象的研究是有限的。 培训补助金的目的是进行指导性研究，通过改善该领域的联合国来解决这些知识差距 了解 SSA 中的不孕水平、耻辱感和恐惧。这项工作利用了行为监测。 乌干达的一项持续的纵向研究（PMA），针对育龄妇女（15-49 岁），我将与我一起工作。 指导者实现三个具体目标：1）通过评估改善人口水平的不孕不育患病率估计 了解乌干达不孕不育测量模型的假设；2) 了解乌干达女性和男性的生育情况； 对不孕症及其相关耻辱的接受、恐惧和经历，以及 3) 确定不孕症的维度； 乌干达妇女的耻辱和恐惧结果对基于人口的测量产生了影响。 不孕症患病率以及我们对不孕症耻辱和恐惧的理解，这可以为干预措施提供信息 减少它们及其对健康和福祉的影响 相应的培训目标将实现。 我完成拟议的研究包括各种培训活动和指导：1）高级分析 测量不孕症的溶解技术；2) 定性方法；3) 心理测量研究技术； 4) 不孕症病因和相关概念框架；5) NIH 拨款写作。 将为在第 4 年提交竞争性 R01 申请奠定基础，提出混合方法长期 不孕不育、相关耻辱和恐惧及其对 SSA 的影响的纵向研究 补充研究。 培训将使我朝着我的长期目标迈进，成为一名利用跨学科的独立调查员 提高对生育相关健康差异的科学认识的多种混合方法 资源匮乏环境中的行为（预防和促进生育）和结果。