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.

项目摘要 不孕症 - 无法在1 - 2年内怀孕的怀孕 - 造成严重的心理困扰和 数以百万计的男女的其他不利结果，但在低收入和中等收入中仍然被理解 国家。在撒哈拉以南非洲（SSA）的目的地调查结果表明，不育研究受到特别限制 SSA在全球不育的最高水平之一，尤其是次要不育（无法概念上的不育 1 - 2年内的第二次或高阶怀孕）。 SSA的不孕估计值范围为2-31％ 等待地点，人口，定义和评估方法；广泛的估计突出显示 需要进一步研究以评估模型假设的需求。除了对不育程度的不确定性外， 我们缺乏对导致不利结果的机制的理解。妇女经历了“ ag- 不孕的人通常被指责，导致身体和情感虐待，婚姻不稳定，贫穷，社会 孤立，心理困扰，甚至自杀。这些影响可能会因不孕症的恐惧而加剧 以及感知的社区水平不孕症的污名，这对妇女的健康有负面影响 大教堂和寻求护理。但是，对这些现象的现有研究是有限的。这个目的 培训赠款是通过改善该领域的不及 SSA中不育水平，污名和恐惧的贫困。这项工作利用绩效监控进行ac- 乌干达的Tion（PMA），这是一项持续的，持续的生殖老化（15-49岁）妇女的研究。我会和我的 指导者实现三个具体目标：1）通过评估改善人口水平的不育患病率估计 - 乌干达的不孕测量模型假设； 2）了解乌干达妇女和男子 引用不育及其相关污名的引用，恐惧和经历，以及； 3）确定不育的维度 乌干达妇女的污名和恐惧。结果对两个基于人群的测量都有影响 关于不孕症的患病率以及我们对不育污名和恐惧的理解，这可以为干预措施告知 减少它们及其对健康和福祉的影响。相应的培训目标将启用 我要完成拟议的研究包括：1）高级ANA- 测量不育症的裂解技术； 2）定性方法； 3）心理测量研究技术； 4）不孕病和相关的概念框架，以及； 5）NIH授予写作。拟议的研究 将在第4年提交竞争性R01申请的基础上提出混合方法 对不育症，相关污名和恐惧及其对SSA的影响的宗教研究。完整的研究 培训将使我朝着我的长期目标迈向使用跨学科的独立调查员 Nary，混合方法的方法，以提高对生育有关的健康分布的科学理解 在低资源环境中的行为（预防和促进）和结果。