Involuntary childlessness : an interpretive phenomenological inquiry into couples' experiences of infertility treatment in the South African public health sector

Abstract

Involuntary childlessness presents an array of far reaching challenges for couples who reside in pronatalistic developing countries. Whilst the literature recognises the diverse difficulties that infertility can present, South African research that centres on the couple system’s experiences of fertility treatment is scant and dated. The goal of my study was to closely explore couples’ joint fertility treatment experiences by providing an opportunity for couples to share their experiences and at the same time for them to make sense of their fertility treatment experiences, the results of which were utilised to establish guidelines for healthcare professionals working in this context. The Reproductive and Endocrine Unit (REU) at the Steve Biko Academic Hospital (SBAH) provided the public healthcare context for sourcing participants for this study. Embracing an Interpretative Phenomenological Analysis (IPA) approach afforded me the opportunity to conduct semi-structured interviews with eight couples over an eight-month period, analysis of which assisted me in gaining an in-depth, experience-near understanding of couples’ joint fertility treatment experiences. The main findings: Participants’ drew on their experiences of private and public healthcare fertility treatment as well as their interpersonal, social, amd spiritual contextual experiences in making sense of their fertility treatment experiences in the public health sector. Couples’ private healthcare experiences were shaped by the unaffordablity and overall disappointment in this treatment option while their public healthcare treatment encounters in contrast were shaped by comprehensive, conversational, informative and facilitative service experiences. Transcending the boundaries of participants’ contextual treatment experiences, couples portrayed their experiences as being further shaped by their interpersonal experiences of their partner as well as their joint coupleship experiences during treatment. Couples experienced treatment as an all-consuming, intrusive process, invading their time, space and thoughts. Although four of the eight couples terminated their fertility treatment due to their inability to financially sustain it, participants shared that the challenges of fertility treatment extended beyond the boundaries of affordability, as it introduced the treated body as a problematic adjunct to their couple relationship. The emotional processes sketched by the couples were etched with emotional highs and lows, which required couples to cope and activate coping strategies in the face of the treatment challenges they faced. Furthermore, couples expressed how their social contexts such as family, friendships, work, community and spirituality shaped their treatment experiences in intricate ways and how this either enabled or inhibited couples to cope during their treatment processes. Taken as a whole, the findings of my study portray fertility treatment experiences as a process rather than a single event (or series of events), which requires the couple to adjust. The implications of these findings are that in planning interventions with couples receiving treatment, healthcare practitioners should consider integrating bio-psycho-social-spiritual elements into the supportive work they do with couples who are receiving fertility treatment.