Infertility in Ghana

It has the following objectives: to identify the categories of people utilizing low tech, medical herbalists and high tech fertility treatments, to understand the motivations behind their treatment seeking, to understand what determines their treatment choice as well as the contestations that exist between couples and other actors over treatment choices and how they are resolved. In addition, the study explored the processes that respondents follow in seeking treatment and reported on the social, religious and cultural context surrounding the use of ARTs as evidenced in respondents’ ways of navigating around components of ART treatment. The respondents for the study were purposively selected from three sites namely a private herbal clinic, a government hospital and a private orthodox fertility clinic which utilises Assisted Reproductive Technologies (i.e. IVF, ICSI etc). These clinics are located in the capital, Accra. Based on qualitative in-depth interview data obtained through convenience sampling of 45 respondents and nine key informants, the study noted the following: infertile men and women continue to desire to become biological parents based on both societal considerations and personal desires. Specifically, factors such as marital security, children as social security and for purposes of inheritance and social status were at play. In addition, although the health seeking behaviour of respondents was influenced by both kin and non-kin actors, some respondents showed a degree of autonomy in the final decision taken regarding treatment. Explanations provided for the cause of infertility by both respondents and their friends and relatives led them to seek treatment from either the biomedical or spiritual healer. However, where such treatment options were unfavourable and/or did not achieve the desired results, some respondents moved from herbal treatment to orthodox treatment and vice versa. In addition, they intensified their efforts at obtaining healing by complementing biomedical healing with spiritual healing. Finally, respondents accessing ART treatment were found to select aspects of the treatment procedure that created the least forms of dissonance for them based on socio-cultural, religious and personal considerations. The use of these technologies were not seen as conflicting with religious beliefs as in most cases, respondents drew on religion to explain treatment successes and failures. The study therefore recommends, amongst other things, that medical herbalism should be developed due to the continued reliance on herbal treatment. Some infertility treatments should also be considered for incorporation into the National Health Insurance scheme to improve access and reduce the burden of infertility. People also need to be well informed about treatment options while reducing the negative effects of media advertising.

本研究的目标如下：明确使用低技术生育手段、寻求草药医师诊疗服务以及接受高技术生育治疗的人群类别，了解其就医的动机，明晰影响其治疗选择的因素，同时探究夫妻与其他主体在治疗选择上的争议及其解决路径。此外，本研究还探讨了受访对象的就医流程，并围绕辅助生殖技术（Assisted Reproductive Technologies，以下简称ART）的使用场景展开分析，通过受访对象应对辅助生殖治疗各环节的方式，呈现其背后的社会、宗教与文化语境。

本研究的受访对象通过目的抽样从三处场所选取：分别是一家私人草药诊所、一家公立医院，以及一家运用辅助生殖技术（即IVF、ICSI等）的私人正统生育诊所。上述诊所均位于首都阿克拉。

本研究基于通过便利抽样获取的45名受访对象与9名关键信息提供者的定性深度访谈数据，得出以下结论：不孕不育男女仍基于社会考量与个人意愿，渴望成为亲生父母。具体而言，婚姻保障、子女作为社会保障、遗产继承与社会地位提升等因素均发挥着作用。

此外，尽管受访对象的就医行为受亲属与非亲属群体的双重影响，但部分受访者在治疗决策的最终环节展现出一定自主性。受访对象及其亲友对不孕成因的解释，促使他们选择向生物医学从业者或精神治疗师寻求治疗。然而，当这些治疗方案效果不佳或未达预期时，部分受访者会从草药治疗转向正统医学治疗，反之亦然。此外，他们会结合精神治疗与生物医学治疗，以强化疗愈效果。

最后，研究发现接受辅助生殖技术（ART）治疗的受访者，会基于社会文化、宗教与个人考量，选择对自身认知冲突最小的治疗流程环节。多数情况下，受访者会借助宗教来解释治疗的成败，因此这类技术的使用并未被视为与宗教信仰相悖。

因此，本研究提出多项建议，其中包括：鉴于民众对草药治疗的持续依赖，应推动传统草药医疗的发展；应考虑将部分不孕不育治疗项目纳入国民健康保险计划，以提升治疗可及性并减轻不孕不育带来的负担；同时，需向民众充分普及各类治疗方案的相关知识，并削弱媒体广告带来的负面影响。