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

项目摘要 不孕症-无法在1-2年内怀孕-导致强烈的心理困扰， 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仍然研究不足 国家不孕症研究在撒哈拉以南非洲（SSA）特别有限，尽管研究结果表明， 撒哈拉以南非洲是全球不孕症发病率最高的地区之一，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）。撒哈拉以南非洲的不孕症估计数从2%至31%不等， 待定的位置，人口，定义和评估方法;广泛的估计强调 需要进一步研究以评估模型假设。除了不孕症程度的不确定性， 我们对造成不利结果的机制缺乏了解。女性经历了“ag- 不孕不育”往往受到指责，造成身体和精神虐待，婚姻不稳定，贫困，社会 孤独，心理压力，甚至自杀。这些影响可能会因对不孕的恐惧而加剧 和社区一级的不孕症耻辱感，这对妇女的健康有负面影响， 照顾者和寻求。然而，现有的研究对这些现象是有限的。的目的 培训补助金将用于开展有指导的研究，通过改善外地的联合国系统， 了解SSA的不孕水平、耻辱和恐惧。这项工作利用性能监测， 乌干达的一项正在进行的育龄妇女（15-49岁）纵向研究。我将与我的 导师，以实现三个具体目标：1）改善人口水平的不孕症患病率估计的评估， 在乌干达的不孕不育测量模型假设; 2）了解乌干达妇女和男子的每- 对不孕症及其相关耻辱的看法、恐惧和经历; 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和 不孕症患病率和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， 我完成拟议的研究，包括各种培训活动和指导：1）高级ana- 不孕症测量的裂解技术; 2）定性方法; 3）心理测量研究技术; 4)不孕症病因学和相关的概念框架，和; 5）NIH资助的写作。拟议研究 将为在第4年提交具有竞争力的R 01申请奠定基础，提出混合方法， 对不育症、相关耻辱和恐惧及其在撒哈拉以南非洲的影响的研究。补充研究 和培训将推动我走向我的长期目标，成为一个独立的调查员使用跨学科- 采用单一的混合方法，提高对生育相关健康差异的科学认识 在低资源环境下的行为（预防和促进生育）和结果。

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.