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

项目总结 不孕症--不能在1-2年内怀孕--会导致强烈的心理痛苦和 对数百万女性和男性的其他不良后果，但在中低收入人群中仍未得到充分研究 国家。不孕症研究在撒哈拉以南非洲(SSA)尤其有限，尽管研究结果表明 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 在1-2年内第二次或更高级别怀孕)。SSA对不孕症的估计范围从2%到31%不等。 在地点、人口、定义和评估方法方面悬而未决；广泛的估计范围突出了 需要进一步的研究来评估模型假设。除了不确定不孕不育的程度外， 我们对造成不利结果的机制缺乏了解。女性经历了“农业-- 不孕不育“经常被指责，导致身体和精神上的虐待、婚姻不稳定、贫困、社会 与世隔绝，心理痛苦，甚至自杀。对不孕不育的恐惧可能会加剧这些影响 和被认为是社区一级的不孕不育耻辱，这对妇女的健康有负面影响，健康应该是- 行为举止和寻求关怀。然而，现有的关于这些现象的研究是有限的。这样做的目的是 培训补助金是进行有指导的研究，通过改善该领域的联合国系统来解决这些知识差距。 了解SSA中的不孕不育水平、耻辱和恐惧。这项工作利用了性能监控的AC- 在乌干达，对育龄妇女(15-49岁)进行了一项持续的纵向研究。我会用我的 指导人员实现三个具体目标：1)通过评估以下各项来改善人口水平的不孕不育患病率估计- 乌干达不孕不育症测量模型假设；2)了解乌干达女性和男性的 不孕不育的概念、恐惧和经历及其相关的耻辱；3)确定不孕不育的各个方面 乌干达妇女中的耻辱和恐惧。结果对两种基于人口的测量都有影响 不孕不育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。相应的培训目标将使 我要完成的拟议研究包括各种培训活动和指导：1)高级分析- 不孕症的检测技术：2)定性方法；3)心理测量学研究技术； 4)不孕不育的病因和相关的概念框架，以及5)NIH-补助金的撰写。拟议的研究 将为在第四年提交竞争性R01申请奠定基础，提出长期混合方法- 不孕症、相关的耻辱和恐惧及其在SSA中的影响的纵向研究。互补性研究 培训将使我朝着我的长期目标前进，成为一名使用跨学科的独立调查员- 改进对与生育有关的健康差距的科学理解的任何混合方法 低资源环境下的行为(包括生育预防和促进生育)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.