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Chido Rwafa-Madzvamutse
Mental Health

As discussed in previous articles mental health is defined as a state of well-being in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to their community.

The wish to have a child and procreate is an innate desire for many of us.

Having children can also be a family and social expectation that can weigh heavily on a couple struggling to conceive. Challenges with fertility or the inability to have children can therefore have a negative impact on our mental wellbeing.

What is infertility and how can it affect our mental wellbeing?

Infertility is the biological inability of a person to contribute to conception or the inability of a couple to achieve pregnancy after at least 1 year of trying to do so without using any means of birth control.

It is estimated that 8–12 percent of couples worldwide experience infertility.

Studies show that 40 percent of infertility challenges may be linked to the male, 40 percent may be linked to the female and 20 percent involve both parties or are due to unknown causes. However, it is often women who are blamed for issues of infertility in many families and cultures.

Infertility and the treatments to try and address it can cause much psychological, emotional and social distress.

Psychological challenges linked to infertility include:

l A sense of failure: we often think that having a baby is something within our control and when we try to conceive repeatedly and are unsuccessful we may start to feel like we have failed. Repeated failed attempts at treatment can worsen these thoughts of ‘I am a failure’.

l Low self-esteem and loss of self-confidence: Not being able to conceive and have children like what their age mates, colleagues and other acquaintances are doing can make a couple struggling with infertility lose their self-confidence and struggle with low self-esteem.

l Psychological turmoil: the infertility can become a constant pre-occupation and can result on mental turmoil. Infertility is often a problem we cannot solve by ourselves and this can lead to a sense of powerlessness. Couples are often frequently asked about their challenges conceiving by family, friends and even complete strangers and this can take its toll on the mind. Again the rising expectation and then dashed hopes with each attempt at conception or fertility treatment can result in waves of helplessness and hopelessness.

Emotional challenges that can occur with infertility include:

l Anxiety and fear: couples may struggle with the constant fear that they will never be able to conceive. There may be fear associated with how the community perceives them and constantly being criticised.

l Grief: the loss of what could have been, or the repeated disappointment from failed attempts at conception, failed attempts at treatment or repeated miscarriages can result in grief and mourning. Miscarriages and stillbirths are often not publicly acknowledged losses and this further complicates the grieving process.

l Guilt: may also be part of the complex mix of emotions. Individuals may blame themselves for the infertility and feel guilty about their role in the challenge.

l Anger: When struggling with infertility one may feel angry, angry at themselves, their spouse, their family, the treatment teams trying to help them even strangers who seem to conceive so easily.

l Depression: Infertility can lead to deep sadness, loss of motivation and drive and mental and physical exhaustion.

Socially, couples struggling with infertility may experience:

l Social and cultural pressure: having children is almost always expected in African communities. Families and communities can put undue pressure on a couple to have a child. Families and communities may constantly ask when a couple will have a child and may lay blame on one of the partners causing unnecessary conflict between the couples or between the families

l Social isolation: This may be from being excluded from social events which involve families with children or from self-isolation to avoid constantly being questioned about the fertility challenges.

l Financial challenges: from costs incurred from investigating the fertility challenges and from fertility treatments which are often very costly.

l Separation and divorce: couples struggling with infertility are three times more likely to separate or get divorced. The pressure of not being able to conceive, blaming each other, the involvement of families, infidelity that is often linked with trying to prove one’s fertility can all result in breakdown of the relationship.

How can I cope with infertility?

1. Acknowledge the mental distress that infertility is causing. This requires emotional awareness and emotional vulnerability. Avoid bottling up difficult emotions, find trusted people or professional counsellors to share your pain with. Receiving counselling as a couple is almost always recommended to help couples navigate the emotional, psychological and social challenges that fertility challenges can bring.
2. Build a support network around you: stay connected with supportive family members and friends. Try not to isolate yourself.
3. Continue to have a strong vision for your life and work towards your goals: infertility can sometimes derail our life plans and conceiving can eclipse all other dreams we had in life. It is crucial to maintain hope and a sense of purpose beyond the ability to have a child.
4. Reach out for help if you need it. If you feel the stress, worry and anxiety linked to the fertility challenges is now affecting your ability to function, work productively and contribute meaningfully, please reach out to your nearest health care provider for help.

l Association of Healthcare Funders of Zimbabwe (AHFoZ) article written by: Dr Chido Rwafa, consultant psychiatrist.

Feedback: Dr Chido Rwafa-Madzvamutse +263714987729) (AHFoZ www.ahfoz.org ; [email protected])