Socioeconomic Status and Women’s Mental Health and Wellbeing in Male-Factor Infertility Marital Circumstances: A Scoping Review

Abstract

AbstractBackgroundInfertility is established where frequent intercourse and non-contraceptive use over 12 to 24-month periods do not result in live births. It is an underemphasized global public health challenge occurring mostly in countries with the highest fertility rates. Infertility can be female- or male-factor-based, combined, unexplained, or impaired. Fertility research emphasizes socio-cultural beliefs, patriarchy, insufficient distinctions between masculinity and virility, etc., as impacting women’s mental health and wellbeing. Conversely, research, policies, and interventions underemphasize the male-factor as central to reproduction. This is counter-productive for their female counterparts in the reproductive equation and contributes to gaps in reproductive health literature. Male-factor infertility, a sensitive, long-neglected public health issue caused by genetic and environmental factors, constitutes 20% of infertility cases globally. The biopsychosocial impacts of childlessness on women in male-factor infertility circumstances are almost equally deleterious across social groups and regions.ObjectiveTo present a scoping review of evidence on the extent to which reproductive health literature recognizes socioeconomic status as central to women’s mental health and wellbeing in male-factor infertility circumstances.MethodsLiterature was mapped across five databases (MedlinePlus, Google Scholar, PubMed, ScienceDirect and Publons Web of Science) without restrictions to geographical regions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist-2018 was the review protocol.Results12 out of 2582 screened articles met the eligibility criteria. The impacts of childlessness on women in male-factor infertility circumstances are similar across regions, but aggravated by socioeconomic circumstances, particularly in low- and middle-income countries (LMICs) and societies that emphasize childbearing. Women with relatively high socioeconomic statuses and access to New/Assisted Reproduction Technologies (NRTs/ARTs) enjoy better mental health and wellbeing.Discussion/ConclusionThe Social Determinants of Health (SDHs) provided the analytical framework. The socioeconomic status influences the quality of the women’s overall wellbeing in male-factor infertility circumstances, with implications for access to and affordability of New/Assisted Reproduction Technologies (NRTs/ARTs) and other related male-factor infertility treatment options. The deleterious impacts are more for those who are unable to afford the fertility treatments. Asides this socioeconomic context of infertility, a politico-legal context exacerbates the suffering of women in male-factor infertility circumstances, through policy gaps that exist in the provision of interventions to cater to the needs of socioeconomically disadvantaged women.