A qualitative scoping review of the psychosocial aspects of infertility among women across Africa

A qualitative scoping review of the psychosocial aspects of infertility among women across Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review A qualitative scoping review of the psychosocial aspects of infertility among women across Africa Katrina Ihebunezie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7919224/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Infertility is defined as a disease of the reproductive system, characterised by the inability to conceive after 12 months of regular, unprotected sexual intercourse. While psychosocial research on infertility is widespread across Africa, focused examinations within specific national contexts remain limited. This scoping review maps the psychosocial research on infertility conducted in Ghana between 2000 and 2025. Searches were conducted across nine academic databases and grey literature sources. Studies were included if they were published in English and reported original qualitative findings from Ghanaian women diagnosed with primary or secondary infertility. 476 studies at the title and abstract stage from a total of 493 identified in the database search were found and screening resulted in 10 articles being included in the scoping review. Most of the studies (40%) were conducted in Accra. The psychosocial aspects explored included quality of life, stigma, mental health, treatment-seeking behaviours and sociocultural and religious influences on infertility experiences. This review provides a comprehensive overview of existing psychosocial research on infertility among Ghanaian women and highlights key gaps for future study, particularly in relation to long-term support and intervention development. Patient Experience Infert* Africa Europe Ethnic* Mental* Qualitative Review Health-Seeking Behaviour Assisted Reproductive Technology IVF Figures Figure 1 Lay Summary This review looked at published research on the psychological and social experiences of men and women seeking infertility treatment in Ghana between 2000 and 2025. Out of 493 articles initially identified, only 10 met the criteria to be included in this review. Most of the studies were conducted in Accra and the northern regions of Ghana, where the psychological and social impact of infertility was most explored. Common research topics included quality of life, barriers to accessing fertility treatment, stigma and attitudes surrounding infertility and the influence of social, cultural and religious beliefs. This review helps show where research on the psychological and social aspects of infertility in Ghana is taking place, what issues are being studied and what areas still need more attention Background Infertility is defined as a disease of the reproductive system and a failure to conceive after 12 months of regular unprotected sexual intercourse, is a significant global health issue [1, 2, 3]. The World Health Organisation (WHO) estimates that 1.9% of women aged 20–44 years, equating to roughly 20 million couples, are affected by primary infertility worldwide [4]. Moreover, a study involving 47 demographic and health surveys across developing countries suggests that 186 million ever-married women of reproductive age (15–49) suffer from either primary or secondary infertility [5, 6]. While infertility is a global concern, it disproportionately affects couples in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA), where infertility rates can range from 30–40% [6]. In SSA, infertility is often a highly stigmatised issue, compounded by limited access to fertility treatment options [6, 7]. The lack of fertility clinics and medical interventions in many resource-poor countries is frequently justified by concerns about population control, healthcare limitations and the competing burden of life-threatening diseases [8, 9]. Despite this, infertility’s impact on women is profound and multifaceted, influencing not only their personal identity but also their social networks, marital stability and economic well-being [7;10–15]. Psychosocial research has documented the significant effects of infertility on mental health, including anxiety and depression, as well as its repercussions on social relationships. Women, in particular, face intense emotional distress due to societal pressure to conceive, with infertility often resulting in marital discord, financial strain, and in some cases, divorce [16–19]. Empirical evidence also suggests the amalgamation of precarity and multiple social traumas in patients with complex co-morbidities may cause or exacerbate existing psychological and physical illnesses [19–24]. As infertility in SSA is commonly perceived as a woman's problem, even though male infertility is equally significant in many cases, women often bear the brunt of the blame, regardless of its cause and it is this social stigma that exacerbates their emotional distress [7;20–21, 25–29]. Though the psychosocial implications of infertility have been explored in different regions, the focus on SSA remains underdeveloped. Existing studies are largely concentrated in Southern and Central Africa, leaving a significant gap in understanding the unique psychosocial experiences of women in West African countries, such as Ghana. Given the rich cultural, social and economic diversity within SSA, there is an urgent need to explore the psychosocial impact of infertility across different regions of West Africa, particularly in Ghana, where infertility intersects with cultural traditions, religious beliefs and societal expectations [30–32]. This scoping review aims to comprehensively map the qualitative studies on the psychosocial aspects of infertility among women in Ghana, providing insights into the emotional, social and economic experiences of these women, as well as identifying gaps in the literature that require further exploration. Method Since no comprehensive reviews have been conducted in this area, a scoping review was deemed the most appropriate approach. Scoping reviews are particularly useful for mapping broad areas of research, especially when a topic is under-explored or lacks cohesion. By collating all available literature, scoping reviews help identify emerging themes, trends and knowledge gaps. This scoping review follows established guidelines for scoping review methodology [33] and will include a range of study designs, prioritising qualitative research to gain in-depth insights into women’s lived experiences [34]. Search strategy A comprehensive search was conducted across multiple academic databases, including CINAHL, Cochrane Library, Google Scholar, PsycINFO, PubMed, Scopus, Web of Science and ProQuest. Key fertility journals were also consulted. The following search terms were used to capture relevant studies: Concept 1: Terms related to infertility: Infertility* OR childless* OR Assisted reproduction OR ART OR MAR OR Secondary infertility. Concept 2: Terms related to psychosocial aspects: cultural OR religion OR spiritual OR stigma OR psychosocial OR counselling OR mental health OR family OR maternal needs OR paternal needs OR tradition OR depression OR psycholog* OR "well being" OR wellbeing OR beliefs* OR feeling* Concept 3: Africa. Additionally, grey literature, such as unpublished theses and reports, were included, as well as emails to researchers in the field for unpublished or peer-reviewed studies. The search was conducted from August to October 2025, ensuring that the most recent research was captured. The inclusion criteria included: studies reported in English between 2000 and 2025; primary qualitative studies (including interviews, grounded theory, phenomenology, focus groups, participant observation and ethnography); women diagnosed with primary or secondary infertility, aged 18 years or older. Quantitative studies (including randomised controlled trials, interventional and surveys) and reviews were excluded. Studies that did not present original data such as review articles were also excluded to maintain a clear focus on in-depth, narrative accounts from participants but their list of references were searched for original research studies that met inclusion criteria. Conference abstracts were also excluded because they provide insufficient details of methodology. Study selection 476 studies at the title and abstract stage from a total of 493 identified in the search were screened and 17 duplicates were detected and removed. Of these, 40 were reviewed at the full text stage and a further 24 excluded, leaving a total of 16 included studies. The most common reason for excluding studies at the full text stage included study country, a lack of clarity related to nationality, religion or race of the participants as well as being a systematic review or article. After reviewing reference lists, 51 additional records were identified through hand searches. A total of 10 studies were deemed suitable for this scoping review [30;35;36;37;38;39;40;41;42;43]. Data extraction Data from each study were systematically extracted, focusing on study design, participant demographics (e.g., number, age and infertility status), context (e.g., location, cultural and social context) and the psychosocial findings. A data extraction form was used to ensure consistency and accuracy and the information was imported into a Microsoft Word document for analysis. Charting the data and reporting the findings Following thematic synthesis, the reviewer read the full-text versions of the 10 articles and charted the data [56]. The data were charted using a charting form. The comprehensiveness of the form was evaluated before the consistency of data extraction was compared. The charting form was deemed appropriate and no changes were made to the chart. Data extraction appeared consistent. Author then summarised the data, as reported in the next section. Results This section outlines the country of study, sample size, research design, summary of findings and an overview of thematic areas relevant to the scoping review. The selection process, including search results and reasons for exclusion at each stage, is presented in a PRISMA flow diagram (Fig. 1 ). Ten studies were identified in this review, which are referred to by first author and year of publication (Table 1 and Supplementary File 1). The reviewed studies represented diverse populations across Ghana, including four conducted in Accra, two spanning the North-East and Ashanti regions, two in the Upper West Region, one in southern Ghana as well as one in Northern Ghana. Table 1 Characteristics of included studies Author(s) Region, Country Methods of data collection Participants and Recruitment Focus of study Age (years) A) Qualitative phenomenological 1. Ofosu-Budu D, Hanninen V 2020 [37] The North-East and Ashanti regions of Ghana In-depth interviews with infertile women (n = 30) A snowball technique was used to recruit participants through local herbalists who gave names and addresses of women. Some women provided the names of others with similar problems in the vicinity • Examining the consequences of infertility on infertile women • 19–43 2. Ofosu-Budu D, Hanninen V 2020 [36] The North-East and Ashanti regions of Ghana In-depth interviews with infertile women (n = 30) A snowball technique was used to recruit participants through local herbalists who gave names and addresses of women. Some women provided the names of others with similar problems in the vicinity • Examining the consequences of infertility on infertile women • 19–43 B) Qualitative descriptive 3. Tabong PT, Adongo PB 2013 [38] Upper West Regions, Ghana In-depth interviews with: (i) Childless couples (n = 15): 15 men and 18 women (ii) Couples with children (n = 45) (iii) One key informant interview with gynaecologists, religious scholars/leaders, traditional medical practitioners, experts of infertility-related insurance policies (n = 8) Three focus groups with: (i) Women who were childless (ii) Women with children Men and women A snowball technique was used to recruit infertile couples through community health volunteers who provided the names and addresses of infertile couples • Experiences of infertility • Range: Males (35–63) and Females (28–52) 4. Kyei et al. 2021 [42] Accra, Ghana Interviews with men (n = 6) and women (n = 12) seeking assisted fertilisation using interview guides (semi-structured interview) Purposive sampling was used to select respondents recruited from five fertility centres who had either primary or secondary infertility and were seeking treatment • Beliefs about children and psychosocial consequences of infertility • Men: 31–50 and women: 31–55 5. Okantey et al. 2021 [39] Southern Ghana In-depth iterviews with participants who had accessed ART (n = 16), nurses (n = 2) and gynaecologists (n = 2) Participants were recruited from two health facilities in an urban community in Southern Ghana using purposive sampling • Sociocultural factors infertility and barriers to accessing ART • 36–51 6. Tabong PT, Adongo PB 2013 [35] Upper West Region, Ghana In-depth interviews with childless married couples: Men (n = 15) and women (n = 18) Focus groups for childless women and community members. Key informant interviews with two gynaecologists, two religious leaders/scholars, two traditional medical practitioners, two experts of infertility-related insurance policies (n = 2) Couples were recruited from rural and urban regions where they lived After interviewing childless couples, a snowball technique was used to recruit more participants in the same community. Couples with children were purposely selected and interviewed • Meaning of infertility and perception of childbearing and childlessness • Not reported 7. Donker et al. 2017 [40] Greater Accra region of Ghana In-depth interviews with women (n = 18) seeking infertility treatment. Recruited from two hospitals in Accra recruited with the help of the matron in charge and selected based on the purpose of the study • Psychological experiences associated with infertility • 27–42 8. Fledderjohann 2012 [30] Accra, Ghana Semi-structured interviews with women seeking treatment from four health clinics with an emphasis on gynaecology and obstetrics outpatients (n = 107) • Mental health, marital instability, social interaction and gendered experiences of infertility • 21–48 9. Nachinab et al. 2019 [41] Northern Ghana In-depth interviews with infertile women recruited from a mission hospital in Northern Ghana (n = 15) Participants were purposively recruited • Exploration of the barriers to child adoption experienced among infertile women • 24–40 10. Asante-Afari et al. 2022 [43] Accra and Kumasi, Ghana Semi-structured interviews with women women that were recruited from Lister Hospital and Fertility Centre, Tema Women’s Hospital, Ruma Fertility and Specialist Hospital, Trustcare Specialist Hospital as well as Finney Hospital and Fertility Centre (n = 40). Participants were purposively recruite • Exploration of the experiences of women who have delivered following the use of assisted reproductive technology in Ghana • 30–50+ The primary method of data collection across the studies was in-depth interviews [35;36;37;38;39;40;41], with some studies also employing focus groups and key informant interviews [35;38]. Three studies utilised semi-structured interviews [30;42;43]. The studies spanned different time periods: three studies were conducted between 2001 and 2015 [30;35;38] and seven were conducted between 2016 and 2025 [36;37;39;40;41;42;43]. All studies explored infertility primarily from the perspectives of women, though three included both men and women [35;42] and three also involved clinicians, religious scholars, traditional and allopathic medical practitioners and infertility-related insurance experts [35;38;39]. Each study addressed various psychosocial and sociocultural dimensions of infertility. All ten examined broader societal perceptions of female infertility and included discussions on social support. Three studies explored male infertility [35, 38, 42] and three addressed community perceptions of infertility [30, 35, 38]. In addition, three studies considered infertility in the context of assisted reproductive technologies (ART) [30, 39, 43] and three examined health-seeking behaviours among infertile individuals [35, 37, 38]. Six studies explored the impact of infertility on marital relationships [30, 35, 36, 38, 42, 43] and three examined the role of polygamy [30, 35, 36]. Holistic management of infertility was addressed in two studies [35, 37], while three discussed religious beliefs surrounding infertility [35, 37, 43] and one study examined perceived barriers to adoption as an alternative path to parenthood [41]. The studies consistently showed that individual needs and sociocultural expectations significantly shaped the desire to have children in Ghana. Children are often seen as a symbol of achievement, marital success, family lineage and security in old age [42], while also fulfilling religious duties and social obligations [35;38;39;42]. Infertility is not just the inability to conceive; it can also involve the inability to bear a male child or fulfil the socially expected minimum number of children [35;41]. The findings also revealed that infertility has profound psychosocial implications for individuals, particularly in the context of Ghanaian family and community life. Six studies reported on the psychological effects of infertility on women, with frequent descriptions of sadness, stress, anxiety, loneliness, frustration and depression resulting from their condition [30;36;37;38;40;42]. Women in Accra also reported extreme depression, with some contemplating suicide [42]. In the Upper West Region, where childbearing is highly valued as a symbol of success, the psychological distress associated with infertility was notably intensified [35]. Throughout regions like Accra, Upper West, North-East and Ashanti, women described enduring feelings of embarrassment and a sense of lost identity, often suffering emotionally for years as they sought treatment and grappled with the fear of a childless future [35;36;40;42]. The cultural taboo surrounding infertility further compounded these emotional burdens, as it inhibited open discussion and created a sense of isolation for many women [35;36;40;42]. Stigma and sociocultural perceptions of infertility were significant sources of distress. Cultural and patriarchal norms often placed the burden of infertility solely on women, who faced harsher social scrutiny than men [30;35;36;37;38;39;40;41;42;43]. This gendered experience may have prompted the more agentive approach that women used to seek treatment options compared to men [35]. Studies in Accra and the Upper West regions highlighted men’s reluctance to pursue infertility diagnoses from orthodox medical practitioners, reinforcing the gendered framing of infertility [30;35;38]. With regards to marital relations, respondents in eight studies frequently described living in fear of social isolation, experiencing reduced libido, facing financial strain, enduring marital instability, being exposed to polygamy as well as increased HIV risk, intimate partner violence and divorce [30;35;36;38;40;41;42;43]. Childless Ghanaian women in polygamous marriages reported being maltreated and feeling less financial support from both their in-laws and husbands, particularly those whose other wives has conceived [36;37;40;43]. These women described feelings of resentment, anger and diminished self-worth. One study found that despite the societal stigma associated with infertility, some women chose to remain in unfulfilling marriages due to fears of intensified community stigmatisation following divorce [36]. However, not all marital outcomes were negative, some women described receiving emotional and financial support from their husbands and in-laws [36;43]. Financial security, higher educational attainment and the ability to access biomedical treatment appeared to buffer the adverse impacts of infertility on marriage [36;43]. Conversely, economic constraints often confined women to traditional healing pathways, which in turn exposed them to further emotional distress and social judgment [36]. Interestingly, none of the women across studies reported that male partners feared losing their relationships due to infertility. Nonetheless, several studies highlighted the emotional burden male infertility placed on men, particularly in terms of diminished and impaired sexual performance [30;35;36;38;40;41;42]. Additionally, familial pressures, particularly from husbands’ relatives were commonly reported across six studies [36;37;38;41;42;43]. Nine studies revealed that women were frequently mocked and labelled as “failures" [36;38;40;43], accused of witchcraft or being cursed [35;39;40;43] or blamed for their infertility based on alleged past promiscuity [35;37;39]. In contrast, men were rarely subjected to equivalent scrutiny. Many women concealed their partner’s infertility diagnoses to protect their husbands from stigma or emasculation and in some cases, even engaged in extramarital relationships in attempts to conceive [30;35;43]. Notably, a study in the North-East and Ashanti regions reported that some men voluntarily disclosed their infertility to reduce pressure on their wives [36]. Sociocultural and religious beliefs played a significant role in shaping perceptions and misconceptions surrounding infertility. Across the reviewed studies, infertility was often attributed to spiritual or supernatural causes, such as divine punishment or the absence of blessings from God [35;37;39;40;43], witchcraft [35;37] or ancestral wrath [35;39]. In addition, women frequently faced accusations of having had previous abortions or overusing contraceptives [35;37;39;42], contracting sexually transmitted infections [35], or engaging in adultery [35;39] from their communities. These behaviours were commonly believed to provoke ancestral curses, further reinforcing blame and stigma [35;38;39]. Notably, one study found that urban participants were more likely to identify natural or medical causes of infertility, whereas rural participants were more inclined to attribute the condition to social or spiritual explanations [35]. Cultural perceptions severely impacted the social identity of infertile individuals, particularly in rural communities. Four studies indicated that infertile couples were excluded from leadership roles and prohibited from participating in fertility-related rituals [30;35;38;39]. For instance, in the Upper West region, infertile individuals were subjected to what they perceived as shameful burial rituals and denied full social recognition [35]. A study in the North-East and Ashanti regions revealed that regardless of a woman’s societal contributions, she was often perceived as “useless” unless she had children [36]. Conversely, women who successfully conceived through ART were often accorded higher social status than their childless peers [43]. Moreover, ART not only helped alleviate symptoms of anxiety and depression but also fosters a sense of happiness, which strengthened and consolidated these women’s status within their families and communities [43]. Regional differences in socioeconomic status influenced access to support and treatment pathways. Studies from southern Ghana, where participants were often gainfully employed, showed that women received more support from spouses and exhibited greater agency in seeking biomedical care [36;37]. In contrast, women in northern Ghana, often with lower socioeconomic status, were more reliant on traditional healers and had limited treatment options [36;37]. One study noted that wealthier couples experienced less pressure to conceive due to their economic role in supporting extended family [38]. These findings demonstrate the intersectional impacts of infertility on psychosocial wellbeing across different economic and geographic settings. The findings highlight the complex and multifaceted nature of infertility in Ghana, especially with respect to the psychosocial and cultural factors influencing the experiences of women. As the studies show, infertility is not only a medical issue but also a deeply ingrained social, spiritual and emotional challenge. The lack of formal psychosocial counselling reflects the scarcity of structured mental health support for infertile individuals, particularly in rural and underserved areas. Women, in particular, rely heavily on informal networks, drawing from family, friends, neighbours, colleagues, religious leaders and traditional healers, albeit with varying degrees of success [36;37;38;39;42;43]. In northern Ghana, spiritual and religious support plays a prominent role in coping with infertility [35;37;38]. Some women expressed a preference for traditional healers, appreciating their perceived ability to maintain confidentiality [38]. However, others reported feeling vulnerable to sexual and financial exploitation by these individuals, which may have compounded the emotional distress they were already experiencing due to infertility [38]. Privacy concerns were also a major issue, as many women avoided biomedical clinics that openly advertised infertility services, fearing it would make their infertility struggles a public matter [38]. Furthermore, due to the lack of recognition of biological causes of infertility in some communities, medical treatment was often delayed or avoided altogether [38]. Despite these challenges, all studies noted that women did eventually seek biomedical support for infertility [35;37;39;43]. However, a study indicated that notable barriers exist that prevent many women in Ghana, from accessing formal healthcare [38;39]. The high costs associated with assisted reproductive technologies (ART), combined with the lack of insurance coverage for such services, particularly in rural regions like the Upper West, create financial hurdles [38;39]. This may lead women to rely on alternative treatments, often outside the biomedical framework, which can delay or prevent them from receiving effective medical care. Additionally, ART often posed religious, cultural and ethical dilemmas in certain communities, which led to discouragement from spouses and social circles, further complicating women's experiences with infertility treatment [39]. Five studies also highlighted varied individual coping strategies such as avoidance [36;38], building internal strength (e.g., confidence, acceptance) [38], engaging in extramarital relationships to conceive [38;41], abstinence [38;39],, fosterage [41], redirecting focus toward career or achievements [38] and migration [36] to alleviate the emotional burden of infertility [36;38;41]. In cases of male infertility, some women transferred reproductive responsibility to other men within the community, often through practices like seeking the help of a male relative or community member to father a child [38;41]. Six studies underscored the critical need for improved access to quality professional care and counselling for individuals experiencing infertility across both northern and southern Ghana [35;36;38;39;42;43]. Due to prevailing cultural taboos, infertility is rarely discussed publicly, which leads many individuals to rely on internal coping mechanisms rather than seeking professional psychological support. Limited resources in rural areas, along with the reluctance of male partners to attend biomedical health facilities, preferring instead to consult traditional medical practitioners, further compound the problem, as emphasised in a study conducted in the Upper West Region [35]. In response to these challenges, several studies recommended the integration of empathic care approaches that involve both traditional and orthodox medical practitioners, recognising the emotional and cultural vulnerability of patients [35;38]. Strengthening inter-practitioner referral systems was also suggested, with the aim of addressing both biological and etiological causes of infertility in a more holistic manner. At the policy level, there is a clear need for national governments to prioritise infertility as a significant public health concern. This includes promoting public awareness to dispel myths and stigma, as well as implementing fertility insurance schemes to improve access to reproductive healthcare services [37;38;39;41;43]. One study raised concerns about the dependency on donors for infertility treatment and the issue’s neglect by both national governments and international agencies, which often prioritise family planning initiatives over infertility care [39]. The usage of donor eggs and sperm, particularly sperm, was deemed largely unacceptable among participants due to perceived sexual connotations [39]. Taken together, these findings suggest that a multi-sectoral and holistic approach, one that incorporates social, spiritual, economic and political dimensions, is essential for meaningfully addressing the psychosocial needs of individuals affected by infertility in Ghana. Discussion The purpose of this scoping review was to map the psychosocial research on infertility conducted in Ghana [33]. A total of 10 articles met the inclusion criteria. Included studies represented diverse populations across Accra (n = 4), North-East and Ashanti regions (n = 2), the Upper West Region (n = 2), southern Ghana (n = 1) as well as one in northern Ghana (n = 1). The articles cover a broad range of thematic areas including quality of life (QOL), documenting symptoms of depression and anxiety and highlighting broader aspects of psychological distress among patients seeking infertility treatment. Other themes included psychological experiences, reproductive and sexual health, relationships, stigma, knowledge and perceptions relating to ART as well as adoption and surrogacy. Other themes included access to care, health-seeking behaviours as well as the sociocultural and religious aspects of infertility. There is a robust body of literature focusing on the psychological sequelae of infertility and its sociocultural implications, which is seen in studies that report how women are treated by family members, in-laws and broader communities when they fail to conceive [7]. However, there is a noticeable gap in research conducted across more diverse cultural settings. Additionally, while several studies identify coping and support strategies, a significant need for long-term psychological and social support was also evident. Many respondents discussed persistent needs years after their initial diagnosis, suggesting that unresolved infertility can result in sustained emotional and social challenges. This underlines the necessity for longitudinal research that expands both the study population and the contextual focus. A notable gap identified in this review is the lack of research on the design and evaluation of psychological interventions for individuals experiencing infertility. Findings suggest that the current resilience-based model used in ART clinics does not sufficiently address the full scope of barriers to care. Moreover, the experience of accessing ART appears to differ between women of different ethnic backgrounds across Ghana [44]. Results from this review show that infertility’s impact extends beyond the individual to affect relationships, mood and financial stability. The WHO International Classification of Functioning, Disability and Health (WHO ICF) recognises the interplay of biological, psychological and social influences on health [45]. While the WHO ICF provides a useful framework for identifying the broader determinants of health, it does not fully capture the complexity of infertile women’s experiences in Ghana. The findings suggest that psychosocial factors, particularly those rooted in cultural and gendered expectations—should be integrated into treatment, research and policy design to better support infertile women, especially those pursuing ART. This review highlights that difficulties associated with infertility persist during and after ART treatment. Women struggle to come to terms with their diagnosis and often experience profound loss of social recognition, leading to deteriorating mental health. This is consistent with existing evidence indicating that access to and awareness of mental health services is limited and that counselling services offered at fertility clinics are often inadequate and not patient-centred [46]. Patient-centred care has been shown to relieve the emotional burden of infertility, which is associated with poorer QoL, heightened anxiety and depression, outcomes that African women are at significantly higher risk of developing [7;47;48;49–53]. As participants in all reviewed studies reported reduced social support from their families and communities due to childlessness, the emotional and psychological support offered at treatment centres is especially important for Ghanaian women [37;47;49]. Although every effort was made to locate studies relevant for this review, I concede that publications may have been overlooked. As I aimed to provide an overview of published literature in the field, I did not conduct a quality assessment of articles included in this review. However, articles in predatory journals or those that were not peer-reviewed were excluded. Conclusion In summary, only 10 studies have been published over the past 25 years on the psychosocial aspects of infertility in Ghana. The reviewed studies represented diverse populations across Ghana, including four in Accra, two spanning the North-East and Ashanti regions, two in the Upper West Region, one in southern Ghana as well as one in northern Ghana. Despite the richness of qualitative data on sociocultural and psychological experiences, there remains a significant gap in intervention-focused research. The findings underscore the urgent need for further psychosocial research, particularly the development and evaluation of psychosocial interventions, to support individuals experiencing infertility in Ghana. Declarations Consent for publication Not applicable as this is a review. Ethics approval and consent to participate Not applicable as this is a review. Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files] Competing interests Not applicable as this is a review. Funding Not applicable as this is a review Authors’ contributions KI synthesised the data critically reviewed, discussed and finalised the submitted manuscript and (will) contribute to all revisions. Author agrees to be accountable for the work and to investigate and resolve any issues related to the accuracy or integrity of the work. 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BMC Res Notes 2017;10(1) Naab F, Kwashie AA. ‘I don’t experience any insults, but my wife does’: The concerns of men with infertility in Ghana. SAJOG 20018;24(2):45-48 Inhorn MC. ‘The worms Are weak.’ Male infertility and patriarchal paradoxes in Egypt. Men Masculinities 2003;5(3):236-256. https://doi.org/10.1177/1097184x02238525 Naab F. Every month becomes a funeral when they menstruate: African women’s beliefs about couple infertility. J Infertil Reprod Biol 2014;2(3):92-100 Nene UA, Coyaji K, Apte H. Infertility: A label of choice in the case of sexually dysfunctional couples. Patient Educ Couns 2005;59(3):234-238. https://doi.org/10.1016/j.pec.2005.08.005 Umezulike AC, Efetie ER. The psychological trauma of infertility in Nigeria. Int J Gynecol Obstet. 2004;84(2):178–80 Fledderjohann JJ. “Zero is not good for me”: implications of infertility in Ghana. Hum Reprod. 2012;27(5):1383–90 Gerrits T. Infertility and matrilineality: the exceptional case of the Macua of Mozambique. In: Inhorn M, van Balen F (eds). Infertility around the Globe: New Thinking on Childlessness, Gender and Reproductive Technologies. Berkeley, CA: University of California Press; 2002. p. 233 – 246 Turner B. The Statesman’s Yearbook. New York, NY: Palgrave Macmillan; 2006 Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8:19–32 Salie M, Roomaney R, Andipatin M, Volks C. Scoping review of the psychosocial aspects of infertility in developing countries: protocol. BMJ Open 2021;11:e044003. DOI:10.1136/bmjopen-2020-044003 Tabong PTN, Adongo PB. Understanding the social meaning of infertility and childbearing: a qualitative study of the perception of childbearing and childlessness in northern Ghana. PLoS One. 2013;8(1) Ofosu-Budu D, Hanninen V. Living as an infertile woman: the case of southern and northern Ghana. Reprod Health. 2020;17(1) Ofosu-Budu D, Hanninen V. Explanations for infertility: the case of women in rural Ghana. Afr J Reprod Health. 2021;25(4):142–52 Tabong PTN, Adongo PB. Infertility and childlessness: a qualitative study of the experiences of infertile couples in Northern Ghana. BMC Pregnancy Childbirth. 2013;13(1):72 Okantey GNO, Adomako EB, Baffour FD, Lim D. Sociocultural implications of infertility and challenges in accessing assisted reproductive technology: experiences of couples from two health facilities in southern Ghana. Marriage Fam Rev. 2021;57(5):375–96 Donkor ES, Naab F, Kussiwaah DY. “I am anxious and desperate”: psychological experiences of women with infertility in The Greater Accra. Region, Ghana. Fertil Res Pract. 2017;3:6. Nachinab GT enkawol, Donkor ES, Naab F. Perceived Barriers of Child Adoption: A Qualitative Study among Women with Infertility in Northern Ghana. Biomed Res Int. 2019;1–9 Kyei JM, Manu A, Kotoh AM, Adjei CA, Ankomah A. Beliefs about children and the psychosocial implications of infertility on individuals seeking assisted fertilization in Ghana. Reprod Biomed Soc Online. 2021;12:88–95 Asante-Afari K, Doku DT, Darteh EKM. Transition to motherhood following the use of assisted reproductive technologies: experiences of women in Ghana. PLoS One. 2022;17(4):1–13 Bailey A, Ellis-Caird HE, Croft C. Living through unsuccessful conception attempts: a grounded theory of resilience among women undergoing fertility treatment. Journal of Reproductive and Infant Psychology 2017;35(4):324-333, DOI:10.1080/02646838.2017.1320366 WHO. Towards a common language for Functioning, Disability and Health ICF. Geneva: World Health Organisation;2002 British Fertility Society (2020). In: British Fertility Society calls for better mental health care within the sector. 2002. https://www.britishfertilitysociety.org.uk/2020/01/09/british-fertility-society-calls-for-better-mental-health-care-within-the-sector/. Accessed 06 October 2025 Makanjuola A, Elegbede A, Abiodun O. Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria: original research. Afr J Psychiatry (Johannesbg). 2010;13(1):36–4 Kudesia R, Muyingo M, Shah M, Aderu D, ByaMugisha J, Klatsky PC. Quality of life and psychosocial impact of infertility in Uganda. Reprod. Sci. 2014;21(3):87A-87A. Fabamwo AO, Akinola OI. The understanding and acceptability of assisted reproductive technology (ART) among infertile women in urban Lagos, Nigeria. J Obstet Gynaecol (Lahore). 2013;33(1):71–4 Omokanye LO, Olatinwo AO, Durowade KA, Raji ST, Biliaminu SA, Salaudeen GA. Assisted reproduction technology: perceptions among infertile couples in Ilorin, Nigeria. Saudi J Health Sci. 2017;6(1):14 Bello FA, Akinajo OR, Olayemi O. In-vitro fertilization, gamete donation and surrogacy: perceptions of women attending an infertility clinic in Ibadan, Nigeria. Afr J Reprod Health. 2014;18(2):127–33 Ugwu EO, Odoh GU, Obi SN, Ezugwu FO. Acceptability of artificial donor insemination among infertile couples in Enugu, southeastern Nigeria. Int J Womens Health. 2014;6:201–4 Omosun AO, Kofoworola O. Knowledge, attitude and practice towards child adoption amongst women attending infertility clinics in Lagos State, Nigeria. Afr J Prim Health Care Fam Med. 2011;3(1) Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":33713,"visible":true,"origin":"","legend":"\u003cp\u003eProcess flow diagram\u003c/p\u003e\n\u003cp\u003eStudy selection flowchart (adapted from PRISMA 2009 flow diagram)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7919224/v1/b6e24eda4ec97e062da5fa47.png"},{"id":95313164,"identity":"605747fc-8b7d-4e0a-aecb-9eaaf546d1a0","added_by":"auto","created_at":"2025-11-06 15:51:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":613259,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7919224/v1/681c4b7d-f9de-4ec2-8f6e-dc9d1916e935.pdf"},{"id":94245985,"identity":"29c61d8d-9c2a-487f-a9bd-be2793a21640","added_by":"auto","created_at":"2025-10-24 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most explored.\u003c/p\u003e\n\u003cp\u003eCommon research topics included quality of life, barriers to accessing fertility treatment, stigma and attitudes surrounding infertility and the influence of social, cultural and religious beliefs.\u003c/p\u003e\n\u003cp\u003eThis review helps show where research on the psychological and social aspects of infertility in Ghana is taking place, what issues are being studied and what areas still need more attention\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eInfertility is defined as a disease of the reproductive system and a failure to conceive after 12 months of regular unprotected sexual intercourse, is a significant global health issue [1, 2, 3]. The World Health Organisation (WHO) estimates that 1.9% of women aged 20\u0026ndash;44 years, equating to roughly 20\u0026nbsp;million couples, are affected by primary infertility worldwide [4]. Moreover, a study involving 47 demographic and health surveys across developing countries suggests that 186\u0026nbsp;million ever-married women of reproductive age (15\u0026ndash;49) suffer from either primary or secondary infertility [5, 6]. While infertility is a global concern, it disproportionately affects couples in low- and middle-income countries, particularly those in Sub-Saharan Africa (SSA), where infertility rates can range from 30\u0026ndash;40% [6].\u003c/p\u003e\u003cp\u003eIn SSA, infertility is often a highly stigmatised issue, compounded by limited access to fertility treatment options [6, 7]. The lack of fertility clinics and medical interventions in many resource-poor countries is frequently justified by concerns about population control, healthcare limitations and the competing burden of life-threatening diseases [8, 9]. Despite this, infertility\u0026rsquo;s impact on women is profound and multifaceted, influencing not only their personal identity but also their social networks, marital stability and economic well-being [7;10\u0026ndash;15].\u003c/p\u003e\u003cp\u003ePsychosocial research has documented the significant effects of infertility on mental health, including anxiety and depression, as well as its repercussions on social relationships. Women, in particular, face intense emotional distress due to societal pressure to conceive, with infertility often resulting in marital discord, financial strain, and in some cases, divorce [16\u0026ndash;19]. Empirical evidence also suggests the amalgamation of precarity and multiple social traumas in patients with complex co-morbidities may cause or exacerbate existing psychological and physical illnesses [19\u0026ndash;24]. As infertility in SSA is commonly perceived as a woman's problem, even though male infertility is equally significant in many cases, women often bear the brunt of the blame, regardless of its cause and it is this social stigma that exacerbates their emotional distress [7;20\u0026ndash;21, 25\u0026ndash;29].\u003c/p\u003e\u003cp\u003eThough the psychosocial implications of infertility have been explored in different regions, the focus on SSA remains underdeveloped. Existing studies are largely concentrated in Southern and Central Africa, leaving a significant gap in understanding the unique psychosocial experiences of women in West African countries, such as Ghana. Given the rich cultural, social and economic diversity within SSA, there is an urgent need to explore the psychosocial impact of infertility across different regions of West Africa, particularly in Ghana, where infertility intersects with cultural traditions, religious beliefs and societal expectations [30\u0026ndash;32].\u003c/p\u003e\u003cp\u003eThis scoping review aims to comprehensively map the qualitative studies on the psychosocial aspects of infertility among women in Ghana, providing insights into the emotional, social and economic experiences of these women, as well as identifying gaps in the literature that require further exploration.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eSince no comprehensive reviews have been conducted in this area, a scoping review was deemed the most appropriate approach. Scoping reviews are particularly useful for mapping broad areas of research, especially when a topic is under-explored or lacks cohesion. By collating all available literature, scoping reviews help identify emerging themes, trends and knowledge gaps. This scoping review follows established guidelines for scoping review methodology [33] and will include a range of study designs, prioritising qualitative research to gain in-depth insights into women\u0026rsquo;s lived experiences [34].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSearch strategy\u003c/h2\u003e\u003cp\u003eA comprehensive search was conducted across multiple academic databases, including CINAHL, Cochrane Library, Google Scholar, PsycINFO, PubMed, Scopus, Web of Science and ProQuest. Key fertility journals were also consulted. The following search terms were used to capture relevant studies:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eConcept 1: Terms related to infertility: Infertility* OR childless* OR Assisted reproduction OR ART OR MAR OR Secondary infertility.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConcept 2: Terms related to psychosocial aspects: cultural OR religion OR spiritual OR stigma OR psychosocial OR counselling OR mental health OR family OR maternal needs OR paternal needs OR tradition OR depression OR psycholog* OR \"well being\" OR wellbeing OR beliefs* OR feeling*\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConcept 3: Africa.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAdditionally, grey literature, such as unpublished theses and reports, were included, as well as emails to researchers in the field for unpublished or peer-reviewed studies. The search was conducted from August to October 2025, ensuring that the most recent research was captured.\u003c/p\u003e\u003cp\u003eThe inclusion criteria included: studies reported in English between 2000 and 2025; primary qualitative studies (including interviews, grounded theory, phenomenology, focus groups, participant observation and ethnography); women diagnosed with primary or secondary infertility, aged 18 years or older. Quantitative studies (including randomised controlled trials, interventional and surveys) and reviews were excluded. Studies that did not present original data such as review articles were also excluded to maintain a clear focus on in-depth, narrative accounts from participants but their list of references were searched for original research studies that met inclusion criteria. Conference abstracts were also excluded because they provide insufficient details of methodology.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy selection\u003c/h3\u003e\n\u003cp\u003e476 studies at the title and abstract stage from a total of 493 identified in the search were screened and 17 duplicates were detected and removed. Of these, 40 were reviewed at the full text stage and a further 24 excluded, leaving a total of 16 included studies. The most common reason for excluding studies at the full text stage included study country, a lack of clarity related to nationality, religion or race of the participants as well as being a systematic review or article. After reviewing reference lists, 51 additional records were identified through hand searches. A total of 10 studies were deemed suitable for this scoping review [30;35;36;37;38;39;40;41;42;43].\u003c/p\u003e\n\u003ch3\u003eData extraction\u003c/h3\u003e\n\u003cp\u003eData from each study were systematically extracted, focusing on study design, participant demographics (e.g., number, age and infertility status), context (e.g., location, cultural and social context) and the psychosocial findings. A data extraction form was used to ensure consistency and accuracy and the information was imported into a Microsoft Word document for analysis.\u003c/p\u003e\n\u003ch3\u003eCharting the data and reporting the findings\u003c/h3\u003e\n\u003cp\u003eFollowing thematic synthesis, the reviewer read the full-text versions of the 10 articles and charted the data [56]. The data were charted using a charting form. The comprehensiveness of the form was evaluated before the consistency of data extraction was compared. The charting form was deemed appropriate and no changes were made to the chart. Data extraction appeared consistent. Author then summarised the data, as reported in the next section.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThis section outlines the country of study, sample size, research design, summary of findings and an overview of thematic areas relevant to the scoping review. The selection process, including search results and reasons for exclusion at each stage, is presented in a PRISMA flow diagram (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eTen studies were identified in this review, which are referred to by first author and year of publication (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Supplementary File 1). The reviewed studies represented diverse populations across Ghana, including four conducted in Accra, two spanning the North-East and Ashanti regions, two in the Upper West Region, one in southern Ghana as well as one in Northern Ghana.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of included studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(s)\u003c/p\u003e\u003cp\u003eRegion, Country\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMethods of data collection\u003c/p\u003e\u003cp\u003eParticipants and Recruitment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFocus of study\u003c/p\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA) Qualitative phenomenological\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Ofosu-Budu D, Hanninen V \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e [37]\u003c/p\u003e\u003cp\u003eThe North-East and Ashanti regions of Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with infertile women (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003cp\u003eA snowball technique was used to recruit participants through local herbalists who gave names and addresses of women. Some women provided the names of others with similar problems in the vicinity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Examining the consequences of infertility on infertile women\u003c/p\u003e\u003cp\u003e\u0026bull; 19\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Ofosu-Budu D, Hanninen V \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2020\u003c/span\u003e [36]\u003c/p\u003e\u003cp\u003eThe North-East and Ashanti regions of Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with infertile women (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003cp\u003eA snowball technique was used to recruit participants through local herbalists who gave names and addresses of women. Some women provided the names of others with similar problems in the vicinity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Examining the consequences of infertility on infertile women\u003c/p\u003e\u003cp\u003e\u0026bull; 19\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eB) Qualitative descriptive\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Tabong PT, Adongo PB 2013 [38]\u003c/p\u003e\u003cp\u003eUpper West Regions, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with:\u003c/p\u003e\u003cp\u003e(i) Childless couples (n\u0026thinsp;=\u0026thinsp;15): 15 men and 18 women\u003c/p\u003e\u003cp\u003e(ii) Couples with children (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\u003cp\u003e(iii) One key informant interview with gynaecologists, religious scholars/leaders, traditional medical practitioners, experts of infertility-related insurance policies (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003cp\u003eThree focus groups with:\u003c/p\u003e\u003cp\u003e(i) Women who were childless\u003c/p\u003e\u003cp\u003e(ii) Women with children\u003c/p\u003e\u003cp\u003eMen and women\u003c/p\u003e\u003cp\u003eA snowball technique was used to recruit infertile couples through community health volunteers who provided the names and addresses of infertile couples\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Experiences of infertility\u003c/p\u003e\u003cp\u003e\u0026bull; Range: Males (35\u0026ndash;63) and Females (28\u0026ndash;52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Kyei et al. \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2021\u003c/span\u003e [42]\u003c/p\u003e\u003cp\u003eAccra, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with men (n\u0026thinsp;=\u0026thinsp;6) and women (n\u0026thinsp;=\u0026thinsp;12) seeking assisted fertilisation using interview guides (semi-structured interview)\u003c/p\u003e\u003cp\u003ePurposive sampling was used to select respondents recruited from five fertility centres who had either primary or secondary infertility and were seeking treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Beliefs about children and psychosocial consequences of infertility\u003c/p\u003e\u003cp\u003e\u0026bull; Men: 31\u0026ndash;50 and women: 31\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Okantey et al. \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e [39]\u003c/p\u003e\u003cp\u003eSouthern Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth iterviews with participants who had accessed ART (n\u0026thinsp;=\u0026thinsp;16), nurses (n\u0026thinsp;=\u0026thinsp;2) and gynaecologists (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003cp\u003eParticipants were recruited from two health facilities in an urban community in Southern Ghana using purposive sampling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Sociocultural factors infertility and barriers to accessing ART\u003c/p\u003e\u003cp\u003e\u0026bull; 36\u0026ndash;51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Tabong PT, Adongo PB 2013 [35]\u003c/p\u003e\u003cp\u003eUpper West Region, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with childless married couples: Men (n\u0026thinsp;=\u0026thinsp;15) and women (n\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003cp\u003eFocus groups for childless women and community members.\u003c/p\u003e\u003cp\u003eKey informant interviews with two gynaecologists, two religious leaders/scholars, two traditional medical practitioners, two experts of infertility-related insurance policies (n\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003cp\u003eCouples were recruited from rural and urban regions where they lived\u003c/p\u003e\u003cp\u003eAfter interviewing childless couples, a snowball technique was used to recruit more participants in the same community. \u003c/p\u003e\u003cp\u003eCouples with children were purposely selected and interviewed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Meaning of infertility and perception of childbearing and childlessness\u003c/p\u003e\u003cp\u003e\u0026bull; Not reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. Donker et al. 2017 [40]\u003c/p\u003e\u003cp\u003eGreater Accra region of Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with women (n\u0026thinsp;=\u0026thinsp;18) seeking infertility treatment. Recruited from two hospitals in Accra recruited with the help of the matron in charge and selected based on the purpose of the study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Psychological experiences associated with infertility\u003c/p\u003e\u003cp\u003e\u0026bull; 27\u0026ndash;42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. Fledderjohann \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e [30]\u003c/p\u003e\u003cp\u003eAccra, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-structured interviews with women seeking treatment from four health clinics with an emphasis on gynaecology and obstetrics outpatients (n\u0026thinsp;=\u0026thinsp;107)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Mental health, marital instability, social interaction and gendered experiences of infertility\u003c/p\u003e\u003cp\u003e\u0026bull; 21\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9. Nachinab et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2019\u003c/span\u003e [41]\u003c/p\u003e\u003cp\u003eNorthern Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIn-depth interviews with infertile women recruited from a mission hospital in Northern Ghana (n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003cp\u003eParticipants were purposively recruited\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Exploration of the barriers to child adoption experienced among infertile women\u003c/p\u003e\u003cp\u003e\u0026bull; 24\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10. Asante-Afari et al. \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2022\u003c/span\u003e [43]\u003c/p\u003e\u003cp\u003eAccra and Kumasi, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSemi-structured interviews with women women that were recruited from Lister Hospital and Fertility Centre, Tema Women\u0026rsquo;s Hospital, Ruma Fertility and Specialist Hospital, Trustcare Specialist Hospital as well as Finney Hospital and Fertility Centre (n\u0026thinsp;=\u0026thinsp;40).\u003c/p\u003e\u003cp\u003eParticipants were purposively recruite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Exploration of the experiences of women who have delivered following the use of assisted reproductive technology in Ghana\u003c/p\u003e\u003cp\u003e\u0026bull; 30\u0026ndash;50+\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe primary method of data collection across the studies was in-depth interviews [35;36;37;38;39;40;41], with some studies also employing focus groups and key informant interviews [35;38]. Three studies utilised semi-structured interviews [30;42;43]. The studies spanned different time periods: three studies were conducted between 2001 and 2015 [30;35;38] and seven were conducted between 2016 and 2025 [36;37;39;40;41;42;43]. All studies explored infertility primarily from the perspectives of women, though three included both men and women [35;42] and three also involved clinicians, religious scholars, traditional and allopathic medical practitioners and infertility-related insurance experts [35;38;39].\u003c/p\u003e\u003cp\u003eEach study addressed various psychosocial and sociocultural dimensions of infertility. All ten examined broader societal perceptions of female infertility and included discussions on social support. Three studies explored male infertility [35, 38, 42] and three addressed community perceptions of infertility [30, 35, 38]. In addition, three studies considered infertility in the context of assisted reproductive technologies (ART) [30, 39, 43] and three examined health-seeking behaviours among infertile individuals [35, 37, 38]. Six studies explored the impact of infertility on marital relationships [30, 35, 36, 38, 42, 43] and three examined the role of polygamy [30, 35, 36]. Holistic management of infertility was addressed in two studies [35, 37], while three discussed religious beliefs surrounding infertility [35, 37, 43] and one study examined perceived barriers to adoption as an alternative path to parenthood [41].\u003c/p\u003e\u003cp\u003eThe studies consistently showed that individual needs and sociocultural expectations significantly shaped the desire to have children in Ghana. Children are often seen as a symbol of achievement, marital success, family lineage and security in old age [42], while also fulfilling religious duties and social obligations [35;38;39;42]. Infertility is not just the inability to conceive; it can also involve the inability to bear a male child or fulfil the socially expected minimum number of children [35;41].\u003c/p\u003e\u003cp\u003eThe findings also revealed that infertility has profound psychosocial implications for individuals, particularly in the context of Ghanaian family and community life. Six studies reported on the psychological effects of infertility on women, with frequent descriptions of sadness, stress, anxiety, loneliness, frustration and depression resulting from their condition [30;36;37;38;40;42]. Women in Accra also reported extreme depression, with some contemplating suicide [42]. In the Upper West Region, where childbearing is highly valued as a symbol of success, the psychological distress associated with infertility was notably intensified [35]. Throughout regions like Accra, Upper West, North-East and Ashanti, women described enduring feelings of embarrassment and a sense of lost identity, often suffering emotionally for years as they sought treatment and grappled with the fear of a childless future [35;36;40;42]. The cultural taboo surrounding infertility further compounded these emotional burdens, as it inhibited open discussion and created a sense of isolation for many women [35;36;40;42].\u003c/p\u003e\u003cp\u003eStigma and sociocultural perceptions of infertility were significant sources of distress. Cultural and patriarchal norms often placed the burden of infertility solely on women, who faced harsher social scrutiny than men [30;35;36;37;38;39;40;41;42;43]. This gendered experience may have prompted the more agentive approach that women used to seek treatment options compared to men [35]. Studies in Accra and the Upper West regions highlighted men\u0026rsquo;s reluctance to pursue infertility diagnoses from orthodox medical practitioners, reinforcing the gendered framing of infertility [30;35;38].\u003c/p\u003e\u003cp\u003eWith regards to marital relations, respondents in eight studies frequently described living in fear of social isolation, experiencing reduced libido, facing financial strain, enduring marital instability, being exposed to polygamy as well as increased HIV risk, intimate partner violence and divorce [30;35;36;38;40;41;42;43]. Childless Ghanaian women in polygamous marriages reported being maltreated and feeling less financial support from both their in-laws and husbands, particularly those whose other wives has conceived [36;37;40;43]. These women described feelings of resentment, anger and diminished self-worth.\u003c/p\u003e\u003cp\u003eOne study found that despite the societal stigma associated with infertility, some women chose to remain in unfulfilling marriages due to fears of intensified community stigmatisation following divorce [36]. However, not all marital outcomes were negative, some women described receiving emotional and financial support from their husbands and in-laws [36;43]. Financial security, higher educational attainment and the ability to access biomedical treatment appeared to buffer the adverse impacts of infertility on marriage [36;43]. Conversely, economic constraints often confined women to traditional healing pathways, which in turn exposed them to further emotional distress and social judgment [36].\u003c/p\u003e\u003cp\u003eInterestingly, none of the women across studies reported that male partners feared losing their relationships due to infertility. Nonetheless, several studies highlighted the emotional burden male infertility placed on men, particularly in terms of diminished and impaired sexual performance [30;35;36;38;40;41;42].\u003c/p\u003e\u003cp\u003eAdditionally, familial pressures, particularly from husbands\u0026rsquo; relatives were commonly reported across six studies [36;37;38;41;42;43]. Nine studies revealed that women were frequently mocked and labelled as \u0026ldquo;failures\" [36;38;40;43], accused of witchcraft or being cursed [35;39;40;43] or blamed for their infertility based on alleged past promiscuity [35;37;39]. In contrast, men were rarely subjected to equivalent scrutiny. Many women concealed their partner\u0026rsquo;s infertility diagnoses to protect their husbands from stigma or emasculation and in some cases, even engaged in extramarital relationships in attempts to conceive [30;35;43]. Notably, a study in the North-East and Ashanti regions reported that some men voluntarily disclosed their infertility to reduce pressure on their wives [36].\u003c/p\u003e\u003cp\u003eSociocultural and religious beliefs played a significant role in shaping perceptions and misconceptions surrounding infertility. Across the reviewed studies, infertility was often attributed to spiritual or supernatural causes, such as divine punishment or the absence of blessings from God [35;37;39;40;43], witchcraft [35;37] or ancestral wrath [35;39]. In addition, women frequently faced accusations of having had previous abortions or overusing contraceptives [35;37;39;42], contracting sexually transmitted infections [35], or engaging in adultery [35;39] from their communities. These behaviours were commonly believed to provoke ancestral curses, further reinforcing blame and stigma [35;38;39]. Notably, one study found that urban participants were more likely to identify natural or medical causes of infertility, whereas rural participants were more inclined to attribute the condition to social or spiritual explanations [35].\u003c/p\u003e\u003cp\u003eCultural perceptions severely impacted the social identity of infertile individuals, particularly in rural communities. Four studies indicated that infertile couples were excluded from leadership roles and prohibited from participating in fertility-related rituals [30;35;38;39]. For instance, in the Upper West region, infertile individuals were subjected to what they perceived as shameful burial rituals and denied full social recognition [35]. A study in the North-East and Ashanti regions revealed that regardless of a woman\u0026rsquo;s societal contributions, she was often perceived as \u0026ldquo;useless\u0026rdquo; unless she had children [36]. Conversely, women who successfully conceived through ART were often accorded higher social status than their childless peers [43]. Moreover, ART not only helped alleviate symptoms of anxiety and depression but also fosters a sense of happiness, which strengthened and consolidated these women\u0026rsquo;s status within their families and communities [43].\u003c/p\u003e\u003cp\u003eRegional differences in socioeconomic status influenced access to support and treatment pathways. Studies from southern Ghana, where participants were often gainfully employed, showed that women received more support from spouses and exhibited greater agency in seeking biomedical care [36;37]. In contrast, women in northern Ghana, often with lower socioeconomic status, were more reliant on traditional healers and had limited treatment options [36;37]. One study noted that wealthier couples experienced less pressure to conceive due to their economic role in supporting extended family [38]. These findings demonstrate the intersectional impacts of infertility on psychosocial wellbeing across different economic and geographic settings.\u003c/p\u003e\u003cp\u003eThe findings highlight the complex and multifaceted nature of infertility in Ghana, especially with respect to the psychosocial and cultural factors influencing the experiences of women. As the studies show, infertility is not only a medical issue but also a deeply ingrained social, spiritual and emotional challenge. The lack of formal psychosocial counselling reflects the scarcity of structured mental health support for infertile individuals, particularly in rural and underserved areas. Women, in particular, rely heavily on informal networks, drawing from family, friends, neighbours, colleagues, religious leaders and traditional healers, albeit with varying degrees of success [36;37;38;39;42;43]. In northern Ghana, spiritual and religious support plays a prominent role in coping with infertility [35;37;38]. Some women expressed a preference for traditional healers, appreciating their perceived ability to maintain confidentiality [38]. However, others reported feeling vulnerable to sexual and financial exploitation by these individuals, which may have compounded the emotional distress they were already experiencing due to infertility [38]. Privacy concerns were also a major issue, as many women avoided biomedical clinics that openly advertised infertility services, fearing it would make their infertility struggles a public matter [38]. Furthermore, due to the lack of recognition of biological causes of infertility in some communities, medical treatment was often delayed or avoided altogether [38].\u003c/p\u003e\u003cp\u003eDespite these challenges, all studies noted that women did eventually seek biomedical support for infertility [35;37;39;43]. However, a study indicated that notable barriers exist that prevent many women in Ghana, from accessing formal healthcare [38;39]. The high costs associated with assisted reproductive technologies (ART), combined with the lack of insurance coverage for such services, particularly in rural regions like the Upper West, create financial hurdles [38;39]. This may lead women to rely on alternative treatments, often outside the biomedical framework, which can delay or prevent them from receiving effective medical care. Additionally, ART often posed religious, cultural and ethical dilemmas in certain communities, which led to discouragement from spouses and social circles, further complicating women's experiences with infertility treatment [39].\u003c/p\u003e\u003cp\u003eFive studies also highlighted varied individual coping strategies such as avoidance [36;38], building internal strength (e.g., confidence, acceptance) [38], engaging in extramarital relationships to conceive [38;41], abstinence [38;39],, fosterage [41], redirecting focus toward career or achievements [38] and migration [36] to alleviate the emotional burden of infertility [36;38;41]. In cases of male infertility, some women transferred reproductive responsibility to other men within the community, often through practices like seeking the help of a male relative or community member to father a child [38;41].\u003c/p\u003e\u003cp\u003eSix studies underscored the critical need for improved access to quality professional care and counselling for individuals experiencing infertility across both northern and southern Ghana [35;36;38;39;42;43]. Due to prevailing cultural taboos, infertility is rarely discussed publicly, which leads many individuals to rely on internal coping mechanisms rather than seeking professional psychological support. Limited resources in rural areas, along with the reluctance of male partners to attend biomedical health facilities, preferring instead to consult traditional medical practitioners, further compound the problem, as emphasised in a study conducted in the Upper West Region [35].\u003c/p\u003e\u003cp\u003eIn response to these challenges, several studies recommended the integration of empathic care approaches that involve both traditional and orthodox medical practitioners, recognising the emotional and cultural vulnerability of patients [35;38]. Strengthening inter-practitioner referral systems was also suggested, with the aim of addressing both biological and etiological causes of infertility in a more holistic manner. At the policy level, there is a clear need for national governments to prioritise infertility as a significant public health concern. This includes promoting public awareness to dispel myths and stigma, as well as implementing fertility insurance schemes to improve access to reproductive healthcare services [37;38;39;41;43].\u003c/p\u003e\u003cp\u003eOne study raised concerns about the dependency on donors for infertility treatment and the issue\u0026rsquo;s neglect by both national governments and international agencies, which often prioritise family planning initiatives over infertility care [39]. The usage of donor eggs and sperm, particularly sperm, was deemed largely unacceptable among participants due to perceived sexual connotations [39]. Taken together, these findings suggest that a multi-sectoral and holistic approach, one that incorporates social, spiritual, economic and political dimensions, is essential for meaningfully addressing the psychosocial needs of individuals affected by infertility in Ghana.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe purpose of this scoping review was to map the psychosocial research on infertility conducted in Ghana [33]. A total of 10 articles met the inclusion criteria. Included studies represented diverse populations across Accra (n\u0026thinsp;=\u0026thinsp;4), North-East and Ashanti regions (n\u0026thinsp;=\u0026thinsp;2), the Upper West Region (n\u0026thinsp;=\u0026thinsp;2), southern Ghana (n\u0026thinsp;=\u0026thinsp;1) as well as one in northern Ghana (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\u003cp\u003eThe articles cover a broad range of thematic areas including quality of life (QOL), documenting symptoms of depression and anxiety and highlighting broader aspects of psychological distress among patients seeking infertility treatment. Other themes included psychological experiences, reproductive and sexual health, relationships, stigma, knowledge and perceptions relating to ART as well as adoption and surrogacy. Other themes included access to care, health-seeking behaviours as well as the sociocultural and religious aspects of infertility.\u003c/p\u003e\u003cp\u003eThere is a robust body of literature focusing on the psychological sequelae of infertility and its sociocultural implications, which is seen in studies that report how women are treated by family members, in-laws and broader communities when they fail to conceive [7]. However, there is a noticeable gap in research conducted across more diverse cultural settings. Additionally, while several studies identify coping and support strategies, a significant need for long-term psychological and social support was also evident. Many respondents discussed persistent needs years after their initial diagnosis, suggesting that unresolved infertility can result in sustained emotional and social challenges. This underlines the necessity for longitudinal research that expands both the study population and the contextual focus.\u003c/p\u003e\u003cp\u003eA notable gap identified in this review is the lack of research on the design and evaluation of psychological interventions for individuals experiencing infertility. Findings suggest that the current resilience-based model used in ART clinics does not sufficiently address the full scope of barriers to care. Moreover, the experience of accessing ART appears to differ between women of different ethnic backgrounds across Ghana [44]. Results from this review show that infertility\u0026rsquo;s impact extends beyond the individual to affect relationships, mood and financial stability.\u003c/p\u003e\u003cp\u003eThe WHO International Classification of Functioning, Disability and Health (WHO ICF) recognises the interplay of biological, psychological and social influences on health [45]. While the WHO ICF provides a useful framework for identifying the broader determinants of health, it does not fully capture the complexity of infertile women\u0026rsquo;s experiences in Ghana. The findings suggest that psychosocial factors, particularly those rooted in cultural and gendered expectations\u0026mdash;should be integrated into treatment, research and policy design to better support infertile women, especially those pursuing ART.\u003c/p\u003e\u003cp\u003eThis review highlights that difficulties associated with infertility persist during and after ART treatment. Women struggle to come to terms with their diagnosis and often experience profound loss of social recognition, leading to deteriorating mental health. This is consistent with existing evidence indicating that access to and awareness of mental health services is limited and that counselling services offered at fertility clinics are often inadequate and not patient-centred [46].\u003c/p\u003e\u003cp\u003ePatient-centred care has been shown to relieve the emotional burden of infertility, which is associated with poorer QoL, heightened anxiety and depression, outcomes that African women are at significantly higher risk of developing [7;47;48;49\u0026ndash;53]. As participants in all reviewed studies reported reduced social support from their families and communities due to childlessness, the emotional and psychological support offered at treatment centres is especially important for Ghanaian women [37;47;49].\u003c/p\u003e\u003cp\u003eAlthough every effort was made to locate studies relevant for this review, I concede that publications may have been overlooked. As I aimed to provide an overview of published literature in the field, I did not conduct a quality assessment of articles included in this review. However, articles in predatory journals or those that were not peer-reviewed were excluded.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, only 10 studies have been published over the past 25 years on the psychosocial aspects of infertility in Ghana. The reviewed studies represented diverse populations across Ghana, including four in Accra, two spanning the North-East and Ashanti regions, two in the Upper West Region, one in southern Ghana as well as one in northern Ghana. Despite the richness of qualitative data on sociocultural and psychological experiences, there remains a significant gap in intervention-focused research. The findings underscore the urgent need for further psychosocial research, particularly the development and evaluation of psychosocial interventions, to support individuals experiencing infertility in Ghana.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003eConsent for publication\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEthics approval and consent to participate\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAvailability of data and materials\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this\u003c/p\u003e\n\u003cp\u003epublished article [and its supplementary information files]\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eCompeting interests\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eFunding\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable as this is a review\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAuthors’\u0026nbsp;contributions\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eKI synthesised the data critically reviewed, discussed and finalised the submitted manuscript and (will) contribute to all revisions. \u0026nbsp; Author agrees to be accountable for the work and to investigate and resolve any issues related to the accuracy or integrity of the work.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAcknowledgements\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNot applicable as this is a review\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRoomaney R, Salie M, Jenkins D, Mutumba-Nakalembe MJ, Volks C, Holland N, Silingile K. 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In-vitro fertilization, gamete donation and surrogacy: perceptions of women attending an infertility clinic in Ibadan, Nigeria. Afr J Reprod Health. 2014;18(2):127\u0026ndash;33\u003c/li\u003e\n\u003cli\u003eUgwu EO, Odoh GU, Obi SN, Ezugwu FO. Acceptability of artificial donor insemination among infertile couples in Enugu, southeastern Nigeria. Int J Womens Health. 2014;6:201\u0026ndash;4\u003c/li\u003e\n\u003cli\u003eOmosun AO, Kofoworola O. Knowledge, attitude and practice towards child adoption amongst women attending infertility clinics in Lagos State, Nigeria. Afr J Prim Health Care Fam Med. 2011;3(1)\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Patient Experience, Infert*, Africa, Europe, Ethnic*, Mental*, Qualitative Review, Health-Seeking Behaviour, Assisted Reproductive Technology, IVF","lastPublishedDoi":"10.21203/rs.3.rs-7919224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7919224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eInfertility is defined as a disease of the reproductive system, characterised by the inability to conceive after 12 months of regular, unprotected sexual intercourse. While psychosocial research on infertility is widespread across Africa, focused examinations within specific national contexts remain limited. This scoping review maps the psychosocial research on infertility conducted in Ghana between 2000 and 2025. Searches were conducted across nine academic databases and grey literature sources. Studies were included if they were published in English and reported original qualitative findings from Ghanaian women diagnosed with primary or secondary infertility. 476 studies at the title and abstract stage from a total of 493 identified in the database search were found and screening resulted in 10 articles being included in the scoping review. Most of the studies (40%) were conducted in Accra. The psychosocial aspects explored included quality of life, stigma, mental health, treatment-seeking behaviours and sociocultural and religious influences on infertility experiences. This review provides a comprehensive overview of existing psychosocial research on infertility among Ghanaian women and highlights key gaps for future study, particularly in relation to long-term support and intervention development.\u003c/p\u003e","manuscriptTitle":"A qualitative scoping review of the psychosocial aspects of infertility among women across Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 05:24:04","doi":"10.21203/rs.3.rs-7919224/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f731699b-255b-4c4c-95d8-ed5eea119ebb","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-06T05:08:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-24 05:24:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7919224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7919224","identity":"rs-7919224","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}