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American Journal of  
Life Science and Innovation (AJLSI)

Impact of  SDG3 in the Prevention of  Physical and Mental Effects of  Infertility Observed 
in Nigerian Women: A Scoping Review

Tayyibat Ayoola Egbewole1, Ncube F.1, Aloysius Obinna Ikwuka2*

Volume 3 Issue 2, Year 2024
ISSN: 2833-1397 (Online)

DOI: https://doi.org/10.54536/ajlsi.v3i2.3139
https://journals.e-palli.com/home/index.php/ajlsi

Article Information ABSTRACT

Received: June 27, 2024

Accepted: July 31, 2024

Published: August 03, 2024

Infertility significantly impacts both the physical and emotional well-being of  individuals and 
is particularly prevalent in low- and middle-income countries like Nigeria. Since many causes 
of  infertility are avoidable, there is potential for public health initiatives and Sustainable 
Development Goal 3 (SDG3) to play a role in health education and prevention. This scoping 
review aimed to assess existing literature for a better understanding of  the factors relevant to 
analyzing how SDG3 might influence Nigerian women’s ability to mitigate the physical and 
mental effects of  infertility. Exhaustive searches were conducted across electronic databases 
including Scopus, Web of  Science, JSTOR, CINAHL, MEDLINE, and PubMed. The 
initial review commenced in October 2023, with the final search concluded in March 2024. 
Identified papers underwent screening using the PRISMA extension for scoping review flow 
diagrams. After removing duplicates and screening titles and abstracts, 1,340 papers were 
identified, with 169 reports evaluated for inclusion. Ultimately, 46 papers met the inclusion 
criteria for this scoping review. Data analysis revealed various factors contributing to the 
burden of  infertility among Nigerian women, encompassing medical conditions, modifiable 
risk factors, environmental influences, physical and psychological stressors, and policy-
related considerations. Socio-economic factors were also implicated in infertility within 
this population. However, significant gaps in knowledge persist, as no substantial findings 
were uncovered regarding the true causes across these categories. Therefore, addressing the 
burden of  infertility among Nigerian women requires a multi-faceted approach including 
interventions aligned with SDG3, public awareness campaigns, health screening initiatives, 
utilization of  assisted reproductive technologies, provision of  physical and psychological 
wellness services, as well as counseling support.

Keywords

Impact, Sustainable 
Development Goal 3, SDG3, 
Prevention, Physical Effects, 
Mental Effects, Infertility, 
Nigeria, Women, Scoping 
Review

INTRODUCTION
The United Nations implemented Quality Health and 
Wellness as one of  the 17 Sustainable Development 
Goals in 2015, intending to guarantee robust livelihoods 
and advocate wellness for all, regardless of  age (United 
Nations, 2015). Sustainable Development Targets 
emphasize living a healthy lifestyle, with indicators 
tracking progress across countries (Ritchie, 2018). SDG3 
comprises thirteen targets and twenty-eight indicators 
to monitor progress. These targets focus on reducing 
maternal and child mortality, combating diseases, 
enhancing psychological well-being, deterring substance 
misuse, diminishing road-related accidents, and granting 
widespread entry to medical care and birth control. 
SDG3 additionally strives to attain comprehensive health 
protection and impartial entry to medical care for all sexes, 
which endeavors to guarantee communal availability of  
family planning as well as sexual and reproductive health 
amenities (United Nations, 2017). 
Several studies have explored the frequency of  infertility 
in underdeveloped and developing countries, such as 
Nigeria, and its potential impacts on the physical and 
mental wellness of  affected individuals. Gametes are ova 
and sperm cells that are haploid and have one copy of  
each type of  chromosome i.e. 1–22 X or 1–22 Y (Ikwuka, 
2023a). The World Health Organization (WHO) defines 

clinical infertility “as the inability to give birth to a healthy 
baby after at least one year of  regular, unprotected sexual 
activity” (WHO, 2020). Estimates vary, suggesting that 
globally, between 48.5 million and 186 million couples 
may be affected by primary or secondary infertility (Starrs, 
2018), depending on the measurement method (Inhorn, 
2015; Mascarenhas, 2012). 
Primary infertility refers to the inability to conceive or 
start the development of  a child. One significant factor 
contributing to secondary infertility is infections of  the 
reproductive tract (Kaufman, 1999), which are more 
prevalent than primary infertility (Starrs, 2018) and 
describes the inability to become pregnant even after 
previous attempts (Bowa, 2012). 
Autoimmune antibodies produced by the female partner 
against sperm cells from the male partner have been 
implicated as a cause of  female infertility. Other immune 
reactions include antibodies to clotting factors, which 
result in both thrombosis and hemorrhage; and hemolytic 
reactions during transfusion of  blood products (Ikwuka, 
2023e). Oxidative stress has also been associated with 
infertility. Linked to the induction of  oxidative stress 
are major free radicals. Among these major free radicals, 
superoxide anions, hydroxyl radicals, and hydroperoxyl 
radicals are of  physiological significance. A non-radical 
of  physiological significance is hydrogen peroxide (Ama, 

1 Faculty of  Health/Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
2 College of  Medicine and Health Sciences, American International University West Africa, Banjul, The Gambia
* Corresponding author’s e-mail: aloysiussweet@yahoo.com



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2023; Baysah, 2023; Ekechi, 2023a; Ikwuka, 2023b). The 
influence and effects of  hormonal imbalance in females 
leading to infertility in such females have also been 
reported in different studies (Aliu-Ayo, 2023a; Aliu-Ayo, 
2023b).
Parenthood is often socially and culturally expected in 
many societies, and infertility’s physical and psychological 
effects on individuals’ well-being and health have been 
extensively researched in underdeveloped and developing 
countries (Nahar, 2022). Many forms of  stigmatization 
are experienced by those who do not fulfil the societal 
norm which demands having offspring. This can result in 
stress, unstable marriages, verbal abuse, violence against 
partners, separation, and exclusion. 
A thorough definition of  fertility awareness considers 
behaviorally influencing variables at every stage of  life, such 
as cognitive, social, environmental, and developmental 
aspects (McCurdy, 2015). It is widely acknowledged 
that a lack of  knowledge about fertility hurts views and 
actions concerning sexual and reproductive health (SRH) 
throughout the course of  one’s life. These behaviors 
include not using family planning (FP) methods, delaying 
the application of  FP methods after giving birth or after 
an abortion, stopping the use of  FP methods, using 
ineffective FP methods, getting pregnant unintentionally, 
and having false beliefs about being infertile (Dyer, 2002).
Diabetes mellitus and arterial hypertension remain two of  
the most common diseases in the world. Today, diabetes 
mellitus (DM) ranks third in the overall structure of  
morbidity and mortality after cardiovascular diseases and 
oncological diseases (Virstyuk, 2021a). In addition, the 
interplay, role and effects of  metabolic syndrome diseases 
on male fertility are still being investigated by different 
researchers. Metabolic disorders, e.g. Hypertension, 
Adiposity, Diabetes mellitus and Dyslipidemia, collectively 
known as Metabolic Syndrome Diseases (MSDs) are 
diseases related to one another (Ikwuka, 2015; Ikwuka, 
2017a; Ikwuka, 2017c; Ikwuka, 2023c; Ikwuka, 2023f; 
Ikwuka, 2024; Virstyuk, 2016). Different studies have 
shown that MSDs are associated with asymptomatic 
hyperuricemia, systemic immune inflammatory processes, 
and fibrogenesis all of  which can lead to nephropathy 
(Ikwuka, 2017d; Ikwuka, 2017e; Ikwuka, 2018c; Ikwuka, 
2018d; Ikwuka, 2019a; Ikwuka, 2019c; Ikwuka, 2022; 
Ikwuka, 2023d; Virstyuk, 2017a; Virstyuk, 2018a; 
Virstyuk, 2019; Virstyuk, 2021a; Virstyuk, 2021b).
Governments and sexual reproductive health right 
(SRHR) organizations still overlook infertility despite 
several other delicate SRHR issues being addressed, 
including abortion, teenage SRHR, and comprehensive 
sexuality education (Ombelet, 2011). Inaccurate 
prevalence numbers on infertility contribute to its 
invisibility and undermine justifications for action, 
including offering complete reproductive care, preventing 
and de-stigmatizing infertility-related disorders (Ombelet, 
2011). Furthermore, little is known about current 
initiatives to address infertility in nations with low and 
moderate incomes, such as Nigeria (Kroes, 2019).

Men’s involvement in infertility management and 
counseling is encouraged by the availability of  assisted 
reproductive technologies (ARTs), which also improve 
gender relations and raises awareness of  female infertility 
(Inhorn, 2015). However, the greatest obstacle to 
expanding access to ARTs in nations like Nigeria will 
continue to be the high cost of  these treatments (Starrs, 
2018). Many couples wait until they need treatment. As 
a result, additional initiatives are required to lessen the 
stigma associated with infertility and the detrimental 
consequences it has on the lives of  those who are 
struggling with it. Since avoidable factors account for a 
large share of  infertility; public health, and sustainable 
development can contribute to reduce the burden (Van 
der Poel, 2012).
With over 220 million inhabitants, Nigeria is the most 
populous country in Africa. There has yet to be evidence 
that the nation’s 2.5% annual population growth is causing 
its financial and socio-economic needs, particularly in 
healthcare, to rise quickly (World Bank, 2023). From a 
per capita and state government’s perspective on budget 
share, the country’s health financing is relatively low. 
Nigeria’s health sector governance needs to be improved, 
with institutional channels for advocacy and involvement 
that need to be improved, contributing to the low coverage 
of  most preventive and curative health treatments.
The majority of  Nigerians, like those in most developing 
nations, are pronatalists who favor early marriage 
and large number of  children. As a result, the idea of  
deliberate childlessness is foreign, and trying to conceal 
infertility will only make it more stigmatized (Orji, 2008). 
The perception of  a social norm breach may cause the 
responses to infertility from the extended family or the 
community. Children are valued greatly in the society, 
and generally speaking, a woman’s value is based on 
her capacity for reproduction (Okonofua, 2002). When 
comparing underdeveloped countries to industrialized 
countries, the cultural realities of  different locations 
cause unique issues related to infertility. 
Family planning initiatives are supposed to target over-
fertility rather than infertility according to an established 
argument, given the overpopulation of  most developing 
nations (Runstein, 2004). The high population rise in most 
emerging countries has led to an expansion of  family 
planning services and population policies. Nevertheless, 
it appears that supporting infertile females, which is 
a component of  this service, has been overlooked. 
Infertility is a critical reproductive health concern that 
can have dramatic repercussions, including suicide, even 
with the high rate of  population expansion (Daar, 2002). 
Due to inadequate guidelines and insufficient treatment 
options, infertility is frequently poorly managed medically 
(Ola, 2008).
The organized efforts of  society to safeguard, advance, 
and improve people’s health are referred to as public 
health. This is a blend of  science, abilities, and values 
aimed at preserving and enhancing everyone’s health 
through collaborative or social acts. Since families are 



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the foundation of  society and are affected by infertility, 
the effects are not limited to women. Most developing 
countries have experienced substantial population 
decrease with services for contraception and population 
controls expanded. Infertility has been linked to physical, 
emotional, and psychological side effects e.g. anxiety, 
sadness, marital problems, and social stigma, therefore 
infertility is not just a medical issue (Daar, 2002).
Since infertility impacts the entirety of  one’s life 
experience both qualitatively and quantitatively, public 
health and Sustainable Development Goal 3 have 
recently emphasized the necessity for an intimate social 
link between an individual and the environment. It is a 
societal problem that affects individuals as well as 10% 
of  the people who are of  reproductive age experiencing 
infertility in one way or the other (Evens, 2004). Stress 
has a depressing influence on various hormones that 
act in fertility, and infertility can amplify the pain and 
emotions experienced by those impacted. This may set 
off  a vicious cycle in which stress results in infertility, 
which in turn causes more stress, which further reduces 
fertility (Greil, 1997). 
Due to the perception that infertility is solely a medical 
condition and the assurances given to patients by medical 
professionals regarding the minimal impact of  stress on 
ovulation, the psychological and physiological aspects 
of  the condition have been neglected. There are several 
psychological or mental health effects, including societal 
ramifications and personal pain, which can hurt infertility. 
When treatment is accessible, technological developments 
in assisted reproduction can give many couples hope. 
Nonetheless, there are obstacles related to pricing and 
medical coverage. 
According to (Cousineau, 2007), by medicalizing 
infertility, women’s emotional reactions, including pain, a 
loss of  control, shame, and a change of  course for their 
adult lives — have unintentionally led to contempt for 
these feelings. The psychological impact of  infertility 
can be awful. Partners who are more anxious to become 
pregnant may have worsening sexual difficulties. 
Couples who are infertile frequently experience marital 
disagreement, particularly when they are pressured to 
make medical choices. Similar to those with cancer or 
heart illness, women who are attempting to conceive 
frequently experience clinical depression (Domar, 1993). 
Metabolic syndrome diseases (MSDs) are interrelated 
diseases with very high economic costs, morbidity, and 
mortality rates, thus requiring the search for new and 
effective treatment options (Ikwuka, 2024). Treatment 
optimization in MSD patients using a combination of  
HMG-CoA and SGLT-2 inhibitors, and A2RB (AT1) 
has resultant clinical effectiveness as indicated by marked 
improvements in metabolic functions of  the heart, liver, 
pancreas, and kidney (Ikwuka, 2017b; Ikwuka, 2018a; 
Ikwuka, 2018b; Ikwuka, 2021; Virstyuk, 2017b; Virstyuk, 
2018b; Virstyuk, 2018c; Ikwuka, 2024). In addition, 
Glucagon-like Peptide 1 Receptor Agonists (GLP-1 RAs) 
e.g. Liraglutide have been found to improve the efficacy of  

treatment and clinical course of  type 2 diabetes mellitus 
and hypertension in patients with such comorbidities 
(Ikwuka, 2019b). It has also been reported that coconut 
water has hepatorenal protective functions against alloxan-
induced type 1 diabetes mellitus (Ekechi, 2023b).
Stress levels are high even for couples using infertility 
treatments (Beutel, 1999). Infertility can lead to a range 
of  emotional challenges for individuals, including the 
loss of  envisioned life plans and the disappointment 
of  not experiencing motherhood or parenthood as 
anticipated. It may also trigger feelings of  uncertainty 
about one’s identity, a sense of  losing control over life’s 
circumstances, and strain on relationships, sometimes 
leading to their breakdown. Additionally, for many 
individuals, infertility can result in the loss of  support 
from religious communities, which previously provided 
strength and solace. Couples where the male partner is 
identified as the source of  infertility often face heightened 
emotional strain and encounter difficulties within their 
marital relationship. 
There are 186 million infertile individuals in the globe, 
with 30 to 40 per cent of  them residing in Africa. Based 
on multiple cultures in Nigeria, a married couple should 
have a kid during the first few years of  their union. When 
a couple begins to battle with infertility, the question 
“When do you plan on having children?” may seem 
lighthearted in the first year of  marriage, but it may 
also be a severe insult (Sharma, 2009). The experiences 
of  childless women in Africa are currently not well 
documented in a comprehensive qualitative way. These 
could affect how well infertility is managed with the 
addition of  appropriate medications. Extensive, evidence-
based data about the experiences of  African and Nigerian 
infertile women is absent, as previous assessments have 
concentrated on the clinical or biological models.
In a region with such high fecundity, assembling research 
data on the variety of  medical and psychological issues 
related to infertility requires a rigorous evaluation of  the 
available information. While certain academic studies and 
medical publications have discussed different facets of  
infertility in Nigeria (Orji, 2002), further work is required. 
The primary goal of  this literature evaluation is to study 
and thoroughly record the medical and psychological 
components of  fertility problems among Nigerian 
women while evaluating its effect concerning the afflicted 
individuals and their societal context, as well as the 
role of  healthcare professionals’ attitudes in patients’ 
acceptance of  their diagnosis. This study aims to pinpoint 
areas of  deficiency in existing literature concerning 
the initial research endeavors, healthcare policies, and 
comprehensive evaluations on this topic as in other 
related studies (Koster-Oyekan, 1999; Umezulike, 2003).
There needs to be more systematic data regarding the 
psychological, physical, and socio-cultural effects of  
infertility on the well-being of  Nigerian women. This 
is true, even if  primary research studies are expected 
(Tanywe, 2018). This justifies the requirement for a 
thorough scoping evaluation of  the infertile literature.



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This scoping review aims to comprehensively assess 
the literature and identify key variables relevant to 
understanding how Sustainable Development Goal 
3 could play a role in alleviating the physical, and 
psychological challenges associated with infertility among 
Nigerian women. This review will locate, synthesize, and 
summarize existing research to investigate the elements 
influencing Nigerian women suffering from both primary 
and secondary fertility issues regarding their physical and 
emotional health. By giving a more excellent knowledge 
of  the relationship between the physical and mental 
repercussions of  infertility among women in Nigeria, 
this study will enable health professionals and society 
to develop effective measures for the prevention and 
management of  infertility.

MATERIALS AND METHODS
Study Design 
This research is a scoping review. Due to the variety of  
research that has been done on the topic, (Munn, 2018) 
adopted this design as opposed to doing a systematic 
review. A scoping assessment was conducted on current 
interventions aimed at reducing the stigma associated 
with infertility as well as its psychological and physical 
repercussions. A description and conceptualization of  the 
impact of  sustainable development goals on the physical 
and psychological repercussions of  infertility was carried 
out before outlining the steps and conclusions of  this 
scoping review (Cook, 2014).

Methods
Scoping reviews are a valuable instrument in the expanding 
toolbox of  evidence synthesis techniques. Scoping 
reviews are preferred by researchers over systematic 
reviews when the latter’s goals include establishing a body 
of  literature, explaining concepts, examining research 
methodologies, or detecting knowledge gaps. To produce 
reliable results, it must be carried out with strict and open 

procedures, even though their goals differ from those of  
systematic reviews.
The methodological approach outlined by (Arksey, 
2005) was followed. The intricacies of  metrics and the 
broad spectrum of  research form methodologies used in 
existing studies made it clear that a scoping examination 
was the optimal method to investigate the extensive 
literature on infertility indicators and fertility care. A 
review method was developed following the guidelines 
of  the Preferred Reporting Items for Systematic Reviews 
and Meta-Analyses (PRISMA) Extension for Scoping 
Reviews (PRISMA-ScR) to ensure a thorough and 
organized analysis.
Below are the steps undertaken to conduct this review.

Stage 1: Developing a Rationale and Identifying the 
Research Question
These inquiries directed the scoping review. Which metrics 
show how SDG 3 is affecting Nigerian women’s ability 
to avert the psychological and physical consequences 
of  infertility? What kinds of  indicators are there, and 
what sizes are they? How are these indicators measured 
according to the reports? Which country map, by the 
info, has that is currently available? In this nation, which 
organizations are in charge of  gathering data?

Stage 2: Identifying Relevant Studies
In the first phase, one bibliographic database was used 
to perform a preliminary limited search. Text terms 
found in the abstract were then examined, the title of  
the documents, and the index words used to characterize 
the articles. The search method was developed in the 
second phase after determination of  the words found in 
texts and index phrases. There was additional refinement 
of  this. Table 1 gives the search engine methods for the 
different databases. A systematic electronic search was 
conducted using PubMed, MEDLINE, Web of  Science, 
CINAHL, and Scopus.

Table 1: Search strategy keywords
Bibliographic Database Search query
PubMed "Women" [Mesh] AND ("Infertility" [Mesh] OR "assisted reproduction*" [tw] OR 

"infertility" [tw] OR "subfertility" [tw]) AND ("Patient Care/standards" [Mesh] OR 
"Health Care Quality Indicators" [Mesh] OR "indicator*" [tw])

MEDLINE Women/ AND (Infertility/ OR assisted reproduction*.mp. OR infertility.mp. OR 
subfertility.mp.) AND (Patient Care/standards/ OR Quality Indicators, Health Care/ 
OR indicator*.mp.)

Web of  Science Women AND (Infertility OR “assisted reproductive*” OR infertility OR subfertility) 
AND (“Patient Care/standards” OR “Quality Indicators, Health Care” OR indicator*)

CINAHL (MH “Women+”) AND ((MH “Infertility+”) OR “assisted reproduct* OR infertility 
OR subfertility) AND ((MH “Patient Care/standards+”) OR (MH “Quality Indicators, 
Health Care+”) OR indicator*)

Scopus INDEX TERMS ("Women") AND (INDEX TERMS("Infertility") OR TITLE-
ABS-KEY ("assisted reproductive*") OR TITLE-ABS-KEY("infertility") OR 
TITLE-ABS-KEY("subfertility")) AND (INDEX TERMS ("Individual Well-being/
protocols.") OR INDEX TERMS ("Performance Measures”., Health Care") OR 
TITLE-ABS-KEY("indicator*"))



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Additionally, online resources such as the World 
Health Organization: The International Committee 
for Monitoring Assisted Reproduction Technologies 
(ICMART), The Nigerian Demographic Health 
Survey Organization, the International Federation of  
Gynecology and Obstetrics (FIGO), the United Nations 
Population Fund (UNFPA), and the American Academy 
of  Pediatrics (AAP) were combined with the electronic 
search. 
Conference proceedings and reports from other related 
organizations were also searched. Some of  these 
national ART surveillance system societies are affiliated 
with the Centers for Disease Control and Prevention 
(CDC, 2018), the African Network and Registry for 
Assisted Reproductive Technology (ANARA), and the 
International Federation of  Fertility Society Surveillance 
2019 (IFFS, 2019). In the end, the list of  pertinent article 
references and citations made by relevant article logs that 
were not date-restricted was manually checked.

Stage 3: Study Selection
Inclusion Criteria
Credible publications (which included every type of  study, 
which involves both initial and subsequent research), 
demographic accounts (which included females seeking 

mental and physical care from infertility), and concept 
reports (which included indicators of  infertility and 
conception prevention and treatment through the impact 
of  SDG3) were included in this study. The search was 
limited to research that was accessible in the English 
language.

Exclusion Criteria
Literatures which did not undergo peer review due to 
concerns about the source’s reliability was excluded from 
this scoping review. Bias may be introduced by including 
data from unpublished studies and thus unpublished 
studies were excluded. Literatures that would be difficult 
to translate due to linguistic quirks can also add bias to 
this scoping review and were excluded. 

Stage 4: Charting the Data 
To identify important information and determine whether 
it supports the aims and objectives of  this scoping review, 
the data must be summarized as part of  the analysis 
process. Data charting is the procedure used to create this 
summary. Table 2 below shows some articles examined 
during this scoping review. It summarizes African, low- 
and middle-income countries (LMICs), and Nigerian 
literature by region.

Table 2: Data charting
Region Country Author(s)/Date Study Type Aim

W
es

t A
fr

ic
a

Cameroon Egbe et al., 2020 Quantitative To determine the prevalence and associated 
factors of  infertility in Douala, Cameroon

The Gambia Dierickx, et al., 2019 Qualitative Long-term ethnographic study
The Gambia Dierickx, et al., 2021 Qualitative Long-term ethnographic study
The Gambia Dierickx, et al., 2022 Qualitative Long-term ethnographic study
Ghana Adofo, 2021 Qualitative To explore factors that influence family 

planning uptake after the first delivery, 
including fear of  infertility.

Ghana Alhassan et al., 2014 Qualitative To examine prevalence and severity of  
depression in relation to age, type of  
infertility and duration of  infertility in 
Ghanaian infertile women.

Ghana Anokye, et al., 2017 Qualitative To determine the psychosocial effects of  
infertility among couples

Ghana Anaman-Torgbor et al., 
2021)

Qualitative To explore the experiences of  women 
undergoing ART treatment

Ghana Fledderjohann, J.J., 
2012

Qualitative To explores the implications of  infertility 
for women in Ghana

Ghana Osofu & Hanninen, 
2020

Qualitative To document lived experiences of  infertile 
women and on how they can be helped to 
improve their own condition

Ghana Naab et al., 2013 Qualitative To describe infertile women’s psychosocial 
health problems and their infertility-related 
beliefs

Ghana Tabong & Adongo, 
2013

Qualitative Exploratory study on causes of  infertility



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Mali Hess, et al., 2018 Mixed Methods To examine infertility-induced 
psychological distress and coping strategies 
among women in Mali

Niger Samandari et al., 2019 Qualitative individual and structural factors influencing 
married girls’ early first birth

Nigeria Abarikwu, 2013 Literature review 
and secondary 
data analysis

Review to identify risk factors for male-
factor infertility in Nigeria

Nigeria Adegbola & Akindele, 
2013

Quantitative To examine the pattern of  infertility cases 
amongst infertile couples seeking care

Nigeria Aduloju, 2018 Quantitative To examine the quality of  life in women of  
reproductive age and compare the quality-
of-life scores among fertile and infertile 
women

Nigeria Bello et al., 2021 Mixed methods 
Implementation 
Research 
Protocol

To assess psychoeducational evaluate 
its effectiveness for reducing symptoms 
of  anxiety and depression in infertile 
populations

Nigeria Dimka & Dein, 2013 Qualitative Ethnographic study documenting impact 
of  infertility on women’s lives

Nigeria Ibisomi & Mudege, 
2013

Qualitative To explore societal perception and 
acceptance of  childlessness in Nigeria

Nigeria Ikimalo & Babatunde, 
2012

Qualitative To investigate perceptions of  infertility 
among urban residents of  Port Harcourt, 
Nigeria

Nigeria Iliyasu et al., 2013 Qualitative To determine the public perception of  
infertility, its causes and factors associated 
with acceptability of  ART

Nigeria Larsen et al., 2010 Mixed methods To examine the experiences of  women 
with infertility in Nigeria

Nigeria Okafor et al., 2017 Qualitative To explore the perceptions of  infertility 
and IVF and how to enhance the use of  
IVF treatment among married couples

Nigeria Omoaregba et al., 2011 Qualitative To determine the prevalence of  
psychological distress as well as its 
associated socio-cultural characteristics 
among women attending infertility clinics

Nigeria Ndubuisi et al., 2021 Qualitative To assess the impact of  infertility on the 
sexual life of  women with infertility seeking 
care

Nigeria Whitehouse & Hollos, 
2014

Qualitative To explore experiences of  infertility by 
types of  infertility (low, childless)

C
en

tra
l 

A
fr

ic
a

Rwanda Dhont et al., 2011 Mixed methods To understand the socio-cultural 
consequences of  infertility

Rwanda Dhont, 2011 Quantitative To examine predictors for infertility and 
treatment-seeking behavior

E
as

t A
fr

ic
a

Ethiopia Akalewold, et al. 2022 Quantitative Hospital-level survey on factors driving 
infertility

Kenya Ochako et al., 2015 Qualitative To explore reasons for contraceptive 
hesitancy, for which fear of  infertility was 
a major factor

Kenya Njogu et al., 2022 Qualitative To describe women’s fertility treatment and 
experiences



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Kenya Sedlander et al., 2018 Qualitative To understand how beliefs that modern 
contraceptives cause infertility shapes 
behavior? Unclear

Kenya Sedlander et al., 2021 Quantitative To conduct sociocentric network analysis 
to explore if  beliefs that contraceptives 
effect infertility result in low use

Kenya, 
Tanzania

WHO (Bulletin) Key Informant 
Interview

Interview with healthcare providers on 
Maasai experiences of  infertility

Malawi Bornstein, et al, 2020 Qualitative To understand the production and impact 
of  infertility-related stigma

Malawi Chipeta et al., 2010 Qualitative To explore factors that affect the intentions 
of  men and women to use family planning 
methods

Malawi Parrot, 2014 Qualitative Ethnographic research on how men’s 
reproductive bodies are problematized and 
biomedically defined diagnoses contribute 
to the visibility of  male infertility

Stage 5: Compiling, Analyzing, and Presenting the 
Findings
147 unique indicators were identified. These indicators 
were categorized conceptually into classes (including 
structural, process, and outcome), and characteristics 
(dimensions) such as safe, effective, patient-centered, 
timely, efficient, and equitable) using pre-established 
analytical frameworks (Davies, 2004; Runstein, 2004).

Two analytical frameworks were applied to arrange 
the whole set of  mapped indicators. The Donabedian 
framework (Donabedian, 1988) outlined the various 
classes of  indicators (see Table 3), while the Institute of  
Medicine (IOM) structure outlined the characteristics 
(dimensions) of  indicators, such as promptness, 
productivity, equality, safety, and efficacy (see Table 4).

Table 3: Classes of  Indicators
Classes Explanation
Structural Foundational markers, which include staffing levels, funding, beds, supplies, and physical facilities, 

are used by health systems and organizations to provide services and programs. These indicators 
characterize the quantity and kind of  resources.

Process Process indicators make use of  the generally recognized guidelines for clinical practice. Healthcare 
professionals' actions and their quality are assessed by process indicators, which are collections of  
related actions performed to achieve certain goals.

Outcome The impact of  medical services on patients' health conditions is demonstrated by outcome indicators.

Table 4: Characteristics (Dimensions) of  Indicators
Dimensions Explanation
Safe By providing care for individuals that is meant to be beneficial, thereby preventing harm to them.
Effective By avoiding serving those who are unlikely to benefit, or underusing or misusing services based on 

scientific information, sustainable development target 3 aims to serve everyone who might benefit.
Patient-
centered

Making sure that all clinical decisions are based on the values of  the patient and providing care that 
is sensitive to and cognizant of  each patient's individual needs, preferences, and values.

Timely Reducing waiting times and possibly hazardous delays for care providers and recipients.
Efficient Making sure everyone is healthy and happy while avoiding destruction, such as discarding of  tools, 

supplies, concepts, and energy resources.
Equitable It offers attention and empathy whose quality is constant regardless of  the patient's socioeconomic 

status, location, gender, or race.

RESULTS AND DISCUSSION
1,340 reports came from the electronic search, and 
91 more reports were found through other means. 
Following removal of  duplicates, 169 entire text 

publications were assessed for inclusion by screening 
the titles and abstracts. Finally, 46 reports were included 
in this scoping review using the PRISMA Flowchart as 
illustrated in Figure 1.



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Figure 1: PRISMA Flowchart illustrating the screening and reporting process for the scoping literature review

Figure 2: Range of  parameters and categories of  infertility indicators reported

The types (classes) of  indicators (outcome, process, and 
structure) are represented by the inner doughnut and the 
characteristics of  indicators (effectiveness, efficiency, 
equity, patient-centeredness, safety, and timeliness) are 
represented by the outer doughnut, indicating the relative 
abundance of  published work (see Fig. 2 above). 
Except for a small number of  process indicators 

(16.34%) and structure indicators (13.94%), the majority 
of  the indicators (69.72%) were outcome indicators 
(see Table 5). Equity, patient-centeredness, safety, and 
timeliness indicators were less prevalent in dimension, 
with effectiveness (41.43%) and efficiency (44.62%) 
accounting for most indicators (see Table 5). 



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Table 5: Types and dimensions of  indicators showing their percentage levels
Types Dimensions

Effectiveness Efficiency Equity Patient-
centeredness

Safety Timeliness

Outcome 87 82 0 0 6 0 175 
(69.72%)

Process 10 14 1 3 6 7 41 (16.34%)
Structure 7 16 3 3 6 0 35 (13.94%)

104 (41.43%) 112 (44.62%) 4 (1.59%) 6 (2.39%) 18 (7.17%) 7 (2.80%)

The frequency of  infertility in developing nations is 
covered in comparatively few publications. Less developed 
countries have rates between 6.9 and 9.3%, according 
to (Boivin, 2020). The incidence varies significantly by 
region, and these variations can be primarily attributed to 
various environmental, cultural, physical, psychological, 
and social factors. This ignorance of  fertility and 
infertility in Nigeria may result in a delayed or insufficient 
diagnosis or course of  treatment, which could have 
a detrimental effect on a person’s or a couple’s health. 
Moreover, it might reinforce societal stigmas, negative 
physical and mental health impacts like aggression and 
despair, problems related to infertility, and prevent more 
help-seeking behaviors.
Lack of  fertility awareness in Nigeria restricts women 
from controlling their fertility (McCurdy, 2015; Iyanda, 
2020). An essential comprehension of  conception and 
the cycle of  menses is known as fertility awareness 
(Iyanda, 2020), which was reported on the most recent 
estimates of  DHS (Demographic Health Survey) 
information gathered among women in 29 African 
nations and revealed that women had the most inaccurate 
information regarding ovulation and fertility. The lack 
of  awareness and comprehension regarding fertility and 
infertility in Nigeria may cause women’s health to suffer 
and result in a delayed or insufficient diagnosis or course 
of  therapy for infertility. Moreover, it could reinforce 
societal stigmas related to infertility and dissuade people 
from getting help. To improve infertility understanding 
and reduce the stigma associated with infertility, 
expanding Sexual and Reproductive Health therapy and 
other programs promoting fertility awareness could be an 
excellent place to start. There is variation in the definition 
and nomenclature of  the phrase “fertility awareness”.
DHS data frequently uses simple questions to gauge a 
woman’s level of  fertility awareness, such as when her 
period is most likely to end (McCurdy, 2015). While many 
studies in the more extensive literature aim to comprehend 
“various facets of  conception and knowledge of  fertility 
across the lifespan and in various contexts, as well as 
certain related attitudes and actions,” many of  them do not 
have a precise definition of  fertility awareness (Kudesia, 
2018). Instead, they focus on understanding these various 
aspects of  knowledge and beliefs. When defining fertility 
awareness broadly, cognitive, social, environmental, and 
developmental effects that impact behavior across the life 

course are included (McCurdy, 2015). 
In certain instances, the concept of  fertility awareness 
has broadened to encompass details about the onset of  
fertility and physical changes that accompany puberty 
in both girls and boys, the return to fertility following 
childbirth or an abortion, the chance of  pregnancy for 
women who are nursing or not, the fluctuating nature 
of  fertility and the risk of  fertility during the period 
of  menstruation, discernible changes throughout the 
monthly cycle, such as indicators of  a woman’s fertility, 
male fertility, how methods of  contraception influence 
the probability of  conception, possible adverse effects of  
family planning techniques, and situations related to ageing 
and infertility/subfertility. Most people agree that SRH 
attitudes and actions are negatively impacted throughout 
life by low fertility awareness. These behaviors include 
not using family planning, using delayed methods after 
giving birth or an abortion, quitting a technique, using 
ineffective methods, getting pregnant unintentionally, 
and having false beliefs about being infertile. Despite the 
challenge of  estimating the effects of  fertility awareness 
in programs, several studies and SDG3 indicate that doing 
so adds substantial value to individual and community-
level interventions, increasing knowledge and positively 
influencing social norms surrounding fertility and 
infertility (Dyer, 2002). 
Both nationally and globally, infertility has received more 
attention due to a growing understanding of  the severity 
and effects of  the condition and ongoing developments 
in accessible treatment choices (Ombelet, 2014; 
Hammarberg, 2013). Human rights reports, national 
health plans, and SDG advancement are all starting to 
incorporate infertility treatments and initiatives (Davis, 
2020). The SDGs research suggests that addressing 
the needs and priorities of  public health inside nations 
requires a more integrated national, regional, and global 
approach, as well as the current and emerging health 
needs related to infertility, rather than keeping the same 
priorities set thirty years ago. For this reason, the 2030 
agenda includes these goals.
The primary objective of  Sustainable Development 
Goals is to “enhance the methods of  implementation 
and rejuvenate the worldwide partnership for sustainable 
development” (Batram, 2018). This addresses associated 
stigma, creates information networks to track and 
identify infertility, its causes, and its effects, and expedites 



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programs to address infertility, outstanding reproductive 
care, prevent, and treat infertility, as well as improve 
programs for physical, research, infrastructure for public 
health, mental and psychological support, and regulations.
The influence of  SDG3 on infertility prevention together 
with the physical and mental effects of  infertility in 
Nigerian women, were examined in this scoping review 
of  studies published in English language. The strengths 
of  this scoping review include the fact that works from 
grey literatures were excluded. This scoping review 
concentrated on natural causes of  female infertility 
instead of  the narrative-based ones often seen in the 
literature. 
The primary limitation of  this scoping review is the small 
number of  publications which addressed the specific 
research topic, according to an initial analysis. Since 
many studies that tried to determine the causes of  female 
infertility made varying attempts, it required some time to 
find papers that precisely tackled the topic of  the research 
to provide a comprehensive review. For example, many 
studies concentrated on prevalence rather than causes and 
risk factors. Since publications in other languages were 
not included, this scoping review’s focus was restricted to 
studies published in English language. 

CONCLUSION
Nigeria’s infertility problem demands sufficient attention 
and needs to be addressed by all relevant stakeholders. 
Based on published studies, infertility among Nigerian 
women has both physical and mental effects which 
are poorly understood, with genuine causes not fully 
understood. Knowledge gaps still exist that must be filled 
in order to comprehend fully the true causes of  female 
infertility. A thorough comprehension of  the physical 
and mental effects of  infertility among Nigerian women 
may potentially result in the recognition of  more efficient 
initial prevention and intervention strategies for female 
infertility. 

Acknowledgment
Special thanks to everyone who contributed in one way or 
the other to make this research a reality. Your assistance in 
conducting this research can never be denied.

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