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Background: To explore the Impact of Infertility on Pschological and Social Status of Women in Iran
Materials and Methods: Design A qualitative design, based on the content analysis approach, was employed for data collection and analysis of the experiences of Iranian women on infertility. Qualitative studies are intended to enhance understanding and describe the world of human experience (Myers, 2010). It should be said that content analysis is a systematic coding and categorizing approach, which can be used to unobtrusively explore large amount of textual information in order to ascertain the trends and patterns of communication (Gbrich, 2007). Data gathering and participants Data gathering tool was semi-structured interviews carried out with 10 women who were seeking infertility treatment at a referral center in an urban area of Iran from January to June 2010. All women were interviewed in a private room without the presence of their male partners (whom they all reported to be their husbands). Each interviews lasted between 45 and 90 minutes on average. The interviews were conducted in Persian language by the first author and then translated into English. The second author as a bilingual translator supervised the translation process and confirmed it. Each interview was recorded and transcribed verbatim and then analyzed concurrently (Satu, Helvi Kygnas, 2008, Graneheim and Land man, 2004). Data analysis Drawing on work by Graneheim and Lundman ( 2004), the following steps were taken to analyze the collected data: • Transcribing the interviews verbatim and reading through several times to obtain the sense of whole; • Dividing the text into meaning units that are condensed; • Abstracting the condensed meaning units and labeling with codes; • Sorting codes into sub-categories and categories based on comparisons regarding their similarities and differences; • Formulating themes as the expression of the latent content of the text.
Results: Themes The analysis of the transcripts resulted in emerging four main themes including “abuse”, “marital instability”, “social isolation”, and “loss of self- esteem” Abuse The theme ‘abuse’ consisted of two parts: psychological abuse’ and ‘physical abuse’. The feeling followed by infertility interrupted the mutual understanding between couples in most cases. One of the extracted themes from the data was abuse. The common type of violence among women was psychological violence. Most of the participants expressed that their husbands humiliated and insulted them because of their infertility. One of the participants said: "My husband sometimes humiliates me due to my infertility and insults me and my family". Besides psychological violence, a few women also talked about physical violence. One of the women said that "My husband sometimes beats me. I remain silent because I want nobody to become aware of my problems". The interactions of relatives were also affected by the infertile couples. When pregnancy was delayed, the relatives started to reproach the couples. The rebuke and pressure of the relatives was actually considered as one of significant concerns in the infertile couple’s lives. One participant disclosed that "My husband`s family particularly my mother – in – law and sister – in – law, provoke my husband against me". Another informant explained that "My sister – in – law always tells to my husband: divorce your wife and remarry with other woman who can bring you a child". Marital instability when the couple realized that they could not have a child, difficulties were grown and the distance between the couples increased. Mental pressure raised from infertility weakened the foundation of the family and even propelled the family to the divorce. Most of the participants felt that they lost trust to their husbands and they also thought that their husbands did not have any interests to them and might remarry with someone else. One informant said "I think that my husband is betraying me. He has several times asserted that ‘I want to marry with another woman and have a child’. This issue always concerns me”. Another women explained that "My husband comes to the house and claim that ‘I want to have a child, until when should I wait for having a child’? I think he is right if he would have married with another woman, she had born a child for him until now". The fear of remarrying of their husbands was an issue that was always mentioned by the infertile women. Based on Islamic doctrine, it is possible for men to remarry. One of the participants explained that "If a woman like me who is infertile and her husband can legally remarry with another woman, it is obvious that living for couples becomes boring and it causes the couples lose their patience, and their affectionate relationship is interrupted”. Social isolation For most women, infertility had negative social consequences and it bothered them. Most of the infertile women asserted that they did not like to participate in the social affairs and preferred being alone. One of them said: "I would like to be alone at home and do not like to go anywhere. Woman, who does not have a child, must stay at home". One informant said: “In our country, it is expected that a couple bear a child one or two years after their marriage. For this reason, their friends and relatives may always ask them about the time that they are going to have child?” Another woman explained that: "I am really tired because people always ask me when I am going to have a child? For this reason, I prefer to stay at home. It is a fact that people talk about their children in the parties and a women like me who suffers from infertility cannot talk about this issue and it is very painful for me". The relatives limit relations with the infertile couples in some cases. These actions made the infertile couples upset and they felt that they were in trouble. One of the participants said: "Ever since my relatives understood that I suffered from infertility, they did not invite me to the birthday celebrations of their children". Loss of self – esteem One of the objectives of the marriage is to have a child in the society. It is believed that having a child maintained and preserved the generation. In our study, when a woman understood that she was infertile, she lost her self-esteem and felt that she was inefficient. One of informants said: "I would never marry, if I knew that I could not bear a child. Now, I feel useless and think that my works are in vain". Another woman said: "One of the characteristics of the female is the fact that she must bear a child and breast feed and grow up children. If a woman does not have a child, she cannot be a complete woman”. Other women expressed: "I believe that a woman can reach its final evolution when she can bear a child". Some participants in the study asserted that they did not deserve to become mother and thought that their infertility was a type of punishment from Almighty God toward them. One woman explained: "Mother is a sacred word and everybody is not deserved this honor. Perhaps I am one of them".
Conclusion: Infertility has a serious effect on both psychological and social status of women in Iran. Awareness of the complications of infertility and the context in which they occur are prerequisite for the delivery of high quality care in the community.

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