Epidemiology of infertility and coping mechanisms in Ethiopia, 2025: a systematic review and meta-analysis
Bibliographic record
Abstract
Infertility is much more than a quality-of-life concern. Its consequences stream into public health domains such as psychological distress, social stigma and marital disagreements. The estimation of infertility is one of the most crucial activities concerning informing policymakers. Therefore, this review was conducted to estimate the pooled prevalence of infertility and coping mechanisms in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline to adhere to standards in conducting and reporting of evidence synthesis. An internet-based search of noninterventional studies in Ethiopia was performed in CINAHL, EMBASE, PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and Google Scholar. A total of 332 studies were screened, and only 11 studies satisfied the inclusion criteria. Studies were included if they described the prevalence and/or coping mechanisms of infertility. The Newcastle–Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used for quantitative and qualitative studies, respectively. The random-effects meta-analysis was done in Stata version 17, and forest plots, test of heterogeneity, and funnel plots were all generated. The pooled prevalence of lifetime and/or specific period of infertility was 25.77% [95% CI: 20.10, 31.45], with a heterogeneity index (I2 = 99.48, P = 0.00). The subgroup prevalence of primary infertility was 22.76% [-0.95–46.47], with heterogeneity (I2 = 99.54, p = 00), and that of secondary was 12.67% [9.14–16.20], with I2 = 98.57, p = 0.00. Spiritual activity, medical treatment, cultural practice, seeking support from family, adoption, acceptance, having a godchild, estranged social life, helplessness, extramarital engagement, and marital separation were the identified coping mechanisms. Compared with the global standard, the pooled prevalence of infertility in Ethiopia is relatively high. Most of the identified coping strategies of infertility were problem-focused mechanisms. The identified coping mechanisms were grouped in the following main themes: (i) seeking medical treatment, (ii) religious/spiritual practices, (iii) seeking social support, (iv) using cultural remedies, (v) acceptance, and (vi) avoidance/harmful behaviors. Policy makers, health authorities and professionals should improve the delivery of infertility prevention and treatment services and ensure coping support is culturally sensitive and integrated with the national health strategy. Infertility is unable to be pregnant after 12 months or more of regular unprotected sex. It can be a primary or secondary type. It leads to distress, social isolation and even marital separation. Estimating infertility is one of the most crucial activities for informing policymakers. Therefore, this review was conducted to determine the prevalence of infertility and coping methods in Ethiopia. The search of studies was conducted in different databases. A total of 332 studies were reviewed, of which 11 studies were included. The New Castle-Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used to assess quantitative and qualitative studies, respectively. Meta-analysis was carried out via Stata version 17. Forest plots, heterogeneity tests, and funnel plots were performed. The total prevalence of infertility was 25.77%. The subgroup prevalence of primary infertility was 22.76%, and that of secondary infertility was 12.67%. Spiritual activity, medical treatment, cultural practice, seeking support from family, adoption, acceptance, having a godchild, estranged social life, helplessness, extramarital engagement, and marital separation were the identified coping mechanisms among infertile couples. There is limited evidence of infertility in Ethiopia. Its magnitude in Ethiopia is high compared to standards. Most of the reported strategies were problem-focused coping mechanisms. The lives of infertile women are burdened with deep emotional and social effects. The health delivery system and health service providers need to look at the psychosocial aspects of advanced infertility treatment options and effective counselling.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.026 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".