Unveiling Silent Struggles – A Qualitative Study on Perception of Subfertility in Rathnapura District, Sri Lanka

Abstract

Introduction: This qualitative study explores the perception of subfertility in the Rathnapura district of Sri Lanka. Subfertility is a public health issue with profound socio-cultural, psychological, and economic consequences for affected individuals and couples. Understanding the social constructs and perceptions of subfertility is essential for addressing the unique challenges individuals face within the social framework. Methods: A qualitative study was conducted through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). The sample size was determined by theoretical saturation. Purposive sampling was used for FGDs, resulting in six groups of subfertile couples, and KIIs comprised 30 key informants from several subfertility service provider categories and relatives of subfertile couples. Data were collected by the trained research team, ensuring methodological rigour. Thematic analysis was conducted to extract meaningful insights from the gathered information. Results and Discussion: The findings of this study described the multifaceted perceptions related to subfertility, including significant emotional effects, societal stress, and stigma associated with subfertility. The desire for children was reflected as a source of happiness and achievement, with a preference for male offspring. Participants had varied beliefs about the causes of subfertility, including biological factors and supernatural influences. Accessing treatment options was challenging due to limited facilities, financial constraints, and cultural trusts. Additionally, religious and spiritual faiths influence the interpretation of subfertility, creating a complex interaction of cultural, social, and psychological factors. Cultural views and traditional norms play a significant role in shaping the perception of subfertility. Conclusion and Recommendations: The perception of subfertility is deeply influenced by cultural beliefs, societal norms, and gender roles. The stigmatisation associated with subfertility places considerable emotional strain on affected individuals and couples. Recognizing these social dynamics is crucial for developing effective interventions that address the unique challenges faced by individuals experiencing subfertility in this context. Sexual and reproductive health knowledge should be increased in the community, and culturally sensitive interventions are required to challenge prevailing societal norms and educate the public about subfertility.