|Year : 2015 | Volume
| Issue : 3 | Page : 156-160
Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria
Idris Sulaiman Abubakar, Rabiu Ayyuba, Ibrahim Garba
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||19-Oct-2015|
Dr. Rabiu Ayyuba
Department of Obstetrics and Gynaecology, Bayero University Kano/Aminu Kano Teaching Hospital, P. M. B. 3011, Kano
Source of Support: None, Conflict of Interest: None
Background: There is a global concern about poor awareness of fertility. Knowledge of fertility period even among fertile women will reduce the burden of infertility. The objective of this study was to determine the awareness of fertility period among fertile women at Aminu Kano Teaching Hospital (AKTH).
Patients and Methods: It was a descriptive study among 220 consenting women at AKTH over a period of 3 months, following approval by the hospital management. Structured pretested questionnaires were administered. Data were analyzed with a computer using Statistical Package for Social Sciences (SPSS) version 17 computer software.
Results: Two hundred and twenty women were recruited. The mean age ± standard deviation (SD) were 28.47 ± 5.91. One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, while 36 (16.36%) were unaware. Menstrual intervals of 30 days was the model (24.50%) followed by 28 days (20.50%). One hundred and seventy-one (77.70%) respondents were aware that pregnancy is related to menstrual cycle, while 49 (22.30%) were not aware. Also, 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not. One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not.
Conclusion: The study revealed good knowledge of fertility awareness among fertile women, but awareness of fertility period was lacking.
Keywords: Fertile women, fertility period, menstrual cycle, Nigerian fertile woman
|How to cite this article:|
Abubakar IS, Ayyuba R, Garba I. Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria. Arch Int Surg 2015;5:156-60
|How to cite this URL:|
Abubakar IS, Ayyuba R, Garba I. Awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital, Northern Nigeria. Arch Int Surg [serial online] 2015 [cited 2019 Jun 20];5:156-60. Available from: http://www.archintsurg.org/text.asp?2015/5/3/156/167509
| Introduction|| |
Globally, an estimated 580 million people experience infertility at some point in their reproductive lives.  Up to 372 million persons out of the 580 million live in low- and middle-income countries.  The burden of infertility is of immense concern in Africa. It is estimated that about 10.1% of couples experience infertility in Africa.  In sub-Saharan Africa, infections, either from sexually transmitted diseases, after childbirth or an abortion are reported to be the major causes of infertility.  This notwithstanding, other causes such as poor timing of sexual intercourse still contribute to infertility among Africans. Fertility is defined as the capacity to produce offspring.  It decreases relatively by about 50% among women in their late 30s when compared with women in their early 20s. , Failure to achieve a successful pregnancy after 1 or more years of regular unprotected sexual intercourse is referred as infertility. 
Fertility period is the time from the first act of intercourse, which may lead to pregnancy, to the demise of the ovum.  This period lasts for an average of 6 days. The average life span of spermatozoa is 3 days. However, sperm can survive up to 7 days in the female genital tract. Its survival depends on the presence of alkaline cervical secretions. Where there are no cervical secretions, the acidic vaginal environment rapidly destroys the sperm. , In a fertile cervical mucus secretion, the average survival time can extend up to 6 days. 
The average life span of the ovum is within 17 h.  For pregnancy to occur, fertilization must take place within these 17 h. Having frequent sexual intercourse during the period is the most important factor in enhancing the likelihood of conception. Hilgers and colleagues  revealed that couples who are aware of their fertile period and have focused intercourse during this period have higher conception rate when compared with those that are oblivious of their fertile time.
Several studies have assessed the length of the fertile period and the chance of conception on different days of the menstrual cycle in relation to ovulation. ,,, The maximum fertile period has been identified to be within 6 days. These days include the day of ovulation and the 5 days before ovulation. , In addition, studies have shown that multiple acts of intercourse within the fertile period significantly increase the probability of conception. , Research in southeast Asia has shown that only 26% of women with infertility have an adequate knowledge of when the fertile period occurred in their menstrual cycle.  Knowledge of awareness of fertility period among African women of child bearing age is not well-documented. We aim to determine the awareness of fertility period among women attending immunization clinic at Aminu Kano Teaching Hospital (AKTH).
| Patients and Methods|| |
It was a descriptive study among 220 women attending immunization clinic at AKTH over a period of 3 months (from 1 st November 2014 to 31 st January 2015). The hospital is a tertiary institution situated in Kano, Northwestern geopolitical zone, and is a teaching hospital for Bayero University Kano. All consenting women in the clinic were recruited for the study within the study period until the required sample size was attained. Women who denied consent for the study, women below the age of 18 years (difficulty in obtaining assent) and above 50 years were excluded from the study. A structured questionnaire on awareness of fertility period was developed by the researchers. The questionnaire consisted of both close- and open-ended questions. Information on sociodemographic characteristics and fertility awareness were recorded on the questionnaires. The questionnaires were pretested before administration.
Approval for the study was obtained from the ethical committee of AKTH and informed consent (written) from the clients after adequate counseling with respect to the purpose of the study was sought for and obtained. Participation of clients in this study was voluntary; respondents were assured of confidentiality. In this study, fertility period (fertile period/window period/fertile time) was defined as the time in the menstrual cycle during which conception is most likely to occur.  Usually 10-18 days after the onset of menstruation. Menstrual interval was defined as a period of time between the 1 st day of the menses to a day before the next menses. Menstrual cycle was defined as a hormonally regulated series of recurrent monthly events during the reproductive years of human female to ensure that the proper internal environment exists for fertilization, implantation, and development of a fetus. 
Data were entered in to a computer and analyzed using Statistical Package for Social Sciences (SPSS) version 17 computer software. Comparison of categorical variables were done using Fisher's exact test (criteria for applying chi-square test were not met). P-values 0.05 or less were considered significant.
| Results|| |
Two hundred and twenty women were recruited within the study period. The age range of the respondents was 18-50 years. The mean age ± standard deviation (SD) were 28.47 ± 5.91. Majority of the respondents (67, 30.50%) were within the age group of 25-29 years followed by 18-24 years (62, 28.20%). Others were 30-34 (52, 23.60%), 35-39 (30, 13.60%), and 40-44 (8, 3.60%). One respondent aged 50 years (0.50%). Hausa was the predominant ethnic group (134, 60.90%), followed by Yoruba (12, 5.50%). The least among the major tribes were Igbos (5, 2.30%). Other minor ethnic groups constituted 31.40% (69). These comprised Igala, Edo, Benin, Idoma, Margi, Ibira, Nufe, Arab, Shua, and Bura among others [Table 1].
All the respondents were married (220, 100.00%). Majority of the respondents were of the Islamic faith (200, 90.90%) and Christians constituted 9.10% (20). A larger proportion (44.50%) of the respondents attended tertiary level of education, followed by secondary level (81, 36.80%). Ninety-one (41.40%) were home managers followed by business women (54, 24.50%), professionals (29, 13.20%), students (21, 9.50%), and artisans (9, 4.10%). Other unspecified occupations represented 7.30% (16) [Table 1].
One hundred and eighty-four (83.64%) of the respondents knew the duration of their menstrual interval, but 36 (16.36%) were oblivious of it. Menstrual intervals of 30 days ranked the highest among the respondents (24.50%) followed by 28 days (20.50%), 21 days (10.50%) and 25 days (9.50%). The least was of 34 day cycle (0.50%). A total of 171 (77.70%) of the respondents were aware pregnancy was related to menstrual cycle, while 49 (22.30%) were oblivious. Also 129 (58.60%) knew their last menstrual periods, while the remaining 91 (41.40%) did not.
One hundred and seventeen (53.20%) respondents knew what fertility period meant, while 103 (46.80%) were ignorant of it. Only 85 (38.60%) of the respondents were aware of their fertility periods, while 135 (61.40%) were not [Table 2]. Similarly, only 13 (5.90%) knew any method to determine fertility periods, while 207 (94.10%) did not. For those that responded they knew, only six responded with degree of certainty. Their responses included: "Change in vaginal discharge", "change of body structure", "by checking ovulation period", and "by counting 5 days after menstruation".
There was statistically significant association between respondents' level of education and awareness of fertility period (P = 0.037, Fisher's exact test = 10.602). However, there were no statistically significant associations between their age groups, their occupations, and their fertility period awareness (P = 0.565 and 0.211; Fisher's exact test = 3.940 and 7.103, respectively) [Table 3].
| Discussion|| |
In this study, majority of the respondents (184, 83.64) knew the duration of their menstrual interval and menstrual interval of 30 days was the most frequent (24.50%) followed by 28 days (20.50%). Harlow and colleagues  found a model length of 28.75 and 29.32 days among African-American and European-American, respectively. Our finding is similar. The study revealed 171 (77.70%) of the respondents were aware that pregnancy is related to menstrual cycle and up to 129 (58.60%) knew the date of their last menstrual period. This showed good knowledge of fertility among the respondents. When they were asked what fertility period meant; 117 (53.29%) knew the answer, but only 85 (38.60%) were aware of their fertility periods [Figure 1]. Byamugisha et al.,  in their study on emergency contraception and fertility awareness among University Students in Kampala, Uganda, showed that 129 (34.70%) of the respondents were oblivious of their fertile period in the menstrual cycle. Our findings are similar. In our study, most of the respondents with knowledge of fertility period described it as "a few days after menstruation" followed by "a time when a woman is ready to get pregnant", "a time of ovulation", and other poorly described conditions [Figure 2]. In the study conducted by Byamugisha and colleagues  in Kampala, majority of the female participants described fertile period as just before the period (115, 30.90%), followed by between two periods (82, 22.00%), and just after the period (24, 6.50%) and others. This showed that knowledge of fertility period is lacking even among those that have awareness of the period. A comprehensive literature review on fertility awareness by the Institute for Reproductive Health, Georgetown University, Washington DC, United States, concluded that there is lack of fertility awareness globally. 
The fertility period can generally be identified by observing physiological indicators such as recording the basal body temperature, monitoring characteristics of cervical secretions, or by calculation based on cycle length. Here, there is information based on woman's menstrual interval or more simplified Standard Days Methods. , Lastly, the window period can be identified by using fertility monitoring devices, like personal hormone monitoring systems and saliva testing devices.  In this study, few of the respondents (13, 5.90%) knew any method to determine fertility period.
Our study revealed statistically significant association between respondents' level of education and awareness of fertility period (P < 0.05), but no statistically significant association between their age groups, occupation, and their fertility period awareness. The more the women are educated, the better they understand and are aware of their fertility period. Age may not necessarily influence their awareness. A young person may be highly educated, while an elderly is uneducated with poor awareness of fertility period. Occupation may have little influence on the fertility period, especially if it is unrelated with the level of education.
| Conclusion|| |
The study revealed good knowledge of fertility awareness among women attending immunization clinic, but awareness of fertility period is lacking even in those with knowledge of fertility. Knowledge of fertility period and fertility awareness will help a long way in natural family planning method for those that require it and in increasing the chances of conception, especially among women with subfertility.
We recommend health education of women of child-bearing age on fertility awareness and fertility period, especially at the service delivery points.
| References|| |
Gerais AS, Rushman H. Infertility in Africa. Popul Sci 1992;12:25-46.
Rutstein SO, Iqbal HS. Infecundity, infertility and childlessness in developing countries. DHS Comparative Reports No 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization. 2004;9:1-74. Available at: www.who.int/reproductivehealth/topics/infertility/DHS-CR9.pdf
. [Last accessed on 2015 Mar 24].
Cates W, Farley TM, Rowe PJ. Worldwide patterns of infertility: Is Africa different? Lancet 1985;2:596-8.
Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: Results of the German prospective study and impact on the management of infertility. Hum Reprod 2003;18:1959-66.
Howe G, Westhoff C, Vessey M, Yeates D. Effects of age, cigarette smoking and other factors on fertility: Finding in a large prospective study. Br Med J (Clin Res Ed) 1985;290:1697-700.
Dunson DB, Baird DD, Colombo B. Increased infertility with age in men and women. Am J Obstet Gynecol 2004; 103:51-6.
Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss. Fertil Steril 2008;89:1603.
Temporal relationships between indices of the fertile period. Fertil Steril 1983;39:647-55.
Odeblad E. Cervical mucus and their functions. J Irish Coll Phys Surg 1997;26:1.
Fordney-Settlage D. A review of cervical mucus and sperm interactions in humans. Int J Fertil 1981;26:161-9.
Ferreira-Poblete A. The probability of conception on different days of the cycle with respect to ovulation: An overview. Adv Contracept 1997;13:83-95.
Royston JP. Basal body temperature, ovulation and the risk of conception on different days of the menstrual cycle with special reference to the lifetimes of the sperm and egg. Biometrics 1982;38:397-406.
Hilgers TW, Daly KD, Prebil AM, Hilgers SK. Cumulative pregnancy rates in patients with apparently normal fertility and fertility-focused intercourse. J Reprod Med 1992;37: 864-6.
Barrett JC, Marshall J. The risk of conception on different days of the menstrual cycle. Popul Stud (Camb) 1969; 23:455-61.
Royston JP. Basal body temperature, ovulation and the risk of conception, with special reference to the lifetimes of sperm and egg. Biometrics 1982;38:397-406.
Scwartz D, MacDonald PD, Heuchel V. Fecundability, coital frequency and the viability of the ova. Popul Stud (Camb) 1980;34:397-400.
Columbo B, Masarotto G. Daily fecundability: First results from a new data base. Demogr Res 2000;3:39.
Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995;333:1517-21.
A prospective multicentre trial of the ovulation method of natural family planning III. Characteristics of the menstrual cycle and of the fertile phase. Fertil Steril 1983;40:773-8.
Blake D, Smith D, Bargiacchi A, France M, Gudex G. Fertility awareness in women attending a fertility clinic. Aust N Z J Obstet Gynecol 1997;37:350-2.
Harlow SD, Campbell B, Lin X, Raz J. Ethnic differences in the length of the menstrual cycle during the postmenarchial period. Am J Epidemiol 1997;146:572-80.
Byamugisha JK, Mirembe FM, Faxelid E, Gemzell-Danielsson K. Emergency contraception and fertility awareness among university students in Kampala, Uganda. Afr Health Sci 2006;6:194-200.
Institute for Reproductive Health. Fertility Awareness across the life course. A comprehensive literature review. Washington DC, Institute for Reproductive Health, Georgetown University, 2013.
Pyper C, Knight J. Glob Libr Women′s Med (ISSN:1756-2228) 2008. Fertility awareness methods of family planning for achieving or avoiding pregnancy.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]