|Year : 2013 | Volume
| Issue : 1 | Page : 19-23
Knowledge and attitudes toward child adoption and fostering among infertile women in northern Nigeria
Sanusi Abubakar1, UM Lawan1, JN Yasir2
1 Department of Community Medicine, Aminu Kano Teaching Hospital, Hospital Road, PMB 3254, Kano, Niger
2 Bayero University Kano, Kano, Niger
|Date of Web Publication||17-May-2013|
Department of Community Medicine, Aminu Kano Teaching Hospital, Hospital Road, PMB 3254, Kano
Background: Infertility is a public health problem in the developing countries. However, the role of child adoption or fostering in the management of infertile couples is underexplored, particularly in northern Nigeria. Materials and Methods: A cross-sectional study involving the use of a structured interview questionnaire was employed to collect information from clients attending the infertility clinic of Aminu Kano University Teaching Hospital (AKTH), Kano. The data were analyzed using MINITAB® 12.21 software. Percentages and means were used to describe categorical and quantitative variables, respectively. The chi-square test was used to assess the significance of associations using a confidence interval of 95%. Results: Majority of the respondents (69.7%) were between 25 and 34 years of age, and of Hausa/Fulani ethnic group (79.6%). Knowledge of child adoption was good in 59.2% of the respondents, while the willingness to adopt versus foster was 28.2% and 44.4%, respectively. Conclusion: There is a need to advocate for infertility counseling services, so as to support infertile clients in taking informed decisions regarding child adoption or fostering as viable options for having their own families.
Keywords: Attitude, child adoption, knowledge, Nigeria
|How to cite this article:|
Abubakar S, Lawan U M, Yasir J N. Knowledge and attitudes toward child adoption and fostering among infertile women in northern Nigeria. Sahel Med J 2013;16:19-23
|How to cite this URL:|
Abubakar S, Lawan U M, Yasir J N. Knowledge and attitudes toward child adoption and fostering among infertile women in northern Nigeria. Sahel Med J [serial online] 2013 [cited 2020 Aug 10];16:19-23. Available from: http://www.smjonline.org/text.asp?2013/16/1/19/112062
| Introduction|| |
Infertility is a worldwide problem and has devastating social and psychological consequences on the affected couples, especially in Africa.  In fact, in all cultures, childlessness is recognized as a crisis that has the potential to threaten the stability of individuals, relationships, and communities.  Every society has culturally approved "solutions" to infertility involving either alone or together, alterations of social relationships, spiritual intercessions, or medical interventions.  In the developed countries, the incidence of infertility is 10%-15% among married couples.  Despite the growing concern about overpopulation and undernutrition in Africa, it is estimated that about 30%-40% of women in sub-Saharan Africa would complete their reproductive years without having a child.  This may be related to the high incidence of genital infections, and makes infertility a public health concern in some parts of Africa.  In the past, it was assumed that infertility in Africa did not warrant specific interventions and pragmatic effort since many African countries have concomitantly high rates of fertility. With the paradigm shift that took place after the 1994 International Conference on Population and Development in Cairo, it is now evident that a conceptual rethink about infertility in Africa is needed. 
Although there are many management options for infertile couples, the outcome of the treatment depends on the etiological factors, available diagnostics tools, skills of the attending physician, and above all, the financial status of the couple. Adoption and fostering are the alternative strategies in the management of infertility, aimed at bringing succor to the affected couple. Adoption is the term given for the permanent transfer of legal rights in relation to the parental responsibility of a child, while foster care describes the temporary acquisition of guardianship rights in relation to a child.  Foster care is often used when a child is waiting to be adopted or the courts are considering an adoption order.  Under the United Nations Convention on the Rights of the Child 1989, adoption is recognized as one of the forms of alternative care for children who have been temporarily or permanently deprived of their family environment, and also for children who are unable to remain in their family environment. 
Adoption has influence on the adopted child's status; hence, it affects his/her legal rights, welfare, and obligations.  Today, adoption involves not only traditional adoption of children but also gametes or embryos.  Infertility is the main reason that the parents seek to adopt children they are not related to, with one study showing that this accounted for 80% of infant adoptions.  Estimates suggest that 11%-24% Americans who cannot conceive or carry pregnancy to term attempt to raise a family through adoption, and the overall rate of ever-married American women who adopt is 1.4%. 
Attitudes and laws guiding adoption vary greatly. Whereas all cultures make arrangements whereby children whose own parents are unavailable to rear them are brought up by others, not all cultures share the same concept of adoption.  In Islam, for instance, the guardian-child relationship has specific rules and the relationship is different from adoption as practiced today. The Islamic term for what is commonly called adoption is kafala, which comes from a word that means "to feed,"  and in essence, it describes a parent-foster child relationship that is very valued and important. Various studies ,, from Nigeria have shown high levels of awareness of adoption and fostering even though only a few people know the exact meaning of the terms. While studies from southeastern  and southwestern  Nigeria have shown low level of acceptability, one study in Zaria  has shown high level of acceptability and uptake of adoption with a preference for fostering because of cultural or religious reasons.
Adoption and fostering are the robust management options for infertile couples that need to be explored, especially in the developing countries. The public health implication of infertility in Nigeria coupled with the lack of access to assisted reproductive technologies and large population of uncared children makes fostering and adoption sensible options. This study was aimed at determining the knowledge, attitude, and practice of child adoption in a northern Nigerian tertiary hospital.
| Materials and Methods|| |
Kano is both the largest commercial center and the most populous state in northern Nigeria.  Majority of the patients who patronize the hospital belong to indigenous Hausa/Fulani ethnic group, although patients from other ethnic groups such as the Yoruba and Igbo also constitute a substantial part of the clientele. Most of the people of Kano state are traders, farmers, and civil servants, and the predominant religions are Islam and Christianity.
In the center of Kano city is situated Aminu Kano Teaching Hospital (AKTH), a 500-bed tertiary hospital that provides health services to the population in Kano and the neighboring states. The obstetrics and gynecology department of AKTH runs the gynecology specialist clinic four times a week, seeing an average of 40 patients per day. The clinic provides services to infertile clients who form approximately 65% of the total cases seen per clinic day. This clinic also receives infertility referrals from other health centers in Kano and its environs.
The study was a cross-sectional study using a trained interviewer who administered pretested questionnaires. We studied 146 women diagnosed with infertility in the specialty clinic of AKTH between August and September, 2010. The required sample size was obtained using an appropriate statistical formula , for calculating the minimum sample size for descriptive studies and a prevalence of 89.4% from a past study. 
The systematic sampling technique was used to recruit clients for the study. Using a sampling interval of five, one in every five patients seen in the clinic was recruited until the required sample of 146 was obtained.
Ethical approval was obtained from the ethics committee of AKTH before conducting this study. Informed written consent was also obtained from the respondents before administration of the questionnaires by the research assistant. The selected respondents were interviewed using an interviewer-administered pre-tested, structured questionnaire.
The questionnaire was in three parts. The first part obtained information on socio-demographic variables, while the second part explored respondents' knowledge of adoption and fostering as well as sources of information regarding adoption and fostering. The third part enquired about respondents' attitude toward child adoption and fostering.
The collected data were analyzed using the MINITAB® 12.21 (USA) statistical software. Absolute numbers and simple percentages were used to describe categorical variables, while quantitative variables were described using mean and standard deviation. Respondents' knowledge of adoption and fostering was assessed using eight parameters drawn from the second part of the questionnaire. Each correct response was accorded one point and wrong response was given no point, thus arriving at a maximum score of eight points. Points were converted into percentages, and respondents who scored 70% and above were considered to have good knowledge (70% cutoff was chosen because it fell between the 2 nd and 3 rd quartiles; anyone with this score and above was adjudged to have good grasp of adoption), while those who scored 39.9-69.9 points were adjudged as having fair knowledge. In the same vein, a score less than 39.9 was considered as poor knowledge. The chi-square test was used to assess the significance of associations between categorical groups. A P-value of 0.05 or less was considered statistically significant.
| Results|| |
Out of the 146 questionnaires administered, 142 were appropriately filled and returned, giving a response rate of 97.3%.
Socio-demographic distribution of the respondents
The modal age of the respondents was 25-29 years (36.6%), while the mean age was 28.5 ± 5.1 years. Only a few (2.1%) respondents were within 40-44 years of age. Majority (85.9%) of the subjects were Muslims, while the remaining were Christians. Eighty percent of the respondents were of Hausa/Fulani ethnic group. Almost all the respondents (99.3%) had at least primary education [Table 1].
Knowledge and attitudes towards child adoption and fostering
Overall, 59.2% of the respondents had good knowledge of child adoption and fostering, while 18.3% and 22.5% had fair and poor knowledge respectively. Most of the respondents mentioned friends (72.3%), family members (70.6%), and television/radio (57.3%), with less than 30% mentioning doctors and nurses as their source of information about child adoption and fostering, respectively.
As shown in [Table 2], more than 80% of the respondents thought fostering was good, 70.4% believed adoption was good, and 44.4% preferred fostering to adoption, with more than 27% saying they preferred neither of them. Only 35.5% of the respondents were willing to adopt a child, while less than 40% of the respondents are willing to foster a child.
Determinants of willingness to adopt/foster a child
- Willingness to foster a child by an infertile couple None of the factors (age P = 0.26, religion P = 0.66, educational status P = 0.68, duration of marriage P = 0.91) were statistically significant on bivariate analysis for willingness to foster in this study.
- Willingness to adopt a child by an infertile couple Religion of respondent was the only social factor that was statistically significant (P = 0.046, P < 0.05) for this parameter on bivariate analysis in this study, but it was not significant on multivariate analysis (P = 0.083).
| Discussion|| |
The majority of the patients were young adults in their twenties, which was similar to what was found in Zaria.  The ethnic and religious distribution of the clients reflects a typical composition of Kano city where majority of the indigenes are Muslims and of Hausa/Fulani ethnic group. 
Majority of the respondents (64.8%) had secondary school education. This is not surprising as most of the clients attending the hospital come from an urban background and are likely to have been enrolled in some form of schooling.
About half of the respondents had been infertile for a period of between 1 and 4 years, with only one of them being infertile for a period for 25-29 years. Majority of the respondents were aware of child adoption and fostering, most of them knew the correct meaning of child adoption and fostering, only a few of them were not sure of the meaning, while a few said that they did not know the meaning of either of the two terms. Although the high awareness of child adoption and fostering among the subjects in this study (82.5%) is similar to what was found in Enugu (86.4%),  the percentage of those who knew the correct meaning of adoption (59.2%) in this study is contrary to what was found in Enugu (27.3%).  However, the finding is similar to the report from Ibadan.  These variations may be as a result of difficulty in translating the real meaning of adoption and fostering into the local language of the respondents, which is a possible limitation of the study.
Main sources of information about child adoption and fostering mentioned by the respondents in order of their frequency included friends, family members, television/radio, doctors, and nurses. This is similar to that reported from Ibadan and Zaria, , and this is not unconnected to the fact that the above mentioned are the most common sources of information with regards to health issues in some societies. 
Majority of the respondents thought that fostering was good, a few of them believed that it was not good, while the rest were not sure. With regards to adoption, about two-thirds of the respondents believed it was good, while less than one-third of them were not sure. This is also in keeping with a typical Hausa-Muslim community where fostering and some form of adoption is culturally acceptable and widely practiced from time immemorial, even though Islamic jurisprudence emphasizes to the adoptive parents that they are not taking the place of the biological family, but rather they are trustees and caretakers of someone else's child.  This is similar to what was found in a study conducted in Oromo, Ethiopia, which revealed that Oromo people used to practice different types of adoption since antiquity, known as Guddifachaa,  at domestic and community levels with different objectives. While more than one-third of the respondents in this study believed that child adoption and fostering are the effective options of managing infertility, less than half did not agree, while the rest were not sure. This is similar to what was reported from Ibadan. 
Only a little more than one-third of the respondents were willing to adopt a child and more than one-third of the respondents were willing to foster a child. This is similar to the reports from Ibadan and Enugu. , Similarly, the findings are contrary to the findings from several studies conducted in the United States and Canada, which showed that adoption and fostering have gained more popularity and legal backing over the years in the western world, especially in the United States where 65% of the Americans have experience with adoption either through their own family or through close friends, and that people are connecting with the idea of adoption as good for their families and for the society. ,
However, it was found out in this study that less than half of the respondents are willing to adopt or foster a child despite the fact that they are infertile. This finding may be explained by the cultural environment of Kano where the study was conducted, and the religion of most of the respondents, i.e. Islam, which favors child fostering over child adoption.
This study was hospital based with the limitations of being non-generalizable to the whole population, as well as with a bias for self-selection of patients attending any tertiary health institution. However, the findings indicate the need for sustained infertility counseling to be delivered frequently by gynecologists/social workers working in infertility clinics, in addition to community engagement with traditional and religious leaders on the merits of adoption or fostering in our society. This will sustain and further promote better knowledge about adoption and fostering, disseminate information, and help support infertile couples to adopt or foster a child. These are viable and fulfilling options, especially for infertile clients in the developing countries that generally have large populations of children requiring parental care as well as limited facilities offering high-tech assisted reproductive technologies. Finally, this study would have benefited from a larger sample size that may probably yield better inferences, if more resources had been available.
| Acknowledgments|| |
We acknowledge Dr. Jamilu Tukur (Head of Department, Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria) for the support given throughout the study. We also thank all the patients for participating in the study.
| References|| |
|1.||Araoye MO. Epidemiology of infertility: social problems of the infertile couples. West Afr J Med 2003;22:190-6. |
|2.||Linda HB, Sharon NC. Psychology of infertility. In: Linda H B, Sharon NC, editors. Infertility counseling- A Comprehensive Handbook for Clinicians. 2 nd ed. Cambridge: Cambridge University Press; 2000. p. 1 - 21. |
|3.||Remah MK. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol 2010;8:21 |
|4.||Belsey MA. The epidemiology of infertility: a review with particular reference to sub-Saharan Africa. Bull World Health Organ 1976;54:319-41. |
|5.||Otubu JA. Infertility. In: Agboola A, editor. Textbook of Obstetrics and Gynaecology for Medical Students. 2 nd ed. Nigeria: Heinemann Educational Books; p. 128-38. |
|6.||Etuk SJ. Reproductive health: global infertility trend. Niger J Physiol Sci 2009;24:85-90. |
|7.||Adoption and Fostering. Available from: http://www.politics.co.uk. [Last accessed 2010 Mar 10]. |
|8.||United Nations General Assembly. Convention on the Rights of the Child. Available from: http://www.un.org/documents/ga/res/44/a44r025.htm. [Last accessed on 2012 Jan 16]. |
|9.||Old lessons for a new world: Applying Adoption Research and Experience to Assisted Reproductive Technology. Evan B. Donaldson Adoption Institute. Available from: http:// http://www.adoptioninstitute.org/publications/2009_02_OldLessons.pdf. [Last accessed on 2012 Feb 12]. |
|10.||Adoption from Wikipedia, the free encyclopedia. Available from: http://en.wikipaedia.org/wiki/category: Adoption. [Last accessed on 2010 Mar 14]. |
|11.||Kafala. Adopting a child in Islam. Available from: http://www.islam.about.com/cs/parenting/a/adoption.htm. [Last accessed 2010 Mar 19]. |
|12.||Oladokun A, Oyedunni A, Oladokun R, Imran OM, Elijah AB, Isaac FA,et al. Acceptability of child adoption as management option for infertility in Nigeria: evidence from focus group discussions. Afr J Reprod Health 2009;13:79-91. |
|13.||Ezugwu FO, Obi SN, Onah HE. The knowledge, attitude and practice of child adoption among infertile Nigerian women. J Obstet Gynaecol 2002;22:211-6. |
|14.||Avidime S, Isaac N, Aliyu Y, Sullyman K, Idris H, Ojabo A, et al. Women's knowledge and acceptability of adoption in Zaria, northern Nigeria. Trop J Obstet Gynaecol 2009;26(Suppl 1):8. |
|15.||Kano from Wikipedia, the free encyclopedia. Available from: http://en.wikipedia.org/wiki/Kano. [Last accessed on 2013 Feb 12]. |
|16.||Lwanga S, Lemeshow S. Sample size determination in health studies. A practical manual Geneva: World Health Organisation; 1991. p. 23-41. |
|17.||Kang'oma S. Fertility preferences and unmet need for family planning. Available from: http://www.measuredhs.com/pubs/pdf/FR175/07Chapter07.pdf. [Last accessed on 2012 Feb 16]. |
|18.||Nigeria: Information on the city of Kano, its population, its ethnic composition and religions practised, and maps of the city showing the Old City and the Kou and Sabon Gari neighborhood, 1 June 1996, NGA24110.E. Available from: http://www.unhcr.org/refworld/docid/3ae6aabf88.html. [Last accessed 2012 Feb 17]. |
|19.||Cutili CC. Patient education corner: Seeking health information: What sources do your patients use? Orthop Nursing 2010;29:214-9. |
|20.||Adopting a Child in Islam. Islamic legal rulings about foster parenting and adoption. Available from: http://islam.about.com/cs/parenting/a/adoption.htm. [Last accessed on 2013 Feb 12]. |
|21.||Ayalew D. Guddifachaa: Adoption practice in Oromo society with particular reference to the Borana Oromo. M.A Thesis. Available from: http://etd.aau.edu.et/dspace/bitstream/123456789/1099/1/AYALEW%20DURESSA.pdf. [Last accessed on 2012 Feb 16]. |
|22.||National Adoption Attitude Survey. Dave Thomas Foundation for Adoption and Evan B. Donaldson Adoption Institute. Available from: http://www.adoptioninstitute.org/survey/Adoption_Attitudes_Survey.pdf. [Last accessed on 2012 Feb 16]. |
|23.||Alcalay R, Tybjee T, Taplin S, O'Loughlin L. Adoption, foster care and concurrent planning: A study of awareness, attitudes, motivations, barriers and implications for communication. David and Lucille Packard Foundation and California Department of Social services, Children and Family Services Division. Available at http://bakids.org/wp-content/uploads/packardreport.pdf. [Last accessed on 2012 Feb 16]. |
[Table 1], [Table 2]