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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 6  |  Page : 806-811

The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample


1 Department of Gynecology and Obstetrics Nursing, Dokuz Eylul University, Institute of Health Sciences, Izmir, Turkey
2 Department of Gynecology and Obstetrics Nursing, Dokuz Eylul University, Nursing Faculty, Izmir, Turkey
3 IVF Center, Health Science University Tepecik Training and Research Hospital, Izmir, Turkey
4 Department of Women's Health and Birth, Health Science University Tepecik Training and Research Hospital, Izmir, Turkey

Date of Acceptance28-Feb-2019
Date of Web Publication12-Jun-2019

Correspondence Address:
Dr. S Fata
Dokuz Eylul University, Institute of Health Sciences, 35340 Balcova, Izmir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_383_18

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   Abstract 


Objective: Studies related to traditional practices and benefits have been usually performed among women. The literature regarding the traditional practices used by men in Turkey and around the world and their expected benefits is more limited. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths. Materials and Methods: The descriptive study was performed between May and July 2017 in Izmir, Turkey. In total, 151 women with infertility were included. The data related to the use of this practice by men were obtained from women partners. “Personal information form” and “traditional practices evaluation form” were used to obtain the data. Results: In total, 35.8% of the women and 25.8% of the men used traditional practices. The 24.4% of women and 52.1% of men used other practices such as figs, onion cures, and hacamat, whereas 18.2% of women and 14.9% of men used various herbs. The benefits they expected from traditional practices were facilitating conception, ensuring follicle development in women, increasing sperm count, and quality and facilitating conception in men. Overall, 37.0% of women learned of these practices from their friends, 30.7% of men learned from their partners, 20.4% of women and 20.6% of men learned from the internet. Conclusion: The couples in this study widely used traditional practices to solve fertility problems and learned from their friends and partners.

Keywords: Couples, fertility problem, traditional practice, Turkey


How to cite this article:
Fata S, Tokat M A, Bagardi N, Yilmaz B. The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample. Niger J Clin Pract 2019;22:806-11

How to cite this URL:
Fata S, Tokat M A, Bagardi N, Yilmaz B. The traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths: The Turkey Sample. Niger J Clin Pract [serial online] 2019 [cited 2019 Sep 17];22:806-11. Available from: http://www.njcponline.com/text.asp?2019/22/6/806/260033




   Introduction Top


The World Health Organization[1] defines traditional medicine as the sum total of the knowledge, skills, and practices based on the beliefs and experiences of different cultures, and it is used in physical and mental illness prevention, diagnosis, healing, or treatment, as well as in maintaining good health. For years, people have been resorting to traditional practices to solve fertility problems related to conception. Today, many traditional practices still vary from culture to culture worldwide. The frequently used methods for fertility in the world include visiting religious leaders, visiting tombs, cutting a red rooster and feeding it to a child, using amulets, drinking Zamzam water (water brought from pilgrimage), multivitamins, herbs, mineral supplements, chiropractic, naturopathy, homeopathy, and acupuncture.[2],[3],[4],[5],[6],[7] In Turkey, visiting religious leaders, using amulets, sacrificing, and using folk medicines were the commonly used traditional practices.[8],[9],[10]

Studies on traditional practices and benefits were generally made among women. The use of traditional practices by men is studied limitedly in literature worldwide. Since fertility problems are often associated with women, traditional practices are more commonly used in women. However, fertility is a problem that affects couples. Nurses and other health professionals working in this area should be aware of the traditional practices used by couples, the benefits or harms of practices, and to give proper counseling. In addition, determining the learning paths of practices will provide data to guide couples toward the right resources. The aim of this study was to examine the traditional practices used by couples with fertility problems, affecting factors, expected benefits, and learning paths.


   Materials and Methods Top


The cross-sectional descriptive study was performed between May and July 2017 in one of the biggest women's health hospitals in Izmir, Turkey. Izmir is a city located in the west of Turkey. Because it is a migrant area, the sample mostly represents other parts of Turkey. Approximately 50 couples apply in 1 month to the in vitro fertilization (IVF) center of this hospital. The population of this study was women who applied in this center between May and July 2017. The 151 women of them were selected by convenience sampling during the period of study. All women participated in this study voluntarily. The post-hoc power analysis was performed by IBM SPSS Statistics for Windows, version 22 after 151 women reached. The power of this study was calculated as 92%.[11]

The data were collected using face-to-face interviews with the women. In the Turkish culture, men experience difficulty in sharing infertility diagnoses and treatment processes, so evaluating the use of medical or traditional practices by men is hard. Also in our culture, mostly women lead their partners to use traditional methods. Therefore, the data on men were gathered by asking their partner. “personal information form” and “traditional practices evaluation form” were used to obtain the data. The personal information form was composed of nine questions about sociodemographic characteristics and three questions about infertility history. We prepared “traditional practices evaluation form” with reference to the literature.[9],[10],[11] It consisted of three questions concerning the use of traditional practices, the commonly used traditional practices and expected benefits, and learning paths. We completed the form through observation in fertility clinics and through face-to-face interviews with fertility nurses. Before starting the study, we took the expert opinions of three academician nurses with expertise in the field of fertility via interviews. According to their suggestions, we finalized the form and started the data collection process. After receiving expert opinions, the level of agreement on our prepared form was 100%. Therefore, we used the form without modification and started data collection without a pilot study.

This study was approved by the university ethical board (Decision No: 2016/13-37) and the hospital administration. As confidence is important in obtaining data related to traditional practices, the researcher first verbally explained the aim of research to participants and subsequently obtained their written consent.

Frequencies and percentages regarding the use of traditional practices, commonly used traditional practices, expected benefits, and learning paths were estimated. The Chi-square test was used to determine the factors affecting traditional practice use. The results were evaluated with a 95% confidence interval, and P value less than. 05 was considered statistically significant.


   Results Top


Sociodemographic characteristics and infertility history

The average age of the women was 32.87 years, the average length of marriage was 7.58 years, and 78.1% had a nuclear family structure. In total, 35.8% of the women were high school graduates and 60.3% were unemployed, whereas 30.5% of the men were high school graduates and 96.7% were employed. In addition, 33.8% of couples were diagnosed with female infertility, 42.4% were diagnosed 1--2 years ago, and 35.1% have been undergoing treatment for 1--2 years.

Use of traditional practices and factors affecting use

In total, 35.8% of the women and 25.8% of the men expressed that they used traditional practices. [Table 1] summarizes the effects of demographic characteristics and infertility history on the use of traditional practices. It was determined that education level, working status, location, and duration since diagnosis did not affect the use of traditional practices by both women and men (P > 0.05 for each characteristic). Regardless, the duration of treatment and the infertility cause influenced the use of traditional practices respectively in women and men (χ2 = 10.76, P = 0.01; χ2 = 13.39, P = 0.01). Women who received infertility treatments for less than 1 year were more likely to use traditional practices. In addition, in couples with determined female infertility, men were more willing to use traditional practices.
Table 1: Use of traditional practices and factors affecting the use (n=151)

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Commonly used traditional practices and expected benefits

In total, 24.4% of the women used figs, onion cures, hacamat, carob, or a honey--pollen mixture, whereas 18.2% used various herbs and 13.1% used sacrificed animals [Table 2]. Overall, 37.0% of women reported that they learned of these practices from their friends, 20.4% from the internet, and 18.6% from television. Findings about men's use of traditional practices showed that 52.1% used a honey--pollen mixture, hacamat, pumpkin seed, onion cure, or carob, whereas 14.9% used various herbs (lion's claw, parsley, Meryem Herb) and 12.8% used sacrificed animals. [Table 2]. Moreover, 30.7% of men learned of these practices from their partners, 20.6% from the internet, and 12.8% from television. These practices were used by couples and how they are used was explained to be understood more clearly [Table 3]. In women, the benefits they expected from traditional practices were facilitating conception, ensuring follicle development, and preventing miscarriages. Expected benefits of men include increasing sperm count and quality and facilitating conception.
Table 2: Commonly used traditional practices and expected benefits

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Table 3: The introduction/usage of traditional practices

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   Discussion Top


This study is quite comprehensive in its provision of information on the use of traditional practices by couples.

The use of traditional practices by couples and factors affecting the use

In the study, one-third of the women and one-fourth of the men used traditional practices. Two studies on the use of traditional practices by women to enhance fertility in Turkey show that one-third of the women and four-fifth of the women used traditional practices, respectively.[10],[12] These findings show that almost one in every three couples tries to use traditional practices. In some studies performed in the eastern part of Turkey and in Central Anatolia, the use of traditional practices by women[9] and men[11] was much higher. In these regions, there is greater cultural pressure to have children and therefore couples resort to different methods. Kashani et al.[13] found that one-third of couples in Iran used herbal remedies. In addition, in studies conducted in America and Lebanon,[7],[14] more than half of the women used traditional practices, whereas in a study conducted in Africa,[15] one-fifth of women used traditional practices. Couples all over the world, mostly women, resort to traditional practices. Women are more exposed to social pressure. They try many ways to solve the fertility problem. Traditional practices are practices that are believed to be safe and sacred from the ancestors of each culture. Therefore, it is expected that the rate of using traditional practices in women is high.

According to the results of the study, it was observed that the educational levels of women and men did not affect the use of traditional practices. However, in studies conducted in Turkey[10] and across the world,[2] it was observed that women and men with lower educational levels more frequently used these practices. Yet, regardless of the educational level of women and men, all felt despair and tried every possible option to become a parent. In our culture, having a child is equated to being a woman/man.

Despite the fact that women and men living in villages in general used traditional practices more often, the difference was not statistically significant. Ayaz et al.[10] also did not determine a difference in the use of traditional practices according to their location. However, in research conducted in the Anatolia part of Turkey by Günay et al.,[12] the use of traditional practices was higher among women that lived in rural areas than among other women. In smaller settlements, such as villages, people are more likely to be influenced by each other; therefore, such practices may be used more often than in other settlements.

It is an interesting result that when infertility problem was in women, men were more likely to use traditional practices because when the infertility problem was not caused by them, the men felt relieved, stronger, and became more willing to help the women. In our culture, men always want to be stronger than women because Turkey has a patriarchal family structure. However, the cause of infertility did not affect the use of traditional practices among women.

In this study, although women who have been undergoing fertility treatment for less than 1 year were more likely to use traditional practices, the duration of treatment did not affect the use of these practices by men. The expected outcome is that over a longer infertility period, women will try more varying ways to become pregnant. However, in a study conducted by Kurçer et al.,[8] women with infertility who were treated for 1--5 years used more traditional practices than did women with a longer treatment period. Consequently, our results show that women who have already started treatment try various methods in the beginning.

Commonly used traditional practices and expected benefits

In addition to the literature, the study highlighted that women did not bathe for a few days after embryo transfer, and they used amulets and adjusted the womb manually, whereas men washed in thermal water. In Turkish studies, women reported drinking boiled black pumpkin, garlic, nettle, parsley, and barley, and they used suppositories with various prepared herbs, olive oil, garlic, and wax,[8],[9],[10] went to tomb, and sacrificed animals.[12] In studies around the world, it has been observed that women drank rabbit's blood, mare's milk, sheep's urine, and wild hyacinth tea, as well as took a relaxing holiday, washed in thermal waters,[16] and visited religious leaders,[7] although there is no information that these applications are scientifically useful. Especially, men preferred the use of herbs, visiting the tomb and religious leaders, and sacrificing animals.[7],[12],[17] The literature in Turkey and around the world is similar in terms of traditional practices used. Women used many practices all over the world without knowing whether they have scientifically positive effects. Some of the practices are religious, and cultural beliefs dictate that they will not adversely affect health, whereas others are harmful, such as placing foreign and hot objects in the vagina. The practices that men used were based on religious beliefs rather than applied to the body.

According to the results of the study, there were both psychological and physiological benefits expected among couples related to traditional practices. Some of the benefits women expected were similar to that of the literature: facilitating conception[7],[10] and reducing stress.[7],[13] Meanwhile, other expected benefits not included in the literature were preventing miscarriage, treating infection, preparing the womb for pregnancy, regulating menstruation, regulating hormones, improving follicle development, and strengthening the immune system. The expected benefit of increasing men's sperm characteristics was similarly found in a study by Ghazeeri et al.,[7] while treating infection and making it easier to conceive were additional expected benefits. The main aim of women was to become pregnant. Some women try to conceive by preparing themselves physiologically, whereas others prepare psychologically. Meanwhile, women in Turkey try physiologically to facilitate pregnancy, whereas women around the world give greater importance to psychological comfort. In Turkey, fertility can only be assessed physiologically and unfortunately, most attempts are physiologic. Some of the world's countries have recently realized that fertility has been affected negatively by stress, and they have enacted many practices in fertility clinics to relax couples psychologically. The fact that men want to increase their sperm characteristics indicates that men feel insufficient as men because in the Turkish culture, if a man has unhealthy sperm, he is not perceived as truly a man.

The fact that women learned traditional practices mostly through social media, followed by friends, but men usually learned from their partners shows that men are more hesitant to talk about and search for solutions to infertility. Ghazeeri et al.'s study[7] also indicated that couples were mostly directed by friends and social media. This result is highly important. Social media can be used to guiding couples correctly toward applying effective interventions.


   Conclusion Top


The couples in this study widely used traditional practices to solve fertility problems. Considering the use of traditional practices:

  • Nurses should be aware of traditional practices used in their society with the aim of improving fertility
  • During anamnesis with couples, the use of traditional practices should be determined
  • Because herbs and other practices, such as the use of figs, onion cures, hacamat, carob, a honey--pollen mixture, and pumpkin seed, were among the most widely used practices, studies evaluating the effects of such herbs and practices are also necessary
  • If the adverse health effects of the practices are known, couples should be informed
  • Expected benefits should be evaluated, and appropriate counseling should be given about the benefits and harms of practices
  • Couples should be directed to social media accounts and other paths that contain beneficial and accurate information.


Limitations of the research: The data on traditional practices used by men were obtained by asking their partner. Therefore, there may be practices that men use that women do not know about. At the same time, if a woman insists on using traditional practices, the man will agree even if he does not really agree.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
World Health Organization. [WHO Traditional medicine strategy 2014-2023]. WHO Traditional Medicine Strategy 2014-2023; 2013. p. 25-53. [cited 20 July 2018]. Available from: http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/.  Back to cited text no. 1
    
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Sami N, Ali TS. Health seeking behavior of couples with secondary infertility. J Coll Physicians Surg Pak 2006;16:261-4.  Back to cited text no. 2
    
3.
Nagieb SM, Ibrahim HDF. Use of alternative therapies for infertility and associated factors among women in Assiut University Hospital. Assiut Vet Med J 2007;31:229-40.  Back to cited text no. 3
    
4.
Stankiewicz M, Smith C, Alvino H, Norman R. The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: A prospective survey. Aust N Z J Obstet Gynaecol 2007;47:145-9.  Back to cited text no. 4
    
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Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Shindel AW, Wing H, et al. The use of complementary and alternative fertility treatment in couples seeking fertility care: Data from a prospective cohort in the United States. Fertil Steril 2010;93:2169-74.  Back to cited text no. 5
    
6.
Weiss DA, Harris CR, Smith JF. The use of complementary and alternative fertility treatments. Curr Opin Obstet Gynecol 2011;23:195-9.  Back to cited text no. 6
    
7.
Ghazeeri GS, Awwad JT, Alameddine M, Younes ZMH, Naja F. Prevalence and determinants of complementary and alternative medicine use among infertile patients in Lebanon: A cross sectional study. BMC Complement Altern Med 2012;12:129.  Back to cited text no. 7
    
8.
Kurcer MA, Egri M, Genc M, Pehlivan E, Gunes G, Karaoglu L, et al. Behaviours of the infertile women with regard to traditional infertility treatments and infl uencing factors. Turgut Ozal Med Center J 1999;6:329-32.  Back to cited text no. 8
    
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Engin R, Pasinlioglu T. The traditional beliefs and applications of infertile women regarding infertility in and around Erzurum. Ataturk Univ Nurs Sch J 2002;5:1-10.  Back to cited text no. 9
    
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Ayaz S, Efe SY. Traditional practices used by infertile women in Turkey. Int Nurs Rev 2010;57:383-7.  Back to cited text no. 10
    
11.
IBM SPSS Statistics for Windows, version 22. Armonk, N.Y., USA: IBM Corp.; 2013.  Back to cited text no. 11
    
12.
Gunay O, Cetinkaya F, Nacar M, Aydin T. Modern and traditional practices of Turkish infertile couples. Eur J Contracept Reprod Health Care 2005;10:105-10.  Back to cited text no. 12
    
13.
Kashani L, Hassanzadeh E, Mirzabeighi A, Akhondzadeh S. Knowledge, attitude and practice of herbal remedies in a group of infertile couples. Acta Medica Iranca 2013;51:189-94.  Back to cited text no. 13
    
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Schaffir J, McGee A, Kennard E. Use of non-medical treatments by infertility patients. J Reprod Med 2009;54:415-20.  Back to cited text no. 14
    
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Dyer SJ, Abrahams N, Hoffman M, Van De Spuy ZMI. Infertilite in South Africa: Women's reproductive health knowledge and treatment-seeking behavior for involuntary childlessness. Hum Reprod 2002;17:1657-62.  Back to cited text no. 15
    
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Brown LM. Productiveparent.com [homepage on the Internet]. 2000. Available from: http://www.productiveparent.com. [Last cited on 2018 Jul 20].  Back to cited text no. 16
    
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Edirne T, Arica SG, Gucuk S, Yildizhan R, Kolusari A, Adali E, Can M. Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: A descriptive study. BMC Complement Altern Med 2010;10:1-7.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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