Knowledge and attitudes toward infertility and reproductive health among nursing and midwifery students from selected universities in Accra, Ghana
A cross-sectional study of 263 nursing and midwifery students in Accra, Ghana, reveals that while their overall knowledge and attitudes toward infertility are generally high and favorable, significant differences exist by gender and program, with knowledge serving as a key predictor of positive attitudes and a strong majority advocating for expanded curriculum content.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
In many parts of the world, the ability to have children is not just a biological function but a central pillar of social identity and family stability. In Ghana, as in much of sub-Saharan Africa, the pressure to bear children is intense, and the inability to do so often carries a heavy social burden, particularly for women. When a couple cannot conceive, they may face stigma, isolation, or even the breakdown of their marriage. In this environment, nurses and midwives serve as the first line of defense and support. They are the ones who meet families in clinics, offer advice, and guide them through the complex journey of reproductive health. For these healthcare workers to be effective, they need more than just medical training; they need a deep understanding of infertility, the ability to recognize its causes without bias, and the emotional capacity to support couples with kindness rather than judgment. If the people training to become these caregivers do not fully grasp the science of infertility or hold hidden prejudices, the care they provide could inadvertently deepen the pain of those they are meant to help.
This study set out to examine the readiness of future nurses and midwives in Ghana to handle these sensitive situations. Researchers gathered a group of 263 final-year students from four universities in Accra, the capital city. These were students who had nearly completed their degrees and were about to enter the workforce. The team asked them a series of questions designed to measure two things: what they knew about infertility and how they felt about it. The questions covered the definition of infertility, its causes in both men and women, common misconceptions, and available treatments. They also asked the students to share their feelings about infertility, such as whether they believed it was a punishment or a medical condition, and whether they felt comfortable discussing it with patients. The goal was to see if the students had the right knowledge and the right attitude to support couples facing this challenge.
The results showed that the students generally knew a lot about the subject. On a test of twenty-three questions, the average student scored eighteen points, a strong performance that placed the vast majority of them in a "high knowledge" category. They correctly understood that infertility affects both men and women, that it is often caused by infections or age, and that it can be treated with medical help. However, the study also uncovered specific gaps in their understanding that could be dangerous in a clinical setting. Only about one-third of the students knew that roughly half of all infertility cases involve a male factor, meaning the man is the primary cause or a significant contributor. This is a critical piece of information because, in many communities, the blame for childlessness is unfairly placed entirely on the woman. If a nurse believes the problem is always the woman's fault, she may not encourage the husband to get tested, delaying the couple's path to a solution. Similarly, fewer than half of the students knew that women over the age of thirty-five should be evaluated for infertility after only six months of trying, rather than the standard twelve months. This specific knowledge is vital for ensuring that older women receive timely care before their window for conception closes.
When it came to attitudes, the students were overwhelmingly positive. Most of them expressed empathy and a willingness to support infertile couples without judgment. They rejected the idea that infertility is a spiritual curse or a punishment. Interestingly, the study found a clear link between what the students knew and how they felt: those who had higher knowledge scores tended to have more positive, supportive attitudes. This suggests that teaching the facts about infertility is a powerful way to reduce stigma. The researchers also noticed that female students scored slightly higher on both knowledge and attitude tests than their male counterparts, and students training specifically to be midwives knew more than those training to be general nurses. This difference likely reflects the fact that midwifery curricula focus more heavily on reproductive health. However, the students' university did not matter; whether they attended a public or private school, their knowledge and attitudes were remarkably similar, suggesting that the national training standards are consistent across the country.
Despite their strong knowledge and good intentions, the students felt they needed more help. Only about a quarter of them had actually seen a patient with infertility during their clinical rotations, yet nearly all of them said they would be willing to start conversations about fertility with future patients. More importantly, a large majority expressed a strong desire for more education on the topic. They asked for more detailed lessons in their textbooks and more practical workshops to learn how to handle these cases with confidence. The students themselves recognized that while they were well-prepared in theory, they needed more tools to deal with the emotional and social complexities of infertility in real life. The study concludes that by filling the specific gaps in their knowledge—particularly regarding male infertility and age-related guidelines—and by providing more structured training, nursing and midwifery schools can better equip their graduates to be compassionate, effective advocates for families struggling to conceive.
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