Epidemiology of infertility and coping mechanisms in Ethiopia, 2025: a systematic review and meta-analysis.

BACKGROUND

Infertility is much more than a quality-of-life concern. Its consequences stream into public health domains such as psychological distress, social stigma and marital disagreements. The estimation of infertility is one of the most crucial activities concerning informing policymakers. Therefore, this review was conducted to estimate the pooled prevalence of infertility and coping mechanisms in Ethiopia.

METHODS

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline to adhere to standards in conducting and reporting of evidence synthesis. An internet-based search of noninterventional studies in Ethiopia was performed in CINAHL, EMBASE, PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science, and Google Scholar. A total of 332 studies were screened, and only 11 studies satisfied the inclusion criteria. Studies were included if they described the prevalence and/or coping mechanisms of infertility. The Newcastle–Ottawa Scale and Joanna Briggs Institute critical appraisal checklist were used for quantitative and qualitative studies, respectively. The random-effects meta-analysis was done in Stata version 17, and forest plots, test of heterogeneity, and funnel plots were all generated.

RESULTS

The pooled prevalence of lifetime and/or specific period of infertility was 25.77% [95% CI: 20.10, 31.45], with a heterogeneity index (I2 = 99.48, P = 0.00). The subgroup prevalence of primary infertility was 22.76% [-0.95–46.47], with heterogeneity (I2 = 99.54, p = 00), and that of secondary was 12.67% [9.14–16.20], with I2 = 98.57, p = 0.00. Spiritual activity, medical treatment, cultural practice, seeking support from family, adoption, acceptance, having a godchild, estranged social life, helplessness, extramarital engagement, and marital separation were the identified coping mechanisms.

CONCLUSION

Compared with the global standard, the pooled prevalence of infertility in Ethiopia is relatively high. Most of the identified coping strategies of infertility were problem-focused mechanisms. The identified coping mechanisms were grouped in the following main themes: (i) seeking medical treatment, (ii) religious/spiritual practices, (iii) seeking social support, (iv) using cultural remedies, (v) acceptance, and (vi) avoidance/harmful behaviors. Policy makers, health authorities and professionals should improve the delivery of infertility prevention and treatment services and ensure coping support is culturally sensitive and integrated with the national health strategy.