China implemented the new universal two-child policy in 2016, allowing all Chinese couples to have a second child. According to a government-led national survey, most women included under the policy would be 35 years old and older, putting them at a higher risk of infertility. This is the first study to use the FAD and FACES II family assessment measures to assess the family functioning of infertile female patients in an infertile Chinese woman after the implementation of the two-child policy. This study is the first to explore the relationship between family functioning and mental health in first- and second-child infertile women in China.
The ability to perform domestic duties and solve problems as a family member is referred to as a family function. When faced with infertility, a major negative event, women, predictably, feel incapable of resolving the crisis. Infertile women had a low family function due to a lack of awareness of the disease, fear of complicated treatment, uncertainty about treatment outcome, and desperation when treatment failed. This study revealed that SI women performed worse on the FACES II subscales, with only two subscales showing a clear difference between FI and SI women. The findings also revealed that infertile women have poorer family functioning, including division of roles, emotional communication, and behavior control15.
In this study, the social-demographic results showed that the age of FI women was younger than SI women, and age was used as covariates when Pearson correlation was performed. Lower family income and lower education levels are more likely to attribute unhealthy family functioning. Furthermore, low-income families may not be able to afford adequate medical insurance for infertile families, resulting in couples experiencing financial stress being more likely to suffer from depression and/or anxiety16. Also, lower education levels are likely to impact the communication of the family members. Individuals with low education levels usually find it difficult to exchange information effectively and optimally among family members. All of these factors will affect family members to work together as a unit to satisfy the basic needs of the family members. In this study, FI has a higher family income and education level than SI, and the proportion of only children in FI is higher than in SI, making it easier for the first infertile women to obtain support from society and their own families. Therefore, we compared the family functions of the two groups. FI has been found to have a better general family function than SI. In the FACES II study, we found that the adaptability in SI families may be poor, related to demographic factors such as income level, education level, and poor family functions. When faced with infertility, a unique disease, patients with better family intimacy and adaptability are more organized in dealing with this crisis and thus achieve a better family function. Normalizing family function alleviates patients’ stress and allows family members to be positively involved in the treatment.
In this study, the FI women had a higher mean score of PHQ-9 than SI women. Among infertile women, the higher mean score of PHQ-9 is a possible risk factor associated with family function. This difference could be a reason that SI women already have a baby. They do not experience more fertility-related stress internally, or from their husbands, so their family cohesion and adaptability are more likely better than the FI family17. Having a child is considered a significant contribution to family and society associated with gender identity, as in Chinese traditional cultures. The inability to reproduce naturally can result in feelings of guilt, shame, and low self-esteem, leading to depression in varying degrees. As a result, FI women may be at a higher risk of depression. Furthermore, people suffering from depression often struggle to carry out their responsibilities in society and in their families, and some symptoms of depression have been linked to impaired communication and cognitive function in patients. All of these are likely to have an impact on how the family functions.
As a result, infertility is regarded as a bio-psycho-social crisis18. Age, social roles, and intricate family problems, in particular, contributed to a more complex re-fertility nature in patients after the full liberalization of the 'second child policy'19. Thus, the likelihood of developing psychological and family disorders in infertile patients is higher than in the other groups, and appropriate steps should be taken in this regard.