Irrational parenthood cognition and infertility stigma among infertile women: a cross- sectional study in Changsha, China

doi:10.21203/rs.3.rs-2497125/v1

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Research Article

Irrational parenthood cognition and infertility stigma among infertile women: a cross- sectional study in Changsha, China

https://doi.org/10.21203/rs.3.rs-2497125/v1

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Background

Stigma is among the most prevalent and disturbing consequences of being infertile among women, yet it remains unknown whether fertility stigma is affected by irrational parenthood cognitions. The current study aimed to assess irrational parenthood cognitions, infertility stigma, and their interrelationship among a group of Chinese women referred to an infertility center in Changsha, Hunan, China.

Methods

In this cross-sectional study, 376 women seeking treatment for infertility at three hospitals in Changsha City were recruited and completed online questionnaires through the questionnaire star from October 2020 to January 2021. Irrational parenthood cognitions and infertility stigma were assessed by the Irrational parenthood cognitions (IPC) scale and Infertility Stigma Scale (ISS), respectively. Pearson correlation test was used to explore the association between IPC and ISS, while multivariate linear regression was used to explore the independent influencing factors of stigma.

Results

Participants had a mean score of 42.41 ± 13.03 for IPC and 62.89 ± 24.50 for ISS. Irrational parenthood cognitions were highly correlated with infertility stigma with a large effect size (r = 0.55, p < 0.001). Multivariate linear regression showed that patients’ infertility stigma was positively associated with irrational parenthood cognitions (β = 1.06, p < 0.001), while negatively associated with education (β=-5.4, p = 0.036) and disclosure of infertility (β= -8.39, p = 0.001).

Conclusion

This study is the first to identify a positive association between irrational parenthood cognitions and infertility stigma among infertile women in China. Our findings provide useful guidance for the future development of effective anti-stigma intervention programs among infertile women.

infertility

irrational parenthood cognition

stigma

China

Infertility is a major public health concern affecting 8%-12% of reproductive-aged couples worldwide (1). The incidence of infertility is expected to increase to 7.7 million by 2025 despite the advancement of reproductive technology (2). Infertility is a disease of the reproductive system characterized by the failure to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner (3). A recent study showed an increasing trend in the global prevalence and disease burden of infertility in 195 countries and territories throughout the period from 1990 to 2017 (4). In the United States, the prevalence of infertility among married females aged 15–44 years was reported to be 6% (5). In China, the prevalence of infertility among couples of reproductive ages was 25%, and almost half of them had not sought medical help (6).

Infertility is among the most devastating experiences and has been described as a major life crisis among the affected couples, especially for women who are deemed as taking the major responsibility of childbirth (7). In many cultures, childbearing is central to a woman’s identity such that womanhood and motherhood are seen as synonymous identities and experiences (8). This viewpoint is predominant in some eastern cultures which emphasize motherhood to be the most important role of a woman to stabilize her status in the family and to maintain her marriage with the spouse. (9). Not having children may be considered as not fulfilling the expectations of society’s standard of being a woman (10). Infertile women have been shown to suffer from high levels of physical, mental, and sexual violence (11). As a result, infertile and childless women have been reported to have significantly higher psychological distress and lower quality of life compared to the general population (12, 13).

Stigma is one of the most important and disturbing consequences of being infertile among women (14, 15). Infertility stigma is characterized by the negative self-perception of an infertile woman, a sense of alienation, insult, and isolation from society, as well as negative self‐perceptions about the behaviors of others (16, 17). The prevalence of self-stigma among infertile women was reported to be as high as 64% in southern Ghana (18) and 69.19% in China (15). Similarly, high levels of stigma have also been reported in other studies (19–21). It has been well established in the literature that infertility stigma was associated with a wide range of negative health outcomes, including low self-esteem, low self-efficiency, failure in coping, and social isolation, which all contributed to high psychological distress such as depression and anxiety, and even suicide ideation (22–25). In addition, infertile women with high stigma were less likely to seek treatment and more likely to discontinue treatment even if they sought treatment (26, 27). Studies have shown that nearly half of infertile women would not seek treatment out of the stigma, which may further aggravate their condition (28–30). It is thus important to understand the levels and influencing factors of stigma among infertile women to guide targeted and effective interventions to improve their general well-being.

Irrational parenthood cognitions (IPC) is a relatively new term developed within the past two decades to indicate specific, irrational cognitions concerning the need and desire to have children in order to have a happy life (31). These irrational ideas can lead to the development of significant emotional, psychological, behavioral, and social problems. A study conducted by Fardiazer et al. (12) demonstrated a strong negative correlation between irrational parenthood cognitions and quality of life (r = − 0.64; P < 0.001). Another recent study conducted by SafaeiNezhad et al. (32) showed a significant positive correlation between irrational parenthood cognitions and destructive behaviors of marital relationships among infertile women (r = 0.47, p < 0.001). Previous research also identified a strong association between irrational parenthood cognitions and depression (33). However, to the best of our knowledge, no study has ever investigated the correlation between irrational parenthood cognitions and infertility stigma among Chinese infertile women in the literature. The current study was thus conducted to fill in the research gap by examining the levels of irrational parenthood cognitions and infertility stigma, as well as exploring their associations among a group of Chinese women referred to an infertility center in Changsha, Hunan, China.

Participants

This was a cross-sectional study conducted from October 2020 to January 2021 in the following three hospitals: Third Xiangya Hospital of Central South University, the Reproductive & Genetic Hospital of Citic-Xiangya, and the Hunan Maternity and Child Health Care Hospital. The convenience sampling method was adopted to consecutively recruit 376 infertile women seeking treatment in the three hospitals. Inclusion criteria included: (1) aged ≥ 18 years old; (2) meeting the infertility diagnosis of no pregnancy after 12 months or more of regular, unprotected sexual intercourse; (3) no other comorbidities; (4) able to read and communicate; (5) consent to participate in the study. Exclusion criteria included: (1) comorbid with mental illness; (2) comorbid with chronic illness; (3) comorbid with cancers; (4) unable to complete the questionnaire due to illiteracy.

Procedures

Ethical approval of the study was granted by the institutional review boards of the Third Xiangya Hospital of Central South University (kuai22063). Patients were approached by trained nurses during their visits/stay in the ward and introduced to the study purpose, procedure, benefits, and risks. They were also informed that all data would be collected anonymously and used for research purposes only. After providing written informed consent, the eligible participants were invited to complete a battery of questionnaires through the online questionnaire platform— questionnaire star (https://www.wjx.cn/m/90935884.aspx). The patients accessed the online questionnaires by scanning the WeChat QR code, which was set to be filled only once for one IP address to ensure the authenticity of the data source. The questionnaires were also set to ensure no inconsistencies or missing items, or logic errors. The researchers recovered the survey results through the questionnaire system.

Measurements

Data were collected using standardized questionnaires, which included two parts. The first part included socio-demographic information such as age, race, educational level, employment status, residence, duration of married life, household monthly income, the only-child status of the patients and their husbands, and family living structure. This part also included clinical information regarding their infertility and treatment such as length of infertility, duration of treatment, history of abortion, number of treatments, number of embryos implanted for the current treatment, and disclosure status of their infertility. The second part of the questionnaire included inventories developed to assess irrational parenthood cognitions and infertility stigma among infertile subjects, each described below:

Irrational parenthood cognitions Irrational parenthood cognitions were assessed by the 14-item Irrational parenthood cognitions (IPC) scale developed by Fekkes et al (31) in the Netherlands to evaluate the patient’s need and desire to have children for a happy life. The IPC is a unidimensional scale measuring 14 various aspects of parenthood cognitions. Participants are asked how much they agree with each item on a 5-point Likert scale from 1= “completely disagree” to 5= “completely agree”. The total score ranges from 14 to 70, with a higher score indicating a stronger need for a child just to have a happier life. The IPC was first translated into Chinese by Li et al (34) in 2016 and showed good reliability and validity. In the current study, the IPC demonstrated good internal consistency with a Cronbach alpha of 0.92.

Infertility stigma Infertility stigma was assessed by the Infertility Stigma Scale (ISS) developed by Fu et al. (15) to measure perceived stigma for women who were coping with a diagnosis and treatment for infertility. The ISS includes 27 items under four subscales: self-devaluation (7 items), social withdrawal (5 items), public stigma (9 items), and family stigma (6 items) to measure various aspects of perceived stigma related to infertility. Participants are asked how much they agree with each item on a 5-point Likert scale from 1= “totally disagree” to 5= “totally agree”. The total score ranges from 27 to 135, with a higher score indicating a higher level of perceived stigma for infertility. In the current study, the IPC demonstrated good internal consistency with a Cronbach alpha of 0.98 for the total scale and 0.89–0.96 for its four subscales.

Statistical methods

Data were analyzed using STATA software version 15.0. Scales and indices were tested for reliability. Continuous variables were presented by means and SDs, while categorical variables were described by numbers and percentages. Two samples independent t-test and ANOVA analysis were used to compare the IPC and ISS scores of patients with different characteristics. Pearson correlation was used to determine the degree of association between IPC and ISS. Based on Cohen’s (35) guidelines, a correlation coefficient (r) of 0.1, 0.3, and 0.5 indicates small, medium, and large effect sizes, respectively. Finally, we performed multivariate linear regression analysis to investigate the correlates of stigma infertility with sociodemographic, clinical, and irrational parenthood cognitions as independent variables, and infertility stigma as the dependent variable. Statistical significance was set at p < 0.05.

IPC and ISS scores by sample characteristics

Table 1 shows the patients’ demographic and clinical characteristics as well as comparisons of their IPC and ISS scores by these characteristics. The patients had a mean age of 31.21 ± 4.66, with most under the age of 35 (81.12%). They had been married for an average of 4.50 ± 4.18 years, with most under 5 years (64.89%). Most were of Han ethnicity (88.03%), with an education level of below college (66.22%), of urban residence (61.97%), with a household income of ≥ 5000 RMB/month (59.31%), and currently living with their husbands (75.53%). Only 22.07% of the patients and 33.24% of their husbands were the only children of their parents. As for fertility-related clinical characteristics, over half of the patients had no history of abortion (55.85%). Their mean infertility duration and treatment duration were 3.14 years and 2.65 years, respectively. Most had been infertile for less than 5 years (80.05%), in treatment for less than 1 year (68.35%), had 1 treatment (58.75%), and with 1 embryo implanted (75.27%). Among the 376 patients, 87 kept their infertility secret (23.14%). Among the remaining 289 patients who have disclosed their infertility status, most only disclosed to someone close (77.51%).

Table 1

IPC and ISS scores by sample characteristics
Variables			IPC		ISS
	N	%	M ± SD	P	M ± SD	P
Demographic characteristics
Age	M ± SD (range): 31.21 ± 4.66 (20–46)
<35	305	81.12	42.75 ± 13.00		62.74 ± 24.21
≥35	71	18.88	40.94 ± 13.15	0.2941	63.55 ± 25.88	0.8019
Ethnicity
Han	331	88.03	42.02 ± 12.98		61.90 ± 23.87
Minority	45	11.97	45.29 ± 13.21	0.114	70.20 ± 27.93	0.0328
Education
Below college	249	66.22	43.39 ± 13.42		66.16 ± 24.27
College & above	127	33.78	40.47 ± 12.05	0.0397	56.49 ± 23.78	< 0.001
Residence
Rural	143	38.03	42.97 ± 13.64		66.17 ± 23.03
Urban	233	61.97	42.06 ± 12.66	0.5108	60.88 ± 25.20	0.042
Household Income (RMB/month)
<5000	153	40.69	44.01 ± 14.38		65.43 ± 25.61
≥5000	223	59.31	41.78 ± 12.43		61.79 ± 23.74	0.0959
Years of marriage, M ± SD (range): 4.50 ± 4.18 (0–23)
<5	244	64.89	41.97 ± 12.55		62.02 ± 23.08
≥5	132	35.11	42.75 ± 13.41	0.5658	63.57 ± 25.60	0.5421
Currently living with husband
No	92	24.47	42.65 ± 14.01		64.32 ± 25.54
Yes	284	75.53	42.33 ± 12.72	0.8358	62.43 ± 24.19	0.5219
Only child
No	293	77.93	42.06 ± 13.01		62.51 ± 23.70
Yes	83	22.07	43.61 ± 13.11	0.3396	64.24 ± 27.26	0.5703
Husband only child
No	251	66.76	42.96 ± 13.12		63.75 ± 23.89
Yes	125	33.24	41.30 ± 12.84	0.2474	61.16 ± 25.71	0.3344
Clinical characteristics
Abortion history
No	210	55.85	42.25 ± 12.92		62.10 ± 24.77
Yes	166	44.15	42.61 ± 13.22	0.7902	63.89 ± 24.19	0.4848
Infertility duration, years M ± SD (range): 3.14 ± 2.59
<5	301	80.05	42.09 ± 13.10		61.73 ± 23.81
≥5	75	19.95	43.70 ± 12.78	0.3400	67.53 ± 26.78	0.0666
Treatment duration, years, M ± SD (range): 2.65 ± 1.46
<1	257	68.35	41.64 ± 13.47		61.95 ± 24.42
≥1	119	31.65	44.07 ± 11.93	0.0928	64.92 ± 24.66	0.2761
Number of treatments
1	221	58.78	41.59 ± 13.21		62.15 ± 23.87
2	73	19.41	41.16 ± 12.43		61.66 ± 25.77
≥3	82	21.81	45.71 ± 12.68	0.0332	65.98 ± 25.09	0.4319
Number of Embryones
1	283	75.27	42.06 ± 12.79		61.42 ± 24.56
2	93	24.73	43.47 ± 13.75	0.3638	67.37 ± 23.90	0.0422
Disclosure of infertility
No	87	23.14	38.37 ± 13.81		65.54 ± 23.95
Yes	289	76.86	43.62 ± 12.56	0.0009	62.09 ± 24.65	0.2506
Note: IPC: Irrational parenthood cognitions; ISS: Infertility Stigma Scale

Further comparisons of the IPC scores by the above characteristics showed significant differences in education, number of treatments, and disclosure of infertility. Patients with below college education (43.39 ± 13.42 vs 40.47 ± 12.05, p = 0.040), received 3 and more treatments (45.71 ± 12.68 vs 41.59 ± 13.21/ 41.16 ± 12.43, p = 0.033), and disclosed infertility status (43.62 ± 12.56 vs 38.37 ± 13.81, p < 0.001) had significantly higher IPC scores than their counterparts, indicating more irrational parenthood cognitions in those groups. Further comparisons of the ISS scores by patient characteristics showed significant differences in ethnicity, education, residence, and number of embryos. Patients with minority ethnicity (70.20 ± 27.93 vs 61.90 ± 23.87, p = 0.0328), below college education (66.16 ± 24.27 vs 56.49 ± 23.78, p < 0.001), of rural residence (66.17 ± 23.03 vs 60.88 ± 25.20, p = 0.042), and with 2 embryos implanted (67.37 ± 23.90 vs 61.42 ± 24.56, p = 0.0422) had significantly higher ISS scores than their counterparts, indicating more perceived stigma in those groups.

Correlations between IPC and ISS scores

Table 2 shows the scores of and correlations among the IPC, ISS, and its four subscales. Patients’ irrational parenthood cognitions were at a moderately high level, with a mean IPC score of 42.41 out of a total score of 70. Patients’ perceived stigma regarding their infertility status was at a moderate level, with a mean ISS score of 62.89 out of a total score of 135. The IPC score was significantly and positively correlated with the ISS score (r = 0.55, p < 0.001) as well as its four subscale scores (r = 0.47–0.55, p < 0.001), indicating large effect sizes. In addition, the total IPC scale and its four subscales were highly correlated with each other, with correlation coefficients ranging from 0.71 to 0.95 (p < 0.001).

Table 2

Associations between IPC and ISS scores
	M ± SD	1	2	3	4	5	6
1. IPC	42.41 ± 13.03	1
2. ISS	62.89 ± 24.50	0.552^***	1
3. Self-devaluation	15.91 ± 6.93	0.554^***	0.907^***	1
4. Social withdrawal	12.77 ± 5.00	0.532^***	0.871^***	0.763^***	1
5. Public stigma	20.39 ± 8.99	0.468^***	0.951^***	0.787^***	0.773^***	1
6. Family stigma	13.82 ± 5.83	0.485^***	0.910^***	0.756^***	0.706^***	0.856^***	1
Note: IPC: Irrational parenthood cognitions; ISS: Infertility Stigma Scale; ^***P < 0.001

Correlates of infertility stigma

A multivariate linear regression analysis was conducted to examine the independent influencing factors of infertility stigma, with demographic, clinical characteristics, and irrational parenthood cognitions as independent variables. As shown in Table 3, three factors remained significant after controlling all other potential confounders: education, disclosure of infertility, and irrational parenthood cognitions. College and above education (β=-5.4, p = 0.036) and disclosure of infertility status (β= -8.39, p = 0.001) were associated with lower perceived stigma, while increased irrational parenthood cognitions (β = 1.06, p < 0.001) were associated with higher perceived stigma.

Table 3

Factors associated with patients' infertility stigma: multiple regression analysis
Variables	B	SE	95% CI	P
Demographic characteristics
Age (< 35 as reference)
≥35	1.85	2.34	(-2.75, 6.45)	0.429
Ethnicity(Han as reference)
Minority	3.53	3.35	(-3.06,10.11)	0.293
Education(Below college as reference)
College and above	-5.4	2.57	(-10.44,-0.35)	0.036
Residence (Rural as reference)
Urban	-1.39	2.5	(-6.31, 3.53)	0.578
Household Income (RMB/month) (< 5000 as reference)
≥5000	0 .52	2.31	( -4.02, 5.06)	0.822
Years of marriage (< 5 as reference)
≥5	-0.2	2.35	( -4.83, 4.42)	0.931
Currently living with husband (No as reference)
Yes	-1.16	2.45	(-5.98, 3.65)	0.635
Only child (No as reference)
Yes	1.15	2.69	(-4.14, 6.44)	0.43
Husband only child (No as reference)
Yes	0.11	2.42	(-4.65, 4.86)	0.964
Clinical characteristics
Abortion history (No as reference)
Yes	-0.11	2.23	(-4.49, 4.28)	0.962
Infertility duration, years (< 5 as reference)
≥5	1.82	2.98	(-4.05, 7.69)	0.543
Treatment duration, years (< 1 as reference)
≥1	0.08	2.73	(-5.28, 5.44)	0.977
Number of treatments (1 as reference)
2	-0.83	2.91	(-6.56, 4.90)	0.775
≥3	-1.35	3.09	( -7.43, 4.74)	0.663
Number of Embryones (1 as reference)
2	2.9	2.63	(-2.26, 8.07)	0.27
Disclosure of infertility (no as reference)
Yes	-8.39	2.6	( -13.50, -3.28)	0.001
IPC	1.06	0.08	(0 .89, 1.22)	< 0.001
Note: IPC: Irrational parenthood cognitions

Summary of the findings

To the best of our knowledge, this is the first study to explore the association between irrational parenthood cognitions and infertility stigma in a Chinese population of infertile women. Our major findings are that the mean scores of IPC and ISS were 42.41 ± 13.03 and 62.89 ± 24.50, respectively, indicating moderate to high levels of irrational parenthood cognitions and infertility stigma. Irrational parenthood cognitions were highly correlated with infertility stigma (r = 0.55, p < 0.001), with a large effect size. Multivariate linear regression showed that patients’ infertility stigma was significantly positively associated with irrational parenthood cognitions (β = 1.06, p < 0.001), while negatively associated with college and above education (β=-5.4, p = 0.036) and disclosure of infertility (β= -8.39, p = 0.001). These findings provide important and useful information and reference for future research and intervention programs to provide targeted support to reduce infertile women’s stigma and improve their general well-being.

Sample characteristics

The typical demographic profile of the infertile women in our study corresponds to a young woman living in urban cities, with a below college education who has been married for less than 5 years. Their typical clinical profile corresponds to a woman who has been infertile and seeking treatment for about 3 years, receiving one treatment and with one embryo implanted. The demographic and clinical characteristics of the infertile women in our study were generally consistent with those of other studies (12, 14, 15, 32). In addition, most of the patients had disclosed their infertility status to others, mainly close ones, a finding that has rarely been reported in previous studies. The high disclosure rate may be due to the difficulty of hiding the truth of not having children in a Chinese culture where childbearing has been considered a major and most important expected outcome of marriage (9). Another explanation may be related to the fact that all patients were already in treatment for infertility, since seeking treatment indicates disclosure of infertility(28).

IPC and ISS scores by sample characteristics

Univariate analyses showed that infertile women with lower education had both higher irrational parenthood cognitions and higher perceived stigma, a finding consistent with previous studies (18, 27). Interestingly, a population-based study in China has demonstrated that lower education is a risk factor for infertility (6). Females with low education levels usually lack reproductive health literacy, which may put them at high risk of pregnancy-related problems that may lead to infertility(6). In addition, less educated infertile women have less knowledge and insight into infertility and its treatment, which may contribute to more irrational parenthood cognitions and higher perceived stigma (36). Furthermore, lower education symbolizes lower socio-economic status and less economic independency, which are associated with more irrational parenthood cognitions and stigma (36). All those findings suggest education should be strengthened among females to prevent infertility, reduce irrational parenthood cognitions, and alleviate infertility stigma (19, 30).

The finding that infertile women with minority ethnicity and of rural residence had higher perceived stigma may be explained by the more conservative cultures related to childbirth in those areas. As an old saying from Confucianism goes, “There are three forms of unfilial conduct, of which the worst is to have no descendants” (15). This finding implies more attention needs to be diverted to rural areas and minority groups to reduce the stigma toward infertility. Consistent with previous literature(36), our study showed clinical factors such as treatment times and the number of embryos were associated with irrational parenthood cognitions and infertility stigma. Infertile women with 3 or more treatments had more irrational parenthood cognitions, while women with more embryos implanted had higher perceived stigma. All these results suggest that clinicians should pay attention to infertile women who have been receiving multiple treatments with more embryos and provide additional support when necessary. Interestingly, we found that patients who disclosed their infertility status had higher IPC scores, a finding that has never been reported before. A possible explanation may be that those with higher irrational parenthood cognitions were more likely to talk to others such as relatives and close friends for emotional support, which still warrants further investigation.

Correlates of infertility stigma

One major finding of the study was that, for the first time, we identified a positive association between infertile women’s irrational parenthood cognitions and perceived infertility stigma, with a large effect size. Such an association remained significant even after controlling for all potential demographic and clinical characteristics, indicating a robust and stable effect of irrational parenthood cognitions on perceived infertility stigma. Infertile women with higher irrational parenthood cognitions had a stronger desire to have a child for a happier life and were more likely to see themselves as useless without a child, which may lead to higher levels of perceived stigma. A closer look at the item scores of the IPC scale showed the highest-scored three items were “1. Having a child is the most important thing in life”, “2. A life without children is useless and empty”, and “14. One would want to do anything to get pregnant”, which further explained the high association between the irrational parenthood cognitions and perceived infertility stigma. These findings suggest that an essential step towards reducing infertile women’s perceived stigma is to decrease their irrational parenthood cognitions. Future intervention programs on improving infertile women’s mental health may benefit from focusing on changing their irrational parenthood cognitions first.

Other correlates that have been identified to significantly affect infertile women’s perceived stigma in multivariate regression analysis included education and disclosure of infertility. The negative association between education and fertility stigma has been discussed above. The finding that disclosure of infertility status was associated with decreased stigma was consistent with the bulk of literature showing the benefits of disclosure, which included greater social support, better physical and mental health, and lower stigma (37). Another explanation may be that those with lower perceived stigma are more likely to disclose their infertility status to others, indicating a bidirectional relationship between disclosure and stigma. Our findings suggest that appropriate disclosure of infertility status to close ones may be beneficial to reduce their perceived stigma and promote their mental well-being.

Limitations

The study had several limitations. First, we used a convenience sample of infertile women from one hospital in Hunan Province and our results may need further external validation in future studies using a more representative sample from various areas of China. Second, we only studied the irrational parenthood cognitions and perceived infertility stigma of infertile females, which may be significantly different from that of infertile males. Future studies may benefit from including both infertile males and females to explore the gender difference. Third, our sample was recruited from a clinic where all participants were already receiving treatment, it is likely that infertile females on treatment may have lower irrational parenthood cognitions and perceived infertility stigma than those who never seek treatment, which warrants future research.

Fourth, we used a cross-sectional study design and cannot establish a causal relationship between the stigma and its correlates, which needs to be tested in future longitudinal study designs.

This study is the first to identify a positive association between irrational parenthood cognitions and infertility stigma among infertile women in China. In addition, lower education and disclosure of infertility were associated with more infertility stigma. These findings provide useful guidance for the development of effective anti-stigma intervention programs among infertile women, which may be realized through reducing their irrational parenthood cognitions, strengthening education and training, as well as encouraging disclosure.

Irrational parenthood cognitions

IPC

Infertility Stigma Scale

ISS

Ethics approval and consent to participate

Ethical approval was obtained from the Institutional Review Committee of the Third Xiangya Hospital of Central South University (kuai22063). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants provided written informed consent before the study.

Consent for publication

Availability of data and materials

The datasets and codes used for analyses are available from the corresponding author upon reasonable request.

Conflict of interest

The authors declare that they have no competing interests.

Funding

This work was funded by a grant from the Project of guiding innovation of clinical medical technology in Hunan province of China (Grant Number 2021SK53709) in support of Dr.Nan Wang.

Authors’ contributions

QT and XQ contributed to the conception and design of the study, QT, XZ, NW, and XQ contributed to data collection, QT and XZ contributed to data analyses, and NW and XQ contributed to data interpretation. QT drafted the article while XZ, NW, and XQ critically appraised it and revised it. All authors approved the final version of the manuscript for submission and publication.

Acknowledgments

The authors would like to thank all the patients for their participation in this study, and the staff from the Third Xiangya Hospital of Central South University, the Reproductive & Genetic Hospital of Citic-Xiangya, and the Hunan Maternity and Child Health Care Hospital for their collaboration and support.

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No competing interests reported.

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Irrational parenthood cognition and infertility stigma among infertile women: a cross- sectional study in Changsha, China

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Abstract

Background

Methods

Results

Conclusion

Background

Methods

Participants

Procedures

Measurements

Statistical methods

Results

IPC and ISS scores by sample characteristics

Correlations between IPC and ISS scores

Correlates of infertility stigma

Discussion

Summary of the findings

Sample characteristics

IPC and ISS scores by sample characteristics

Correlates of infertility stigma

Limitations

Conclusions

List Of Abbreviations

Declarations

References

Additional Declarations

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