Adoption practices among couples with secondary infertility in Karachi: a triangulation study design.

OBJECTIVE To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern. METHODS To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. RESULTS Qualitative methodology result suggests that adoption is the last option for infertile couples. Couples often take this as a "Totka", that when they adopt a child, they could end up having their own baby. The husband's family is usually preferred for adopting a child. The results of quantitative component suggest that the prevalence of adoption among 400 women is 7%. Less than half of the respondents (49.3%) reported to ever having thought of adopting a child to cope with the secondary infertility. The main decision maker for adoption of child is the husband (17%) and the mother-in-law (68%). Though majority of these women (72.5%) were supported by their husbands, however, in-laws and relatives were reluctant to pursue this option and less than one third (29%) of these women had a support from them. CONCLUSIONS This study concludes that couples ever thought of or opted for adoption after prolonged duration of secondary infertility. In cases where the condition cannot be treated, it is necessary to counsel, not only the couple but also the in-laws.