Assisted reproductive technology: perceptions and behaviours in Guatemala before and during the Covid-19 pandemic

Infertility is a challenge many people presently face and will continue to face in the future around the world. Conceiving can present several psychosocial challenges and obstacles in Western and non-Western countries. Two ethnic groups in Guatemala (a non- Western country), namely The Maya1 and Ladino (Maya n = 35, 11 males 14 females, mean age = 27.3, Sd = 7, and Ladino n = 146, 58 males and 88 females, mean age = 29.2, Sd = 10.3) were investigated on the perceptions and behaviour towards Assisted Reproductive Technology (ART) (study 1). The study was conducted a few months before the outbreak of the Covid-19 pandemic. A 13-statement questionnaire e.g., “children born by ART may be socially withdrawn” was presented to the participants to rate on a Likert scale, ranging from 1 = Strongly Agree to 5 = Strongly Disagree. Furthermore, participants were instructed to justify their response by making written comments and rating their level of knowledge about ART on a scale 1 = not at all to 10 = a considerable amount. Half of the participants rated their level of knowledge before reading the questionnaire items, the other half after reading the questionnaire items. Demographic information and factors namely, age, gender, religion, education and knowing someone undergoing ART were also recorded. Data collection took six months to complete (April to September of 2019). Data was subjected to Principal Components Analysis followed by Stepwise Regression, Factorial Anova and Correlational analyses. Written responses (219 from The Maya and 931 from Ladinos) were subjected to Thematic Analysis (TA). The results generally showed that religion, social acceptance, trust in modern medicine, gender, and ethnicity play an important role in Guatemalan populations’ perceptions and behaviour towards ART.

The results of study 1 was supported by findings of key medical fertility practitioners in Guatemala (study 2) and in the UK (study 3), two single case studies. The two single case studies also extended to investigate if Covid-19 will, or has already, had an impact on study 1 findings and patients’ perception and behaviour towards ART. Findings from studies 2 and 3 via the application of Interpretative Phenomenological Analysis (IPA), mirrored study 1 findings to a large extent on secrecy, racial integration issues, religion, and risk factors. Both practitioners in Guatemala and the UK indicated that since Covid-19 there are new concerns about risks involved regarding ART treatment.

Study 4 was a Scope literature review (between the period of 2020-2021) of the impact of Covid-19 and possible changes in behaviour of patients involved in ART treatment. The results indicated an overall distress caused by the Covid-19 pandemic and the worries triggered when undergoing infertility treatments during this very difficult time. The importance of continuing infertility treatment during the Covid-19 pandemic was also a factor in the findings. These findings also illuminate that if treatments were to stop, it would be detrimental to patients and the scientific community.

In general, these findings have significant implications for the scientific community as the data was collected before and during the outbreak of the Covid-19
pandemic. Whether such perceptions and behaviours towards ART in Guatemala may be different post Covid-19, is a study worthy of follow-up investigation. What is significant about the present findings is, the data collected before and during the outbreak of the Covid-19 pandemic. A unique opportunity that can only be replicated retrospectively i.e., what people can recall about their perceptions and behaviour about ART before the period of the Covid-19 outbreak?

More specifically, there are significant implications from the four studies reported for practitioners and those involved in infertility treatments, in giving the best advice to their patients and to the Guatemalan public.