Infertility Knowledge Runs High, but Training Gaps Still Shape Student Attitudes
In a cross-sectional survey of final-year nursing and midwifery students in Accra, Ghana, infertility knowledge was already strong, yet curriculum demands remained unmistakable. The study reached 263 students drawn from four universities and used the Knowledge-Attitude-Practice framework to examine how well future frontline reproductive health providers understand infertility and how they feel about caring for affected couples.
The results point to a workforce in training that is not starting from zero. Students posted a composite knowledge score of 18.25 out of 23, with a standard deviation of 3.17, while attitudes toward infertility were largely favorable, with a composite attitude score of 3.812 out of 5 and a standard deviation of 0.654. In a region where childbearing carries strong social value and infertility can trigger stigma, those numbers matter because they suggest that many trainees already bring a clinically useful baseline of awareness into practice environments.
Female Students and Midwifery Trainees Scored Better on Core Measures
Gender and program track both separated performance. Female respondents scored significantly higher than males on knowledge and attitude, with knowledge showing U = 2800.5 and p = .044, and attitude showing U = 2777.0 and p = .040. Students in BSc Midwifery also outperformed BSc Nursing students on knowledge, with U = 2868.0 and p = .002.
Those differences are not surprising in a setting where midwifery training is closely aligned with reproductive physiology, fertility counseling, pregnancy care, and the emotional realities of childbearing. Even so, the pattern raises a practical question for nursing education: if midwifery trainees are absorbing more infertility-specific content, nursing students may be entering practice with a thinner understanding of a problem they will still encounter in wards, outpatient settings, and community care. Infertility care rarely belongs to one profession alone.
The knowledge-attitude link was measurable and clinically relevant
A moderate positive correlation connected knowledge and attitude scores, with r = .400 and p < .001. In multiple regression, knowledge was the sole significant predictor of attitude, with B = 0.080, p < .001, and R² = .178. In plain clinical terms, students who knew more about infertility tended to hold more supportive views toward affected patients.
That finding fits the logic of the KAP model. Better factual grounding can reduce misconceptions about causes of infertility, blunt moral judgment, and make it easier for future nurses and midwives to approach patients without shame, blame, or delay. In settings where infertility remains socially loaded, knowledge is not just academic content; it shapes the tone of counseling, the quality of referral, and the willingness to treat infertility as a health condition rather than a social verdict.
Curriculum Demand Was Strong and Direct
An especially clear signal emerged from the students themselves. A large majority, 86.3%, supported expanded infertility content in the curriculum.
That percentage points to a training environment where students recognize a mismatch between the burden of reproductive distress in the community and the depth of instruction they receive. For future nurses and midwives, infertility training is not an abstract add-on. It influences how they explain reproductive cycles, when they recognize red flags, how they counsel couples, and whether they respond to distress with empathy or avoidance. The study did not measure patient outcomes, but the educational pathway is obvious: stronger training should produce more confident, less stigmatizing care.
Why this matters in sub-Saharan African practice settings
Infertility in sub-Saharan Africa often carries social consequences that extend far beyond the clinic. Couples may face family pressure, partner conflict, community blame, and psychological strain. Nurses and midwives often become the first professionals to hear these concerns, especially in settings where reproductive health services are limited or where specialist infertility care is difficult to access. When trainees understand infertility well, they are better positioned to recognize that the condition is common, medically multifactorial, and not reducible to one person’s fault.
This is where educational quality becomes a health-system issue. A nurse who can explain likely pathways, communicate without judgment, and refer appropriately can shift a patient’s experience from isolation toward engagement with care. A midwife with stronger infertility knowledge may also be more effective in counseling couples early, before myths harden into harmful beliefs.
What the Preprint Adds to Nursing Education in Ghana
The study was conducted as a descriptive cross-sectional survey among final-year students, which means it captures a single point in training rather than long-term performance. Even with that limitation, the findings provide a useful snapshot of readiness at the edge of professional practice. They suggest that students already possess a solid baseline, but they also reveal unevenness by sex and by academic program.
Because knowledge predicted attitude, curricular reinforcement is not merely about adding more information. The better target is the weak areas that shape uncertainty, stigma, or clinical hesitation. In infertility education, that could mean deeper instruction on causes of infertility, realistic counseling strategies, psychosocial consequences, and the role of nurses and midwives in referral pathways. Those are the points where facts become bedside behavior.
One sentence from the data stands out on its own: students wanted more infertility teaching, and they wanted it in substantial numbers.
Ethical Oversight and Study Boundaries
Ethical approval came from the Dodowa Health Research Centre Institutional Review Board in Dodowa, Accra, Ghana. The preprint also states that relevant consent procedures were followed.
As a preprint, the study has not yet undergone peer review, so its conclusions should be read as provisional rather than definitive. It also does not provide evidence that curriculum changes will automatically improve real-world counseling performance or patient outcomes. What it does provide is a disciplined signal from future reproductive health providers themselves: if training institutions want nurses and midwives who can care well for infertile couples, knowledge needs to be strengthened early, not after graduation.