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Alliu S I, Orji L C, Fagbenro D A, Olaseni A O. Factors Affecting Decisions for Surrogacy Among Nigerian Women After Failed IVF Cycles Using the Health Belief Model. JCCNC 2025; 11 (4) :331-348
URL: http://jccnc.iums.ac.ir/article-1-852-fa.html

Background: Surrogacy is a complex reproductive option for women facing infertility, particularly in sociocultural contexts where biological motherhood is intricately linked with identity and status. This study explored the psychosocial, cultural, and contextual factors influencing surrogacy decision-making among Nigerian women with failed in vitro fertilization (IVF) experiences. The study investigated the factors influencing Nigerian women’s decisions to pursue surrogacy after experiencing one or more failed IVF cycles, focusing on the constructs of the health belief model (HBM). 
Methods: This study employed a qualitative content analysis approach (deductive and inductive), utilizing in-depth semi-structured interviews via WhatsApp with 20 infertile women recruited from 2 online fertility support groups (“voices of fertility and health” and “infertility, IVF and surrogacy”) in Nigeria through purposive and snowball sampling. HBM provides a theoretical framework guiding data collection and directed content analysis. Data that did not fit under the constructs of HBM were classified using conventional content analysis. 
Results: This study identified 6 emergent themes that complemented the constructs of the HBM (perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy). The emergent themes were sociocultural identity pressures, family and marital dynamics, religious and spiritual tensions, medical and legal mistrust, financial class reality, and emotional distress and identity threat. These themes highlight the complex interplay between individual health beliefs and broader sociocultural, emotional, and contextual factors shaping surrogacy decision-making. The findings of this study have provided suggestions for modifying the HBM.
Conclusion: The findings emphasize the need for holistic, culturally sensitive, and client-centered reproductive care. Fertility practitioners and health psychologists are suggested to acknowledge and respond to the sociocultural, emotional, and economic realities influencing surrogacy decisions.