Infertility and childlessness stigmas

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Infertility and childlessness stigmas are social and cultural codes that identify the inability to have children as a disgraceful state of being. Broadly speaking, in many cultures, "Demonstrating fertility is necessary to be considered a full adult, a real man or woman, and to leave a legacy after death," and thus the failure to make this demonstration is penalized. [1] Both male infertility and female infertility can be stigmatized, however, in many traditional cultures, women are held responsible for child-rearing and thus for pregnancy or the lack thereof. Infertility and childlessness stigmas are related to disability or physical-deformity stigmas and violation-of-group-norm stigmas. Infertility is a "deeply intimate matter, often deemed as taboo to discuss publicly." [2]

Contents

No one wants to tell their mother-in-law.

— Whiteford & Gonzalez, "Stigma: The Hidden Burden of Infertility"

Infertility and childlessness can have negative social, [2] psychological [2] and economic consequences, [3] including "discrimination, social exclusion, and abandonment." [4] Adults without children may be subject to derisive language, intrusive questioning, shaming, [3] ostracism, and physical abuse. [5] Other negative consequences of the infertility–childlessness stigma, especially for women, may include depression, low self-esteem, [6] and even suicidal ideation or suicide. [5] People with infertility living in societies where it is a stigmatized condition may suffer from anxiety, may choose to self-isolate, and may become secretive or withdrawn. [7] In pro-natalist societies, voluntary childlessness is often considered a deviant behavior. [7]

Stigmas may be particularly acute in communities that organize themselves collectively and thus place a high value on clan, lineage and perpetuation of family legacy. [2] In these cultures, childlessness may be viewed as a "tragedy for the whole community" beyond the personal significance for infertile or childless individuals. [2] However, even in a prototypically individualistically organized society, 42 percent of women tested in a study of the emotional consequences of infertility were found to have "global distress levels in the clinically significant range," in part due to social norms that judge women without children to be "unnatural and selfish." [8]

Most academic study of infertility addresses expensive treatment technologies, rather than the "anthropological and public health" effects. [3] In more-developed countries, the widespread availability of assisted reproductive technologies has "transformed infertility from an acute, private agony that was accepted as fate, into a chronic, public stigma from which there were costly, and often unfulfilled hopes, of deliverance." [9] In some cultures, biomedical explanations for infertility may be disregarded in favor of traditional beliefs that past wrong choices have resulted in the placement of an infertility curse, thus accelerating the vicious cycle of stigma. [2] Blame may assigned, variously, to having offended gods or ancestors, abortions in a past life, [2] practicing witchcraft, past promiscuity, use of birth control, [1] wrong living generally, etc. Exclusion of the infertile or childlessness from social events is known, enacted as a means of quarantine to prevent the "contagion" or "toxin" of non-reproduction from spreading within the community. [5] Infertile people are also viewed as sad people who may bring sadness with them and "spoil" celebrations. [5]

As one scholar put it, "Like leprosy and epilepsy, infertility bears an ancient social stigma. [7] An archaic term for the condition of female infertility, present in the Old Testament, is barren woman . [10] There have been three traditional means of addressing infertility: [2]

  1. Medical interventions or quasi-medical treatments; [2] the ancient Greeks called childless women ateknos, and possible causes and treatments for infertility were considered in Hippocratic texts. [11]
  2. Spiritual recourse (prayer for fecundity, or alternately, submission to the will of a deity or power) [2]
  3. Realignment of social relationships, including divorce, polygamy, adultery, or promiscuity. [2] One study showed that infertility in Ghana led to "increased risk of precarious sexual behaviour of both men and women...trying out different partners, attempting to prove that they are not the source of the infecundity." [3] In traditional Chinese family structure (called the Dishu system in English), "The first of the seven conditions under which a wife may be repudiated is infecundity." [12]

In some societies, women with children are allowed access to certain community resources and privileges from which childless women may be excluded, thus children act as a sort of universal passport to humanity. [5] [13]

In some cultures, funeral practices for childless women are different from those for women who successfully conceived and bore offspring. [3] Notably, "In the Hindu religion, a woman without a child, particularly a son, can't go to heaven. Sons perform death rituals." [5] In Catholicism, there is a limbo of infants for stillborn babies (as baptism is a sacrament available only to the living), thus women unable to bring a pregnancy to term would be told they would not encounter their children's souls in an afterlife. [14] The original doctrine was that these fetuses or babies were consigned to hell, resulting in a latter-day practice called respite sanctuaries. [15] In the traditional Vietnamese belief system, childlessness risks destroying "the entire âm realm of one's ancestors and consequently scatters all ancestral linh hon into wandering ghosts and demons (ma qüy)." [16]

An individual's ability to deflect or resist stigma may depend on array of intersecting age, gender, class, economic, and/or psychological factors. [17]

A study of infertility experiences in Zambia concluded: [1]

Stigma cannot be broken in silence. Healthcare policies and education should increase discussion of infertility without shaming infertile people. Men may have more power in their communities; their experiences must be included.

See also

Related Research Articles

<span class="mw-page-title-main">In vitro fertilisation</span> Assisted reproductive technology procedure

In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a patient's ovulatory process, removing an ovum or ova from their ovaries and letting sperm fertilise them in a culture medium in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is transferred by catheter into the uterus, with the intention of establishing a successful pregnancy.

Reproductive technology encompasses all current and anticipated uses of technology in human and animal reproduction, including assisted reproductive technology (ART), contraception and others. It is also termed Assisted Reproductive Technology, where it entails an array of appliances and procedures that enable the realization of safe, improved and healthier reproduction. While this is not true of all people, for an array of married couples, the ability to have children is vital. But through the technology, infertile couples have been provided with options that would allow them to conceive children.

Infertility is the inability of an animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species. It is the normal state of a human child or other young offspring, because they have not undergone puberty, which is the body's start of reproductive capacity.

<span class="mw-page-title-main">Artificial insemination</span> Pregnancy through in vivo fertilization

Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatment for humans, and is a common practice in animal breeding, including dairy cattle and pigs.

<span class="mw-page-title-main">Family planning</span> Planning when to have children

Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Fertility is the ability to conceive a child. The fertility rate is the average number of children born during an individual's lifetime and is quantified demographically. Conversely, infertility is the difficulty or inability to reproduce naturally. In general, infertility is defined as not being able to conceive a child after one year of unprotected sex. Infertility is widespread, with fertility specialists available all over the world to assist parents and couples who experience difficulties conceiving a baby.

Fecundity is defined in two ways; in human demography, it is the potential for reproduction of a recorded population as opposed to a sole organism, while in population biology, it is considered similar to fertility, the natural capability to produce offspring, measured by the number of gametes (eggs), seed set, or asexual propagules.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

Male infertility refers to a sexually mature male's inability to impregnate a fertile female. In humans, it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. More recently, advance sperm analyses that examine intracellular sperm components are being developed.

<span class="mw-page-title-main">Female infertility</span> Diminished or absent ability of a female to achieve conception

Female infertility refers to infertility in women. It affects an estimated 48 million women, with the highest prevalence of infertility affecting women in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Infertility is caused by many sources, including nutrition, diseases, and other malformations of the uterus. Infertility affects women from around the world, and the cultural and social stigma surrounding it varies.

Childlessness is the state of not having children. Childlessness may have personal, social or political significance.

<span class="mw-page-title-main">Oocyte cryopreservation</span> Procedure to preserve a womans eggs (oocytes)

Oocyte cryopreservation is a procedure to preserve a woman's eggs (oocytes). This technique has been used to enable women to postpone pregnancy to a later date – whether for medical or social reasons. Several studies have shown that most infertility problems are due to germ cell deterioration related to aging. The procedure intends that the woman may choose to have the eggs thawed, fertilized, and transferred to the uterus as embryos to facilitate a pregnancy in the future. The procedure's success rate varies depending on the age of the woman, with the odds being higher in younger, adult women.

<span class="mw-page-title-main">Marcia C. Inhorn</span>

Marcia Claire Inhorn is a medical anthropologist and William K. Lanman Jr. Professor of Anthropology and International Affairs at Yale University where she serves as Chair of the Council on Middle East Studies. A specialist on Middle Eastern gender and health issues, Inhorn conducts research on the social impact of infertility and assisted reproductive technologies in Egypt, Lebanon, the United Arab Emirates, and Arab America. She has also completed a major study of egg freezing in the United States, featured in her latest book, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs. Inhorn has published 22 books, as well as more than 150 articles and book chapters.

Research suggests that men and women differ in their psychological responses to infertility. Samaira Malik, from the Institute of Work, Health, and Organizations at the University of Nottingham, UK, said, “men are in fact equally affected by the unfulfilled desire for a child but are less open about their feelings.”

Female fertility is affected by age and is a major fertility factor for women. A woman's fertility is in generally good quality from the late teens to early thirties, although it declines gradually over time. Around 35, fertility is noted to decline at a more rapid rate. At age 45, a woman starting to try to conceive will have no live birth in 50–80 percent of cases. Menopause, or the cessation of menstrual periods, generally occurs in the 40s and 50s and marks the cessation of fertility, although age-related infertility can occur before then. The relationship between age and female fertility is sometimes referred to as a woman's "biological clock."

Obesity is defined as an abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. This is often described as a body mass index (BMI) over 30. However, BMI does not account for whether the excess weight is fat or muscle, and is not a measure of body composition. For most people, however, BMI is an indication used worldwide to estimate nutritional status. Obesity is usually the result of consuming more calories than the body needs and not expending that energy by doing exercise. There are genetic causes and hormonal disorders that cause people to gain significant amounts of weight but this is rare. People in the obese category are much more likely to suffer from fertility problems than people of normal healthy weight.

Stratified reproduction is a widely used social scientific concept, created by Shellee Colen, that describes imbalances in the ability of people of different races, ethnicities, nationalities, classes, and genders to reproduce and nurture their children. Researchers use the concept to describe the "power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered," as Rayna Rapp and Faye D. Ginsburg defined the term in 1995.

The male infertility crisis is an increase in male infertility since the mid-1970s. The issue attracted media attention after a 2017 meta-analysis found that sperm counts had declined by 52.4 percent between 1973 and 2011. The decline is particularly prevalent in Western countries such as New Zealand, Australia, Europe, and North America. A 2022 meta-analysis reported that this decline extends to non-Western countries, namely those in Asia, Africa, Central America, and South America. This meta-analysis also suggests that the decline in sperm counts may be accelerating.

Reproductive loss, sometimes reproductive grief, describes a potential emotional response to unsuccessful attempts at human reproduction or family-building. These experienced losses may include involuntary childlessness generally, pregnancy loss from all causes, perinatal death, stillbirth, infecundity and infertility from all causes, failed attempts to conceive, failed fertility treatments, failed gestational surrogacy procedures, and losses related to all dimensions of the adoption process. Responses to miscarriage, stillbirth, selective reduction and neonatal death are a subtype of reproductive loss called perinatal bereavement.

Reproductive privilege is a form of social privilege that describes people who have been able to regenerate themselves biologically and produce new generations with an unremarkable level of difficulty. People with a reproductive disadvantage use the term in reference to the variant levels of ease or difficulty with which people can become/stay pregnant and carry to term or father a living child. The concept of reproductive difference is controversial and discussion of reproductive privilege is fraught with the social and sociological conflicts that are common to public discourse about children and families.

References

  1. 1 2 3 Howe, S.; Zulu, J. M.; Boivin, J.; Gerrits, T. (2020-10-08). "The social and cultural meanings of infertility for men and women in Zambia: legacy, family and divine intervention". Facts, Views & Vision in ObGyn. 12 (3): 185–193. ISSN   2032-0418. PMC   7580265 . PMID   33123694.
  2. 1 2 3 4 5 6 7 8 9 10 11 "Multicultural Considerations in Infertility Counseling" Article 18 Paper based on a program presented at 2015 ACA Annual Conference, March 11–15, 2015, Orlando, FL. Ebru Buluc-Halper and Paul W. Griffin, url=https://www.counseling.org/docs/default-source/vistas/article_18f0bf24f16116603abcacff0000bee5e7.pdf?sfvrsn=4
  3. 1 2 3 4 5 Rouchou, Brittany (May 2013). "Consequences of infertility in developing countries". Perspectives in Public Health. 133 (3): 174–179. doi:10.1177/1757913912472415. ISSN   1757-9139. PMID   23327901. S2CID   25953224.
  4. ↑ Roberts, Lisa; Renati, Solomon; Solomon, Shreeletha; Montgomery, Susanne (2020-11-06). "Women and Infertility in a Pronatalist Culture: Mental Health in the Slums of Mumbai". International Journal of Women's Health. 12: 993–1003. doi: 10.2147/IJWH.S273149 . PMC   7654515 . PMID   33192102.
  5. 1 2 3 4 5 6 Springen, Karen (2008-09-14). "How Women Around the World Cope With Infertility". Newsweek. Retrieved 2023-04-13.
  6. ↑ "Infertility". World Health Organization (who.int). Retrieved 2023-04-13.
  7. 1 2 3 Miall, Charlene E. (April 1986). "The Stigma of Involuntary Childlessness". Social Problems. 33 (4): 268–282. doi:10.2307/800719. JSTOR   800719.
  8. ↑ Miles, Laura M.; Keitel, Merle; Jackson, Margo; Harris, Abigail; Licciardi, Fred (August 2009). "Predictors of distress in women being treated for infertility". Journal of Reproductive and Infant Psychology. 27 (3): 238–257. doi:10.1080/02646830802350880. ISSN   0264-6838. S2CID   144386113.
  9. ↑ Whiteford, Linda M.; Gonzalez, Lois (January 1995). "Stigma: The hidden burden of infertility". Social Science & Medicine. 40 (1): 27–36. doi:10.1016/0277-9536(94)00124-c. ISSN   0277-9536. PMID   7899919.
  10. ↑ Miranda Larbi (31 July 2019). "Women are reclaiming the word 'barren' to talk about their fertility issues" . Retrieved 2023-04-13.
  11. ↑ Flemming, Rebecca (2013). "The Invention of Infertility in the Classical Greek World: Medicine, Divinity, and Gender". Bulletin of the History of Medicine. 87 (4): 565–590. doi:10.1353/bhm.2013.0064. ISSN   1086-3176. PMC   3904772 . PMID   24362276.
  12. ↑ Lee, Shu-Ching (1953). "China's Traditional Family, Its Characteristics and Disintegration". American Sociological Review. 18 (3): 272–280. doi:10.2307/2087881. ISSN   0003-1224. JSTOR   2087881.
  13. ↑ Slawson, Nicola (20 March 2023). "Can we build a bridge between childless women and mothers?". thesinglesupplement.substack.com. Retrieved 2023-04-14.
  14. ↑ "Why belief in 'Limbo' has disappeared in recent decades – Queen's Research". www.qub.ac.uk. 2018-01-04. Retrieved 2023-04-13.
  15. ↑ Obladen, Michael (July 2021), Obladen, Michael (ed.), "Revived for paradise: Respite sanctuaries", Oxford Textbook of the Newborn, Oxford University Press, pp. 397–402, doi:10.1093/med/9780198854807.003.0057, ISBN   978-0-19-885480-7 , retrieved 2023-04-13
  16. ↑ Phan, Chánh Công (1993). "The Việtnamese Concept of the Human Souls and the Rituals of Birth and Death". Southeast Asian Journal of Social Science. 21 (2): 159–198. doi:10.1163/030382493X00161. ISSN   0303-8246. JSTOR   24491690.
  17. ↑ Riessman, Catherine Kohler (2000). "Stigma and Everyday Resistance Practices: Childless Women in South India". Gender and Society. 14 (1): 111–135. doi:10.1177/089124300014001007. ISSN   0891-2432. JSTOR   190424. S2CID   141078314.
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