fertility news

Stigma, as defined by Webster's dictionary, is "a mark of social disgrace." Across the ages people struggling with infertility have described this as well as a myriad of negative feelings surrounding their inability to achieve pregnancy. It helps to understand the evolution of the societal expectations that put such value on having children.

In Biblical times infertility was considered a punishment for a woman's sins and in Colonial times up to the 19th century, children were necessary for economic survival. The inability to have children therefore was a potential threat ones' status within the community and to the stability and well-being of a community. Child labor laws altered this view and a shift occurred so that children were then valued for the warmth, affection, companionship and stimulation they provided their parents. Children, especially males, were also the heirs to the family property and name. By the 20th century yet another cultural shift occurred and the focus changed from a communal view to one of the family as "the ideological center of happiness."

North America is considered a pronatalistic society. Loosely interpreted it is "pro-birth" and a society in which the married couple is expected to and should want to reproduce. A number of authors maintain that these expectations transcend sex, age, race, religion, ethnicity and class divisions. Parenthood is encouraged and celebrated and the inability to fulfill these societal expectations can be devastating. Research indicates that the societal pressure to reproduce starts in the second year of marriage and continues to a peak by the fourth or fifth year. This may occur at exactly the same time when the couple is going through their infertility evaluation and feeling most vulnerable.

There are many reasons proposed in the literature for wanting children. Achieving parenthood allows one to achieve adult status, social identity, fulfill gender-role requirements (especially true for women) and to complete the marriage. The psychological response to the widely accepted socio-cultural theories range from societal approval for having babies to the expectations that motherhood would make them happy, fulfilled and give them a secure adult identity. Miall has described the stigma of involuntary childlessness (infertility) as having an adverse effect on the identities and interpersonal relationships of the couple. She and others suggest that women in particular feel the effects of infertility since motherhood is emphasized by cultural norms and sexual and psychological adjustment is tied to childbearing. Moreover, since motherhood and reproduction are played out in the female partner's body the failure to achieve pregnancy can significantly alter a woman's self-perception, self-esteem and personal fulfillment.

The stigma of infertility affects men as well. The respondents in Miall's study considered male infertility more harmful to masculinity than female infertility is to femininity and associated it with impotence and a lack of virility [Miall, 1986: p. 274]. Commonly women assume responsibility for the infertility even if the cause is male factor in order to protect their partners from what they perceive as the greater stigma associated with male sexual dysfunction.

The failure to fulfill the gender role expectations of motherhood affects a women's perception of herself whereas the ability to have children does not appear to be the only measure of a man's ability to fulfill male gender roles. It is important to note that for men with a diagnosis of male factor infertility the stigma may be a result of the failure to impregnate since it is common for them to confuse potency with virility. As a result of this thinking they may consider the diagnosis a threat to their sexual adequacy

How each gender copes with the perceived stigma may also be different. Women are more likely to participate in groups and seek counseling whereas men may use denial, avoidance behaviors and withdrawal to deal with the negative emotions they feel. It is important to consider the male perspective a little deeper since they can be the forgotten partner in the infertile couple. Men often lack an adequate support system since they are not as open as their wives. They tend to feel their role is to comfort and support their wives, a task which may be impossible to accomplish, and that can leave them feeling vulnerable and isolated. The ability to produce a sample or have sexual relations "on demand" can be extremely stressful despite male sexual stereotypes. Like women, men may feel their marriage is threatened by the strain infertility puts on the marriage and his relationship with his spouse. He may feel helpless because he is unable to comfort his wife or because she is emotionally unavailable to him. Finally, he may hide his longing for a baby or the guilt and shame that accompanies the diagnosis of male factor.

References:
Burns L, Covington S. Psychology of infertility. In: Burns L, Covington S editors. Infertility Counseling. New York: The Parthenon Publishing Group; 1999. 3-25.

Greil A. Not yet pregnant: infertile couples in contemporary America. New Brunswick: Rutgers University Press; 1991.

Greil A, Leitko T, Porter K. Infertility: his and hers. Gender and Societ. 1988; 2:172-99.

Hoffman L, Hoffman M. the value of children to parents. In: Fawcett JT, ed. Psychological Perspectives on Population. New York: Basic Books, 1973; 19-73.

Ireland M. Reconceiving Women: Separating Motherhood from Female Identity. New York: Guilford Press, 1993

Marsh M, Ronner W. the Empty Cradle: Infertility in America from Colonial times to the Present. Baltimore: Johns Hopkins University Press, 1996.

May E. Barren in the Promised Land: Childless Americans and the Pursuit of Happiness. Nre Yoek: Basic Books, 1995.

Miall C. The stigma of involuntary childlessness. Social Problems. 1986; 33: 268-82.

Nachtigall R, Becker G, Wozney M. The effects of gender-specific diagnosis on men's and women's response to infertility. Fertil Steril. 1992; 113-20

Pohlman E. Motivations in wanting conceptions. In Peck E, Senderowitz J, editors. Pronatalism: the myth of mom and apple pie. New York: Thomas Y. Crowell; 1974.

Veevers J. The violation of fertility mores: voluntary childlessness as deviant behavior. In: Boydell C, Grindstaff C, Whitehead P, editors. Deviant behavior and social reaction. Toronto: Holt, Rinehart and Winston; 1972.

Veevers J. Voluntary childlessness: a review of issues and evidence. Marriage and Family Review. 1979; 2: 1-26.

Veevers J. Childless by choice. Toronto: Butterworth; 1980.

Veevers J. Researching voluntary childlessness: a critical assessment of current strategies and findings. In: Macklin E, Rubin R, editors. Contemporary families and alternative lifestyles. Beverly Hills: Sage; 1983.