Thursday, 19 January 2012

Consequences of Infertility

Infertility interferes with one of the most fundamental and highly prized activities and thus presents a major life challenge to those who desire children. The condition brings up issues related to the health and well-being of individuals, couples and society as a whole. Infertility almost always leads to decreased levels of personal well-being and for many individuals it causes significantly more severe consequences. The burden of infertility includes psychological, social and physical suffering. Documented consequences include: anxiety, depression, lower life satisfaction, frustration, grief, fear, guilt, helplessness, reduced job
performance, marital duress, dissolution and abandonment; economic hardship, loss of social status, social stigma, social isolation and alienation, community ostracism, physical violence and where treatment is available uncomfortable, painful and life-threatening medical interventions. In most areas in the world, women’s well-being appears to be more seriously affected by infertility than men’s.

The nature and severity of the consequences of infertility differs between developing and developed countries and although effects vary depending on multiple factors, the consequences appear greater in the developing world. In general few health conditions affect person’s well-being more profoundly or pervasively than infertility in developing countries where the private agony of infertility is transformed into a harsh public stigma with devastating consequences.

The reason why infertility may be difficult for individuals and couples to accept vary. To understand the consequences of infertility both the reason why children are desired and the importance of having children must be examined. In the West, having children is widely viewed as a choice to be weighed carefully with other life goals. Personal happiness and the possibility of giving and receiving love within the parent-child relationship play into the decision of having a child. Because of widely held beliefs of individualism, free choice, and control of one’s life, unwanted childlessness causes frustration for Western couples that may not be experienced in the same way in other societies. In other locations, personal happiness is no less important, but not having children is seldom viewed as an option. Adherence to social norms, desire and need for social security, power and perpetuity are oft-cited reasons for having a family in developing countries. In countries with no social security system, many families depend on children for economic survival and childless couple risk severe economic deprivation and social isolation without children to assist them in old age.

Women’s body, especially in developing countries, is frequently the locus through which social, economic, and political power is exercised. Where the role or status of women is defined by their reproductive capacity, as when womanhood is defined by motherhood, infertility can have significant social repercussions including unstable marriages, domestic violence, stigmatization and in severe cases, ostracism. Infertile women in developing countries may suffer life-threatening physical or psychological violence when having children is a woman’s only chance to improve her status in her society or family. Examples of the effects of infertility in several developing countries are explored below.

The effects of involuntary childlessness vary by location. In Asia, being childless has more negative social, cultural, and emotional repercussions for women than perhaps any other condition which is not immediately life threatening. A study in Andhra Pradesh, India reported that 70% of women experiencing infertility would be punish with physical violence for their “failure” and nearly 20% of these women reported that they suffer severe violence at the hands of their husbands as a result of being childless. Some Indian women have reported not being allowed to hold new-born relatives or participate in infant naming ceremonies because of superstitious fears that a new child will die in the arms of an infertile woman. In Andhra Pradesh infertile women reported feeling isolated and ashamed with actual and anticipated rude comments at social functions forcing some women into social isolation.

Children are highly valued in Francophone Africa with procreation considered the main purpose of marriage and polygamous marriage justified as a means to increase family size. A marriage without children is equivalent to no marriage at all, and childlessness remains the main cause of divorce. The inability to have as many children as desired is considered a curse and difficulty conceiving or fathering a child is one of the most common reasons for seeking both traditional and modern health care.

In China and other population with Confucian traditions, infertility is seen to disturb not only this life, but the extended life of a couple’s ancestors. Filial piety is an essential ethical principle which requires people to extend the life of their ancestors and make their family line run continuously from generation to generation through the production of children. A person is understood to exist only interdependent relationships with their family and community; having no children breaks this chain and negatively affects the infertile couple as well as their ancestors and community. In pronatalist Confucian societies infertile individuals who maintain cultural traditions suffer significant psychological pressure and social stigma.

A study of female infertility in Tanzania found that women experience many grave hardship and serious social consequences as a result of infertility. In this setting, marriage is considered an exchange of productive and reproductive capacities between a woman and her husband’s family. The main aim of marriage is reproduction and an infertile woman is considered a “loss” in both reproductive and economic terms. Both men and women greatly desire children and no one chooses a life without them. A large family is needed because infant mortality is high and life spans are limited due to lack of health care. Children also provide economically for their parents in old age and improve their parent’s status in the domestic hierarchy. Consequences of infertility in this setting include diminished identity and status, stigmatization, and even ostracization. Infertility can engender spousal neglect and a withdrawal of economic support; it almost always signals the end of marriage through divorce or abandonment. If the marriage is not ended a husband will often take an additional wife in the hopes of proving his infertility and producing children. Other consequences include unpleasant or dangerous traditional remedies undertaken in the hopes of curing infertility such as eating feces and inducing vomiting.

Infertility engenders harsh consequences on personal and social levels with women often receiving the blame for the couple’s inability to have children. The consequences of involuntary childlessness on men are regrettably understudied however. Additional research is needed to provide an in-depth understanding of the social and cultural effects of infertility.

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