You would be forgiven for thinking that Dr Vincent Molelekwa is a psychiatrist. Listening to the fertility expert from Gaborone Fertility Clinic explaining the stress and shame women who are struggling to conceive go through, it becomes apparent that often times he probably finds himself doubling as a shrink.
“Women seeking fertility treatment often arrive at my office feeling anxious and upset. They express feeling like a failure because they are, say, 36, and their relationship just ended. Others may express fear that they won’t meet “the one” with whom to create a family. Some express guilt over having an abortion a decade ago, at a time when they weren’t ready for parenthood, while others blame themselves for not prioritizing motherhood earlier in life. n some cases, I believe women can benefit from counseling and/or support groups to help them cope.”
Dr Molelekwa says, “there is a cloak of shame that surrounds infertility, which may explain why women trying to conceive have the same levels of anxiety and depression as women diagnosed with HIV, cancer and heart disease. In about 20% to 40% of cases, infertility is associated with male factors – most often, low sperm count. However, regardless of cause, most treatments to enhance fertility require increased effort by the women. In other words, the burden of overcoming infertility is most often placed squarely on women. This can cause undue levels of stress and anxiety that ironically may make it harder to conceive: Female patients who report high levels of day-to-day stress are 13% less likely to conceive than women who experience much lower levels.”
But you do not have to be a psychiatrist of fertility expert to understand the pressures of being childless in a pro-natalist society like Botswana.
For many women, infertility carries a hidden stigma borne of shame and secrecy. The stigma partially obscures the exact number of infertile women because some are so devastated by the inability to conceive that they never seek treatment.
Women seek treatment more often and with greater frequency than do their male partners even though the treatment of female infertility is more invasive and more costly than treatments for male infertility. Others obsessively seek treatments to enable them to bear a child and to remove the stigma associated with childlessness. Moreover, another group of women experiencing infertility are never enumerated because they cannot afford to seek medical treatment. Some years back, an infertile couple would decide either to remain childless or to adopt often meeting their desire to parent by becoming their nieces’ and nephews’ favourite aunt or uncle. Today, however, the cultural construction of infertility has changed as infertile couples face a bevy of medical interventions. In rural Botswana, childbearing is an important marker of adult status and is expected.
For women, motherhood is essential to securing status within one’s family and community. Women often feel the pressure brought on by themselves, their partner, family and community to become pregnant. The visibility of pregnancy contributes to this pressure by clearly marking those who had and had not achieved pregnancy when expected. Women are blamed for not becoming pregnant. She is either accused of using contraceptives when she shouldn’t or excluded by friends when she cant join the big belly club.
Senior Social Work lecturer at the University of Botswana, Dr Poloko Ntshwarang says, “Stigma doesn’t just come from others; personalized stigma is the negative beliefs you hold about yourself because of your difficulty in having a child. You may mistakenly believe that your infertility is a sign of weakness or “bad karma” for something in your past. Seeking counseling, educating yourself about the causes of infertility, and connecting with others who are facing the same challenges can help you overcome this destructive self-judgment. One of the ways to overcome the stigma is to educate yourself about the negativity behind it as well as the medical treatment options available to you. Shining a light on something “scary” (like infertility) can take away some of the fear and the stigma of it. The more you know about your current situation and what is going on with your body, the more empowered you will feel.
Fertility manifests itself as an acute and unanticipated life crisis. It is unanticipated and may be unexplained in some instances. It creates overwhelming stress and tests normal coping mechanisms. To be childless in a pronatalist society is to run against the norm with all its accompanying sanctions. As members of society, many women are victims of a culturally shaped desire to have children which appears to be extremely strong, transcending sex, age, religion and social class division. The heart of the experience of infertility lies in the inability to proceed with one’s life according to life course norms that are both reinforced by others and accepted as valid by the affected individual. For many infertile women, infertility is a secret stigma that is distinguished from more obvious examples of stigmatization because it is invisible. Unlike the blind or paraplegics, the infertile display has no obvious stigmatizing features – only their own knowledge of their condition tells them apart from others. In a society that values fertility, childlessness becomes an attribute of the individual which can be discrediting.
It seems clear that for most people, involuntary childlessness is regarded as a deficient or abnormal condition. The social stigma for childlessness especially for infertile women still leads to isolation and stigmatization in many cultures. Although male factors contribute to about half of all cases of infertility, women are overwhelmingly perceived as being the party responsible for a couple’s infertility and subsequently the social suffering. Women who maintain friendships with young parents find it most hard to deal with their circumstances as openness about infertility can be challenging to navigate. These women often avoid conversation topics related to family or children and many admitted to selectively disclosing the truth or simply telling lies to avoid uncomfortable conversations.Discrimination, stigma and ostracism are still very much a reality for childless women. An inability to have a child or to become pregnant can result in being greatly isolated and this often leads to divorce, physical or psychological violence.
Orapeleng Phuswane-Katse a physician with the Ministry Of Health, says, “Woman’s health has been located in her capability to reproduce for more than a hundred years. Her ability to menstruate and bear children is the main focus of her bodily health. If something was wrong with her body’s ability to perform these activities she is seen as faulty, deviant or incomplete. Women are essentialised as child bearers. Their reproductive health is seen by the medical community as the most important part of a women’s well-being.
How many women see a doctor only for a yearly pap test/pelvic examine but otherwise do not see a doctor unless it was an emergency? There are many reasons why couples suffer from infertility. These include: endometriosis, ovulation problems, blocked fallopian tubes, or even low sperm in men. Before the present reproductive technologies were available, infertility was possibly seen as something that a woman or couple had to accept. Now, with the technological progress that has been made in the field of infertility, there is a greater chance for a woman to become pregnant. But still, there is a great degree of stress in the process of treatment.”