Infertility & Body Image
According to the World Health Organization, infertility affects 1 in 10 couples, or 80 million people internationally (Clarke, Martin-Matthews, & Matthews, 2006). The causes of infertility are multiple and complex (see Buck, et al., 1997; Covington & Burns, 2006; Fjällbrant, 1975; Herer & Holzapfel, 1993; Higgins, 1997; and Weiss, 1987). The social and emotional consequences of infertility are equally varied, but are generally quite negative.
The Social and Psychological Effects of Infertility
Infertility is often accompanied by “identity shock” with the painful realization that the failings of one’s body have led to a permanent change in one’s self-concept (Clarke, Martin-Matthews, & Matthews, 2006). Therefore, frustration with the body’s perceived deficiency is the emotion expressed most often by both males and females around the world. However, experiences of infertility can differ quite substantially in more industrialized versus less developed nations.
Some researchers have reported, for instance, that infertile women in much of Africa can face not only divorce but social ostracism. They note that infertility tends to be a very public matter in such settings. In Botswana, for example, a woman’s fertility or infertility is announced by her own name. After the delivery her first child, a woman is addressed simply as “mother of such-and-such,” for instance, Mma Baruti, “mother of Baruti,” therefore providing a tangible reminder of her achieved motherhood/adulthood and higher social status. This leads infertile women to feel conspicuous, embarrassed and excluded when in the company of mothers (Mogobe, 2005). In an attempt to achieve social acceptance, infertile women may take desperate measures, such as risky sexual practices, that endanger their health (Samucidine, Barreto, Folgosa, Mondlane, & Bergström, 1999).
In Western developed nations, by contrast, infertility is a more private matter; and while infertile couples may not face social ostracism, they may experience intense feelings of inadequacy and personal failure. In addition, the reluctance to address fertility publicly may, in fact, leave couples feeling forgotten or unimportant (Afek, 1990; Greil, 1991).
Greil (1997) describes the experience of infertility as a “roller coaster of raised hopes followed by tragic disappointment.” Infertile women report feeling:
- Powerless. They feel that they are no longer in control of their bodies, and they feel powerless when it comes to decisions about when they will become parents or when they will be intimate (Dunkel-Schetter & Lobel, 1991).
- Broken or disabled. Some infertile women have reported feeling empty or broken, describing their bodies as “defective machines” (Clarke, Martin-Matthews, & Matthews, 2006). While this perception of the body can be painful enough when first diagnosed, infertility treatments tend to perpetuate and intensify this feeling. Women's bodies are typically the focus of fertility treatments, and many women come to feel a sense of alienation from their own bodies, as the inner workings of what was once her private body are now described in medical terminology and exposed to unfamiliar, invasive procedures.
- “Hollow” or incomplete. 63% of women interviewed in a study by Clarke, Martin-Matthews, and Matthews (2006) expressed the opinion that the ability to bear children is necessary for someone to be a “full-fledged woman,” and those who are infertile feel that it is not only their bodies that are incomplete, but also their sense of self.
- Responsible. Infertile women tend to hold the decision-making authority in regard to treatment, which adds a considerable amount of stress. Women's bodies are usually given more intensive medical treatments, often even when the man is the sole reason for the couple's infertility. Therefore, many couples claim that the decision to either continue or end treatment should be up to the woman, as it is her body that needs to be “fixed” (Clarke, Martin-Matthews, & Matthews, 2006).
Although men often report many of the same reactions to infertility as women, they tend to specifically equate infertility with a defect in their masculinity (Davis, 1987). The societal construction of a masculine man requires that he be sexually potent enough to impregnate a woman. However, without this ability, the man is left to question his sexual identity and manhood (Clarke, Martin-Matthews, & Matthews, 2006). Also, just as women report feeling hollow, men report feelings of incompleteness, saying that they feel as if they are “shooting blanks” (Abbey, Andrews, & Halman, 1992).
Infertile individuals may feel the need to distance themselves from others. They may:
- Isolate themselves from friends, family, or significant others as a result of feeling worthless or unattractive (Davis, 1987).
- Avoid social gatherings that may remind one of infertility, such as baby showers, family gatherings where children are present, or even the infant or toy sections at department stores (Elson, 2004).
- Hide their infertility from friends and family out of fear of disapproval.
Even when friends and family are aware of one’s infertility, communication can be exceptionally difficult or stressful. The mere knowledge that others know such personal details about one’s reproductive organs can cause infertile individuals to feel that their bodies are exposed or no longer private. Often a well-meaning relative will make an off-handed comment such as “Just relax, you’re trying too hard” to an infertile individual. Such a comment, while said with good intentions, may cause the individual to feel as though no one else understands what he or she is going through. It may also cause the individual to wonder if the infertility is actually due to a personal fault after all, or if there is something that could be done differently to improve the chances of becoming pregnant (Davis, 1987).
Infertility and Body Image
The damage to one’s body image and self-concept caused by infertility can be painful and life altering, but it certainly does not have to be hopeless. Many couples become parents through adoption, surrogacy or egg and sperm donation. Others choose to remain childless while devoting their time and energies to nieces, nephews and godchildren, to foster children or to any number of worthy and self-fulfilling pursuits.
More research is needed to determine how such choices affect the self-image of those who experience infertility. Perhaps the more pressing question, however, is why fertility is so important to self-concept in our society and in others. Is parenthood a marker of full adulthood, maturity and higher status? Is motherhood still seen as a woman’s natural role and primary goal in life? Is the ability to father a child seen as the ultimate proof of manhood? And do we, as a society, need to adjust our ideas about gender, sexuality and reproduction to ensure that those who experience infertility are no longer stigmatized and traumatized?
In our society, how important is the ability to have children to our ideas about femininity (womanhood) and masculinity (manhood)? Do we need to change the ways we think about what makes a us "real women" and "real men"?
- Abby, A., Andrews, F. M., & Halman, L. J. (1992). Infertility and subjective well-being: the mediating roles of self-esteem, internal control, and interpersonal conflict. Journal of Marriage and the Family, 54, 408-417.
- Afek, D. (1990). Sarah and the women's movement: the experience of infertility.Motherhood: A Feminist Perspective. London: Haworth Press.
- Buck, G. M., Sever, L. E., Batt, R. E., & Mendola, P. (1997). Life-style factors andfemale infertility. Epidemiology, 8(4), 435-441.
- Clarke, L. H., Martin-Matthews, A, & Matthews, R. (2006). The continuity anddiscontinuity of the embodied self in infertility. CRSA/RCSA, 43.1, 95-113.
- Covington, S. N. & Burns, L. H. (2006). Infertility Counseling: A Comprehensive
- Handbook for Clinicians. New York, NY: Cambridge University Press.
- Davis, D. C. (1987). A Conceptual Framework for Infertility. Journal of Obstetric,Gynecologic, and Neonatal Nursing, 16(1), 30-35.
- Dunkel-Schetter, C. & Lobel, M. (1991). “Psychological Reactions to Infertility.”Infertility: Prospectives from Stress and Coping Reasearch. New York: Plenum Press.
- Elson, J. (2004). Am I Still a Woman? Hysterectomy and Gender Identity. Philadelphia: Temple University Press.
- Fjällbrant, B. (1975). Autoimmune human sperm antibodies and age in males. Journal of Reproduction and Fertility, 43, 145-148.
- Griel, A. L. et al. (1990). Sex and intimacy among infertile couples. Journal ofPsychology & Human Sexuality. 2(2), 117-138.
- Greil, A. (1997). Infertility and psychological distress: A critical review of the literature. Soc. Sci. Med., 44(11), 1679-1704.
- Herer, E. & Holzapfel, S. (1993). The medical causes of infertility and their effects on sexuality. The Canadian Journal of Human Sexuality, 2(3), 113-120.
- Higgins, B. S. (1990). Couple infertility: from the perspective of the close relationship model. Family Relations, 39, 81-86.
- Mogobe, D. K. (2005). Denying and preserving self: Batswana women’s experiences of infertility. African Journal of Reproductive Health, 9(2), 26-37.
- Samucidine, M., Barreto, J., Folgosa, E., Mondlane, C., & Bergström, S. (1999). Infertile women in developing countries at potentially high risk of HIV transmission. African Journal of Reproductive Health, 3(1), 98-102.
- Weiss, R. (1987). Autoimmunity may cause infertility. Science News, 132(4), 52-53.