By Reem Wehbe – Staff Writer
“Barren womb, dark spaces,
Bearing a child, I am appreciated.
Loneliness prevails, I am searching to embrace,
Where are you? I am already hated.” (Sheikh, 2021)
“Mom”, “my daughter”, and “my son”, women are calling their children. Other women listened only because they did not have children to call, and here stigma, psychological issues, and social disturbances come into place. The relation between fertility and motherhood as well as motherhood and womanhood is still questioned to be pre-requisite to each other. Social constructs have encouraged women to have children, which is viewed as inevitable. Moreover, from a psychological perspective, reinforcing the idea that motherhood and womanhood go hand in hand led to endorsing those beliefs in women to have a healthy and happy life viewing infertility as pathological and unnatural (Ulrich & Weatherall, 2000). On the other hand, the infertility rate around the world is increasing. Global infertility rates are on the rise where a study conducted by the WHO in 2023 revealed that more than 48 million couples and 186 individuals are suffering from infertility trying to have children categorized under child-wish couples (WHO, 2023). However, researchers and healthcare providers specialized in OBGYN are trying to find solutions for infertility by providing alternative solutions such as in-vitro fertilization, hormonal therapy, and even artificial wombs, but the question of ethics surrounding these treatments has influenced women’s decisions to opt for such solutions. Other services may be provided for infertile women wishing to have children as adoption, but social stigma also plays a role in decision-making when opting for this step. Here, women wishing to have children and become mothers face hurdles telling them to stop trying. Women in the infertility cloud face storms from medical, social, and even psychological areas.
Medical Angle:
Motherhood was limited to biological and gestational mothers, but the context of motherhood nowadays is translated in complex terms, taking into consideration the wide range of medical inventions assisting reproduction. Many women around the world who are struggling to conceive find hope in the possibility of a life-changing transition that may occur after receiving any form of assistance or treatment for their infertility. However, it is important to note that these treatments are not always successful, and the root cause of infertility may not always be identified. Indeed, modern medicine has adopted assisted reproductive technology (ART) and at least five million infants were born by ART (De Geyter, 2019). In 1978, the first in-vitro fertilization (IVF) child was born in the UK, but this case triggered huge protests, negative comments, and insults for such medical interventions (Aspulund, 2020). The concerns surrounding IVF are since the child has the right to be born safely and the woman has reproductive autonomy. While in-vitro fertilization (IVF) offers single women or same-sex couples the opportunity to have children and start a family, some ethical considerations suggest that this method may be unfair and compromise the anonymity of the donor’s genetic material. The American Society of Reproductive Medicine employed equality in all requests for IVF, disregarding sexual orientation or partner status (Ethics Committee of the American Society for Reproductive Medicine, 2013). The use of IVF is very common around the world, especially after the integration of women into the workforce.
Other medically assisted reproduction includes embryo transfer, cryopreservation, and insemination. The medical field is in progressive research for further interventions to solve infertility problems. But what is infertility and how is it diagnosed?
Many cases of infertility cannot be easily defined by medical terms alone, leaving individuals to make difficult decisions about whether to continue trying to conceive or to accept the possibility of not having children. The absence of a clear-cut answer, such as a definitive “yes, there is a solution” or “no, we will not be able to have a child,” can create a sense of hopelessness, leading to regret or prolonged suffering. Therefore, the definition borders of infertility are not set, and it appears highly limited to medical diagnoses which most women do not understand or classify as dreadful. In brief, research about fertility in medicine is still ongoing, but in the meantime many cases of infertility remain undiagnosed, setting the couple in a reluctant situation to proceed in further trials or to give up.
Social Construction:
Even after attempting several medical interventions that may have failed, many women continue to have a strong desire to become mothers. In such cases, adoption can provide these women with an opportunity to experience motherhood while also giving children in need a chance to experience a better life. Adoption is a way for these women to build a family and provide a loving and supportive home for a child who may not have had the same opportunity otherwise. However, adoption has several steps, including legal and social aspects that differ from country to country. On the other hand, there is a stigma falling around women who choose to adopt, including rejection, negative social judgment, and exclusion. An example of the benefits of adoption can be seen in the case of a woman diagnosed as infertile due to Type 1 diabetes. Despite facing the challenge of adoption, including its often-lengthy process and logistical difficulties, this woman chose to pursue it as an option, particularly as she had an adopted cousin herself. While acknowledging that adoption is not without its challenges, she also described it as a “bittersweet” experience that can be both challenging and wonderful at the same time (Megala, 2021). Many women who choose adoption experience a mixture of emotions, including acceptance of their decision, hesitation, and worries about the possibility of the child being taken back by the biological parents. For example, one woman who adopted twin babies for five weeks had to give them back when the biological parents decided to reclaim custody, which left her with emotional scars and affected her future adoption decisions. Motherhood is a complex journey, involving numerous social and legal issues that can present significant obstacles, causing women to either fight and persevere or give up and return to their previous situation.
Moving forward, many women classified motherhood as an instinct that feminist theories have criticized, as it limits women to motherhood. A study conducted by Ulrich and Weatherall (2000) interviewed women with infertility conflicts. One participant explained her reasons for the many trials she endured to get pregnant and said that she felt something in her like nature. On the other hand, another woman interrupts this discussion to confirm that she feels that she needs to have her own biological children to be a “normal woman”, but what is normal and how do you define a woman? These social expectations follow women and restrict them to their role as mothers.
Psychological Theorizing:
Infertile women often experience significant psychological distress, including depression and anxiety. Research conducted by Peterson et al. (2014) has shown that the prevalence of depression and anxiety is twice as high in infertile women compared to control subjects experiencing these conditions for other reasons. Another study illustrated that the level of psychological distress experienced by infertile women is the same as that felt by cancer patients. his distress can lead to women discontinuing their treatment or seeking alternative solutions, which is particularly common in the early stages of treatment (Sax, M.R, & Lawson, 2022). Statistics reveal that approximately 40% of infertile women experience psychological distress during assisted reproductive technology (ART) procedures (American Psychiatric Association, 2019). Another study by Volgsten et al. (2010) showed that there was a progressive increase in the risk of depression among women who had negative tests after applying IVF treatment, as well as with women who had unexplained infertility. Such distress puts women at a higher risk of discontinuing fertility care, increasing the chances of experiencing depression.
All the above-mentioned cases indicate the need for the integration of multidisciplinary treatment for women struggling with infertility, especially psychologists and mental health experts. Therefore, it is crucial to increase the scope of awareness about mental health needs for infertile women and the significance of the integration of mental health professionals in the treatment process. By screening their psychological status, early identification of mood disorders can be detected early allowing for psychological support as needed. In addition, mental health care services for women experiencing infertility can improve their emotional well-being as well as help them gain a better understanding of the treatment process, resulting in better outcomes.
Conclusion:
The experience of infertility can have a profound impact on a woman’s life, affecting her psychological well-being, social identity, and medical status. Despite medical interventions, many women face unexplained infertility, which highlights the importance of considering multidisciplinary teams in fertility care. While medical diagnoses are crucial, they should not be the sole focus of treatment. Raising awareness about the significance of integrating mental health and social support services in the care plan can help provide holistic care for women trying to become mothers. Additionally, separating the concepts of womanhood from motherhood and fertility can offer a wider perspective on the complex issues women face. Although fertility is a significant aspect of motherhood, it should not define a woman’s identity or worth.
References:
- American Psychiatric Association (2019). Infertility: The Impact of Stress and Mental Health. American Psychiatric Association. Retrieved from https://www.psychiatry.org/news-room/apa-blogs/infertility-the-impact-of-stress-and-mental-health#:~:text=Up%20to%2040%25%20of%20women,compared
%20to%20the%20general%20population. - Asplund K. (2020). Use of in vitro fertilization-ethical issues. Upsala journal of medical sciences, 125(2), 192–199. https://doi.org/10.1080/03009734.2019.1684405
- De Geyter C. (2019). Assisted reproductive technology: Impact on society and need for surveillance. Best practice & research. Clinical endocrinology & metabolism, 33(1), 3–8. https://doi.org/10.1016/j.beem.2019.01.004
- Ethics Committee of American Society for Reproductive Medicine (2013). Access to fertility treatment by gays, lesbians, and unmarried persons: a committee opinion. Fertility and sterility, 100(6), 1524–1527. https://doi.org/10.1016/j.fertnstert.2013.08.042
- Megala (2017). ‘I adopted a child-here’s what it was like’. Women’s Health. Retrieved from https://www.womenshealthmag.com/life/a19957606/adoption-stories/
- Peterson, B. D., Sejbaek, C. S., Pirritano, M., & Schmidt, L. (2014). Are severe depressive symptoms associated with infertility-related distress in individuals and their partners?. Human reproduction (Oxford, England), 29(1), 76–82. https://doi.org/10.1093/
humrep/det412 - Sax, M. R., & Lawson, A. K. (2022). Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team. Women, 2(1), 68–75. https://doi.org/10.3390/women2010008
- Sheikh (2021). Infertility – infertility. PoemHunter.com. Retrieved from https://www.poemhunter.com/poem/infertility-1/
- Ulrich, M., & Weatherall, A. (2000). Motherhood and Infertility: Viewing Motherhood through the Lens of Infertility. Feminism & Psychology, 10(3), 323–336. https://doi.org/10.1177/0959353500010003003
- Volgsten, H., Skoog Svanberg, A., Ekselius, L., Lundkvist, O., & Sundström Poromaa, I. (2010). Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertility and sterility, 93(4), 1088–1096. https://doi.org/
1016/j.fertnstert.2008.11.008 - World Health Organization. (2023). Infertility. World Health Organization. Retrieved from https://www.who.int/health-topics/infertility#tab=tab_1