Transformations: Gender, Reproduction and Contemporary Society

1. Transformations: Gender, Reproduction and Contemporary Society Week 15: Reproductive Disruptions: Infertility Dr Caroline Wright c.wright@warwick.ac.uk

2. Lecture Outline • Definitions • Prevalence and causes • Experiences of infertility • Gendering infertility • A global perspective • Feminist approaches to infertility

3. Medical Definitions of Infertility • Zegers-Hochschild et al (2009) • ‘a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse’ • National Institute for Health and Clinical Excellence (NICE) (2004: 10) • ‘Infertility should be defined as failure to conceive after regular unprotected sexual intercourse for 2 years in the absence of known reproductive pathology.’ [Clinical versus epidemiological definitions; Epidemiology = branch of medicine dealing with prevalence and incidence of disease in large populations]

4. Alternative Scenarios • Woman / man who knows that s/he cannot have children for some biological reason, but doesn’t try / want to – is s/he infertile? • A woman has a diagnosed fertility problem (blocked tubes), and has a baby using IVF; is she infertile afterwards? • A woman’s male partner has no sperm at all but she has no known fertility problem. Who is infertile? Is infertility the property of an individual or a couple? • 50 year old (menopausal) woman – is she infertile?

5. Social Definitions of Infertility • Greil (1991: 7): Infertility is not a ‘static condition’ but ‘a dynamic, socially conditioned process whereby couples come to define their inability to bear their desired number of children as problematic and attempt to interpret and correct this situation.’ • Britt (2001): the ‘socially infertile’ • Throsby (2004: 14) ‘the active but frustrated desire for a biologically related child.’

6. Involuntary Childlessness • Unwanted/un-chosen absence of children to parent • May have biological child but not be parenting socially • Tonkin (2010): the ‘contingently childless’ Social factors see fertility postponed, ageing produces biological infertility • Doesn’t capture experiences of those parenting non-genetic children and still wanting a genetic child • Doesn’t capture experiences of those who have genetic children and would have liked to have more

7. Prevalence of Infertility • Taboo topic • 8-12% of couples worldwide (medical definitions) • 50-80 million people may be experiencing infertility • Varies – as high as 33% in the ‘infertility belt’ of SSA • Male infertility at least half of all cases, may be more • Primary and secondary infertility • Much infertility is preventable

8. Causes of Infertility • Anatomical / genetic / endocrinological / immunological problems (primary infertility) – about 5% • Infections (tubal scarring; blocking sperm) • Post-partum complications • Post-abortive complications (esp. ‘backstreet’ abortions) • Iatrogenic eg. unsanitary healthcare practices, infection-inducing IUDs, chemotherapy, some drugs • Dietary / environmental factors • Smoking / alcohol (“sub-fertility”) • “waiting” (common concept in minority world – very woman-blaming)

9. Miscarriage • Miscarriage: between 1 in 6 and 1 in 4 pregnancies • Early: missed period to 12 weeks (1st trimester). Cause: usually genetic/ chromosomal abnormalities • Late: 13-24 weeks (2nd trimester). Causes: infection, food poisoning, weak cervix, ?? • Still-born: 24 weeks+ • Women may not be allowed time to grieve, may feel guilty, blame themselves • Affects men/other family members too • Information, support, validation needed • ‘Miscarriage is a normal event that is experienced by many but has unique implications for each individual’ (Letherby, 1993, p. 178)

10. Experiences of infertility • ‘A man should be able to have children… to give his wife children. So because I couldn’t I wasn’t a real man … simple, straightforward … that’s why I felt an attack on my maleness… It all comes down to one word… inadequate.’ (Webb and Daniluk, 1999: 15) • ‘There are times when I don’t feel like a real woman. I wonder how am I ever going to feel that whole.’ (Earle and Letherby, 2007: 244) • ‘I was shocked and I must admit I felt a real failure (pause) I thought oh gosh I’ve failed as a mum and a wife (pause) to kill my child.’ (Letherby, 1993: 170)

11. Gendering infertility • Beth: ‘I sent [partner] a card on Valentine’s Day last year, saying “To the world’s greatest lover” and there’s a friend of mine in here, who actually has 4 children […] and her boyfriend said, “Oh, how come I didn’t get a card saying, “Greatest lover?” and she said “You’ve got children to prove you are’ (Throsby 2004: 148) • Martin: ‘But one of the really funny aspects about telling people, especially from a male point, is that you let people know that, without really realizing, the next bit a male person throws in is, “There ain’t nothing wrong with me. . . .” Because . . . you don’t want people to think, “Oh, he can’t have a baby. There’s something wrong with him. He’s not up to it.” So it becomes a very male ego sort of situation . . . that you’re prepared to tell people that you’ve got a problem, but you want to quickly make sure that they’re aware that it ain’tyou (Throsby and Gill, 2004: 338)

12. Infertility – a global perspective • An overlooked health problem globally • Inequitable access • Local norms and practices (religious / social) concerns around masturbation (Inhorn, Kahn) concerns around donated gametes concerns around adoption • The reproductive imperative • Global infertility networks • Reproductive technologies have gone global • NRTs can transform gender relations

13. Feminist approaches to infertility • Maintain a global perspective • Focus on social as well as medical infertility • Advocate (reproductive) health care to prevent infertility • Pay attention to gender • Recognise/resist the reproductive imperative

14. Conclusions • Defining infertility is challenging if we’re to recognise the complexities of people’s lives and choices • Medical definitions structure treatment but infertility is socially experienced • Infertility is a process not a state • Many causes of infertility are preventable • Miscarriage may be a normal event but it’s not experienced as such • Infertility can lead to feelings of loss, blame, grief, inadequacy, it’s often experienced as a major disruption to life plans • Infertility can be ‘caused’ by men, women or both but it’s often assumed to be ‘caused’ by the woman • Infertility is a global phenomenon, still too often a taboo topic