Transformations: Gender, Reproduction and Contemporary Society Week 14

Lecture Outline  Definitions  Prevalence and causes  The experience of infertility  The gendering of infertility  A global perspective  Feminist approaches to infertility

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]

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?

Social Definitions of Infertility  Greil (1991: 7) Infertility is not a ‘static condition’ but a ‘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.’

Prevalence of Infertility  Taboo topic  8-12% of couples worldwide (medical definitions)  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  Miscarriage: between 1 in 6 and 1 in 4 pregnancies  Much infertility is preventable

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

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)

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) John: […] ‘Now it’s like, “Do you have any children?” I say, “Well, no, unfortunately, my wife couldn’t have any. We’ve tried. We couldn’t”’. (Throsby 2004: 150)

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

Feminist approaches to infertility  Global perspective  Social as well as medical infertility  (Reproductive) health care to prevent infertility  Paying attention to gender  Recognising/resisting the reproductive imperative