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Feminization and Stigmatization of Infertility in Malawi

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Boetumelo Julianne Nyasulu

1. Introduction

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1In this chapter I will provide a background on infertility and how it is positioned and constructed globally, as well as in the context of Sub-Saharan Africa. Additionally, I will provide a description of the study context – the community of Mngwangwa – under the categories of population, religion, marriage, funerals, economy and health, to better contextualize the discussion on infertility.

1.1 Background

2Infertility is not a discriminatory condition – in that it can affect anyone of any background, race, or culture – while ironically, it is a source of socio-cultural discrimination in numerous societies. The World Health Organization (WHO) defines infertility as the inability to conceive after 12 months of regular and unprotected sex (WHO, 1975). A distinction is normally made between primary and secondary infertility; the first being when a woman has never conceived, and the latter when she has conceived once but failed to become pregnant again despite efforts to do so (WHO, 1975).

3Infertility exists as a global problem, with statistics showing that 1 in 8 couples struggle with impaired fecundity (Resolve, 2019). Sub-Saharan Africa is one of the regions highest affected by infertility, with prevalence rates across the different countries ranging from 7 to 29 per cent (Ericksen and Brunette, 1996, p. 211). The major causes of infertility in Sub-Saharan Africa are infections that arise post-childbirth, post-abortion or through sexually transmitted diseases (Larsen, 2000, p. 285).

4While statistics can give us an alternative understanding of infertility and its effects, they don’t demonstrate the social and cultural consequences of infertility. The rates vary across Sub-Saharan Africa, and even globally, as infertility is influenced by multiple factors including environmental, social, institutional and cultural conditions. An individual’s experience of infertility, and the treatment they receive, are affected by the availability, acceptance and utilization of care systems, assumptions about childlessness, and a society’s emphasis on pronatalism (Greil, McQuillan and Slauson-Blevins, 2011, p. 740-742). In Sub-Saharan Africa, infertility exists within a socio-cultural context where children are valued as a source of wealth for the family; as such, infertility can result in neglect, abuse, marital instability, banishment, discrimination or social stigma (Barden-O’Fallon, 2005, p. 2229).

5Unsurprisingly, over the last few decades reproductive responsibility has disproportionately fallen on the woman. As such, the inability to reproduce is constructed as both a bodily and a social failure, due to an inability to enact the socially constructed role of motherhood. While there have been developments in Assisted Reproductive Technologies (ARTs), in the developing world, the Sub-Saharan African scene has been left fairly untouched by these advances, creating a problem space in this area.

6There is a need for further research on the effects of infertility on an individual, on communities and on a wider national level, the better to give insight into people’s needs and experiences, and in turn develop culturally sensitive and contextualized effective reproductive health programs. In Malawi there is a high secondary infertility rate, but a lack of any form of ARTs or Invitro Fertility clinics. The construction of infertility thus results in various social, physical, emotional, financial and psychological consequences for those suffering from it. The topic of infertility is often considered to be a taboo subject, with the woman being accused of witchcraft, prior abortions or prostitution. Despite research that has shown that 50 per cent of infertility cases can be attributed to men, the blame is cast on the woman, her voice silenced, and any action taken by the man is deemed justified. This includes physical or emotional abuse, financial isolation, divorce, banishment, or the taking on of an additional wife (Barden-O’Fallon, 2005, p. 2229).

7This study investigates the feminization and stigmatization of infertility. The stigma perpetuated around reproductive failures, such as infertility, can be most pervasive in pronatalist and patriarchal societies, such as Malawi, where motherhood is valorised.

1.2 Research Area

8Malawi is a small country in Central-East Africa bordered by Tanzania and Mozambique, with a population of 18 million, 85 per cent of which resides in rural areas where – similar to other countries in the region – fertility is highly desired and valued (World Bank, 2018). Malawi’s total fertility rate (TFR) has declined over the years but still sits relatively high, at 5.49 children per woman as of 2017 (Index Mundi, 2018).

Figure 1: Map of Research Area (Mngwangwa in green)

Figure 1: Map of Research Area (Mngwangwa in green)
  • 1 Records by Malawi’s National Statistic Office only cover district and regional statistics. As such, (...)

9Mngwangwa, the case study area, is in the Central Region of Malawi (Mteza, Lilongwe Northwest). Records from a community worker in Mngwangwa indicate that there are 807 families living there, each of which typically includes 7 to 8 people.1 This would place the estimated total population at 5,649.

10Religion: The Chewa tribe is the predominant tribe in Mngwangwa. The tribe’s most significant cultural marker is the Gulewamkulu – which translates as “the great dance” (Mtonga, 2006, p. 59). The origins of Gulewamkulu can be found in a Chewa creation myth that stipulates that Chauta (God) lived on earth harmoniously with men, women and animals until man sought to equal God’s grandeur and wisdom by creating fire, and set all the grasslands and forest aflame (Curran, 1999, p. 68). This angered God, who withdrew from earth to go live “in a village in the sky” and all the animals ran away; this marked the beginning of chaos and discord on the earth (Mtonga, 2006, p. 60). Gulewamkulu dancers wear nyau (masks) that hide their identities and adorn themselves with trimmings of fur and sacking while engaging in song and dance to represent the spirits of the animals and ancestors who temporarily visit from the spirit world to try to reconcile with mankind (Curran, 1999, p. 68). In Mngwangwa, community members reported that Gulewamkulu dancers perform at important events in the community, such as funerals, weddings or celebrations, but also guard certain pathways around the village demanding money or certain signs that are emblematic of one’s part in the society. Gulewamkulu emerged with an “ameliorating role” (Kachapila, 2006, p. 328) for men when the matrilineal social and political system of the Chewa tribe valorised women and gave them power and authority in village life. This disparity in social relations led to the creation of Gulewamkulu; a secret brotherhood, it allowed men to showcase their power and control, and protest against the women. Behind their masks, their actions and offences were justified as actions of the spirits and considered above court jurisdiction (Mtonga, 2006, p. 63). This immunity allowed, and still allows, for “the physical intimidation and degradation” (Kachapila, 2006, p. 334) of women, and indeed many Gulewamkulu members commit atrocities in the form of insults, sexual jokes and in some cases even acts of violence or assault (Mtonga, 2006, p. 63). Invasions by other tribes that culturally influenced the Chewa, as well as the arrival of Christianity, shifted the Chewa’s matrilineal structure into more patrilineal practices, however they struggled to eliminate the practice of Gulewamkulu. The elevation of men’s status in the community transformed Gulewamkulu from a secret society of men on the margins into a male initiation rite performed by a larger group of men (Kachapila, 2006, p. 335).

11Despite the existence of Gulewamkulu practices, Christianity is the most predominant religion in Mngwangwa, at an estimated 90 percent of the Malawian population (StudyCountry, 2019). The coexistence of Christianity, Gulewamkulu and witchcraft in the Mngwangwa community is evidence of its dynamism, and its ability to incorporate indigenous and foreign forms in an almost symbiotic manner (Kachapila, 2006, p. 321). Christianity was brought to Africa in the nineteenth century, and was met by many Africans with a response that author Mlenga refers to as “dual religiosity”. Dual religiosity refers to the choice individuals make to practice two different religions or parts of those religions simultaneously (Mlenga, 2016, p. 10). Unlike the concept of syncretism, dual religiosity does not require the creation of a new religion from the combination of two different ones, but rather allows for both religions to be practiced “[either to] supplement or complement the other, or as a way of life” (Mlenga, 2016, p. 10). This concept is imperative to understanding many of the inhabitants of Mngwangwa, who practice Gulewamkulu and Christianity concurrently. In this context, many Christians make use of elements of other religions or practices – i.e. Gulewamkulu or witchcraft – without intending to be less Christian, or even regarding themselves as such (Mlenga, 2016, p. 10).

12Marriage: In Mngwangwa, generally people get married at the age of 16, although the revised marriage law of Malawi now declares 18 to be the minimum age (Girls Not Brides, 2017). If there are no purely judicially registered marriages in Mngwangwa, three types of marriage are common practice:

  1. For a religious marriage, everything is prepared with the involvement of the church, and a clerk presides over the marriage. The marriage certificate itself is provided by the church (Mawila, 2019). The church prohibits divorce from this type of marriage, in reference to the scriptures (Matthew 5:32). This type of marriage is rare; when someone gets married through the church, they become the talk of the neighbouring villages and many people attend the wedding (Mawila, 2019). It is an exciting event for the community that is often grandiose (Mawila, 2019).

  2. In a traditional marriage, the couple picks nkhoswe (representatives from their families), who come together and discuss their potential marriage (Phiri, 1983, p. 260). The two families come together when the husband’s family brings a hen (representative of the bride) and the bride’s brings a cock (representative of the groom) (Phiri, 1983). The elderly members of the family exchange the hen and cock, cook the food and then feast and drink to signify the completion of the marriage ceremony.

  3. The third and most predominant type of marriage is the kubachikumu, which translates as “stealing with the help of an insider” (Kapulula, 2015, p. 99). The allusion to theft refers to the man ‘stealing’ his spouse from her family and nkhoswe. A community worker described the events that unfold in a kubachikumu: the man sneaks the woman out at night, and then shows up at his home with the woman to declare their marriage. People cite this form of marriage as occurring when the man is pushed by his “untamed sexual urges”, or when he lacks the financial means for a traditional marriage with nkhoswe, where he is expected to fund gifts and the costs of the celebration (Kapulula, 2015, p. 99). Once the man has brought his desired spouse to his home, his family must conduct certain services to officialise the marriage (Kapulula, 2015, p. 100). The woman’s family is contacted and alerted about the kubachikumu and invited to the man’s family home. There are penalties for the kubachikumu marriage; when the woman’s parents arrive, they demand a first payment (chamlolo), as a recompense for speaking to the man’s family, and thereafter a second payment (chaminga) as a recompense for the inconvenience caused by the search for their child (Kapulula, 2015, p. 100). Then a conversation begins as to what happened, and the marriage is officially recognized by both families.

13Funerals: Funerals are normally used as an opportunity for meeting or gathering to discuss community issues, as they assemble large numbers of the community together (Manda, 1987, p. 35). Funerals and weddings are big celebrations in the community; life literally stops for these events, shops are closed, and everyone gathers together (Manda, 1987). There are four types of funeral ceremonies, with the first two being the most predominant: a Gulewamkulu funeral, a church funeral, a funeral without a ceremony and an mntayo (baby funeral).

14The mntayo funeral is held when a baby is stillborn or dies prior to reaching 2 months of age (Manda, 1987, p. 35). No man attends this funeral, and instead women from the neighbourhood and community gather together (Manda, 1987, p. 35). A community worker added that if there is a chief in the area who is a woman, she leads the funeral. The child is carried by a designated woman, who wears a cloth wrapping to carry them (Manda, 1987, p. 32). The community worker explained that there is no singing or talking during the funeral procession to the cemetery. A small hole is dug for the baby and the child is buried. A word of prayer or comfort is said, and the procession goes back to the deceased’s home.

15Economy: As an agrarian economy, 90 per cent of Malawians are employed in the agricultural sector, which accounts for 40 per cent of the country’s GDP and 88 per cent of export revenue (Odekon, 2006). The main exports are tobacco, tea and sugar (Nations Encyclopedia, 2019). More than half of the population lives under the poverty line, with more than 50 per cent of children suffering from acute or severe malnutrition (FAO, 2015). In Mngwangwa, people earn money mostly through agriculture focused on crop production (Nations Encyclopedia, 2019). Maize is farmed predominantly, and tobacco is cultivated as a commercial crop, the second being ground nuts (Nations Encyclopedia, 2019). The majority of the population earn their money through tobacco farming, while maize is predominantly used for food, with a surplus for business. Family subsistence farming is most common (Nations Encyclopedia, 2019).

16Health services: The 5 central hospitals in the country are tertiary-care facilities and are understaffed, poorly equipped and under-stocked (World Bank, 2013). The distance between health care facilities and poor communities is significant, compared to the distance found in wealthier communities. 80 per cent of children in Mngwangwa are born in hospitals, nonetheless in Malawi there is only one doctor for every 50,000 individuals, putting a heavy burden on the healthcare sector (World Bank, 2013). There are two main hospitals located 10-15km distant from the Mngwangwa community – the Area 25 hospital and Mbavi clinic.

17Infertility stands as a critical public health issue in Malawi, one of the poorest countries in the world ranking 171 out of 189 countries on the Human Development Index (UNDP, 2018). There is currently no form of infertility treatment in Malawi, with several myths circulating around its causes.

18Malawi’s HIV prevalence is the 8th highest in the world, at 9.2 per cent, and with a significant prevalence of other STIs (Avert, 2015). A doctor from the interview sample provided various Mngwangwa-specific health statistics: STIs in Mngwangwa predominantly affect the 12-15 age group; out of 10 people in this group, 2 or 3 would be infected by an STI. Syphilis is the most common STI, with gonorrhoea as the second. This means that infertility and its intersection with STIs represent a significant burden on the already strained health care system.

1.3 Research Question

19This thesis will examine the social stigmatization and feminization of infertility in Malawi, and specifically how stigma is understood and managed in the context of socio-cultural perceptions of infertility, within the local ecology of Malawi, as well as its effect on lived experiences and gender identities. Social theory thus far has focused on a Goffmanian analysis, and on delegitimization in the local moral world. However, in the local ecology of Malawi, what does it mean to say stigma, and how does this Euro-American concept fare in the context of Malawi? This research explores Fertility and Reproduction Studies in the field of Medical Anthropology, as well as the Anthropology of Sexuality and Reproductive Health, and will focus on literature that examines experiences, perceptions and the management of infertility. The theoretical approach of this thesis will include Goffman’s theory of stigma and Kleinman’s theory of delegitimation. The Goffmanian theory of stigma analyses the social construction of stigma and its effect on tarnishing the identity and image of an individual, often through subtle manifestations that are embedded in social processes. However, stigma cannot be analysed in isolation from the socio-cultural context in which it occurs. Kleinman’s approach to stigma will provide a deeper examination of experience, by offering lenses focusing on how illness is constructed by culture and society, and how the body is embedded in social, political and moral worlds.

Notes

1 Records by Malawi’s National Statistic Office only cover district and regional statistics. As such, official statistics for Mngwangwa could only be extrapolated from the broader statistics of the Lilongwe district. More specific information was provided by the community worker.

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