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Feminization and Stigmatization of Infertility in Malawi

Boetumelo Julianne Nyasulu

3. Theoretical Framework

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1Chapter Three introduces the two theoretical frameworks that will be used to analyse and explain the empirical findings of the study. Goffman’s stigma theory will be used as a grounding framework, while Kleinman’s delegitimation theory will be used to build on the Goffmanian approach, to capture the dynamic nature of stigma and its inextricable ties to the social context in which it occurs.

3.1 Stigma Theory Goffman

2In Goffman’s seminal work, Notes on the Management of Spoiled Identity, he explains that the word stigma has its origins in Greek, and defines it as “bodily signs designed to expose something unusual and bad about the moral status of the signifier” (Goffman, 1986, p. 1). These signs indicate that the individual is either a criminal, a slave, or has been “ritually polluted”, and that they should be avoided in public (Goffman, 1986, p. 1).

3Goffman asserts that the original definition of stigma is more widely used today, except with the concept of shame or disgrace attached to it. He separates stigma into three categories: (1) physical deformities (2) individual character blemishes (e.g. mental health disorder, homosexuality, addiction) and (3) tribal stigma (e.g. race) (Goffman, 1986, 4). Cultural and gender assumptions attached to reproduction assign the responsibility for fertility to women. Consequently, infertility is often attributed to the category of individual character blemishes, owing to the fact that it breaks with the group norm.

4Stigma acts as a “discrediting attribute” that presents a person as tainted or discounted, but can only be defined within the context of relationships (Goffman, 1986, p. 3). Goffman identifies two ways in which stigma can be experienced: the first is when a difference is evident or visible (discredited stigma) and the second is when a difference is not known or immediately perceivable (discreditable stigma) (Goffman, 1986, p. 4). Globally, perceptions of womanhood that equate it with motherhood and define females by their reproductive capabilities, construct childlessness or infertility as discreditable and stigmatizing (Miall, 1994, p. 34). People with discreditable stigma can often adopt what Goffman coins as “passing” – living and interacting without visibility or discovery of the stigma (Goffman, 1986, p. 48). However, individuals of the discreditable type are tasked with managing information about their stigma and often encounter a tension between revealing and concealing, or determining the context in which they feel safe enough to reveal (Goffman, 1986, p. 48). Goffman emphasizes that revealing the stigma also brings with it its own risks. It can affect future paths, reputation and appearances, or cause trauma and anxiety when exposed unintentionally (Goffman, 1986, p. 65). Additionally, there is the psychological burden of maintaining the secret of the stigma, and at times this leads to self-imposed isolation from the stigmatized group to avoid associating with them, as well as feelings of isolation from general society (Goffman, 1986, p. 87). The majority of literature on infertility places it in the category of the discreditable, but most of this literature is not contextualized in the locale of a rural community in the Global South, where intimacy does not afford the invisibility of infertility.

5Goffman describes four patterns by which an individual can be socialized to a stigma. In the first pattern, the individual learns of the disadvantages of their stigma while living through it – an orphan, for example (Goffman, 1986, p. 32). In the second, an individual with a stigma is protected from society by their family or those close to them (Goffman, 1986, p. 33). The third pattern constitutes an individual who only develops their stigmatized attribute at a later stage and is faced with having been socialized to understandings, meanings and perceptions of the stigma from a young age (Goffman, 1986, p. 34). Owing to this, they can often encounter challenges defining their identity, or challenges resisting the definition of their attribute as a deficiency (Goffman, 1986, p. 34). The last pattern is that of a foreigner who is socialized into a new community with different ways of knowing and being that he must conform to. Goffman makes note, for the third pattern, that it might be applied to an infertile individual – someone who discovers their infertile status at a later stage not only deals with challenges self-identifying because of their socialization, but also deals with challenges in their relationships (Goffman, 1986, p. 34). An individual who discovers a stigmatized attribute at a later stage has to deal with new acquaintances seeing them through the lens of that ‘deficiency’, and the possibility of old friends treating them differently because of new knowledge, and attachment to the person that the stigmatized individual once was (Goffman, 1986, p. 34).

6A stigmatized person is constructed as a deviation from the norm, and as such, a non-human (Goffman, 1986, p. 4). Attributes that are constructed as markers of stigma are indoctrinated in community members, creating an environment where both the group and the stigmatized individual regard the marker as a failing, which can lead to discrimination as well as self-hate. Goffman describes the various discriminatory methods employed as actively reducing the life chances of the stigmatized individual (Goffman, 1986, p. 4). Interactions between the individual and the community can provoke feelings of anxiety, hostility, suspiciousness or depression, because they lack knowledge of the thoughts of those around him (Goffman, 1986, p. 13).

7The interactions, experiences and perceptions of a stigmatizing attribute are socially constructed, and thus these attributes can be different things in different contexts. The management of stigma will occur in any society that has identity norms and expectations (Goffman, 1986, p. 130). As Goffman notes, “the normal and the stigmatized are not persons but rather perspectives”.

3.2 Delegitimation Theory – Kleinman

8In his book, Writing at the Margin, Kleinman explores concepts of pain, resistance, stigma and delegitimation. He categorizes illness as socially constructed – modelled by cultural patterns, social interactions in the family and workplace, the psychophysiology of the individual, and diverse intersections of gender, class and ethnicity (Kleinman, 1997, p. 122). An illness is thus a disruption of the norm – the moral structure imposed by a dominant group – and of the normative – that structure embodied by an individual – in a society (Kleinman, 1997, p. 123). These multiple factors conjoin in the construction of illness to create what he refers to as an “intersubjective experience of suffering” (Kleinman, 1997, p. 122) – one that is influenced by the individual’s identity and the network of their social world. This intersubjective experience of suffering is seen in certain societies where culture and tradition make meanings of illness that often affect not only the patient, but their family’s lives, goals, opportunities and emotional wellbeing (Kleinman, 1997, p. 163).

9Kleinman’s approach emphasizes the importance of developing an understanding of local knowledge and daily practices around the body, suffering and misfortune in order to analyse pain and illness as both biologically and culturally established (Kleinman, 1997, p. 125). Pain and suffering draw on concurrent religious, medical, somatic and social experiences, erasing the mutually exclusive divides between these categories (Kleinman, 1997, p. 133-4). His concept of delegitimation asserts that an individual’s experience of pain and suffering delegitimizes their previous experience of their social world. Perhaps, prior to the illness the individual might have experienced a social world in which they were characterized as confident, happy and successful. The onset of the illness – for example, infertility – however, transforms their perception of themself in their social world to abnormal, lacking or distressed. The experience of delegitimation is furthered by a state of incurability, where practitioners or healers deem the situation as “too extreme, too troubling [or] too difficult to control” (Kleinman, 1997, p. 133).

10Delegitimation is marked by a loss of control of one’s identity and perception in the local world, and this loss is compounded by a lack of resources for those in environments of poverty, insecurity or oppression (Kleinman, 1997, p. 139). Often symptoms of bodily pain and experiences of chronic pain can be a physical manifestation of this loss of control. The source of pain and bodily pain can often converge and routinize the transformation of the individual’s local world into a world of suffering – a delegitimated world (Kleinman, 1997, p. 139).

11Building on this background of pain and suffering, Kleinman’s theory around stigma builds on the Goffmanian approach by contextualizing stigma in its social, cultural and moral worlds. The socio-cultural world intermediates personal and societal relationships, while the moral world constructs regulations around beliefs and behaviour (Kleinman, 1997, p. 124). By embedding stigma in the social world, Kleinman acknowledges that it does not exist solely as an individual and psychological condition, but also affects and is affected by social life and relationships (Kleinman and Hall-Clifford, 2009, p. 418). Owing to power relations embedded in the social, political and economic world, stigma is experienced differently depending on the background and identity of the stigmatised person (Kleinman and Hall-Clifford, 2009, p. 418).

12Contextualizing stigma in the social world that it exists in brings an understanding that an individual’s experience of stigma can affect their social life and what it is composed of – relationships, networks, opportunities, wealth acquisition and other elements (Kleinman and Hall-Clifford, 2009, p. 418). Essentially, Kleinman accepts Goffman’s theory that stigma labels certain conditions as culturally or socially devalued, and whether it is discredited or discreditable, this stigma spoils the identity of the individual who has been labelled as such. Kleinman, however, furthers the theory by localizing this socio-cultural devaluation and acknowledging that the way in which it is experienced and expressed is locally distinctive (Kleinman, 1997, p. 148). Stigma experienced in an African context, for example, brings with it beliefs about the polluting nature of an illness, accusations of witchcraft, traditional healers, and reactionary families – a complexity and diversity of social processes that is largely overlooked by the Goffmanian approach. Kleinman’s approach to stigma centralizes analysis on local settings of informal and formal health care, the network of relations and connections, opportunity for resource mobilization and the capacity of an individual’s social circle to support emotionally and financially or to exacerbate suffering (Kleinman, 1997, p. 163). With Kleinman’s theory, stigma is not individual, it is interpersonal; and its contextualization in local contexts creates a diversity of experiences.


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