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Feminization and Stigmatization of Infertility in Malawi

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Boetumelo Julianne Nyasulu

4. Methodology

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1Chapter Four will cover the relevance of qualitative methodology for this study, and will also discuss the methods chosen for recruiting interlocutors, data collection and analysis, and ethics. I will conclude with the challenges I encountered as someone who is Malawian-born but perceived as foreign, and mediating between using NGO networks while interacting with interlocutors independently.

4.1 Qualitative Methodology

2The data collection and analysis methods that I utilized for this thesis were subjected to a feminist methodological lens. Giving centrality to a gender-sensitive research methodology entailed taking gender into account as a significant variable, and in this case specifically focusing on women’s voices through this study, to highlight the discrimination and inequality they are confronted with at home or in their communities. The feminist methodological lens not only offered ethical guidance in the study and evaluation of a gender issue, but also encouraged reflexivity on my part, as the researcher. As such, I was conscious of my own positionality as a Malawian-born but foreign-residing woman, as well as of how my positionality influenced interpretation of the results. As my thesis focuses on socio-cultural perceptions and explanations of the infertile identity, as well as the anxieties or stigma that may surround it, a qualitative approach seemed to be the best fit. The specific tools that I used were in-depth interviews, discussion groups and informal conversations.

4.2 Interlocutor Selection

3The target groups of my interviews, discussions and conversations included primary and secondary infertile women, religious leaders, health workers, and community members. Primary data was collected from January 3rd, 2019 to February 21st, 2019. I liaised with a local non-governmental organization that works on maternal health, as well as health service workers or assistants to identify my first infertile female interlocutors. Time spent volunteering and working with said NGO in the past allowed me to build relationships and trust among the staff, and allowed for an ease of entry into the field as well as access to interlocutors. I not only relied on the NGO’s records but also employed snowball sampling to recruit further interlocutors in order to have a better balance of recruitment methods. The NGO not only had its own records but also employed health workers working in the study area who had relationships with the women and were able to identify them.

4Health professionals and religious leaders were selected according to their position in the community, and contacted through information collected by the NGO and community members. I selected health professionals and religious leaders who worked in the community, as well as those who resided in the city, through random selection via word of mouth and snowball sampling. For the discussion groups, informants were randomly selected from community gatherings, and common meeting locations for women such as boreholes and church gatherings.

4.3 Data Collection

5Data was collected from the four aforementioned participant groups – infertile women, religious leaders, health workers and community members – using interviews, discussion groups, and informal conversation. With the consent of those involved, I recorded the conversations and took notes.

6Interviews were the main data collection method for my thesis. Fontein mentions the advantage of the blurred line between the interview and casual conversation, that can often occur in fieldwork and create what he coins as a “deep hanging out”, and I capitalized on this aspect (Konopinski, 2013, p. 77). However, the distinction between casual conversation and interview – the prearranged questions and preparation – was still maintained as I worked on an interview guide to steer interlocutors towards issues, themes and concerns around my research question.

7Fontein also highlights the fact that interviews allow the researcher to gather data rapidly and transition from a more basic questionnaire guide in the preliminary stage, to a more specifically contextualized guide at a later stage with more precise questions, that can help to unveil “richer, evocative ethnographic material” (Konopinski, 2013, p. 78). With Malawian society rooted in oral culture and tradition, it followed that the most suitable approach for gleaning information and building relationships would be orally. Additionally, with my focus community located in a rural area, there are lower literacy levels than in the city; thus, relying on oral rather than written methods allowed me to have a wider sample size and avoid exclusionary tendencies. This not only prioritized the informant’s voice, but also avoided what could be perceived as a strict researcher-interlocutor structure, in favour of a more conversational and informal environment.

8Interviews: The in-depth interviews included questions related to perceived causes and consequences of infertility, as well as questions related to the stigma experienced, coping strategies and social support or lack thereof. The target group of these interviews was primary and secondary infertile women. 30 interviews were conducted with an average length of 1 hour. As seen from the table below, many of the women married at an early age, had been divorced and had, on average, only attained primary school education. These interviews allowed for a better understanding of the infertility experience, stigma experienced by the community and how the women perceived or understood those experiences.

Table 1: Basic backgrounds of (pseudonymized) women participating in the in-depth interviews.

  • 1 The Malawian education system comprises of eight primary school grades, from Standard 1 to Standard (...)

Pseudonyms

Interlocutor

Age

Age at First Marriage

Number of Marriages

Gender

Education Level1

Children

Mphatso

1

52

28/30

8

Female

Standard 8

0

Madalitso

2

45

14

4

Female

None

1 (22 years)

Chipi

3

61

19

2

Female

Standard 2

0

Fusani

4

33

17

3

Female

Standard 7

1

Mpho

5

59

18

7

Female

Standard 1

0

Theresa

6

35

18

2

Female

Form 1

1

Chikondi

7

31

19

1

Female

Standard 5

0

Dalitso

8

66

22

2

Female

Standard 6

0

Chimwemwe

9

22

18

1

Female

Standard 6

0

Pemphero

10

21

13

1

Female

Standard 7

0

Tadala

11

22

15

1

Female

Standard 7

0

Tiyamike

12

37

15

2

Female

Standard 2

1

Yamiko

13

24

20

1

Female

Form 3

1

Pilirani

14

37

18

1

Female

Standard 3

0

Mayeso

15

22

19

1

Female

Standard 5

1

Takondwa

16

34

18

1

Female

Standard 8

1

Thokozani

17

35

21

1

Female

Standard 8

1

Yamikani

18

47

33

1

Female

None

0

Mayamiko

19

47

18

2

Female

Standard 3

1

Mayeso

20

31

19

1

Female

Standard 8

2

Limbikani

21

38

14

1

Female

Standard 3

1

Fatsani

22

54

23

2

Female

Standard 3

1

Chisomo

23

20

14

1

Female

Standard 7

2

Chiyembekezo

24

33

18

5

Female

Standard 4

3

Chikumbutso

25

53

19

1

Female

Standard 2

1 (one died)

Kondwani

26

45

18

2

Female

Standard 2

1

Kumbukani

27

Unknown

Unknown

3

Female

None

0

Chifundo

28

52

22

1

Female

Standard 2

1

Chifuniro

29

42

26

1

Female

Standard 2

0

Ganizani

30

35

21

1

Female

Standard 7

9Three semi-structured interviews were conducted with health workers who had an insight on community relations and perceptions that exist in the community surrounding infertility. The interviews provided information on health workers’ perceptions of the problem, and of the stigma related to it.

10Discussion groups: Two discussion groups were organised with community members and religious leaders. This provided an opportunity to analyse the value that the former group placed on children and community perceptions of infertility, and glean insights into the latter group’s religious explanations or responses to infertility, as well as the church’s response to infertile individuals, and allowed me to examine how this played into experiences and management of stigma. The average length of each discussion group was 2 hours. The discussion group with religious leaders consisted of pastors from different churches including Assemblies of God, Seventh Day Adventist, The Nazarene Church of Malawi, Redeemed Christian Church of God, Destiny International Pentecostal Church and Hope in Jesus Ministry Church. The community member discussion group consisted of three men and four women, none whom were infertile or identified as infertile, with different marital statuses and a diverse number of children.

11The community group and religious leaders group were structured diversely to ensure that different perspectives and interpretations among the community were heard. Owing to the sensitivity of infertility and ‘infertility talk’, the questions discussed in the groups started with more of a focus on general questions about children, marriage, and family. This allowed the group to navigate around these topics, and both groups independently ended up steering the discussion towards the topic of infertility. The discussion groups allowed for the examination of people’s perspectives when operating within a social network or environment. In other words, the discussion groups allowed for an embedded and interactive environment for understanding how people in the community interact with each other and express themselves differently (Konopinski, 2013, p. 80).

12Kitzinger emphasizes the value of discussion groups for encouraging participants to express themselves in their own vocabulary and explore issues of importance to them (Kitzinger, 1995, p. 299). As such, the question guide for the groups included more general questions and allowed participants to generate their own questions and discussion based on these questions. The nature of the group also allowed for insight into different forms of interaction, communication and social realities not only between researcher and participants, but also among participants in the forms of jokes, arguments, or anecdotes (Kitzinger, 1995, p. 299). Unveiling these interactions and forms of communication provided an opportunity to observe cultural and normative values (Kitzinger, 1995, p. 300) and thus gain a richer account of people’s knowledge and experiences around (in)fertility, health and sexuality, as well as buttressing the information revealed in the interviews.

4.4 Ethics

13As mentioned before, my positionality plays a role in this research. I am cognizant that I am a middle-class, educated, Malawian-born but foreign-living researcher. My positionality required me to be reflexive during my research and during the writing process – to be cautious of power differentials that exist and how they may affect interactions and responses, as well as to separate my own role as a researcher from that of the NGO I worked with.

14Owing to the sensitive nature of the research topic, where individuals’ personal experiences of infertility potentially extended to sensitive emotional issues – such as sexually transmitted infections, marital relations, stigma, or social exclusion – ethical principles were key to this process.

15Specifically, the principles of confidentiality and consent:

  • Prior to the interviews, participants were informed that I hoped to ask personal questions of them in order to gain information on their experiences in trying to conceive and any challenges or struggles they may have encountered individually, both within their families and in the community. When I received consent to conduct the interview I maintained openness with my participants in explaining that I hoped to use the data in a document exploring theirs, and others’, experiences to produce a sample of experiences in the Mngwangwa community, primarily for my schooling purposes but also for the provision of data and information to NGOs on the ground, government or other organizations and institutions that could utilize the thesis for the benefit of the people.

  • All the participants included in my study were informed beforehand of the research objectives and promised confidentiality of any information given to me. The interlocutors were informed of the nature of the study, reasons for conducting it and any emotional or traumatic risks that may come up through talking through sensitive emotional matters. Additionally, the interlocutors were informed that should they not want to answer specific questions if they were uncomfortable, that was entirely acceptable.

  • The privacy, confidentiality and anonymity of participants was ensured; in those instances where I used an audio recorder or took notes, the interlocutors were duly asked beforehand. Pseudonyms are used for all interlocutors interviewed to protect their identity, unless they stated willingness for their true names to be made public.

4.5 Challenges

16Firstly, despite being Malawian, my proficiency in the local language, Chichewa, was only advanced enough for me to understand but not to speak at the level that was needed to ask the interview questions and follow up questions. As such, it was necessary for me to use an interpreter when in the field. This in itself was a challenge as it added a barrier to conducting the interviews. I believe that the use of interpreters may have complicated the perception of me with my middle-class status and accent, adding layers to my perceived foreignness. However, I found that once the interview had begun and the interlocutor began to notice that I only used my translator for my own questions rather than their answers, they understood that I could understand the language; most of the interlocutors began to speak directly to me rather than my interpreter by this point. However, when I didn’t understand a response, this was a challenge as my interpreter would often forget that we would need to interrupt the interlocutor for a translation, or they would have forgotten the response, thinking I had picked it up, which would result in their translating a paraphrased response.

17Secondly, while my access to the field was made easier through my relationship with the local NGO, at times this confused interlocutors and positioned me as someone who could remedy their situation either through emotional or medical resources. My apparent foreignness and approach as an outsider asking several probing medical and health questions perhaps added to this. At times, even despite stating my intentions and the distinction of my study from the activities and identity of the NGO’s work or from medical personnel, confusion still remained with the interlocutors. This was challenging, as at the end of the interviews many of the women would ask what I would suggest to remedy their situations: either their marriages, their infertile status, or their health status. Being unable to provide an answer other than mentioning the purpose of my study and my lack of professional expertise in any of those areas at times made me feel helpless. Sensing the earnestness of the interlocutors and their disappointment after the delivery of my answer, repeated each day, was at times disheartening – for me, for my interpreter and for them. As such, my study was challenging not only in terms of academic work but often times in terms of emotional work. Thankfully, my interpreters also worked with health workers and were at times able to offer some health advice or referrals. All in all, however, I understand that reliving trauma or emotions through the interviews was not an easy task for the interlocutors.

18Ultimately, my hope is that this research was more therapeutic than harmful, through its conversational aspect, and I was thanked for this by several interlocutors at the end of their interviews. After these interactions and conversations, I hope that this study exists not only as a thesis, but potentially for use by the NGO that I worked with or other Malawian organizations to better serve the needs of the Mngwangwa community.

4.6 Data Analysis

19A thematic analysis was used to establish clear and comprehensive findings for the research questions. This entailed identifying, analysing and reporting themes in the data through 5 phases:

  1. Familiarization with the data through close listening to recordings of the interviews, discussions or conversations and transcription of recordings. Thereafter producing of a list of interesting notes on the data and preliminary interests.

  2. Reading and re-reading transcriptions while conducting provisional coding of the data – that is, organizing chunks of the data under a category that described it – conducting a search for themes and producing a draft report of coded findings. Thereafter grouping the codes into different data sets for ease of review.

  3. Defining and naming themes or sub-themes and placing data sets in them. These themes included a) cultural issues b) perceived treatments c) perceived causes d) recommendations e) religion f) social consequences g) stigma experience h) SRH knowledge i) key quotes, and others.

  4. Conducting a detailed analysis of the code sets, looking at content, utterances, pauses, silences, laughter or other discursive strategies. Additionally, identifying differences among interlocutors.

20Refining analysis through discussion and exchange with thesis supervisor and selecting specific extracts to include in the thesis.

Notes

1 The Malawian education system comprises of eight primary school grades, from Standard 1 to Standard 8, followed by four secondary grades from Form 1 to Form 4

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