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Feminization and Stigmatization of Infertility in Malawi

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Boetumelo Julianne Nyasulu

6. Experiences of Stigma

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1Chapter Six will examine the shifting nature of stigma. Stigma as a category is continuously in a state of flux. It is a truism that stigma will not be experienced by everyone in the same way, but also that the way in which it operates produces a state of exclusion that is delegitimating and impacts all aspects of social intercourse. The empirical data analysed for the theoretical framework underlines the fact that stigma is a very unstable, variable category. It is universal and yet is experienced as a certain disability. There can be two identical situations, and yet the way in which people experience the stigma can be very different, as well as the way in which it is ascribed to them.

6.1 Social Stigma

6.1.1 Pronatalism

2When asked “Do you think people have a lot of children in Mngwangwa?” a community member in a discussion group responded, “when most people get married they think the greatest achievement of marriage is to have children and people think that the aim of marriage is to bear children.” His answer reflects the general attitude of a pronatalist society that venerates reproduction and exalts parenthood (Miall, 1994, p. 34). Miall establishes that two procreative norms exist in such a society – that all married couples should procreate, and that all married couples should want to.

3When motherhood is normative, infertility is not afforded a secretive status and instead becomes a hyper-visible state. Goffman speaks about stigma being a polluting substance that discredits the social identity of the person who possesses it (Goffman, 1986, p. 34). In the same way, the infertile woman becomes stigmatized, or polluted, for her failure to reproduce in a society that constructs gender in such a way that womanhood is equated with reproductive ability. Madalitso encapsulates the pressure of this societal construct in her comment that “people say that I’m not a person because I can’t give birth to a person.”

4In the context of Sub-Saharan Africa, where a number of economies are on the decline and women’s social positions are vulnerable, children exist as sources of wealth, markers of adulthood and assurance of the obligations of their husbands (Richards, 2002, p. 85). Interlocutors often spoke of needing children, as opposed to wanting them, or would choose to mention that they only had ‘x’ number of children when the number was two or lower. The insecurity of the environment and prevalence of poverty and disease often complicates reproductive patterns, further implicating the woman’s body as a reproductive machine, as elaborated by a community elder:

“[Women] give birth to a lot of children because they are afraid of their children dying; so, they feel that when something happens, they should still have children. If they have one or two children and one child dies, they are left with hardly any. But if you have five or six and one or two die, you are still left with children. You see?”

5Interlocutors recounting their experiences demonstrated that with the high number of children being born in the community, often no distinction is made between primary and secondary infertile women, due to the stark difference between one child and the average of five. With a woman’s social status intrinsically linked to her achievement of motherhood, failure to achieve that through infertility can lead to exclusion from her community, friends and family. This is especially felt through her perceived inability to contribute or engage in conversations concerning pregnancy, delivery or parenthood, as Mphatso relayed:

“I envy the other women who have children in the village. Most of the time when other women are talking about motherhood, they mock me by saying ‘hey don’t talk about these things while there is someone here who hasn’t had a child and who doesn’t know what it’s like to be a mother.’”

6Goffmanian stigma theory suggests that infertility exists as a discreditable rather than as a discredited condition, and thus allows individuals to manage their stigma and the knowledge of it (Goffman, 1986, p. 54). This theory of manageable stigma rests on the assumption that it can be maintained as a secret and has no visible, obvious stigmatizing features that would prevent the individual from passing as normal (Goffman, 1986, p. 54). However, this takes on a Eurocentric and problematic assumption that the stigmatized individual is self-reliant and autonomous, faced with a diverse range of options, and lives in a context that allows privacy (Bharadwaj, 2017, p. 70). This also assumes that without a visible physical deformity, there is no sign that marks an individual as infertile.

7In a non-Western rural context, like that of Mngwangwa, infertility stigma fails to exist as a “secret stigma” and instead exists as a hyper-visible trait and attaches to the body and identity of the infertile individual (Bharadwaj, 2017, p. 70). Beyond that attachment, the community often makes known the woman’s infertile status in conversation, passing by, at gatherings or even in the way she is addressed, as one elder explained: “Once you have children a woman is called ‘mother of...’ and so too the man ‘father of...’. With no children the woman would only be called by her clan name.” The elder suggests that lacking this reference to their child is almost to lack a sense of belonging to a large group of the community, or to miss the transition from an average clan member to a contributing clan member. She reflected on this as she continued, stating “Without children, people don’t regard the couple as worthy of being a family or part of a clan. The family and clan are strengthened because of children.”

8In a society that venerates parenthood and reproduction, there exists a surveillance, at times even a hyper-surveillance, of the female body that often transitions into personal interference, particularly when a woman marries. A community member described the social pressure that is exerted on a couple who has not borne children after marriage, as parents and those around them interrogate them with warnings and questions such as “what are you doing??”, “What are you waiting for?”, “Are you having problems bearing children?”, “You must have children soon.” An assumption is made that the absence of children cannot be a voluntary decision, or that if it were, it would be irrational.

9A community member reflected on this irrationality as he commented on voluntary childlessness, stating that “For someone to choose not to have children in our area can’t happen. It is the way of life and culture – you meet someone, you get married, and you have children right away.” The absence of children or the absence of signs of pregnancy thus physically marks an infertile woman, and surveillance of her complicates her ability to secretly manage the mark of stigma.

6.1.2 Patriarchy

10Infertility stigma in Malawi needs to be understood and contextualized in a social context where men have a dominant status, and where that status is maintained through institutions and systems. In Mngwangwa, social systems exist that consistently disadvantage the woman, whether it be through low representation in the workforce, higher school drop-out rates or even the construction of parenthood as an ultimate life goal. Infertility stigma thus doubles onto the already-existing burden of patriarchal forms of control that affect the social and emotional position of women in society.

11The tendency for society to extol men and their status often leads to the construction and gendering of infertility as a woman’s disease, which typically results in victim blaming. The gendering of infertility is preceded by the gendering of bodies, in which the responsibility and goal of the female body is prescribed as fertility. Kleinman asserts that stigma as a moral category exists in the West, but in other contexts the moral blame for an illness extends to include not only the patient but also their family, and can bring about accusations of bad heredity, witchcraft, or assumptions of punishment by the gods (Kleinman, 1997, p. 169). With this, the emotional and economic consequences for the infertile woman are high, particularly in a rural context, as Mphatso mentioned:

“I got bad treatment from my own family and his. My past husbands’ families felt like I brought them no value. That we were doing all this work for no purpose, with no children and that the only thing I would do is just sleep and lodge in the house. Their families would tell them ‘just leave her; she doesn’t bring you any help or success.’ My own family would say that I would die poor because I had no help or children to bring me wealth. Both families felt that there was no point even helping me, for example, take care of a farm, because they felt there was no one who could reap the benefits of the fruits of that labour. I had no help for the work I was doing. I had to do this work on my own for my survival. My past husbands wouldn’t help me. They threw me to the side. I was something that needed to be disposed of.”

12In many, if not the majority, of cases explained by the interlocutors the husband’s family or the husband himself often blamed the woman for the infertility. Fusani even recalled her husband yelling, “‘I wanted a child, why aren’t you giving me one?’ all the time he kept saying ‘I want another child.’” Placing blame on the woman absolved these husbands and their families of the social and moral guilt that would emerge out of the inability to bear a child in an exceptionally pronatalist society (Van Hollen, 2010, p. 650). Once the blame had been placed, several interlocutors faced challenges seeking treatment or infertility help with their husbands, who would tell them to “figure out their problem” alone, seeing as they were responsible for their infertility. Seeking treatment or support was challenging for many interlocutors, who depended on their husbands and consequently did not have the financial or emotional support to even begin exploring options.

13Even when treatment seeking is carried out by the couple, hospitals, sing’angas and family members are mindful in the delivery of their diagnosis. Fatsani demonstrated this when describing her treatment seeking visit:

“After the [first] child was born, some time passed without me being able to conceive. My husband sent me to inquire about this from my grandmother, who gave some herbs for both me and my husband. The herb was initially just for my husband, but she just gave it to both of us so as not to insinuate that he was the one with the problem.”

14If a treatment fails to succeed, the maltreatment towards the wife intensifies as the husband or family scrutinize the wife’s past decisions in efforts to place blame. Interlocutors cited families blaming past abortions, promiscuity, use of contraceptives, hospital operations (i.e. Caesareans), or even going so far as saying that the woman had performed witchcraft on the man.

15Once the blame was placed on the interlocutor, many of them found that their husband would divorce or abandon them shortly after, with little backlash from family or the community, who would see the decision as well-motivated or often be involved in making it. Mayamiko, who was divorced by her husband, was never consulted on his intentions to do so, despite community knowledge of it:

“He left because he wanted children, but he never told me, yet he was always telling his friends outside or around the house that he wanted children and I wasn’t giving him any.”

16In other instances, where the husband’s family or the interlocutor’s family stood in support with her, the woman was either encouraged to persevere through the husband’s ill-treatment, or was encouraged to return home to her family. The families who encouraged the interlocutor to persevere with her husband believed that the couple would eventually be blessed with the “gift of a child” if they continued to wait or sought help, or that those in relation to the woman would eventually accept her. Chifundo decided to stay through her husband’s physical and emotional abuse because of her family’s input:

“It was because my family advised me to persevere, saying he would change and sometimes we would live together civilly. Sometimes I would leave and stay at my relatives’ place for some time, and then my husband would come and apologize so I would just go back home.”

17When it comes to infertility, the sanctioned blame that is placed on women perpetuates disadvantaging social systems that already reduce women’s economic opportunities and social opportunities within Mngwangwa (O’Brien and Broom, 2014, p. 343). In this way, infertility or childlessness becomes another structure that perpetuates ‘social marginality’ (O’Brien and Broom, 2014, p. 343).

18While the focus of the interviews was with female interlocutors and their experiences of infertility, a few comments arose in the discussion groups regarding instances when the man was known or assumed to be infertile:

How do you see infertile people in your community?

“Infertile people are never at peace because of the discrimination they face. And most of the people that suffer from it are women, whereas a man uses a friend to cover up for him. If a man is infertile, he will ask his friend or relative to sleep with his wife. Then his wife can get pregnant without anyone in the community knowing. But if a woman is infertile, she can’t do anything.”

Why is it okay for a man to do that but not a woman?

“It is just the way culture is. If a man is infertile, he can choose someone to sleep with his wife. But if a woman is… our culture just cannot allow a woman to choose someone.”

19As the community member explained, when a man is infertile in the community he selects what is known as a “sexual hyena” – a close friend or relative – who comes secretly in the night to sleep with his wife and impregnate her, so that no one in the community may know he is infertile. There is a stark contrast between what seems to be a ‘secret’ stigma for male infertility – or a discredited stigma in Goffmanian terms – and the openly ostracized and vilified discreditable stigma of female infertility that can only be understood through the structures and institutions of the Mngwangwa society that favour and allow men to dominate and exploit women.

6.2 Cultural Stigma

6.2.1 Constructions of Infertility

20In Mngwangwa the words and phrases used to describe infertile people influence interactions and relationships with those people, and construct a stigmatized infertile identity. Many of the interlocutors mentioned hearing “chuumba [childless/barren]!” yelled at them when passing by a group of people, whether from strangers or friends, in the community. The pervasiveness of the mockery and marking of infertile individuals in the community makes it challenging for the interlocutors to find a safe space either publicly or privately. This means that for an infertile woman in Mngwangwa there is no opportunity to avoid what Goffman calls “living on a leash”, or the Cinderella syndrome. In other words, she remains in locations and spaces where she cannot maintain her disguise, and rest from stigma management tactics (Goffman, 1986, p. 94). This absence of spaces where her spoiled identity is unknown poses higher risks for the mental and social health of an infertile woman in Mngwangwa. Management strategies such as name-changing or ‘passing’ as normal in the community become near-impossible when the private sphere merges with the public sphere in a rural context, and familial or personal interference in reproductive matters is not only commonplace but validated.

21The intimacy of rural living makes it easy for strangers, neighbours and friends to identify those without children and those who have remained so for months or years. An elderly woman in Mngwangwa mentioned the numerous ways infertile women are labelled in the community:

“There is name-calling – women are called chuumba and men Gojo or chimbuwira [infertile man/impotent man] these are derogatory terms. Women are referred to as pupa [rotten or worthless]. Another term for women is ada yala tanthwe [literally, a woman with a rock in her vagina] or ama lavula [she cannot hold in/down anything, she vomits it out]. When a woman has one child only, they call her kuumira mwana mmodzi [dried up woman].

22It is intriguing that the Chichewa words used to describe infertile men translate directly, while the phrases used to describe infertile women have a certain vileness or violence attached to them – insinuating an un-humanness or a lack of value for infertile women. Metaphors of fruit came up frequently in interviews, with health workers and interlocutors adding other names and phrases to reference infertile women, such as “Anagwa mu papaya” [you fell off a papaya tree (because a papaya tree cannot be climbed)] and “kumangolima pa lubwe” [wasting energy on something that cannot bear fruit].

23Language is an integral part of culture in that it reflects and communicates the ideas, values and attitudes of a community (Borisoff and Hahn, 1993, p. 254). Consequently, the use of specific metaphors to describe infertility do not occur in a vacuum. The reference of fertility and fruit in the Mngwangwan community can be situated in its religious context – following biblical injunctions referenced in one community discussion group, that God has commanded us to “be fruitful and multiply” (Genesis 1:28). In this way, the inability to do so is even judged on moral grounds, as a failure to fulfil one’s divine purpose.

24Metaphorical descriptions of fruit can also be understood in the community’s agrarian context – where rural everyday life circulates around planting, harvesting and animal husbandry to sustain the life of the family and the community (Jensen, 2015, p. 28). Within these contexts and discursive frameworks, the inability of the woman to ‘produce’ or to bear life is perceived as cutting off the sustenance of the family and the lineage of the community, and in so doing she becomes labelled as ‘fruitless’ or barren. One community member used this fruit metaphor to explain infertility stigma by saying:

“When a tree is planted, we expect fruits, and if it does not bring forth fruits it’s taken as useless, which is the same with a person – when a man and woman marry, we expect fruits from that marriage.”

25Fruit metaphors position women as consumable and have starkly sexual connotations, where the man engages in eating his lover. Positioning infertile women on the opposite end of the scale – as rotten – positions them as untouchable, inedible and undesirable. The imagery of rotting fruit depicts an attitude towards the infertile woman as something disposable and expired: that no longer serves a purpose. These attitudes seemed to extend towards even secondary infertile interlocutors; describing these women as “dried up”.

26These labels, attitudes and experiences influence treatment the seeking behaviour of infertile individuals, even when deciding to visit a hospital. A doctor at the Area 18 Clinic mentioned that often people who come with infertility problems avoid using direct terms or explanations:

“The most common way [of explaining infertility] is saying ‘lower abdominal pains.’ They mention they were trying to conceive and failed and are wondering what is happening. Generally, with men they say they have lower back aches when they want to have sexual relations. Most don’t really go as far as mentioning sexual relations though, so you really have to listen for what they’re explaining. Most just mention lower back aches – we get that a lot and so it forces you to immediately start thinking of reproductive screening.”

27It is quite revealing that infertility is stigmatized to the extent that infertility talk itself becomes taboo – even in the context of treatment seeking, in a space like the hospital that is typically regarded as safe as concerns discussions of illness and disease.

28As Kleinman explains, “culture is not a thing [but] a process”; a process in which activities and conditions are ascribed meaning (Van Hollen, 2010, p. 650; Kleinman, 2004, p. 951). These meanings then influence interpersonal relationships and interactions, as well as collective and individual identity. These meanings are perpetuated in the ways people communicate and the words they use to do so.

6.2.1 Institutionalization of Stigma

29Kleinman’s theory establishes that social experiences reflect everyday practices of culture. These practices attach meaning to the body; they contextualize and localize the experience of a certain kind of body (Kleinman and Kleinman, 1994, p. 712). The discourse used by interlocutors, such as ndimatonzedwa [I was reproached in society], wopanda pake [I was a nobody/valueless/useless], or kusalidwa [people shun me because of an ailment] demonstrates the construction of a female infertile body in Mngwangwa.

30Goffman suggests that an individual with infertility has a discreditable stigma and avoids forbidden or out-of-bounds places for fear of exposure of their hidden stigma (Goffman, 1986, p. 81). Antithetically, in Mngwangwa, interlocutors’ infertility exists more as a discredited stigma, and as such they explain that these locations are not forbidden out of fear of exposure but rather due to the reality that crossing into these areas while discredited will result in ostracism, shaming, and vilification. The interlocutors don’t battle the tension and anxiety of hiding their stigma, as suggested by Goffman; instead, they battle with the tension that arises out of their stigma being known and the hyper-visibility of that stigma in these forbidden areas. When questioned on how the community knew about their infertility, most interlocutors mentioned that they had been seen without children over the years, or that it had been noted they hadn’t returned to their parents’ home to announce their pregnancy, as is custom. In one instance, an interlocutor’s entire community had knowledge of her infertility, as her husband had begun drinking heavily after years of her struggling to conceive, and would go yelling through the community that his wife was barren. The blurred lines between private and public sphere validate community members’ obtrusiveness in matters of childbearing, as described by Mphatso when random people approached her in her day-to-day activities:

“They see that I stay by myself with no children and realize that I can’t bear a child. Other people in the village talk about me so that’s how others know. They say, ‘that one she has no child.’ I’ll even bump into people in a farther village who will ask ‘oh how are you, people say you don’t have children?’ and I’ll just answer, ‘yes I have no children.’ The men that I was married to also spread the news that the marriage didn’t work out because I couldn’t bear them a child.”

31Interlocutors recounting their experiences demonstrated that community talk around children and family affairs is quite common, often positioning infertile people as a topic of concern. Some interlocutors mentioned that while not all community members would mock or discriminate against them, many still felt it appropriate to comment on their infertility, saying “one day you will give birth” or “just keep waiting and praying”, which ultimately would still add to the visibility of their state. Often the people who chose to be encouraging or offer some form of pity were the interlocutor’s parents, immediate family members and in very rare occasions a mother-in-law:

“A lot of them do not like the idea that I am still staying in their brother’s place, considering the fact that I do not have a child for their brother. But a few of them encourage me, saying that I should not move out of the place as it is not my will that I do not have a child. They say when the time will come God will bless me with a child. My own family pities me a lot and asks questions like what happened for something like this to happen to me. Some of my relatives even encourage me to go out and seek help from sing’angas but I do not agree with that; I say when the time comes, I will have a child through God’s will.”

32Goffman’s stigma theory postulated that the ‘normals’ that live around or come into contact with the stigmatized individual feel “direct sympathetic concern” for their condition, and thus enact a kind of “courtesy stigma” that either ignores the part of their social identity that is polluting and attempts to reassure them that they are human, or offers them moral support (Goffman, 1986, p. 20-21). While of course, there are some cases that were mentioned where community members would offer encouragement or pity, the majority of interlocutors described a hostile and superior attitude from other community members:

[People] say I can never have children because ‘mchombo unagwera munsi’ [my navel cord fell inside] and that is why my husband left me. They sometimes sit in circles and talk about me and someone from the group comes and tells me to my face what they’re talking about or insults me.”

- - -

“I receive a lot of mistreatment and abusive words [from my husband’s family]. They sometimes come and tell me that I’m wasting their brother’s time and energy. Sometimes when I’m around people they stop talking normally and start talking about me and my situation.”

33Various interlocutors commented on the exclusion they faced in community groups and programs; exclusion that was enforced by community leaders and members, as the words of Tadala, Kumbukani and Tiyamike below demonstrate:

“There is this other group where they talk of safe motherhood techniques and issues, they used to say everyone who has ever given birth should come but later some people started saying because I have given birth once I am not eligible to gather together with them.”

- - -

“Sometimes pregnant women or mothers in the community get porridge from the Chiefs or organizations and I am not allowed to receive. Other times they receive other gifts or services, but I don’t know what exactly because they hide it from me.”

- - -

“There are, for example, the fertilizer subsidy program and the food for work program. The chiefs organize people on a list who can receive money or fertilizer to sustain themselves, but because I have no children I am normally excluded from these lists. I went to the Chief in the community last year and explained to him, and I was assured that things would change, but nothing has changed.”

34These experiences of exclusion were not limited to the childless women, as secondary infertile interlocutors often repeated the same hardships:

“When different organizations come, I am not included because I have a single child. World Program, this other NGO from Likuni, and Children of the Nations. When Children of the Nations are gifting families with supplies, food, or clothes they look for families with more than one child because they say those are the families that need things the most.”

35People talk in groups around a woman with infertility, approach her with insults, offer unsolicited advice, pity, encouragement to wait, or even laugh or immediately leave when she visits certain community areas. One community member even mentioned songs that people mockingly sing when an infertile woman approaches:

Kachumba iwe, Kachumba iwe – Barren woman, Barren woman

Ubeleke wako mwana – Bear your own child

Kachumba iwe – Barren woman

Ubeleke wako mwana – Bear your own child

Oti uzikamutuma – The one you will be sending on errands

Kachumba iwe – Barren woman

Opita naye ku munda – The one you will be going to the farm with

Kachumba iwe – Barren woman

Omutuma kumadzi – The one you will be sending to draw water

Kachumba iwe – Barren woman

36Video 1 (click hyperlink to open): Kachumba iwe song

Kachumba tiye, Kachumba tiye – Come barren woman, come barren woman

Ukamgulire wayilesi – Buy a radio

Udzikamvera – You should listen to it

Ukamgulire wayilesi – Buy a radio

Ukayese mwana adzimvera – And think that is your child listenin to you

Kachumba tiye, Kachumba tiye – Come barren woman, come barren woman

Mkakugulire wayilesi – I should buy you a radio

Ukayese mwana iwe – You can take it as your child

37Video 2 (click hyperlink to open): Kachumba tiye song

38Goffman’s model of normalization, where the stigmatized individual is treated as if the stigma does not exist is absent in the Mngwangwa context, where the infertile woman struggles to escape her stigma and knowledge of it by the greater public. His theory of infertility and sterility as discreditable rather than discredited fails to recognize the heterogeneity of experiences of stigma, which vary across ethnicities, class and gender. Indeed, he did not consider a context in which the stigma is so entrenched and institutionalized that, rather than receiving sympathy, a stigmatised individual is isolated and avoided and, in that state, becomes almost more polluted than before.

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