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Feminization and Stigmatization of Infertility in Malawi

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Boetumelo Julianne Nyasulu

7. Consequences and Delegitimation

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1Chapter Seven will give empirical insight into the conceptual context of stigma. It will identify key aspects in the empirical data, to establish a conversation between Goffman’s and Kleinman’s theories, and to better understand the experience of stigma as an intolerable, discredited state. Further, it will expand on Kleinman’s concept of delegitimation and how it relates to the experiences of the infertile women in Mngwangwa. The chapter will conclude with the localized resistance strategies that many of the women evidenced in discussions.

7.1 Marital Consequences

2In his analysis of stigma and social interaction, Goffman suggests that vilification and stereotyping are more commonly enacted by strangers towards the stigmatized individual, while those in the closer circle of the individual have a greater tendency to understand and sympathize with them because of a deeper level of intimacy (Goffman, 1986, p. 51). He suggests that there are two groups of support that a stigmatized individual can reach out to – those who share their stigma with them and those he coins as “the wise”, “who [are] related to the stigmatized individual through the social structure”. Goffman’s assumption is that those who are related to the stigmatized individual share his discredited attribute and are thus able to empathize on a deeper level and recognize his humanity (Goffman, 1986, p. 29). Goffman does add, however, that this may not always be the norm, saying:

“In spite of this evidence for everyday beliefs about stigma and familiarity, one must go on to see that familiarity need not reduce contempt... There are sure to be cases where those who are not required to share the individual’s stigma or spend much time exerting tact and care in regard to it may find it easier to accept him, just because of this, than do those who are obliged to be in full time contact with him.”

3While one interlocutor’s marriage had survived without children, and two others had supportive husbands despite in-laws who mistreated them, the majority of the interlocutors’ descriptions of their experiences within their close-knit social groups and families align more with Goffman’s exception. Many of them described volatile reactions from their husband and in-laws after months of the interlocutors being unable to conceive. Several interlocutors had survived through marriages of emotional and physical abuse perpetrated by their husband or his family members, as recounted by Fusani and Limbikani:

“[My husband] drank when we got married but he didn’t drink so much. But after he saw I was struggling to conceive he began to drink more and more and during that time he would come back to shout at me. He beat me. I would tell the relatives on my side and my in-laws, but I would never see them talking to my husband about it. So, some people would tell me that I should go home to my home village before I lose my life.”

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[My husband] would drag me through the community and hit me, saying he is just wasting his energy on nothing. That he is basically discharging on a rock when he has sex because there are no fruits to show for it. His mother sometimes joins him and tells me to leave her son.”

4Some interlocutors who struggled to conceive but then managed to bear one child still encountered problems in their marriages if they failed to conceive again, highlighting how a wife’s role is constructed in Mngwangwa and how the female body can often come to be treated as a reproductive machine. Those women who experienced this highlighted the rollercoaster of emotions they were taken on, from negative reactions prior to them conceiving the first child, to momentary peace and happiness, only to return to a toxic environment once again:

“My husband changed his character and started having affairs with other women. He also told me to my face that he would rather just marry another wife that will give him a child. By the grace of God, I started seeing changes in my body which were signs of pregnancy, although at the time I did not know it was because I was pregnant. I went to the hospital where they confirmed that I was four months pregnant. I did not believe the news until I gave birth to a girl child in 2005. Since I gave birth to that child I have never conceived again. When the child was four years old my husband started saying that we should have another child, that was the beginning of the problems in my family as he started doing the same things he used to do when we had no child. So, in 2009 we separated, and I went back to my home village.”

5Dyer et al. noted that the stigmatization, ostracism and marital instability faced by infertile women was recorded at a higher frequency and severity in the developing world. They linked these experiences to the tendency for African cultures to venerate children and position them as the purpose for marriage – which then allows for the absence of children to be due cause for divorce and abandonment (Dyer et al., 2002, p. 1666). At times, the focus on children complicated matters for couples who married out of love or desire and later discovered they could not have children; some interlocutors described relationships with men that would begin well, and then suddenly switch after the discovery of infertility. Others described men who would pursue them and initially assure them that their inability to have children was not an issue, only to change attitudes months or years later, as noted by Mpho:

“I had real problems. Problems with not having a child. My third husband left his first wife and came to live with me in my house. He only stayed for four months. I think because I couldn’t conceive.”

Did you not tell him you couldn’t conceive?

“I did. He had insisted that he had children already and that he didn’t care. But after some time, he wanted to try to have children with me.”

6At these points, various husbands would decide to go forward with divorce or to transition into a polygamous union. Many interlocutors described instances where the husbands would give no forewarning of their intentions to divorce them or take another wife, making it challenging for them to discern between moments when their husbands were acting out, and when their husbands were actually abandoning them, as Madalitso mentioned:

How did your husbands treat you? (she had been married four times)

“In the beginning it was okay with each of them – he would treat me well and buy me things. After some time though he began to ask me what was going on and why I wasn’t bearing him a child. From that point, things changed, and he stopped the nicer things he was doing for me. One husband would leave for 3 months, another 6 months, and then eventually they would just leave and never come back. That’s how I would marry again.”

7Should the husband decide to stay, in the majority of the situations recounted, he would engage in extra-marital affairs or take on an additional wife. This not only affected the family economically, as resources had to stretch further between members, but frequently placed the first wife in an inferior position to the second, especially if the additional wife began bearing children. Chikondi wistfully told of how her life took a dramatic turn after she failed to conceive a child and her husband took another wife:

“I have been married for 12 years and I have no child. From the look of things, it looks like I am the one who has a problem because my husband got another wife and has had three children from her. My circumstances changed so much because of having no child; it got to an extent that all the utensils I was using were taken away from me and given to the other wife because I have no child. I had a very big piece of land before my husband married the second wife. He then took a very big portion of my land from me, leaving me with only a small portion and gave the larger portion to the wife that bore children. My husband pays a lot of attention to the other family, so I do everything on my own. He moved into a different house with them and even stopped coming to my house; this is the second year he has not set foot in my house, so I hadn’t had a chance to see him in two years. They used to stay at the second wife’s home village, but then last month I saw him for the first time in two years. When my husband returned last month with his second family, I was vacated from the house I used to live in with my husband, to smaller, dilapidated quarters. I just accepted what happened as my misfortune.”

8Many polygamous unions also seemed to instigate jealousy between the wives – the infertile woman feeling envious of the children, or the second wife wary of sharing household resources and the husband with the first wife. This can result in the second wife mistreating the first, whose social status has already shifted down once the second wife births a child. Many interlocutors also noted instances where the other wife would engage in direct mockery or witchcraft to push the interlocutor to leave:

“When I came back from the hospital one day, I found some charms that I didn’t know anything about. So, a meeting was called with all three families – the husband’s, mine and the other wife’s. At the meeting the other wife confessed that she was the one who had left the charms because she wanted our husband and me to separate. So, my second marriage didn’t work out because of the other wife.”

9In one instance, Dalitso, despite knowing her infertile status, was still wed by a man in her community who made it explicit that he needed no children from her, as he already had another wife. However, Dalitso found that while her relationship with her husband was conflict-free, the first wife complicated living together: “I had no problem with my fellow wife, but she was not happy with me because her husband took a second wife. She thought I wanted to take everything she and her husband had worked for. She would tell me that I was responsible for her marital problems. She thought that the husband took all the money they earned from selling the yields and gave it to me, and maybe because he loved me more, he would give me everything.” Consequently, being taken on as a second wife – rather than having an additional wife added to their own union – still seemed to generate a different set of problems for the interlocutors.

10Whether dealing with emotional or physical abuse, divorce, abandonment, or the transition into a polygamous union, each interlocutor demonstrated a true sense of grit in all that they experienced. This was particularly striking for a sample of interlocutors who averaged two failed marriages. For many, motivations to stick through the negative experiences in their marriage were financial security, pressure from family or the belief that, as Tadala expressed, “marriage is about persevering”, whatever the cost of that might be in Mngwangwa.

7.2 Emotional Consequences

11Within any social space, everyday feelings and perceptions that are repeated have the potential to become norms that become attached to social meanings and affect biological responses and social relationships (Kleinman and Kleinman, 1994, p. 712). Kleinman describes this process of the social experience transferring into a felt psychological experience, as a socio-somatic experience that delegitimizes the individual. This delegitimation is the experience of withdrawal and alienation in the individual’s social world, resulting in them losing touch with reality (Kleinman and Kleinman, 1994, p. 719). In this process “social relations affect (and are affected by) blood pressure, heart rate and respiration and social loss and demoralization contribute to illness and disease” (Kleinman and Kleinman, 1994, p. 712). In line with this concept, the social experience of infertility affected and was affected by the mind-body state of the interlocutor. One nurse mentioned that at times, the experience of infertility leads people to literal madness, and they are often taken to a mental institute or hospital. She explained that this is often because, “A lot of infertile people suffer psychologically, as every time they see people, they think the people are talking about them. People also speak badly of them or mock them. So, they end up sinking into sadness or depression or isolating themselves, whether or not they encounter bad treatment in the community.” She added that “People with infertility issues are actually considered to be mental health patients because of the mental stress and trauma they go through. I went to a mental hospital when I was in school and there was this lady who was there because of the same issue. She stayed for 14 years without having a child, and was mocked to the point of going mad, and now stays at Zomba mental hospital.”

12Several interlocutors recounted the hurt, fear and isolation they suffered due to ill-treatment by their community, families and husbands. A large majority of them suffered from emotional and physical abuse from their husbands, or even their family members:

“There were no problems between my husband and I during the time we were waiting to have a child, but my mother in-law was the one who I had problems with. She talked a lot, insulted me and told my husband to get another wife because I was wasting his time since I could not conceive. She would sometimes throw food at my face or throw it away when I cooked for her, and sometimes beat me.”

13Other interlocutors recounted abandonment or divorce by their husbands, and feelings of vulnerability, as they no longer had anyone to depend on and were burdened with an uncertain future. Interlocutors left with children they had previously borne were thrust into traumatic emotional and economic vulnerability, as they became the sole supporter of the child. Some interlocutors who had children faced distress when their marriages collapsed, as the husbands would often take the only child, as was the case for Tadala and Dalitso:

“I then left on the 23rd of August, and I took our child with me. But [my ex-husband] came this month [January 2019] on the 6th to get the child. He did not tell me anything in advance of this plan though. I felt hurt and I still feel so, but because of the way he came [violently] I just had to give him the child. I was afraid he would hurt me.”

“When my brothers heard of what I have been going through, they decided to come and take me back home. So, in the process of discussing the divorce the relatives of my husband just took away my son. My brothers told me to just leave him and that he would return to me when he gets older. I felt hurt leaving my son behind, considering my mother in-law was evil, but I just trusted God for his safety.”

14Conversely, for those interlocutors who did manage to keep their children, upon entering a new marital union they would find that their new husband would not want to care for or keep the children from their previous marriage, and their dependency on him would often force them to send the children away, or consider returning to their previous marriage despite the chances of it becoming polygamous. At times, the women who chose to keep the children even in the new marriage would find their new husband mistreating or abusing the children, as Chiyembekezo explained how in her third marriage her husband “would swear at the children when I was not around, and he would not give food to them and lock them out the house.” In this case, Chiyembekezo had to consider the costs against the benefits of remarrying.

15Polygamous unions bring with them other complexities, as interlocutors described being mistreated by the other wife or her children. One interlocutor described a difficult polygamous marriage experience, as the second wife’s children would refuse to obey her, mocking her and saying she did not know how to raise children as she had none of her own.

16Delegitimization that is directly experienced through the body becomes even more nuanced when an interlocutor experiences bodily suffering, due to their inability to bear a child. In such cases, they experience and express the social consequences of that inability through bodily distress:

“I was so worried and upset. I have a lot of questions in my head, like why is this happening to me? A lot of people talk bad about me saying I can’t have a family because I can’t give birth. Most of the time I’m by myself because people talk about me or say bad things to me to my face. I mostly do not have the energy to wake up and work based on what people say about me.”

17Kleinman describes this expression of bodily pain as almost an extended and lived metaphor of the social pains experienced in family and community settings – the social body (Kleinman and Kleinman, 1994, p. 715). In Kleinman’s study of the impact of culture on the experience of depression, he notes that in Chinese society the experience was more physical than it was psychological (Kleinman, 2004, p. 951). Rather than express Western codes of depression, Chinese participants expressed feelings of boredom, discomfort, pain, dizziness or fatigue (Kleinman, 2004, p. 951). The infertile women from this study expressed their responses to the ostracism and exclusion similarly, with a large majority of participants articulating how the negative reactions of community members and family made them feel, using the phrase mtima kuwawa [literally, my insides/heart is sore].

18The work done by Lawrence Langer on Holocaust survivors underlines this connection between bodily pain and social trauma, describing it as “deep memory”. He takes Kleinman’s theory of an individual feeling delegitimated in their social world to almost feeling out-of-this-world because of enduring pain. Expanding on this idea, he asserts that “Events are relived yet remain permanently unredeemed and unredeemable; unhealed (and unhealable) wounds.” As such, rather than the worst outcome of illness and stigma being a spoiled identity, as in Goffmanian theory, it is the experience of delegitimation that is the worst outcome. This is attributed to its effects on family, marriage, livelihood, and social relations as a whole; as Kleinman asserts, “the ruins of social relations ruins lives” (Kleinman, 1997, p. 170). If we apply this concept to the infertile body of the interlocutors, through the way in which they describe their past and present infertile experience, one could suggest that their pained experiences are expressed through bodily or psychological pain. These experiences of pain were articulated when they were asked how they felt about life currently. Many responded in a similar manner: “I am always sad because I still want a child”, “I pity myself”, “I feel like getting married and that after that I could live happily”, or “I miss my children, I feel lonely.” The suffering of an infertile person thus doubles as both an experience of individual suffering and social suffering as they are subject to isolation, exclusion and ostracism (Kleinman and Kleinman, 1994, p. 712).

7.3 Economic Consequences

19To understand the consequences of the experience of stigmatization for infertile interlocutors, one must contextualize and localize their experience as rural women living in Mngwangwa. Firstly, the starkly low level of education, with interlocutors averaging at Standard 4 (the first four years of primary school) and few economic opportunities available to women. Secondly, the lack of a welfare system, thus positioning children as a form of security and wealth for the family – not only through the support they offer but through the leverage they represent in keeping the husband in the marital union and allowing the wife to economically depend on him. Nahar and Richters’ study of childless women in Bangladesh found that the women perceived economic consequences as “the most damaging results of childlessness” (Nahar and Richters, 2011, p. 335). Mpho demonstrated how her inability to have children led to the loss of her marriage, as well as the loss of the income-generating business she ran with her husband:

“I got married in 1977, by 1978 the problems began. I would produce tobacco with my husband to bring in finances for the family. But my husband began to get irritated when we couldn’t have children; he began asking ‘what is all this money for? Our friends are having children and using the money to support their families, but what is our money for?’ He began to say that he wanted to get another wife. So, after five years of trying for a child I was sent back home to my family. My ex-husband took another wife and they had a child.”

20The contributions of a child to the household are valued in many African societies, particularly for the woman, as the child can provide help with household labour or piecework, or be sent on errands such as market shopping trips, fetching water from the well and various other tasks (Fledderjohann, 2012, p. 1384). In the village’s economic context, with minimal social welfare mechanisms, the child acts as an economic security for the elderly, and for wealthy families the child represents a guarantee of the transfer of inheritance or property (Riessman, 2002, p. 112). Traditionally, in many African societies, wealth is maintained through ownership of property or land, and is for the most part owned by the men of the household (Pearce, 1999, p.70). This structure was reflected in one community member’s explanation of land ownership and inheritance in Mngwangwa:

“With 5 acres of land it’s a guarantee that a male child will get 4 acres and the daughter 1 acre if the son is even willing to give up land for his sister. Ownership of land by wives depends on the level of education of the husband and whether he would share the land with his wife in the will, but land cannot be divided among them while the husband is still alive. This is why the wife will depend on the children who will inherit the land and support her.”

21When a family has children, the land is distributed among them, while the wife receives nothing, forcing her to depend on her husband during the marriage and her children thereafter (Pearce, 1999, p.70). This bears stark consequences for women who are childless.

22For a society that upholds children as the purpose of marriage, without them infertile women are often divorced, abandoned or find their husbands taking an additional wife. Being divorced or abandoned in a rural context adds to the economic consequences for the woman, and these consequences can be just as dire for those in a polygynous union. In rural areas, with households already steeped in poverty, the taking of an additional wife can often add to the economic burden. While the husband may keep the infertile woman as his first wife, he often rescinds any responsibility for her economically or emotionally, and may refuse to engage socially or sexually with her. Chikondi’s experience demonstrate these very consequences, which she described in her struggle to conceive during her first years of marriage and the aftermath of it:

Why did you not use your revenue from your garden to see a sing’anga?

“I use the money to buy food as my husband does not support me in any way.”

Before the second wife, was your husband supporting you?

“Yes, he was supporting a bit.”

How did he treat you after getting the second wife?

“There was no love. He would tell me that even though I have a second wife I will be supporting you, and yet I did not receive anything. I explained to his parents that I planned to go back to my home village, but they told me not to leave as my parents were not even in my home village. He only came to visit me and help me once this other year but since then he has never visited.”

23Chikondi touched on the fact that, after a husband’s decision to take an additional wife, the infertile woman may explore the option of returning to her parents’ home. However, this option is rarely, if ever, resorted to, owing either to parents moving locations or the potential burden her return might pose by adding to their living expenses (Nahar and Richters, 2011, p. 332). The risk of becoming an added burden and becoming stigmatized as infertile and divorced can often lead a family to persuade the woman to stay, despite toxic circumstances, as Pemphero and Tadala both mentioned:

How did you feel when your husband took the second wife and essentially left you?

“I thought of moving on with my life but when he came back to take me, my family pressured me to accept him, as a woman who has been divorced is never respected in the communities. I just agreed and went with my husband.”

Did they ever encourage you to leave or did you ever think of leaving?

“I thought of just leaving but when I explained to my family, they discouraged me, until one day my husband beat me till I fainted… that’s when they encouraged me to leave.”

Why did he do this?

“Because we took a loan from a village bank that he said we will use to start a business and pay fees for his sister. He did not pay the fees but instead used it for women and alcohol, so the day I asked him why he was using the money for this he beat me.”

24Tadala explained that she faced emotional abuse and uncovered her husband’s extra-marital affairs, but was persuaded by her family to stay with him and keep waiting and believing for a child. Even after the first instance of physical abuse in 2017, when she made the decision to leave after her husband visited her family home to apologize, the opportunity to be economically supported once again re-initiated her family’s encouragement to reconcile.

25The economic costs for an infertile woman are particularly high within poor households in rural areas, where there are less economic opportunities for women and higher dependency levels on the men of the household.

7.4 Resistance Strategies

26‘Resistance strategies’ refers to the mechanisms that were adopted by the interlocutors to manage their infertility in the Mngwangwa community. This term is borrowed from Riessman’s study examining Indian women’s experiences of stigma. Riessman acknowledges that the Indian women’s strategies may not fit under the Western feminist form of “ideological emancipation from the sex/gender system” (Riessman, 2002, p. 114) but that they cannot be disregarded simply for not fitting Eurocentric modes of thinking. Similarly, the strategies to be noted from conversations with the interlocutors, exist within the context of Malawi, and challenge Western ways of thinking of resistance by offering a localized perspective. The following five strategies for managing stigma emerged in the interlocutors’ accounts of their experiences: blame, avoidance, taking control, acceptance and talking to others.

Blame

27A more recent work on stigma by Cook and Dickens describes three forms of stigma: perceived stigma influenced by others’ views and expectations, experienced stigma that encompasses the discrimination and exclusion faced by the stigmatized individual, and internalized stigma when the stigmatized individual internalizes the expectations and perceptions of others, and consequently reduces their self-esteem and increases feelings of shame (Cook and Dickens, 2014, p. 89). Several interlocutors demonstrated internalized perceptions of their infertile status, as they blamed themselves for what they saw as a failure to meet their responsibilities. This is exemplified in Chifuniro’s comment on how she felt about her life, as she woefully answered, “I have just accepted that I am the cause of my problems.”

28Ganizani, who spoke of her husband engaging in extra-marital affairs after months of them trying for a child, added that she “just accepted every decision he made after I found out I was the cause of the infertility.”

29The interlocutors who had internalized the negative perceptions of infertility by their community and those closest to them would take on the blame for failed marriages, abandonment, their husband cheating, the physical or emotional abuse they suffered, or even the discrimination and exclusion they faced in the community. This internalization is rooted in the normative pressure the women face in their community to have children, and this pressure is exerted either overtly through direct blame for their barrenness, or covertly through questions and interactions with community members (Dyer et al., 2002, p. 1664). For these interlocutors, the inability to be a model member of society was perceived as “a failure to continue that society”, and through the interviews was expressed as a personal burden they carried (Feldman-Savelsberg, 1994, p. 469).

Avoidance

30The close-knit nature of the village often makes it difficult for women to avoid interactions with their community, where there is high likelihood of encountering someone in public transportation, on journeys to the shop, or while collecting water at the pump (Riessman, 2002, p. 118). This proximity makes it difficult to hide the fact that you have no children, and is conducive to village gossip over those who don’t (Riessman, 2002, p. 118). Avoidance tactics in Mngwangwa made it challenging for the interlocutors to frequent and use community locations that are necessary for their everyday lives – the borehole, the church, the market, and others. This sentiment was nuanced by different interlocutors:

“Chuumba [infertile woman], Osa beleka [person who cannot have children], person whose womb has dried up. They would say these to me to my face. But what could I do? I would just ignore them.”

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“I just leave the place. Especially if there is a situation where there has been a stillbirth, and there needs to be a burial assisted by other mothers. I leave quickly. I give an excuse like ‘ah my feet hurt’ and I go back to my home. Because I know they will exclude me or tell me that I cannot join the burial because I am not a mother. Sometimes if I’m alone and people talk ill of me, I just take my hoe and go to my garden to work.”

31While a few interlocutors mentioned explicit avoidance by isolating themselves at home to deal with the fear of running daily errands, the majority of them cited disregarding community members or switching tasks and locations as an ‘avoidance’ tactic.

Taking control

32A few interlocutors described resistance strategies in which they seemed to take control of their current or future experiences. Three approaches emerged under this strategy: the first was adopted by those who decided not to get married in future and strove to become financially independent, as Pilirani exclaimed: “I am kind of bitter about marriage now, so I do not want to have anything to do with marriage or care about having children for a man.”

33The second approach, the decision to stop trying for children, was mentioned by three interlocutors. Chipi was one of the three who became voluntarily childless and found happiness in her decision, as she disclosed: “After that one trip to the clinic when nothing happened, I stopped trying to find out what was wrong, especially with my second husband. I didn’t go to the sing’anga, or the church or again to the clinic. My second husband just didn’t have a problem with it. He said that his children are my children, and my sister’s children are my children and that we should just sit with that knowledge and not worry about me birthing a child. My relatives stay well with me and my sister has accepted me like this as well.” Mayeso, the second interlocutor, emphatically declared her response to community members: “I respond to them knowing that I have made the decision to delay another child and it is a decision I made with my husband. But really, I try to avoid paying them any attention because our family matters are ours and not theirs.” The last interlocutor, Dalitso, chose to stop trying for children and did so without the known cooperation of her husband: “I decided to use the withdrawal method of contraception, but with me jumping off of him before he discharged rather than the other way around – to make sure that his sperm would not come into me and fertilize me. So, I did this every time we had sex, but I did not tell him of this plan. I had gotten married for the second time for the help, I did not want another child considering how many children were already in the household from the other wife.”

34The third approach under the strategy of ‘taking control’ was mentioned as a reference rather than an experience by interlocutors – the performance of pregnancy. One interlocutor mentioned that some women who are infertile may stuff bundles of material underneath their clothes to feign pregnancy and navigate the hyper-surveillance of women in Mngwangwa society. Several interlocutors also added that some infertile women are known to go to hospital maternity wards and simply steal another woman’s new-born from the ward and leave under the pretence that they have just given birth. Mphatso reflected on this with her own thoughts about her infertility, remarking, “I think that if I get a child it will be a gift from God. And if he wills it, I can have it from the womb. But if he desires, I would adopt. Other infertile women have gotten so desperate that they go to hospitals to steal children that are not their own. This isn’t the right thing to do. They should just wait upon the Lord.”

35These drastic actions exhibit the intimate ties between human reproduction and socialization, which equate the ability to reproduce as an achievement of motherhood, high social status or high economic status (Caldwell and Caldwell, 1987, p. 434). A Chadian proverb quintessentially reflects this concept: “A woman without children is like a tree without leaves” (Dyer, 2007, p. 70). Several African societies are alike in the immense value they place on children, and with it the responsibility and pressure they place on the woman – especially the African rural woman with few livelihood opportunities.

Talking to others

36Talking to community members or even family can at times be risky, as Madalitso referenced in stating her reasons for turning to prayer: “At first, I would talk to this other cousin of mine, but then I stopped because everything I told her, I would hear it somewhere else. So now, every time I hear people speaking badly of me, I go home and pray to God to help me work through my pain.”

37All in all, however, several interlocutors found comfort and solace in talking to friends, family members or church members and leaders. Abbey et al.’s study on the impact of infertility on wellbeing found that the stress experienced due to infertility can often increase an individual’s vulnerability to anxiety, illness, depression and low self-esteem (Abbey, Andrews, and Halman, 1992, p. 408). Findings demonstrated that women often suffered from these effects more than men, and stress levels were compounded in instances where they were blamed for their infertility or treated as inferior by other women with children (Abbey, Andrews, and Halman, 1992, p. 416). In analysing how these effects can be mediated, the authors discovered the importance of psycho-social support, which a few interlocutors touched on when describing the interactions and relationships they sought out in their moments of distress:

“I speak to my in-laws. I realized that I can talk to them because I saw how they encouraged me when my family members talked about me.”

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“[I talk to] my husband; he tells me to ignore them and to pray. That they don’t understand that we do have children [my sister and her husband’s children] and that I am a mother to them. Satan just wants my spirits to be low.”

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“I talk to my friends and they encourage me, saying ‘you never know, perhaps someday you will give birth. How come the hospital told you to take tablets and come back when they could have told you, you will never give birth? Perhaps one day you will give birth.’”

38One point of note for the interlocutors who engaged in this study is discussed in Rossetto’s work on methodology. He made the comment that, while the “qualitative research interview is not therapy, it is therapeutic in that it offers a space for catharsis through sharing” (Rossetto, 2014, p. 282). A few interlocutors not only mentioned the support and comfort they gained from talking to family members or friends, but also the comfort they felt in telling their story and experiences through the interview process, which was often framed as a conversation. An expression of this was at the end of Fatsani’s interview, when she added “I really just want to thank you for meeting with me today. I am very grateful that I had someone to share my story with. I think talking really helps work through things.”

Acceptance

39The experience of delegitimation centres around the key question of ‘why’ rather than ‘how’ – it focuses on the meaning of the experience rather than causation, and on the hope for change rather than the failures of treatment (Kleinman, 1997, p. 133). With the acceptance approach, interlocutors responded to their experiences of delegitmation by turning to God and described prayer bringing with it undertones of hope, faith and possibility. For many, this meant understanding the reasons for their infertile state as God’s will and placating their distress around the question ‘why?’ in the understanding that God’s will is at times undiscernible, but always “for the good of those who love him” (Romans 8:28). This reliance on a spiritual explanation to mitigate anxiety and understand what seems to be unknown and inexplicable is termed a theodicy. Bharadwaj explains the function of theodicies operating in the biomedical sphere as mechanisms that allow individuals “to make sense of the unknown working of the human body” (Bharadwaj, 2006, p. 458). Theodicies offer an answer to the ‘why’ question for interlocutors struggling emotionally and cognitively when no reason is found for the cause of their infertile status (Bharadwaj, 2006, p. 462). For the majority of interlocutors who were dealing with their infertile status and identity, who had sought help from doctors and sing’angas to no avail, their spiritual beliefs replaced the absent or incomplete ‘rational’, or even traditional, explanations from doctors and sing’angas:

“I also go to church and get encouragement from the word of God. They teach that a child is a gift from God. They know I’m infertile and have told me to wait upon God because his timing is best.”

Do you ever get angry at God?

“Angry? No. but in the beginning, I was upset, I felt he wasn’t hearing me. In the Bible it talks about family, but it doesn’t guarantee a child – a child is a gift that God decides to give.”

“Sometimes I pity myself, but I think about it as the infertility not being my fault, it’s just the way I am, and I can’t do anything about it. The person who knows everything is God so sometimes, I just pray.”

“I pray that God should bless me with a child. I know in his perfect timing things will happen.”

40With the belief that God is in control of both the good and the bad, some interlocutors rest in the acceptance of this knowledge, and others even practice prayer constantly in the hopes that God will later “grant the gift of a child”. Numerous interlocutors referenced the story of Sara and Abraham, where Sara in her old age had not yet conceived and laughed when a man of God came to tell her husband that they were still to have a son, only for the prophecy to come to pass years later. This Bible story stood as a testimony of hope, faith and possibility for several interlocutors, and allowed them to resist narratives of their status and identity and manage emotions around their infertility.

41While each strategy was quite different from the next, those interlocutors who did engage in these forms of resistance and infertility management demonstrate a localized and contextualized Mngwangwan understanding of coping. These findings stand as an acknowledgement that infertility treatments, perceptions, reactions and forms of resistance are not homogenous, and in Mngwangwa they occur at intersections such as class, gender and education under broader systems including, but not limited to, pronatalism, patriarchy and culture.

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