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Feminization and Stigmatization of Infertility in Malawi

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Boetumelo Julianne Nyasulu

8. Concluding Remarks

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1This study is a qualitative study of infertility in Malawi and used the lens of Goffman and Kleinman’s theories to analyse the localized experience and management of stigma in Mngwangwa. The study first analysed perceptions of infertility rooted in causes and treatments, followed by an analysis of the emergence of stigma in cultural and social interactions and practices, and concluded with the social and emotional consequences this has for infertile individuals. In this way, the findings come together to demonstrate how stigma is understood through socio-cultural perceptions of infertility in the local ecology of Malawi, and its effect on lived experiences and gender identities.

2Two emerging issues in the research warrant further attention and studies. The first of these is the role of traditional healers in infertility, or on a broader level, disease and illness. Traditional healers exist as a critical resource for health education, diagnosis, treatment and care when we consider that treatment seeking behaviour is influenced by accessibility, availability and alignment with perceived causes. Many interviews highlighted the lack of information around general sexual reproductive health by the interlocutors, as well as the limited information provided by the hospitals, clinics or healers they frequented. Traditional healers are in an ideal position for reaching out to a large population of affected people, for participating in sensitization efforts that seek to educate about sexual reproductive health or change customs and traditions that put people at risk (Chipfakacha, 1997, p. 419).

3The second emerging issue was the silence and secrecy around male infertility in Malawi, despite one doctor’s assertion that in about 40-60 per cent of cases of infertility, the low sperm count of men was a contributing factor, and several studies stand behind this claim (Irvine, 1998; Parrott, 2014). Currently, only one study exists on male infertility in Malawi, and it examines the role of diagnosis and how this may contribute to the visibility and discourse around male infertility. The discussions that emerged through the interviews in this study, around sexual hyenas or the role of culture in perpetuating female infertility while hiding male infertility, stand as an intriguing opportunity for further research that could contribute to the broader conversation on infertility in Malawi.

4A limitation, albeit an intended approach, of this study is its focus on only one member of the couple dealing with infertility. Future studies examining behaviours and responses to infertility by couples in Mngwangwa could offer valuable insight into how to model education and interventions that include the male partner, as well as offering better approaches to infertility counselling and care.

5The principal recommendation that emerges out of these findings is the need for interventions that are appropriate to the socio-cultural context in which they are applied. For interventions to move towards success in Malawi, they do not only need to focus on diagnoses of infertility, but also sensitization and awareness-raising, and beyond that, address the experiences of being labelled, stigmatized and ostracized in these communities. This requires careful consideration of the intersectional disempowerment that Malawian women face in their community, owing to the nature of power structures and relations.

6It is imperative that the government develop a policy around infertility care, and effectively integrate it into the Malawian National SRHR Policy, rather than its most recent policy statement, to “reduce the incidence of infertility among men and women” (SRHR Policy 2017-2022, see Government of Malawi, Ministry of Health, no date), without any measurable indicators. A holistic policy should include an analysis and impact assessment of the current health care system and its current effectiveness, or lack thereof, in addressing infertility, and thereafter incorporate all levels of health services to produce a more cost-effective approach.

7As identified in this study, STDs, unsafe abortions and reproductive infections have largely contributed to the high rates of infertility in Sub-Saharan Africa. As such, a focus on prevention efforts could certainly lend to a decrease in these climbing numbers. However, it is important to note that infertility does not exist solely as a biological or physiological condition that requires a biomedical approach, but also encompasses emotional, social, cultural, religious and economic spheres, as demonstrated through the findings of this study as well as other previous studies. The solution for tackling, for example, youth pregnancies that often result in unsafe abortions or reproductive problems, is not simply to increase access to contraceptives or legislate on the age of marriage. Instead, the answer should be sought in the question ‘why?’ Why are young girls engaging in early or pre-marital sex, and how does motherhood contribute towards defining status or ensuring economic stability? (Richards, 2002, p. 86) In asking these questions, we begin to address the root problems, such as lack of access to economic opportunities, community attitudes that venerate children, or gender inequalities that set motherhood a young girl’s life goal.

8As such, the approach to infertility response must also encompass these spheres, focusing not only on preventive measures, but also addressing stigma, patriarchal structures, gender inequality, poverty, and sexual and reproductive health knowledge. Rather than looking at the biomedical natural course of a disease, Kleinman asserts that disease takes on a social course – its experience is influenced by the economic, moral and social structures within which it is set (Kleinman, 1997, p. 171). It thus follows that in responding to illness and disease, a society must marry health policy with social policy, and social policy with social theory (Kleinman, 1997, p. 171). This approach certainly requires the commitment and involvement of health workers, but also calls on teachers, leaders, influencers, community workers and members, and patients to join the discussion table.

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