Why infertility can be a cultural stigma

Even in 2020, the face of infertility is largely white and female. Flicking through celeb magazines at my previous clinic, the pages full of baby bumps and births, and scanning the countless collages of new-borns on the walls, anyone would think that women of colour aren’t affected by fertility issues. According to the Human Fertility and Embryo Authority (HFEA), there has been a 20.6% increase in women from Black and Minority Ethnic (BAME) backgrounds receiving IVF treatment in the UK over the past five years. So why aren’t we seeing more stories which represent our specific struggles?

In many minority ethnic communities, there’s a strong, multi-layered sense of shame around infertility. At an individual level, the inability to have children makes us feel like failures. Many of us are the children of immigrants, raised to be “good girls” who hit all the right milestones in the right order and at the right time, i.e. university, career, marriage and at least two children. Whenever we deviate from this trajectory, the guilt kicks in.

Some may even fear having a daughter, sons being revered for social, economic and religious reasons. They remain part of the family after marriage, supporting their parents in their golden years and performing the rituals of death (Hindus believe that the departed person’s soul won’t reach heaven otherwise). Even if the diagnosis is male factor infertility, which is rarely disclosed, many women are afraid of being blamed for the couple’s childlessness; infertility is almost always seen as a woman’s problem in our patriarchal societies. In traditional households, it’s not uncommon for women to be ill-treated, socially ostracised, face divorce or step aside while their husband takes another wife.

At a wider community level, infertility is usually considered shameful for the family and therefore kept hidden. Becoming the focus of salacious community gossip is to be avoided at all costs because it could damage their reputation and status. For example, if infertility becomes public knowledge, it could damage a sibling’s or cousin’s marriage prospects as it may be assumed that they too will struggle to conceive. Children are viewed as an integral part of our family units, so the absence of them isn’t easily accepted at all; the couples and their family will be subject to social scrutiny.

Since our cultures are inherently conservative, conversations regarding women’s bodies are virtually non-existent. As such, any attempt to discuss them, even among family and friends, can be excruciatingly embarrassing, particularly with members of the older generation. Often, their limited education means that they’re unaware of the complexities of our reproductive systems, the nature of fertility-related issues and how they can be overcome with medical intervention. This lack of awareness can manifest itself as an ongoing onslaught of intrusive comments and questions, which frequently start while the ink is still drying on the marriage certificate.

Having been married and child-free for over a decade, I’ve been on the receiving end of many insensitive enquiries, most of which were expressed early on. As a friend told me, “there seems to be a cultural expectation of getting pregnant within the year, or at most two, of getting married.” However, as my husband and I were living with his parents during this time, we hadn’t considered trying to conceive then. Had we been battling infertility or grieving a loss, every single question would’ve felt like a dagger to the heart, making me feel utterly worthless. While this behaviour may have been free from malicious intent, the damage would nevertheless have been done.

And I do feel damaged to some extent. Since our devastating miscarriage four years ago, I’ve been diagnosed with low ovarian reserve, making it much harder to conceive. After two brutal failed IVF cycles, my self-esteem was smashed to smithereens. Although our close family and friends were supportive, it was all so overwhelming that like TV presenter Anita Rani, who spoke out about her own painful experience of miscarriage, I became “a master of ignoring anything that involves introspection and feelings.” I felt abnormal and ashamed and didn’t want to acknowledge that privately, let alone broadcast it publicly.

But when an Indian friend told me about an awkward dinner where her cousin’s English wife had openly discussed their IVF plans, I decided to share our story to help destigmatise infertility among Indians. Shortly afterwards, I was inundated by messages from family, friends and strangers alike who were grateful that someone who resembled them was articulating emotions that they’d been unable to voice. My words, they said, made them feel more visible and understood.

The pressure to adhere to social norms and avoid bringing shame on our families and communities is ingrained in us from the cradle. But if we want to change the narrative and break down barriers within and beyond our communities, we must be part of the conversation.