‘I am always crying on the inside’: a qualitative study on the implications of infertility on women’s lives in urban Gambia

Abstract

BackgroundThere is an increasing awareness that infertility in Sub-Saharan Africa constitutes a severe social and public health problem. Few of the existing studies on infertility explicitly take into account the differences between women. However, how women experience infertility is formed by their various social positions. This research explores the implications of infertility on women’s lives in urban Gambia and aims to provide an in-depth understanding of how this relates to gender and cultural norms as well as different social positions.MethodsQualitative data were collected through interviews (33), group discussions (13), participatory observations (14) and informal conversations (31). Purposive and snowball sampling techniques were used to identify participants. The data was analysed thematically using NVivo 11.ResultsResults showed that there was strong social pressure on urban women in The Gambia to procreate. Unable to conform to their gender role, women with infertility were confronted with financial problems, social stigma, as well as emotional and physical violence in their marriage. All women expressed feelings of trauma, stress and sadness. The intersectional approach used in this study highlighted how different positions influenced women’s experiences of infertility. Urban women with a high socio-economic status had a more powerful position within their marriages and the broader community, due to their financial position, professional career and, sometimes, their educational background. In contrast, women from a lower socio-economic background were more likely to be harshly confronted with the social stigma of infertility.ConclusionThe lives of most women with infertility in The Gambia are characterized by social suffering resulting from gender and pro-natal norms, cultural beliefs and moral concerns, cultural practices and limited access to health care. An intersectional approach is an effective tool to inform public health and social policy since it highlights how, in specific situations, certain groups are more vulnerable than others.

Infertility Stigma Scale: A psychometric study in a Turkish sample

“…8 Likewise, in a qualitative study, infertile women stated that infertility jokes and gossips were spread easily in society. 9 In another study, regardless of gender, it was found that almost half of the infertile couples tend to hide their infertility status from the society with the fear of stigma. 10 Infertility is an important public-health issue with an everincreasing prevalence despite rapidly developing assisted reproduction techniques.…”

“…Women encounter with this pressure as having to tell other people who they do not have children, get exposed to critical and despising implications, experience the stress of environments with children, aspire other people who love their kids, feel deficient and insufficient when they see their husbands showing love on other kids, see the children of their peers and get exposed to divorce and/or fellow wife threats of their mothers‐in‐law . Likewise, in a qualitative study, infertile women stated that infertility jokes and gossips were spread easily in society . In another study, regardless of gender, it was found that almost half of the infertile couples tend to hide their infertility status from the society with the fear of stigma…”

A rapid scoping review of fear of infertility in Africa

“…Fear of infertility is critical to understand and address because it is often unfounded [2], persists from adolescence to adulthood and can have adverse effects on health [3,[6][7][8]. Fear of infertility is strongest where childlessness is most stigmatised, in rural areas of lowest functional and health literacy [4] and where childlessness is associated with severe consequences especially for women [9,10]. The research referring to FOI has not yet been mapped.…”

Interaction Between Coping Strategies Among Infertile Couples and Women’s Psychological Symptoms

“…Increasing the probability of domestic violence [1], divorce [2], Polygyny in some countries [3] and social isolation [4] will reduce the life quality of infertile couples [5]. Although using the methods of fertility assistance has had noticeable successes but the suffering from social stigma after infertility [2,6], stress from treatment processes [7] and the costs of treatment and negative results of treatment in 65% of treatment cycles [8] have turned infertility into a crisis for the involved couples and will be accompanied by increasing stress, anxiety and depression [9]. Therefore, preventing the malignant effects requires balancing the crisis by using effective and efficient coping strategies.…”

“…Accompanying infertility experience with infertility stigma and social suffering [6] and the importance of fertility dependent on the social context of Asian countries in keeping marital lives have turned infertility into a social problem [13].…”