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Global Infertility

Experiences in Other Countries

By Debora Geary

When it comes to having children in other parts of the world, most people imagine the biggest problem is too many children. Especially in the developing world, news stories tell of explosive population growth and unwanted children suffering from disease and malnutrition. What you almost never hear about are the large numbers of couples who badly want children and can't have them.

In Africa, for example, some of the fastest population growth in the world co-exists with an infertility rate that in some areas is more than 30 percent. For women and men struggling with infertility in other cultures, often their experience can be much different, and maybe even more heartbreaking, than here in North America.

One of the biggest differences for infertile couples in developing countries is the visibility of their inability to have children. "Having children in the West is generally something individual and personal, the concerned couple's own business," says Frank van Balen, a well-known researcher of global infertility issues at the University of Amsterdam. "Some people do not want children, some postpone having children, and some cannot have children. Very often we do not know why couples do not have children; we are reluctant to ask about these things."

By contrast, in developing countries, a lack of fertility is a highly public event. "In most developing countries having children is the rule," says van Balen. "Voluntary childlessness is practically non-existent. Being infertile is painfully clear to others. Childlessness is highly visible and has to be explained and accounted for to others."

For a woman in North America, the struggle with infertility can be an enormous psychological and emotional burden. In developing countries, the weight only gets heavier. "The burden of infertility is generally much greater for women in developing societies than for women in the Western world," says Marcia Inhorn, professor and anthropologist at the University of Michigan and a published expert on global infertility. "Many developing societies are 'pronatalist' – people love and desire children. Thus, women are expected to become mothers in order to achieve full adult personhood."

This low status of infertile women in developing countries can have far reaching consequences in a woman's life. "It can lead to social isolation, a woman being outcast or not welcome at certain ceremonies and parties," says van Balen. He also points out that lack of children can threaten a woman's ability to survive. Low status may mean that women lose access to resources to support themselves, and without children to take care of them, many women face abject poverty in old age.

The impact of infertility for a woman is compounded because women are generally held responsible for reproductive failure in a couple. "Women are blamed for men's infertility, which is 'hidden' in most societies, even though male factor infertility may account for between 40 and 70 percent of the problems," says Inhorn. This blame may translate into very serious consequences, such as divorce, husbands taking second wives, difficulties with in-laws, domestic violence and economic abandonment. In developing countries, where the social safety net is often very limited, loss of stable family relationships can have life or death consequences for an infertile woman."

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• Truth Be Told: Uncovering Common Infertility Myths
• Talk about it!