Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California - Los Angeles, Los Angeles, CA, USA; California Center for Population Research, University of California - Los Angeles, Los Angeles, CA, USA.
Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California - Los Angeles, Los Angeles, CA, USA; California Center for Population Research, University of California - Los Angeles, Los Angeles, CA, USA.
Soc Sci Med. 2020 Apr;251:112910. doi: 10.1016/j.socscimed.2020.112910. Epub 2020 Mar 10.
Infertility, a common experience among women and men worldwide, remains on the margins of public health and medicine in low-resource settings. Previous studies identified associations between individual experiences of infertility and negative outcomes, particularly in contexts where childbearing is imperative, but few have examined broader implications of infertility and infertility-related stigma on communities. To understand the production and impact of infertility-related stigma, this study analyzes 12 focus group discussions (FGDs) conducted with 104 women and men in rural Malawi. FGDs, conducted July-September 2018, were used to elicit the range of community norms around family formation, pregnancy, fertility, and infertility. Data were analyzed through memo-ing during and after data collection and collaborative, thematic coding. We found that stigma manifested within existing systems of gender and power. Aligning with Link and Phelan's stigma framework (2001) there were three primary mechanisms by which infertility-related stigma was produced and reinforced: labeling of a person perceived to be infertile (i.e., establishing 'other'), perpetuating negative stereotypes associated with suspected causes of infertility (e.g., abortion, multiple sexual partners, weak sperm), and consequences of infertility that reinforced stigma (e.g., social ridicule and distancing, divorce). Labels, presumed causes, and consequences of infertility were entrenched within gender and sexuality norms. Women perceived as infertile were unable to follow a normative path to achieving adult status, presumed to be sexually transgressive, and considered "useless." Men's masculinity was questioned. Both women's and men's identities, as well as social positions within relationships and communities, were threatened by perceptions of infertility. Ultimately, the manifestation of infertility-related stigma contributed to an environment wherein the risk of being perceived as infertile was highly consequential and unrelenting. Pervasive stigma, at the community-level, impacts decisions around contraceptive use and timing of childbearing, as women and men not only wanted to avoid infertility, but also the appearance of infertility.
不孕不育是全球范围内女性和男性普遍存在的问题，但在资源匮乏的环境中，它仍然处于公共卫生和医学的边缘。以前的研究已经确定了个体不孕经历与负面结果之间的关联，尤其是在生育至关重要的情况下，但很少有研究探讨不孕不育及其相关污名对社区的更广泛影响。为了了解不孕相关污名的产生和影响，本研究分析了在马拉维农村地区进行的 12 次焦点小组讨论（FGD）中 104 名女性和男性的情况。FGD 于 2018 年 7 月至 9 月进行，旨在引出围绕家庭形成、怀孕、生育和不孕不育的社区规范范围。通过数据收集期间和之后的备忘录编制以及协作性主题编码对数据进行分析。我们发现污名是在现有的性别和权力体系内产生的。根据 Link 和 Phelan（2001）的污名框架，不孕相关污名的产生和强化有三个主要机制：对被认为不孕的人进行标签化（即建立“他者”），延续与疑似不孕原因相关的负面刻板印象（例如，堕胎、多个性伴侣、弱精），以及强化污名的不孕后果（例如，社会嘲笑和疏远、离婚）。不孕的标签、假定原因和后果都深深植根于性别和性规范中。被认为不孕的女性无法遵循实现成年地位的正常途径，被认为是性越轨的，被认为是“无用的”。男性的男子气概受到质疑。女性和男性的身份以及他们在关系和社区中的社会地位都受到不孕观念的威胁。最终，不孕相关污名的表现导致了一种环境，在这种环境中，被认为不孕的风险是非常严重和不可避免的。在社区层面上，普遍的污名将影响到避孕措施的使用和生育时间的决策，因为女性和男性不仅希望避免不孕不育，还希望避免不孕不育的表象。
