Where does your interest for the stigmatisation of infertility stem from?

I always had an interest in issues related to sexual and reproductive health, gender equality, race and human rights, so many of my papers and my study focus at the Institute revolved around these themes. Being Malawian-South African, my geographic area of interest has been Sub-Saharan Africa, particularly the Eastern and Southern region. When it came time to choose my research topic, I was largely influenced by a class I took on Gender, Health and Inequalities where I wrote a paper on the trajectory of contraception in Zimbabwe and the influence politics had on policing the female body. This paper on contraception sparked my reflections around pronatalism, fertility and the nation-state, and after doing research on studies in Malawi I found that infertility was scarcely researched, especially using a qualitative methodology. Conversations with my supervisor, Professor Aditya Bharadwaj, allowed me to bounce ideas off him and draw the topic out more expertly to look at stigma in relation to infertility and how its theoretical body of work, largely produced by sociologist Erving Goffman, could or could not apply to a context in the Global South.

How did you formulate your research questions and what methodology did you use?

I wanted to examine the social stigmatisation and feminisation of infertility in Malawi, specifically how stigma is understood and managed under sociocultural perceptions of infertility and what the effect of that is on lived experiences and gender identities. In simpler terms – in the local ecology of Malawi, what does it mean to say stigma and how does the Euro-American concept travel to the context of Malawi? The dissertation’s theoretical approach included Goffman’s theory of stigma and Kleinman’s theory of delegitimation. The Goffmanian theory of stigma analyses the social construction of stigma and its effect on tarnishing the identity and image of an individual, often through subtle manifestations that are embedded in social processes. Kleinman’s approach to stigma allows for an examination of experiences through lenses that focus on how illness is constructed by culture and society and how the body is embedded in social, political and moral worlds.

Data was collected from four participant groups: I conducted 30 interviews with infertile women, 3 interviews with health workers, and 2 discussion groups with religious leaders and community members. This data was then transcribed, analysed, placed into subthemes and data sets, and specific extracts were drawn out to compare with the theory and understand or challenge it.

What are your major findings?

My findings are trifold, relating to the perceived causes and treatments of infertility, the experience of infertility, and the consequences of it.

Firstly, perceived causes and treatments are embedded in the social and cultural world of the participants, including reasons ranging from the biomedical sphere, to witchcraft, to traditional healing and God. For the study participants, these spheres aren’t mutually exclusive but rather complement each other: multiple trajectories of treatment were often mentioned and a wide range of causes existed. 

Secondly, infertility stigma is experienced in the social and cultural web of participants’ networks. The nation itself being pronatalist and patriarchal creates a foundation on which reproduction is venerated and womanhood often equated to reproductive ability. In a society with a tendency to extol men this often leads to the construction of infertility as a woman’s disease and results in victim blaming and/or abuse. Culturally, infertility talk is embedded in derogatory words and phrases in the local language and institutionalised as infertile women are excluded from various women’s groups or activities, charitable donations and even community spaces. 

Thirdly, this experience of infertility and stigma has emotional, economic and marital consequences on the women’s lives. Many face vilification, emotional and physical abuse, economic isolation, and infidelity from their husbands who take another wife or divorce. Nonetheless, I identified five localised strategies of resistance that emerged as the interlocutors were telling their experiences: blame, avoidance, taking control, acceptance and talking to others.

How do these findings compare with Goffman’s theory of stigma and Kleinman’s theory of delegitimation?

The dissertation highlights the extent of the institutionalisation of infertility stigma in Malawi and how this institutionalisation is embedded in language, used for exclusionary purposes, and passes down ideologies and stereotypes through infertility talk, perspectives and songs. Goffman’s theory of stigma is challenged in my study context – the community of Mngwangwa – where the infertile woman struggles to escape her stigma and knowledge of it by the greater public. His theory of infertility and sterility as discreditable (when a difference is not known or immediately perceivable) rather than discredited (evident or visible) fails to recognise the heterogeneity of stigma experience that varies across ethnicity, class and gender. Following that, he did not consider a context in which the stigma is so entrenched and institutionalised that the individual, rather than being sympathised with, is isolated and avoided and, in that state, almost more polluted than before. So, my work shows through experiences and qualitative data exactly how culture is not a thing but a process, as Kleinman stipulates, and how everyday practices of culture ascribe meanings to different bodies, which then influences interpersonal relationships and collective and individual identity. 

Given your findings, what policy recommendations would you make?

The main recommendation that emerges out of these findings is the necessity of interventions that are appropriate to the sociocultural context in which they are applied. For interventions to move towards success in Malawi, they need not focus only on diagnosis of infertility, but also on sensitisation and awareness-raising, and beyond that, they must address the experiences of being labelled, stigmatised and ostracised in the communities. It is imperative that the government develop policy around infertility care and effectively integrate it into the Malawian National SRHR Policy rather than its most current policy statement to “reduce incidence of infertility among men and women” without any measurable indicators. As such, the approach to infertility response must encompass spheres that not only focus on preventive measures but address stigma, patriarchal structures, gender inequality, poverty, and sexual and reproductive health knowledge. 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.

What are you doing now and what are your plans for the future?

I’m working as a Programme Assistant at a Canadian national non-profit called the Breakfast Club of Canada, which funds breakfast programmes for kids in public schools to combat child hunger and create sustainable socio-economic change by impacting education and child health. I plan to continue to work my way up the ladder in the non-profit field, hopefully ending up in development work in the Southern/Eastern African region to work with local people for community driven solutions. I’ve also continued my passion for writing as I’m in the process of developing an article version of my dissertation for publication and distribution amongst Malawian networks to see how this data can make a difference. I also have other articles out on the Visual Economy of HIV/AIDs in South Africa, the Perpetual Public Spectacle of Blackness and Coercion and Agency in Zimbabwean Sex Work. More pieces will be coming soon, so watch the internet space for my name! Reach out at julianne.nyasulu@gmail.com for any writing proposals, offers or needs or just to say a hello.

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This e-paper was published thanks to the financial support of the Vahabzadeh Foundation. It reproduces Boetumelo Julianne Nyasulu’s Master dissertation in Anthropology and Sociology (supervisor: Professor Aditya Bharadwaj), which won the 2019 Anthropology and Sociology Department Prize.

Full citation of the e-paper:
Nyasulu, Boetumelo Julianne. Feminization and Stigmatization of Infertility in Malawi. Graduate Institute ePaper 28. Geneva: Graduate Institute Publications, 2020. https://doi.org/10.4000/books.iheid.7597. 

Interview edited by Nathalie Tanner, Research Office.
Banner image: excerpt from a picture by ilcsi/Shutterstock.com.