"Dreamt Was Holding Baby Boy Infertility in Northern Malawi"
“I Dreamt I Was Holding a Baby Boy": Infertility in Northern Malawi Joanne M Hemmings, London School of Hygiene and Tropical Medicine EXTENDED ABSTRACT BACKGROUND: Infertility can have profound and damaging effects on women’s lives, especially in societies where women’s status is largely constituted through childbearing. However, little attention has been paid to the problem of infertility in the developing world. METHODS: Qualitative life history interviews with forty three fertile and infertile women were carried out to explore how social responses to infertility affected women’s lives, and in particular, their marital status, in rural northern Malawi. Complementary demographic and health data were analysed to quantify aspects of the effects of infertility such as associations with HIV status and marital disruption. RESULTS: Women with fertility problems were more likely to experience marital disruption (odds ratio 1.92; p<0.001) and were more likely to be HIV positive (odds ratio 1.94; p=0.013). Qualitative data suggest interpretations for these associations: childless women had often left marriages in preference to living with lowered status, and pressure to remarry was subsequently high. In this area, re-marriage is associated with increased HIV risk. However, many infertile women had happy and stable marriages, particularly with polygamous men whose desire for children was met by other wives. But even for these women, their desire for children and quest for fertility treatment persisted for many years. CONCLUSIONS: Infertility increases risk of harm to women’s health and marital disruption, which confirms findings in previous literature and adds weight to the argument that infertility should be considered a public health problem. However, existing literature does not fully capture the wide range of outcomes for infertile women in this rural sub-Saharan African setting. The demand for infertile women as wives and long duration of some childless marriages may reflect an increased focus on ‘the romantic couple’ as the basis of marriage, as opposed to the production of children.