“I Dreamt I Was Holding a Baby Boy": Infertility in Northern Malawi
Joanne M Hemmings, London School of Hygiene and Tropical Medicine
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
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