The number of children a woman of reproductive age bears has been declining globally. Yet childbearing expectations in some parts of Africa remain high. In Ghana, for example, the total fertility rate – the average number of children expected per woman over a lifetime – stands at 4.2.
Children provide emotional fulfilment and social status, and can contribute to the household economy by helping with domestic and subsistence activities. As parents age, children become an important source of old age support.
As a result of the high value of children, the social consequences of infertility can be severe. For example, infertile women often face considerable stigma, mental distress, and potential exposure to domestic violence.
Gossip and social stigma can also arise. When members of the community see that a woman has not become pregnant after an expected period of time, rumours of infertility may begin.
About one in five couples in Ghana have difficulty conceiving or carrying a pregnancy to term.
Previous research has shown that women often report feeling that their relationships are at risk due to their infertility. The considerable pressure women are under to have children is cited as a key reason.
To test this suggested link between infertility and relationship breakdown, I analysed data collected over a six year period. The data were collected from 1,364 Ghanaian women living in six communities in the Western, Central, and Greater Accra regions. Women were asked a range of questions about factors including their contraceptive use, pregnancy histories, and current relationship status.
Fertility and social pressure
The study looked at the relationship between infertility and the stability of romantic partnerships.
I categorised infertility in two ways:
- biomedical infertility – women failing to become pregnant after two or more years of unprotected intercourse, and
- self-reported infertility – women reporting that either it takes them a long time to become pregnant or that it is not possible for them to become pregnant at all.
I found that a woman’s ability to conceive has a powerful effect on whether the relationship with her partner will survive. Women who had difficulties conceiving faced a much greater risk of their relationships ending.
Interestingly, this was only the case when I looked at self-reported infertility. Biomedical infertility was not linked to a greater risk of the relationship ending.
In other words, only women who perceived themselves to have difficulties conceiving were at greater risk of a breakup, regardless of their physiological ability to conceive. Where relationship stability is concerned, perceptions matter.
I also investigated whether the risk of a breakup differed between married women compared with those in non-marital sexual unions. This was particularly important because previous work has tended to focus on married women.
If unmarried women’s relationships are also at risk of ending due to infertility, this would not be detectable in studies which only consider married women.
I found that, indeed, women in non-marital unions were at greater risk of the relationship ending compared to married women. This is consistent with the idea that unmarried women have fewer legal protections, contributing to a less stable relationship.
What can be done?
A combination of scaled-up diagnosis and treatment options, targeted attempts to reduce stigma, and a diversified picture of family life are needed.
Wider availability of diagnosis and assisted reproductive technologies may help some couples meet their fertility desires.
These technologies are costly, however, and tend not to be widely available. This makes them the preserve of wealthier couples living in urban areas.
Scaling up biomedical interventions could therefore potentially contribute to the stratification of reproduction. In turn, this could actually increase stigma for those who continue to be unable to access such services.
This solution also misses the point that perceived infertility seems to be what matters most for relationship stability.
A biomedical intervention is therefore unlikely to be sufficient on its own.
From a social perspective, stigmatisation of infertile women must be reduced. One possible option would be to strengthen social welfare and old age support systems. This would reduce the economic pressure on couples who struggle to have children.
More broadly, a concerted effort is needed to redefine the family to include childless couples. This might, for example, take the form of public campaigns to highlight the diversity of family life in Ghana.
These interventions have the potential to reduce the social stigma for childless women, and to contribute to the stability of romantic relationships.