Our culture is one of procreation; children are regarded as blessings from God, and we are told our progeny will spread Islam. Delaying marriage, waiting to begin a family, or experiencing infertility each amount to disregarding this sacred duty. While it is considered taboo in many cultures to remain childless- and the Muslim culture is no exception- what viable options exist for couples who are unable to conceive naturally, or choose not to adopt? What space does our culture provide for women who are either unable or unwilling to marry, choose to remain married without children or suffer from infertility?
Women typically bear the brunt of the cultural stigma of infertility because society looks down upon them for failing to provide an heir for their husbands. One such woman struggling with infertility and repeated miscarriages, blogged about her struggle to reconcile her physical state with her psychological one.
On an intellectual level I knew that I was not defective nor a failure as a woman. I knew that my worth transcended my ability to procreate. But shame and inadequacy hit me on a level where reason does not tread.
Reproductive infertility is, in fact, caused by several factors, some circumstantial and others biological, and almost none of which are under a person’s control. Yet shame and inadequacy are exactly the feelings a woman experiences first and most. The Mayo Clinic researchers posit that we can attribute one-third of infertility cases to the male only, another third to the female only, and the last third of cases can be chalked up to both partners. Circumstantial factors- including a woman’s age, a sterile partner, cancer treatment, female sexual dysfunction , medications, and an improper functioning thyroid (hyper/hypothyroidism)- often play a role. Two of the most common biological causes for infertility are endometriosis and polycystic ovarian syndrome (PCOS). It is becoming increasingly common within the Muslim community to find couples struggling with these conditions, and unfortunately an adequate emotional support system remains unavailable.
Within the Muslim community infertility is almost a taboo topic, and rather than offer empathy and understanding, many families unknowingly contribute to the pressure. Infertility is often immediately blamed on the women, while their husbands do not even get tested to determine if they are, in fact, culpable. To examine the impact of this added stress through a cultural lens, a study was done in 2001 of 49 women (between the ages of 18-39 years old) at the University Clinic for Obstetrics and Gynecology in Vienna, Austria comparing non-Muslim, Austrian women and immigrant Muslim women of Turkish and Near East descent. Despite the fact that both groups demonstrated the same levels of infertility caused by the same circumstances or health conditions, the Muslim women endured far greater pressures to have children, which, in turn, contributed to a diminished quality of life. The Muslim participants in this study were often illiterate about their reproductive health and history, and felt uneasy speaking candidly in the physician’s office- in fact, sisters and husbands often answered on their behalf- which further compounded these women’s stress (Schmid, 2004).
Apart from coping with the enormous pressure to have children, couples facing infertility must also come to terms with the perennial “why.” There are some who believe infertility is the will of God, and leave all to Him to decide. Others take matters in their own hands and seek treatments that are within Sharia law. Artificial insemination and in-vitro fertilization (IVF) are viable options, the latter being a more expensive and an increasingly common choice in the Muslim community, while surrogacy and sperm donations are prohibited. I spoke with one 35-year-old South Asian woman about her PCOS journey through a successful IVF treatment. She ignored early symptoms of PCOS- excessive hair growth, dramatic weight gain, and irregular periods. She attributed each telltale sign to something else in her life, and did not imagine that together these anomalies painted a picture of PCOS. It was not until she was 25, four years after marriage and several different gynecologists later, that she received the diagnosis of PCOS. The pieces of the puzzle came together. Within that four year span, she and her husband had tried artificial insemination twice and IVF three times. Countless ovulation kits were purchased, hundreds of nights spent tossing, and turning, weeping, and even a pilgrimage to Mecca was made. Alas, the third time was the charm, as the baby conceived was actually a frozen embryo from a previous fertilization. This journey had a happy ending, but others are not as fortunate. One 40-year-old South Asian woman suffering from endometriosis for nearly a decade endured close to a dozen surgeries to remedy the problem, all the while taking pain medication that led to excessive weight gain. She eventually gave up trying to conceive, but says that while her journey has come to an end, the sense of pain and the question of “Why me?” remains.
In the end, it is the cultural stigma of being childless, whatever the reason may be, that we need to address. Women dealing with infertility often endure questions like, “Do you have children?” The person asking means no harm, but leaves the woman embarrassed and grasping for an answer. There are tens of thousands of Muslim couples struggling with infertility in the United States, and our culture must move beyond the ‘scarlet letter’ stigma attached to couples who are childless. What we do require is a better understanding of the complexities that arise from infertility, such as the ovulation kits, IVF treatments, ovarian surgeries, and most importantly, the frustration and the tears.
Ayesha Akhtar is Director of Policy & Research at HEART Women and Girls Project. HEART empowers women through: Health Education (increasing access to accurate information and resources about one’s body and health issues), Advocacy (advocating for culturally-sensitive health care services & education for faith based communities), Research (conducting research to generate data and information about the status of women and girls from faith based communities), and Training (training women and girls to become leaders of wellness in their communities).
(Photo by Tamara Manning)