What it Means to Be a Woman

Mamta Jhunjhun Wala, 42, of Mumbai still remembers the stigma of being unable to bear children for the first 13 years of her marriage. People ask a woman's name—and then, "How many children do you have?" When the woman answers "none," she says, "they don't know what they can talk to you about." Thanks to treatments at Mumbai's Malpani Infertility Clinic, Wala finally conceived a daughter, now 10, and twin boys, now 8. With her doctor, she started a support group to help give other infertile couples the help she wishes she had had, she says. "There were a lot of emotional questions, and support I needed, and there was nobody for me."

Wala is lucky. "It is very, very difficult for people in the United States to deal with [infertility], and yet, when you go to other cultures, it's even more devastating to people," says Dr. David Adamson, president of the American Society for Reproductive Medicine and a board member of the International Federation of Fertility Societies. Worldwide, the World Health Organization says about one in 10 couples experiences difficulty conceiving a child at some point in their lives.

In some developing countries, the consequences of infertility—which can include ostracism, physical abuse and even suicide—are heartbreaking. "If you are infertile in some cultures, you are less than a dog," says Willem Ombelet of the Genk Institute for Fertility Technology in Belgium. Women are often uneducated, so their only identity comes from being moms. "It [infertility] is an issue of profound human suffering, particularly for women," says Marcia Inhorn, professor of anthropology and international affairs at Yale University. "It's a human-rights issue."

The stigma that infertile women face can infiltrate every aspect of life. They may not even be invited to weddings or other important gatherings. "People see them as having a "bad eye" that will make you infertile, too. Infertile women are considered inauspicious," says Inhorn. Other people simply "don't want to have them around at joyous occasions," says Frank van Balen, coauthor (with Inhorn) of "Infertility Around the Globe" and a professor in the department of social and behavioral sciences at the University of Amsterdam. Their reasoning: "they could spoil it," he says.

Often the female takes the blame even when the problem lies with the man, says Inhorn. The women often keep their husband's secret and bear the insults. In Chad, a proverb says, "A woman without children is like a tree without leaves." If a woman doesn't bear children, their husbands may leave them or take new wives with society's blessing. In some Muslim places, women can't go on the street on their own. "If they have a child with them, they can do their errands," says van Balen.

Childlessness can also be an enormous economic problem in developing countries where Social Security, pensions and retirement-savings plans are not the norm. "If you don't have your children, no one looks after you," says Guido Pennings, professor of philosophy and moral science at Belgium's Ghent University. Religion shapes attitudes, too. "People are supposed to go out and populate the earth," says Ian Cooke, director of education for the International Federation of Fertility Societies and cofounder of the Low-Cost IVF Foundation. In the Hindu religion, a woman without a child, particularly a son, can't go to heaven. Sons perform death rituals. Infertile couples worry that without a child, who will mourn for them and bury them? In China and Vietnam, the traditional belief is that the souls of childless people can't easily rest. In India, the eldest son traditionally lights the funeral pyre. In Muslim cultures, the stigma follows childless women even after death: women without children aren't always allowed to be buried in graveyards or sacred grounds.