Our culture is one of procreation. Regarded as blessings from God, we are told our progeny will spread Islam and further our barakah. Delaying marriage, waiting to begin a family, or experiencing infertility – each amount to disregarding this sacred duty.
Childlessness is taboo in many cultures, including Muslim cultures. But 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, or suffer from infertility?
Women typically bear the brunt of the cultural stigma of infertility. Societies 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.J. Samia Mair
Reproductive infertility is, in fact, caused by several factors. Some are 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 only the male. Another third of cases are due only to the female, and the last third can be chalked up to both partners. Circumstantial factors often play a role. They can include a woman’s age, a sterile partner, cancer treatment, female sexual dysfunction, medications, and an improper functioning thyroid.
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. Unfortunately an adequate emotional support system remains unavailable.
What About Him?
Within the Muslim community infertility is almost a taboo topic, and rather than offer empathy and understanding, many families unknowingly contribute to the pressure. Women are often immediately blamed for infertility and this isn’t corrected! Their husbands normally do not even get tested to determine if they are culpable.
It’s not uncommon for divorces to occur only for men to remarry and still be unable to conceive.
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. They compared non-Muslim, Austrian women and immigrant Muslim women of Turkish and Near East descent. Both groups demonstrated the same levels of infertility caused by the same circumstances or health conditions. However, the Muslim women endured far greater pressures to have children, in turn contributing to a diminished quality of life.
The Muslim participants in this study were often illiterate about their reproductive health and history. They 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).
Seeking Whys and Ways
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 Shari’ah 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. The sister 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.
Desperate for conceiving, the couple purchased countless ovulation kits, hundreds of nights were spent tossing, and turning, weeping, and they even made a pilgrimage to Makkah. Finally, the third time was the charm. 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.
Stress! Even From the Beloved Ones!
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.