Interpreting infertility: medical anthropological perspectives. Introduction.

Within the past two decades, medical anthropology has contributed significantly to the exploration of human reproduction. From menarche to menopause, few aspects of the normal, human reproductive life cycle, particularly as it pertains to women, have been left unexamined by medical anthropologists working in a wide variety of cultural settings. This interest in reproduction is evident in a number of important collections on the related subjects of fertility and birth [l-4]. Furthermore, numerous recent articles and medical anthropological ethnographies are devoted in part or in toto to issues of fertility, family planning, and parturition. Yet, when reproduction goes awry, few medical anthropologists have been there to record and interpret the accompanying pain and suffering. Although infant morbidity and mortality have generated great concern and pathos among medical anthropologists, as have sexually transmitted diseases (STDs) in the era of AIDS, reproductive morbidity-including infertility, ectopic pregnancy, and pregnancy loss through miscarriage and stillbirth-has generated mostly silence in the medical anthropological community. This lacuna is particularly noteworthy, given the human drama engendered by reproductive failure and its rising worldwide incidence as a result of the so-called ‘sterilizing STDs’ (primarily gonorrhea and genital chlamydial infection) [5-71. For example, among selected populations in the AIDS-endemic ‘infertility belt’ of Central Africa, STD-induced infertility is estimated to affect as many as one-third to one-half of all couples, leading to further threatening depopulation [S, 8-121. Medical anthropology’s neglect of reproductive morbidity is all the more surprising given the significant gender issues involved. Namely, women worldwide appear to bear the major burden of reproductive setbacks of all kinds, in terms of blame for the reproductive failing, personal grief and frustration, marital duress, social stigma and ostracism, and, in some cases, life-threatening, iatrogenic interventions. In this issue of Social Science & Medicine, we explore the cultural ramifications and interpret the lived experiences of infertile women in four distinct geographic milieus: Cameroon, India, Egypt, and the United States. Removed as they are in space, these studies demonstrate that, for women, the infertility experience is usually marked by anxiety and fear, normative pressures to conceive, social stigmatization, and often relentless searches for therapy, which, whether biomedical or ethnomedical in nature, tend to be ritualistic, risky, and ethically complex. Furthermore, infertility often profoundly affects women’s moral identities and the local moral worlds [ 131 in which infertile women live, given that suspicion, blame, guilt, and accusation are among the common byproducts of the experience of continuing childlessness. These studies on the cross-cultural dilemma of infertility also demonstrate the intimate articulation of infertility with many other important domains of social life, including inter ah kinship, inheritance, marriage and divorce patterns, household residence patterns, economic production, religion, cosmology, gender relations, and notions of the body, health and illness, to name but a few. Furthermore, infertility is inherently political in that it threatens the perpetuation of the body politic. Thus, even when the Sate attempts to ‘control’ fertility among a reluctant populace, infertility is rarely viewed as a tenable option, as apparent in the recent proliferation of ‘high-tech infertility clinics in purportedly ‘overpopulated,’ developing countries. Infertility also provides a convenient lens through which issues of fertility can be explored. Indeed, infertility and fertility exist in a dialectical relationship of contrast, such that understanding one leads to a much greater understanding of the other. Exploring infertility, in particular, inevitably leads to the discovery of many important fertility-related beliefs and behaviors, including, among others, ideas about conception and how it is prevented both intentionally and unintentionally; understandings of and attitudes toward contraception and its perceived dangers; beliefs about the importance of motherhood, fatherhood, and children themselves; and perceptions of risk and risk-taking regarding the body and its reproductive processes.