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“Give me children, or I shall die!” :Women’s Reproductive Rights

By: Shazmeen Razak Daruni

“Give me children, or I shall die!” or “When you are having children" (Steirteghem & Lunenfeld, 2004). When these type of questions are asked by from the couple who can not conceive, so these statements cause frustration, disappointment and dissatisfaction from their lives and relationships. I encountered the following scenario when I was doing my academic clinicals in tertiary care hospital. I was assigned in the clinic of sexually transmitted diseases (STD) and there I interviewed Ms. A, who was 35 years old. She had no baby since her marriage. When I interviewed her, she mentioned that she had no baby since 12 years and she had not become the pregnant since marriage. Through this information, I understood that she is suffering from primary infertility. When I enquired about the checkups or any treatment related to this problem, she notified that she had gone to different treatment prescribed by the homoeopathists and from two hospitals but no treatment was successful. She further said that one of the doctors prescribed some diagnostic tests and she had gone through those tests but she had not brought those report in the clinic. On asking about her husband’s job, she mentioned that he works in factory of clothes and carpets since many years. When I asked about the reproductive problem of her husband, she mentioned that sometimes her husband is having hematuria and pelvic pain. Then I brought Ms. A to the senior doctor and she asked all the history to the patient. Then the doctor did the physical examination of patient. During physical examination, she told that she is having pain in lower abdomen and pelvic area since 2 years and was having pain during intercourse since 1 year. The doctor said to me that these are probably the signs of pelvic inflammatory disease. . Moreover, she was feeling very shy to mention her history and was looking slightly distress. Then I told the doctor about the occupation of her husband and also the problem of hematuria and pelvic pain. She confirmed these things from the patient and the patient agreed. The doctor praised my colleagues and me; and told the importance and benefits of detailed history taking. Then the doctor prescribed the symptomatic treatment and recommended some other diagnostic tests to the patient and told to bring the reports in the next visit so that correct treatment should be given after thorough assessment.

My feelings at the time of assessment were empathetic because after twelve years of marriage, she had not the children. I was just thinking and looking deep into the whole picture which is mentioning that the problem could either be with any of the spouse as the wife she was showing the symptoms of pelvic inflammatory disease or may be her husband; because he was working in carpet factory and was suffering from any infection. This is the serious and most importantly a sensitive issue according to our, Pakistani, culture so we can’t just blame to any body directly. At that time I was just concerned about the woman’s life because infertility causes big stigmatization in our culture. In addition, Infertility is a chronic stressor with no clear solution and often results in strong feelings of doubt and ambiguity about the future. Moreover, I was little bit confused that if they choose any treatment so there is continued hope by the couple that the woman will become pregnant, and if this would not be successful, then it could be followed by feelings of helplessness and powerlessness and may subjects her to disapproval and exploitation. And if she is able to give birth, what could be the effects on baby, how healthy the baby would born. I am thinking from this angle because, patient is 35 years old ant there are chances that baby born after this age, might have any defect like down syndrome. And if they choose to adapt the child, it also affects the psychology of the adopted child. In future, if he would knew about this fact, he may not trust his parents and may go through the psychological distress like may go for the searching of is birth parents and may search himself. Besides, the breast-feeding issues could be raised because adopted mother would not be able to breastfed her child.

The interaction period between the patient and me was very short so I was unable to assess the patient thoroughly especially the psychological distress cause by infertility. But during interview, I noticed that patient was very concerned about this issue and was very quite during interview. As I analyze this scenario, I found that it is very important to assess both the partners when treating the reproductive issues like STDs, HIV’s or the infertility problems. As mentioned earlier that my colleague and I brought the important thing into doctors account, which was the history of her husband. Besides this, thorough history taking is very important and for this; patient’s privacy and maintaining patient’s confidentiality is of the utmost importance. As I mentioned that patient was feeling shy while disclosing her problem so it could be because at that time we were five people, two doctors and three students including me. So it is very important to maintain client’s privacy. The important thing that I missed to assess because of the lack of time was that I ignored to assess the impacts of infertility on patient. So, the assessment of all the patterns of health should be assessed so that we can treat or take care of the patient holistically.

“The desire for childbearing is a complex amalgam of psychological development, unconscious wishes, cultural expectations, and gut instinct” (Rosenthal). The inability to conceive or infertility not only affects women or both the partners physically but it also has the implications on psychological and social well being of the women. In our, Pakistani, culture the women is considered incomplete, incompetent and defective when she is unable to reproduce or, in the other, way women are considered supreme and complete when she can become mother. This sense of incompleteness and defectiveness leads to the women’s isolation. The causes of isolation could be many for example, the women’s low self-esteem and low self-concept and consider that she is incomplete sexually. Firstly, the reason of disturbed self concept is that patient may feel that she is not succeeded in providing a baby to the family. According to Sami & Ali (2006) “A women gets prestige and security in her husband’s home only after she succeeds in providing her infertility” (p.21). Considering the above scenario, I mentioned that during interview the patient was expressing the feelings of incompleteness, as she was feeling shy while giving interview. This could be because of the reason that she was unable to complete her in-laws expectation. Secondly, a woman may develop feelings of hatred or disgust towards her body, perceiving it as inadequate, dysfunctional and diseased. Similarly, a woman’s sense of femaleness is often closely associated with pregnancy and motherhood. Infertility, therefore, may have a serious impact on a woman’s sexual identity, leaving her feeling less sexually attractive or asexual. She may feel shame and embarrassment over not functioning normally so these feelings may lead to live in segregation. Beside, the women may have the feelings of guilt, regarding their infertility as punishment for putting their career first, using contraception, or for a previous termination. As considering the above scenario, the patient told during the history that in the beginning years of her marriage she used contraceptive pills so that’s the reason today I was unable to conceive. This statement of the patient shows that she is feeling that it’s the punishment for her, as she had not become pregnant in the initial period of marriage. The feelings of guilt and lower self-esteem cause the women to be isolated. Some women may feel uncomfortable to live between or around children and consequently start to isolate themselves from family and friends who have children. Feelings of frustration, anger, denial, guilt, blame, self pity and jealousy begin to occur. “Increasing isolation leaves the women without social support networks to help them overcome the feelings of depression and frustration commonly associated with infertility” (Braun, 2006). As mentioned earlier that I was unable to assess the different impacts of infertility with the patient but as the patient came after ten to eleven years for her treatment so this delay in seeking the medical help by the patient indicates that may be in the earlier days when she was unable to conceive, she may go through the social isolation, depression and sense of hopelessness. These emotional reactions of infertility made her unable to choose the treatment for her problem. So the isolation cause by the infertility may hinder the patient to reach the proper treatment in the earlier stage.

Moreover, Infertility can also place a great strain on a relationship between husband and wife. The infertile partner may constantly fear being left during important decision-making regarding future plans or in family matters. In our Pakistani culture, According to Sami and Saeed Ali (2006), “Only woman is thought to be responsible for producing next generation and the blame for absence of desired number and sex of children is unquestioningly placed on her” (p.19). Considering the above scenario, the patient came alone in the clinic for her treatment and her husband was not with her so, this attitude shows that might be she was also facing this type of tradition that only women is responsible to give birth or to reproduce. In addition to this tradition, the other tradition is that often only the woman is examined, because nobody asks for the partner, or he refuses to attend the clinic. In our culture, man are considered as supreme being and it’s the custom that men cant have these type of disability so they usually do not go through the tests as they believe that these things could devastate their prestige as being “man”. These types of traditions put the entire burden only on women and the agreement in diagnostic tests and sometimes the treatment may also cause the conflict between partners and may destroy their relationship. These conflicts lead to the violence and abuse towards women and they are badly harmed physically, psychologically and socially. According to Bentley & Taylor by Sami and Ali (2006), “Studies have revealed that severe emotional harassment is experienced by large number of such women in their marital homes in the form of family celebrations, taunting and stigmatisation, negative attitude as well as beating, withholding of food and health care” (p.19). Moreover, families, in particular prospective grandparents, may place added pressure on people by publicising their expectations for grandchildren. These enquiries from in-laws can be especially stressful. Grandparents, especially in our culture, take the wife to different religious ‘baba’ and different tombs for getting rid of the evil as they consider that someone from their enemies did the magic on the woman or, they go to different treatments of homeopathy. As mentioned earlier that my patient also went to homoeopathist but it was unsuccessful. And after giving pressure and describing their expectation, if couple is unable to provide baby to them, they enforce male to either remarry to some other girl or give divorce to the wife. So when women listens these types of statement and punishment from in-laws, she may gone to depression, hopelessness and powerlessness and eventually to isolation.

Hence, infertility or sterility destructs the entire life of the couple; especially of woman as it disturb the physical, social and psychological aspects of woman. According to Cousineau & Domar (2007), “The inability to conceive children is experienced as a stressful situation by individuals and couples all around the world. The consequences of infertility are manifold and can include societal repercussions and personal suffering”. Besides, creating awareness, the next step is giving them support and psychological treatment. Olshansky (2004) provided some important interventions while treating these types of patients. She stated that “First, help patients assess the various options available to them and make decisions regarding what they want to do next in regard to infertility treatment or seeking other options, such as adoption or choosing to be childfree. Second, encourage them to develop ongoing supportive relationships with friends and family, which may include speaking authentically with their significant others about their feelings and their needs.” Thus the main purpose of our intervention should be that they see themselves as successful individual and develop healthy relationships with other. Besides, the other psychological interventions for example, stress management and enhancing their coping skills may have beneficial effects on patients. Consequently, I learnt these things from the above scenario and I will apply this knowledge in the future.