Monica N. Starkman M.D.

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Embarrassment

Infertility and Miscarriage: Shame and Stigma

Open, compassionate discussion helps people ask for necessary social support..

Posted Sep 21, 2016

Public Domain, PIxabay
Source: Public Domain, PIxabay

Infertility and miscarriage are conditions that carry so much personal shame and social stigma that they have, until now, been kept mostly in the shadows. Think not?  One example: women often keep their pregnancies secret until the first trimester - with its highest risk of miscarriage – is completed.  This secrecy avoids the embarrassment of revealing to others that they lost the baby. 

Problems with fertility are frequent enough that many individuals are in this situation, and likely people we know. More than one in 10 married women ages 15 to 44 in the US had problems with fertility (according to a recent report from the Centers for Disease Control and Prevention). For women ages 35 to 44, the number jumps:  27% had impaired fertility.

Not Just a Problem of Women

The CDC report showed that 12% of men between the ages of 25 to 44 had impaired fertility. And if keeping such problems under wraps is common in women, it is even more so in men.

Learning from the Brave

We can learn much from those courageous enough to speak out.

Mark Zuckerberg revealed on Facebook the personal tragedies he and his wife had experienced with miscarriages. He wrote: "Most people don't discuss miscarriages because you worry your problems will distance you or reflect on you – as if you are defective or did something to cause this. So you struggle on your own.”

Robert Johnson disclosed in The New York Times his siege with infertility, and described his state of mind after years of multiple hormone treatments and discouraging laboratory tests for sperm counts:  "The really heartbreaking thing was that time after time of going to labs, it's embarrassing, it's expensive, it breaks your spirit kind of thing.” (State of the Unions, March 2015).

Michell Obama, in her memoir Becoming, tells of her distressed feelings after her miscarriage, including feelings of being damaged.

The Psychological Impact of Impaired Fertility

The psychological consequences are indeed profound. There’s the feeling you’ve lost control over your life, both present and future.  There’s the feeling of being damaged, which unleashes intensely painful shame.  Guilt also lashes the one who considers themself responsible, since no one wants to inflict childlessness on someone they love.

The Fear of Social Stigma

Fear of social stigma adds yet another burden. This fear is not unrealistic.  But the sad thing is that it prevents them from receiving the social support that is known to be so effective in reducing stress of all kinds.

Perhaps evolutionary psychology would explain that social disapproval exists for the very situation that threatens the survival of our species: the failure to reproduce.

But whatever the reason, the stigma prevents those with impaired fertility from receiving what study after study has shown to be one of the best ways to reduce stress in any number of situations:  social support from others.

 Social Stigma Is Being Reduced

Open, compassionate discussion of reproductive failure is necessary to lessen its stigma. Until now, that has not happened.

There are signs this is finally improving.

On-line Support Groups

More groups - public and private – are now available so that people can reveal their feelings and receive support from strangers also coping with similar anxieties and losses. As an addition to talking to friends and relatives - or instead of, if telling them seems impossible - joining one or more of these groups is very helpful. However, it is still rare to see groups online for men - unlike the situation for women, it has not been socially acceptable for men to share problems and feelings with others. What’s needed are more groups for men, as well as encouragement for men to join them.

Increased Media Coverage

Newspapers and other established media are bolder in reporting personal stories about miscarriage and infertility, such as the article about Mr. Johnson and Ms. Obama. This provides the daylight so necessary to help diminish stigma.

Since people will become increasingly likely to risk disclosing their situation to others, the media can take on another role: publishing articles that educate the public about how best to respond when friends and relatives confide in them.  For example, they could advise it is best not to make upbeat comments about the success stories of others, which may backfire when what a person needs most is empathy for their immediate problem and acceptance of their grief. (For more on how to help others, see Psychology Today blog article Pregnancy Loss Awareness: How to Help Others.)

The Arts Are Leading the Way

As is so often the case, the arts are at the forefront in bringing a taboo topic into the open.

Recent films and novels are honing in on infertility and miscarriage. In the book/movie The Light Between Oceans, the deep despair of a woman distraught after multiple miscarriages is poignantly portrayed. The Girl on the Train is about a woman who is alcoholic and depressed because of her infertility. The film: When the Bough Breaks tells the story of an infertile couple who decide to hire a surrogate. In the novel The End of Miracles, infertility and miscarriage propel a good woman burdened by grief into a false pregnancy, psychiatric hospitalization and an impulsive, unthinkable act.

The arts have power. Through these fictional characters, we are brought closer to experiencing the intense feelings of those burdened with infertility and miscarriage. This creates the awareness and empathy so necessary to decisively diminish silence and social stigma.

Goodreads Author page: https://www.goodreads.com/book/show/27037957-the-end-of-miracles