The Social Construction of Infertility

Health and illness are not objective states but socially constructed categories. We focus here on infertility, a phenomenon that has shifted from being seen as a private problem of couples to being seen as a medical condition. Studying infertility provides an ideal vantage point from which to study such features of health care as inter-societal and cross-cultural disparities in health care, the relationship between identity and health, gender roles, and social and cultural variations in the process of medicalization. Infertility is stratified, both globally and within Western societies. Access to care is extremely limited for many women in developing societies and also for marginalized women in some highly industrialized societies. We also discuss the ways in which responses to infertility are influenced by the process of self-definition. The experience of infertility is profoundly shaped by varying degrees of pronatalism and patriarchy. In advanced industrial societies, where voluntary childfree status is acknowledged, many women experience infertility as a “secret stigma”; in other cultures, where motherhood is normative for all women, infertility may be impossible to hide. In the West, acceptance of the medical model is virtually hegemonic, but in other societies medical interpretations of infertility coexist with traditional interpretations

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States

Background: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States. Methods: The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services. Results: Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant. Discussion: Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States. Conclusion: Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States

Background: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States. Methods: The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services. Results: Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant. Discussion: Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States. Conclusion: Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child

A New Way to Estimate the Potential Unmet Need for Infertility Services Among Women in the United States

Background: Fewer than 50% of women who meet the medical/behavioral criteria for infertility receive medical services. Estimating the number of women who both meet the medical/behavioral criteria for infertility and who have pro-conception attitudes will allow for better estimates of the potential need and unmet need for infertility services in the United States. Methods: The National Survey of Fertility Barriers was administered by telephone to a probability sample of 4,712 women in the United States. The sample for this analysis was 292 women who reported an experience of infertility within 3 years of the time of the interview. Infertile women were asked if they were trying to conceive at the time of their infertility experience and if they wanted to have a child to determine who could be considered in need of services. Results: Among U.S. women who have met medical criteria for infertility within the past three years, 15.9% report that they were neither trying to have a child nor wanted to have a child and can be classified as not in need of treatment. Of the 84.9% of infertile women in need of treatment, 58.1% did not even talk to a doctor about ways to become pregnant. Discussion: Even after taking into account that not all infertile women are in need of treatment, there is still a large unmet need for infertility treatment in the United States. Conclusion: Studies of the incidence of infertility should include measures of both trying to have a child and wanting to have a child

The Importance of Social Cues for Discretionary Health Services Utilization: The Case of Infertility

Infertility is a discretionary health condition; although it carries with it important life course implications, treatment is rarely necessary for health reasons. Sociological theories of medical help-seeking emphasize demographic factors, perceived need, and enabling conditions in health services utilization, but we find that social cues are also strongly associated with health services utilization for infertility. Adjusted for conventional predictors of medical help-seeking, several social cue indicators have significant associations with utilization, including having friends and family with children, perceiving infertility stigma, and having a partner and/or family member who encourages treatment. Perceived need accounts for the largest portion of the variation in utilization. Enabling conditions explain less of the variance than social cues. Social cues should be especially important for discretionary health services utilization. Studies of service utilization for discretionary health conditions should explicitly incorporate a range of measures of social cues into their models

Change in Motherhood Status and Fertility Problem Identification: Implications for Changes in Life Satisfaction

Objective: To determine whether the association between changes in life satisfaction and becoming a mother (or not) depends on fertility problem identification status. Background: Evidence and symbolic interactionist theory suggest that, for women who initially perceive a fertility barrier, gaining the valued identity “mother” should be associated with increases and continuing to face a blocked goal (i.e., not becoming a mother) should be associated with decreases in life satisfaction. Method: This study used the nationally representative two-wave National Survey of Fertility Barriers to conduct a change-score analysis with chained multiple imputation. The focal dependent variable was change in life satisfaction. Focal independent variables were Wave 1 life satisfaction, fertility problem identification status, and birth between waves, controlling for stability and change in relationship status, talking to a doctor about how to get pregnant, religiosity, social support, importance of parenthood, importance of leisure, importance of work success, and economic hardship. Results: Among women who perceived a fertility problem at both waves, becoming a mother was associated with increased life satisfaction and not becoming a mother was associated with decreased life satisfaction. Women who gained or lost a fertility problem perception between waves but did not have a live birth experienced a gain in life satisfaction between waves, suggesting the relevance of the duration of fertility problem perception for change in life satisfaction

Relationship Satisfaction Among Infertile Couples: Implications of Gender and Self-Identification

We use path analysis to analyze heterosexual couples from the U.S. National Survey of Fertility Barriers, a probability-based sample of women and their male partners. We restrict the sample to couples in which the women are infertile. We estimate a path model of each partner’s relationship satisfaction on indicators of self-identifying as having a fertility problem or not at the individual and couple levels. We find a gender effect: for women, but not men, relationship satisfaction was significantly higher when neither partner self-identified as having a fertility problem. Women’s relationship satisfaction exerted a strong influence on their partners’ relationship satisfaction, but no similar association between men’s relationship satisfaction and their partner’s satisfaction was found. In infertile couples, higher levels of perceived social support are associated with higher levels of relationship satisfaction for women but not for men

Infertility Help Seeking and Social Support: Do Conventional Theories Explain Internet Behaviors and Outcomes

This dissertation uses data from the National Survey of Fertility Barriers (NSFB), a nationally representative sample, to assess factors associated with face-to-face and internet help seeking (study 1) and perceived social support (study 2). In study one, I examine whether the General Help Seeking Model, a theory that has been used to explain in-person help seeking, generalizes to internet help seeking. I assess four types of help seeking: (1) no help seeking, (2) only internet help seeking, (3)only medical help seeking, and (4) both online and medical help seeking. Results suggest that online help seeking is differentiated from in person help seeking by attitudes towards medical science, infertility stigma, age, income, and educational attainment. In study two I explore whether the type of help seeking that individuals engage in and the types of activities that people do online are associated with perceived social support. Perceived social support does not differ by type of help seeking, nor are the types of online activities associated with perceptions of social support. Finally, I provide descriptive information on patterns of infertility help seeking on the internet – information that is important as the use of the internet for health related activities continues to grow. I show that use of the internet varies by several individual and social characteristics

Supplementary file for \u3ci\u3eSocial Science and Medicine\u3c/i\u3e article: Online and In-Person Health Seeking for Infertility -- Table 2. Descriptive Statistics of Type of Health-Seeking and Independent Variables

Descriptive Statistics of Type of Health-Seeking and Independent Variable

Online and in-person health-seeking for infertility

Using data from Wave 1 (2004–2006) of the National Survey of Fertility Barriers (NSFB), a national probability sample of women ages 25–45, we examine online information-seeking among ever-infertile women. Of the 1352 women who met criteria for infertility, 459 (34%) neither talked to a doctor nor went online for information, 9% went online only for information, 32% talked to a doctor but did not go online, and 25% did both. Guided by Chrisman’s Health-Seeking Model and previous research on Internet use to obtain health information, we employ multinomial logistic regression to compare these four groups of ever-infertile women. Findings generally support Chrisman’s model. Infertile women tend to seek information online as a complement to, rather than as a substitute for, in-person health-seeking. Greater faith in the ability of medical science to treat infertility and greater perceived stigma were associated with higher odds of using the Internet to obtain information about infertility. In general, women who perceived the symptoms of infertility as more salient had higher odds of using both online and in-person or only in-person health-seeking compared to online health-seeking. Women with greater resources had higher odds of using online sources of information. Strong network encouragement to seek treatment was associated with higher odds of in-person health-seeking and combining in-person and online health-seeking compared to only going online or doing nothing