IV Agency and Invisibility in Constructions of Infertility
Introduction: Agency and Invisibility in Constructions of Infertility
Tracey Loughran and Gayle Davis
As 1979 drew to its close, Hilary Mantel spent the Christmas period in hospital, ‘having my fertility confiscated and my insides rearranged’.1 She had suffered from chronic undiagnosed endometriosis (a condition in which tissue that normally forms the womb lining is found outside the uterus) for several years. By the time she managed to prise this diagnosis out of doctors, following her own extensive research on the condition, the endometriosis had wreaked such havoc on her reproductive system that she needed a hysterectomy. She was 27 years old.
Mantel had first noticed odd ‘nibbling’, ‘stabbing’, ‘flitting’ pains several years earlier, when she was reading for an undergraduate degree in law.2 The first time she went to see a doctor, he was nonplussed. The second time, he put her on antidepressants that blurred her vision, disturbed her sleep, and left her dull and apathetic, but did nothing for her pain. The doctor sent her to a psychiatrist, who diagnosed her with the ‘female complaint’ of ‘stress, caused by overambition’, and recommended that she rethink her future career. On her second visit to the psychiatrist, she was prescribed even stronger pills and sent to the university psychiatric clinic, where staff interpreted her insistence that she was physically ill as further evidence of her delusions. There, she was pulled onto a nightmarish merry-go-round of violent episodes, extreme panic, and insensibility caused by a combination of Valium, Fentazine, and Largactil.3 Looking back years later, the terror still raw, Mantel recollected that her doctors did not even attempt a physical diagnosis. Of course not; no further
T. Loughran (*)
School of History, Classics and Archaeology, University of Edinburgh, Edinburgh,
G. Davis, T. Loughran (eds.), The Palgrave Handbook of Infertility in History, DOI 10.1057/978-1-137-52080-7_20
explanation was necessary, for it was widely perceived to be ‘in the nature of educated young women [... ] to be hysterical, neurotic, difficult, and out of control’. The only object of doctors was ‘to get them back under control’.4
After being discharged from the clinic, Mantel tried to stay out of the medical system, despite chronic abdominal pain, sickness, and agonizing menstrual periods. By the age of 24, she had learnt that ‘whatever my mental distress - and it does distress one, to be ignored, invalidated, and humiliated -1 must never, ever go near a psychiatrist or take a psychotropic drug’. When driven to the doctor’s surgery because she could bear the pain no longer, GPs assured her that these ‘period pains’ would clear up when she had her first baby. Although she was eventually able to diagnose herself through extensive research in medical textbooks, this knowledge came too late to prevent the loss of her womb, ovaries, and a ‘few lengths of bowel’ into the bargain.5
At 27, Mantel had never tried to get pregnant. In fact, despite the availability of the oral contraceptive pill, she had always ‘only half believed I could coerce my body and suspected that it might have some filthy tricks in store; the filthy tricks would be on the line of putting a baby in your arms before you were ready’.6 But now:
I was not free and the possibilities were closed off. Biology was destiny. Neglect - my own, and that of the medical profession - had taken away my choices. Now my body was not my own. It was a thing done to, operated on. I was twenty- seven and an old woman, all at once [... ] I was no good at breeding, so what was I good for? Who was I at all? My hormonal circuits were busted, my endocrinology was shot to pieces. I was old while I was young. I was an ape, I was a blot on the page, I was a nothing, zilch.7
In the aftermath of the operation, her marriage collapsed, her medication altered her body out of all recognition, and when the endometriosis returned a few years later, she had to battle once again to make doctors accept the reality of her physical pain.8 Although she remarried (the same man), published several novels, and made a happy life for herself, more than two decades after the hysterectomy she still missed and felt haunted by ‘the child I never had’.9
This is Mantel’s story, but it is also a story about what could and what did happen to women in the Western world in the second half of the twentieth century. The history of women in these decades is usually told as a story of ‘liberation’, as a resurgent feminist movement capitalized on the freedoms offered by the oral contraceptive pill and legalized abortion to demand better education, rights in the workplace, and sexual equality. How, then, at the height of this onward march, could a young working-class woman from the North of England end up cowering and afraid in a psychiatric hospital because she had dared to tell a doctor that she was in pain? Making sense of Mantel’s experiences helps us to understand women’s expectations of their reproductive futures, their abilities to shape their own lives, and the forces that constrained these choices even in this era of unprecedented freedom and choice.
In histories of infertility, the issues of agency and invisibility are deeply entwined. The power to act depends in part on social recognition of a ‘problem’, and the choices of those whose voices are not heard, or, even worse, are deliberately silenced, are narrowed - sometimes to the point of non-existence. In past societies, as in the contemporary world, disparities of power marked and determined the experience of infertility. This section, substantially focused on the period since 1945, explores how constructions of infertility have contributed to either expanding or limiting the capacities of different groups. It demonstrates how the claims of certain groups (whether Freudian psychologists, feminists in the global North, or white middle-class infertile couples) to reproductive rights have often marginalized those with less power and status (female patients, women in the global South, or indigenous peoples and ethnic minorities). At the same time, while ideological constructions of gender, race, and class have conditioned popular, legal, and medical approaches to infertility, stigmatized and neglected groups have managed to fight back and to challenge these constructions in unexpected ways.
The section opens with Sofia Gameiro and Jacky Boivin’s historical overview of the use of psychological models within infertility medicine. From the 1930s, the Freudian-derived model of ‘psychogenic infertility’ which explained infertility as a result of psychic conflict, often believed to result from failure to adapt to socially prescribed gender roles, dominated infertility medicine. Although the cruder manifestations of this model have been superseded, debates about whether stress affects fertility are ongoing. In the 1980s, the ‘psychological sequelae’ model suggested that psychological problems in the infertile were an outcome of the emotional tribulations provoked by the experience of involuntary childlessness, rather than a cause of the condition. This model highlighted the need for professional support for infertile couples and resulted in an influx of mental health professionals into the field of infertility medicine. With the proliferation of assisted reproductive technologies, the role of mental health professionals became entrenched, and often they served as gatekeepers for access to treatment - often, in the process of determining who could be deemed fit to parent, further entrenching heteronormative and class-based ideals. However, as evidence began to show that the intervention of psychologists during the treatment period was not always effective, a trend evolved towards psychosocial care delivered at different points in the process of diagnosis and treatment, by all staff in the fertility clinic rather than simply mental health professionals. Today’s psychological interventions in infertility medicine are more thoroughly based on evidence than past practices, and more sensitive to the needs and desires of previously stigmatized groups such as same-sex parenting couples.
Hilary Mantel’s horrific experiences in the British mental health system in the 1970s give some indication of the potential consequences of the misuse of psychological models within medicine. Shurlee Swain’s chapter on the interplay between infertility and adoption in twentieth-century Australia provides another chilling example of how the psychogenic model of infertility ruined the lives of those without sufficient power to negotiate the medical and legal system. In postwar Australia, a decline in the number of babies available for adoption coincided with the rise of the psychogenic model of infertility. In doctors’ surgeries and in the popular media, it became common belief that infertility caused by psychological barriers could often be ‘cured’ by the adoption of a child; taking on the mothering role would resolve a woman’s psychological conflicts, and pregnancy would surely follow. Infertile couples therefore sought adoption as a route to biological parenthood. Tragically, their desires for adoptive children coincided with the beliefs of medical personnel and social workers that white middle-class infertile couples were more ‘deserving’ parents than single mothers. As a result, between the 1950s and 1970s, thousands of babies were forcibly taken from single mothers and given to childless married couples for adoption. It is only in the past decade, with a national inquiry into forced adoption, that the voices of the mothers and children whose lives were irrevocably altered by these policies and practices have finally been heard.
Tracey Loughran’s chapter on feminism and infertility in Britain between the 1960s and 1970s addresses from a different angle the issue of whose voices are privileged, and why, in different discourses of infertility. Loughran compares representations of involuntary childlessness in popular women’s magazines and Women’s Liberation Movement (WLM) publications to illustrate the dilemmas infertility posed for feminism. Mass-market women’s magazines were sympathetic to the suffering of infertile women, but this validation of infertile women’s desires depended on the implicit (and sometimes explicit) belief that the maternal instinct governed women’s social roles. The WLM challenged this biological determinism and fought for women’s control over reproduction. In practice, however, feminist assertions of ‘the right to choose’ usually focused on the right not to have children, and so the feminist press rarely engaged with infertility in the 1970s. In the 1980s, as influential feminist theorists argued that new reproductive technologies resulted from a ‘technopatriarchal’ conspiracy and reified global inequalities in power, infertile women were further marginalized within the feminist movement. Yet although elements within the movement stigmatized and marginalized their infertile sisters, Loughran argues that the WLM nevertheless provided women with the tools to create alternative discourses of infertility - tools which feminist historians can use to create new histories.
These complexities are further explored in Sara MacBride-Stewart and Rachel Simon-Kumar’s review of feminist debates on infertility in the global North and global South. In the 1970s, feminists in the First World fought for women’s rights to reproductive choice and control, but by the 1990s it was increasingly clear that discourse focused on the right to contraception and abortion was ill-adapted to the needs of women in other parts of the world who were subject to policies of population control. Moreover, the claims of infertile women in the West to a ‘right’ to biological parenthood, underpinned by the rhetoric of individualism, often depended on the exploitation of women in the Third World. Although there are no easy answers for a feminism that seeks to challenge patriarchy, ethnocentrism, and the exploitative legacy of colonialism while maintaining the rhetoric of emancipation for all, its best hope lies in the efforts of feminists in the global South to claim self-defined reproductive rights, autonomy, and recognition. The global feminism of the future must work to develop understandings that resolve the tensions between women’s productive and reproductive roles, and are equally valid for high- fertility developing countries and low-fertility Western nations.
The next two chapters turn to groups whose members might be considered privileged in certain contexts, but who are also potentially subject to commercial exploitation or stigmatization. Rene Almeling’s ethnographic research on egg and sperm donors in the contemporary USA examines gendered experiences of bodily commodification. Almeling compares the different physical experiences of men and women in gamete donation. She argues that although egg donors undergo similar physical experiences to women in the first stage of an IVF cycle, financial reimbursement for these risks results in very different bodily experiences to those who are paying to undergo them. Although sperm donors do not undertake similar kinds of physical risks, they also report that masturbation is experienced differently in the contexts of ‘work’ and ‘pleasure’. Finally, Almeling reflects on the effects of the social organization of egg donation as gift exchange, and sperm donation as paid work. Throughout, she argues that the social context in which physical experiences occur directly affects how the body feels. Her research should warn ethnographers of past societies to be wary of treating the body as a transhistorical object, experienced in the same way regardless of context; the problem of how to balance awareness of bodies as constructed objects without reducing them to mere constructs is one of the most urgent problems facing historians of the body.
The section ends with Virpi Ylanne’s analysis of media representations of postmenopausal reproduction and infertility in twenty-first-century Britain. Those who can access reproductive technologies to become pregnant and give birth even after the end of their ‘natural’ childbearing lives might be viewed as one of the most privileged groups of women in contemporary society. However, as Ylanne shows through a close reading of headlines, common adjectives, and terms of reference within newspaper articles, media representations of ageing mothers are riven by contradictions. While these mothers are sometimes represented positively, usually by female journalists, as committed, experienced, and good parents, when these representations are perceived as atypical they can reinforce negative perceptions of older mothers as unrealistic and selfish. Yet, as Ylanne shows, while postmenopausal mothers are often marginalized as ‘others’ and represented as a threat to traditional social and familial structures, the positioning of these women as objects of evaluation also credits them with agency in making choices about their reproductive lives - an agency often denied to younger infertile women in media narratives that focus on their ‘desperation’.
In all, this section illustrates how issues of power and control reverberate in strange and unexpected ways in discourses and experiences of infertility. Often, an individual’s status as victim, hero, or abuser depends on perspective, and the same person can hold these positions simultaneously. The white middle-class adoptive parents of illegitimate children in mid-century Australia could be seen either as victims of infertility, cruelly denied biological parenthood by a twist of fate, as loving and generous people who saved innocent children from the stigma of illegitimacy and provided them with homes, or as powerful perpetrators complicit in the abuse of single mothers’ rights. Similarly, postmenopausal mothers in contemporary Britain can be viewed as unfortunate women who were unable to fulfil their dreams of parenting at a younger age because they did not have the financial or practical resources to provide for children, as brave pioneers of a new reproductive landscape where technology has defeated biology, or as immensely privileged individuals who exploit both lax legal controls on the use of reproductive technology in other countries and the bodies of their economically marginalized sisters in the Third World.
This might lead to the depressing conclusion that exploitation is inevitable wherever infertile individuals and couples pursue their desires for parenthood, but there are perhaps more positive lessons to be taken from this exploration of agency and invisibility. These historical investigations also show that no matter how apparently marginalized and powerless, people can find ways to enact their agency within and against oppressive structures, and although the struggle is often long, painful, and costly, it makes the path easier for those who follow. As groups organize to resist stigmatization and marginalization, they are able to make their voices heard. Mantel’s story, which opened this section, remains a tragedy; the children she might have had will remain ghostly presences forever. However, her ability to tell her story, and for it to be published and read, was dependent not only on her own grit, determination, and talent, but on the social effects of a feminist movement that exposed the influence of gender ideologies on medicine and psychiatry. Finally, of course, in making the stories of the powerless known, history itself becomes a tool to right the wrongs of the past, and a resource that can be used to prevent the same disasters being repeated in a different age. This section demonstrates and enacts this work of reparative justice.
- 1. Hilary Mantel, Giving Up the Ghost: A Memoir (London, 2010), p. 185.
- 2. Mantel, Giving Up the Ghost, p. 155.
- 3. Mantel, Giving Up the Ghost, pp. 171-82 (quotation p. 174).
- 4. Mantel, Giving Up the Ghost, p. 177.
- 5. Mantel, Giving Up the Ghost, pp. 184, 209.
- 6. Mantel, Giving Up the Ghost, p. 158.
- 7. Mantel, Giving Up the Ghost, pp. 211-12.
- 8. Mantel, Giving Up the Ghost, pp. 231, 239.
- 9. Mantel, Giving Up the Ghost, p. 227.