Talking about infertility in Malawi A starting point for developing interventions in order to alleviate the problem of infertility

Executive Summary

‘Everyone has stories, but some stories actively devalue people and other stories are not recognized as valuable at all. Some stories empower people and other stories disempower people’

Infertility is a significant public health problem in African countries like Malawi. There are strong expectations that married people ought to bear children, and those who do not are often excluded, (verbally) abused and blamed for their infertility.2,3,4 Tackling infertility is essential, if the holistic reproductive health concept adopted by the Malawian government: ‘a state of complete physical, mental and social well-being’ is to be met.5 This study examined how people in Malawi with a fertility problem, their relatives and practitioners talk about infertility, its consequences and solutions. In particular, it looked at effects of their descriptions and explanations, such as justifying actions or attributing blame. Four ways of talking about and understanding infertility may have problematic consequences, thus contributing to the problem of infertility:

  • People portray polygamy and extramarital affairs as culturally required, reasonable and inevitable responses to infertility. This minimizes people’s responsibility for these practices, which may have problematic (health) implications.
  • People avoid blaming others when describing relationship troubles. This may limit their potential to stand up for themselves.
  • When explaining their (in)action, people take into account that they ought to seek help. However, seeking help intensively may have financial and physical consequences, and places considerable demands on Malawi’s health system.
  • Some practitioners emphasize their ability to cure infertility, and some attribute problems to patients. This may give clients false hopes, and obscures health services as a potential source and solution for problems.

Call for action

The government, NGOs, medical institutes, traditional and religious leaders should develop cost-effective social interventions, aimed at:

  • Raising awareness about: – the problem of infertility and related problematic practices (e.g. having unsafe sex to solve a fertility problem). – unhelpful ways of describing and understanding childbearing, infertility, its consequences and solutions, which contribute to the problem.
  • Discouraging unhelpful practices and ways of talking, whilst facilitating more empowering alternatives (e.g. ‘marriage is not about children’, rather than ‘when married you have to have children’).


  • For instance, through initiating critical discussions (in communities, churches, media) of exemplary ‘unhelpful’ and empowering stories of childbearing, infertility, its consequences and solutions.

Source: Queen Margaret University


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