The Effects Of Infertility On Status And Access To Resources Among
Wamakonde Women Of Tanzania

Principal Investigator: Monique Borgerhoff Mulder

Co-Principal Investigator: Jeanette M. Frediani

University of California at Davis

Abstract

This project involves the dissertation research of an anthropology
student from the University of California‑Davis, studying the effects of
infertility on the status of women in a Tanzanian society of Africa. The
proposal will test the hypothesis that infertile women will undergo
marital stress because of divorce, lack of resources, and general lack
of prestige, subject to the women\'s\' position in local kin networks.
In addition the proposal will look at the role of children\'s labor in
their mother\'s general status position. Methods include a survey sample
of a complete village, more in‑depth interviews of a stratified
subsample of women of the village, and a time allocation study.

This research is important because Africa has a very high population
growth rate and is known as containing societies in which the group
welfare is promoted above that of individuals. This sort of fine‑grained
research will tease apart the causes of high and low prestige among
women as they relate to the number of children they have. The advance in
our knowledge will be useful to population planners who must design
policies to limit reproduction which are acceptable to the local
population. In addition it adds to our expertise about this important
region of the world.

Principal Investigator: Monique Borgerhoff Mulder Co‑Principal
Investigator: Jcanette M. Frediani

**[Project Summary]{.underline}**

Sub‑Saharan Africa is noted for its pronatalist cultural tradition,
making subfertile and childless women social deviants. Although women
themselves may not necessarily be the source of the infertility problem,
the pressure to produce many children can become an important source of
stress that can affect her in several spheres of her life. Infertility
is a complicated problem. Research has shown that infertility can
produce distress of crisis proportions among many Western women, yet no
study has examined its multifactorial affects on the quality of life for
sub‑Saharan African women. Studies about demographic aspects of high or
low fertility levels in sub‑Saharan Africa characteristically
concentrate on the epidemiologic or demographic aspects of high or low
fertility levels, including their relation to gender, political and
ecological issues. The psychological impact of infertility on women in
Third World countries remains understudied making the infertile African
woman a little known subject.

Although the literature is filled with accounts about how infertility is
a devastating life experience for African women, no study has
systematically examined how different fertility levels affect women\'s
position within their community (in terms of status and prestige).
Furthermore no study has methodologically examined how various fertility
levels affect a woman\'s access to important economic resources and how
her fertility may affect her productivity. This project proposes to be
the first study to examine the effects of differential levels of
fertility in order to understand how infertility affects African women
with the primary declared hypothesis stating that women with higher
fertility levels acquire more resources and acquire higher levels of
status and prestige than do infertile women.

The WaMakonde of the Mtwara region on southeast coast of Tanzania suffer
from one of the highest infertility rates in Tanzania. Sexually
transmitted diseases (STDs), especially in the form of pelvic
inflammatory disease (PID), are the leading causes of infertility in the
region. A pilot study conducted during the summer of 1996 confirmed that
the Mtwara region is ideal for this study. Confirmation was obtained by
interviewing women from several villages who perceived themselves as
infertile, District Medical Officers and physicians, and village
leaders.

The hypothesis will be tested by using data collected through detailed
demographic and economic surveys, pile‑sorting techniques to determine
indigenously perceived ratings of community members status, prestige and
wealth (which will be statistically tested against fertility levels),
time allocation studies of women (and their children\'s) activities, and
semi‑structured and unstructured interviews to examine how fertile women
perceive the lives of infertile women as well as to better understand
how infertile women experience their lives.

**NSF FORM 1358 (1/94)**

![](media/image1.png){width="5.020138888888889in" height="8.26875in"}

**PROJECT DESCRIPTION See GPG Section II.D.4 for guidance on contents.**

THE EFFECTS OF INFERTILITY ON STATUS AND ACCESS TO RESOURCES AMONG
WAMAKONDE WOMEN OF TANZANIA

Principal Investigator: Monique Borgerhoff Mulder

Co‑Principal Investigator: Jeanette M. Frediani

**[Problem Statement]{.underline}**

Without children to help in labor intensive setting, how do infertile\'
women accomplish the many tasks they are required to fulfill? Are
subfertile and childless women in sub‑Saharan Africa in a more
impoverished position than their more fertile peers? Are there
differences in resource allocation between fertile and infertile women?
How are infertile women treated in family dynamics? How are they viewed
by their community? Is the cause of their infertility affecting their
health and possibly their productivity? Where do women seek help for
infertility and how are they treated? More importantly, how do all these
factors affect infertile women psychologically, especially when they
live in a pronatalist society? There are many questions that must be
addressed to understand how infertility may affect a woman\'s life in
the sub‑Saharan African setting. Infertility is a complex issue
entailing material, social, biological and psychosocial outcomes for
those who suffer from it.

As one wades through the literature dealing with fertility in western
and developing nations, one comes across numerous anecdotal reports that
childless women suffer in a myriad of ways ‑ economic/material, social,
status, psychosocial. For the present, these negative outcomes are
referred to here as \"stress\". The aim of this research is to identify
the significance of each of these factors. While infertility has come
under detailed investigation in Western societies, there is still a
considerable gap in understanding the mechanisms whereby infertile women
are stressed. Furthermore, few studies have directly addressed the
multifactorial aspects of infertility in developing nations. Indeed the
few studies that do address infertility focus on only one aspect of how
infertility affects women\'s lives. Though the results will only be
appropriate to the particular community in which it is studied, future
research should be able to build on the design of this study to evaluate
the hypotheses across a wider range of ethnographic and social contexts.

This project will investigate the relationship between differential
levels of fertility and how infertility affects women\'s status,
prestige and access to valuable economic resources throughout their
life‑cycle among the Muslim WaMakonde of southeast Tanzania. Specific
economic and social forces encouraging high fertility will be
investigated. I propose that studying differential levels of fertility
(high, medium, low‑infertile) will demonstrate that infertile women
experience a lower quality of life, both materially (economically) and
socially by testing if infertility, especially childlessness, leads to
higher levels of poverty among women. The combination of traditional
pressures that women bear large numbers of children in order to attain
community status and prestige and to gain access to important economic
resources through marriage are the stressful mechanisms that I argue
will contribute to the relationship of fertility levels to a woman\'s
overall quality of life. If PID is the cause of infertility, then there
may be additional stress resulting from chronic pelvic pain. The
cumulative effects of these factors must not be ignored.

\' In this proposal, infertility will refer to childlessness (primary
infertility, never having a live birth) and subfertility (secondary
infertility, the cessation of previously possessed reproductive
ability).

**[Theoretical Background and Hypotheses]{.underline}**

[1. Social and Material Stress]{.underline}

The conventional ethnographic literature on Sub‑Saharan African sheds
considerable light on the potential impacts of differing fertility
levels on women\'s status. First, the literature on marriage and
bridewealth is particularly revealing. Marriage has been the dominant
mechanism regulating the social relations of human reproduction. In
Africa, the transfer of bridewealth appears to be closely tied to the
reproductive and economic services of women (Fortes, 1962;
Radcliffe‑Brown 1950; Schneider 1964) demonstrating many of the
relationships that would be predicted from such premises. Among
patrilineal pastoral groups the quote \"bridewealth is childwealth\"
exemplifies the emphasis on women\'s procreative ability (Goody 1973:
11). Marriages are considered to be more stable among groups with
bridewealth systems, however in many African groups bridewealth may be
returned when a woman is barren, or it is expected that her family will
provide another wife (Radcliffe‑Brown, 1950). Furthermore, while there
is much reason in questioning the old fashioned view that variations in
bridewealth directly reflect variation in women\'s status (Ogbu 1978),
it is clear that in some cases women are themselves very concerned with
the smooth and successful transmission of payments on their behalf
(Hakansson 1988). Marriage, the transactions involved, and the
expectations as a result of the union therefore involve economic,
political and social issues dependent on the intertwining between
productive and reproductive processes (Goody, 1973; Meillassoux 1981;
Paige and Paige 1981; Vuorela 1987). Borgerhoff Mulder (1989) suggests
that women who have high bridewealth paid for them produce large
families as compared to those who do not accrue as high of a
bridewealth, indicating that men place great value on their wives
fertility.

Joseph\'s (1993a, b) concept of \"patriarchal connectivity\" suggests
the mechanisms whereby family and community relationships affect status
and may relate to the links between social value, fertility, and
patriarchy found in studies such as Borgerhoff Mulder\'s. Joseph uses
the term \"patriarchal connectivity\" to describe the relationships that
allow a person to feel a part of significant others. Like Joseph\'s
study of Arab families in Lebanon, patriarchal lineage based societies
such as also seen in sub‑Saharan Africa regard the family or community
as being more valued than the person. The individual achieves meaning
and a sense of self within the context of the family or community.

Second, numbers of children appear to have a major impact on women\'s
wealth. Many African societies allocate resource distribution for both
production and consumption purposes, based on lineage, kinship, gender,
and age groups (Dankelman and Davidson 1988). Because land is typically
held by the lineage, farm size becomes dependent upon the size of one\'s
household (Goody, 1973), making it difficult for women without children
or few children to gain access to these important resources.
Furthermore, men tend to hold rights in property and resources and
marriages typically consists of younger women marrying older men.
Because of this age discrepancy, women typically outlive their husbands.
Property rights are transferred after the men die, making women
dependent on their children or their lineage and reflects how access to
material property is affected by the numbers of children. Studies such
as Oboler (1985), Borgerhoff Mulder (1995, 1988), Vuorela (1987),
Hakansson (1988) examine the various aspects of the economy and their
relationship to production and reproduction. Although studies such as
Borgerhoff Mulder\'s (1989) demonstrates a relationship between
bridewealth payments, age of menarche and marriage, and fertility
levels, no study has systematically tested the longterm outcome of
differential levels of fertility on a woman\'s status, prestige, and
access to economic resources with special reference to its effects on
infertile women.

Third, children ensure marital stability. A woman\'s infertility may
lead to rejection by her partner, social ostracism, and loss of access
to land or other productive resources (Jigging 1994). Even though the
infertility problem may not be due to reproductive malfunctioning of the
woman, she is typically the one who is blamed and who experiences the
personal grief and frustration (Inhorn 1994a,b). In many African
societies it is considered the husband\'s right to have children, with
divorce or taking a second wife as the common result of a childless or
subfertile union (Ardener 1962, Betzig 1989; Larsen 1989; Pebley and
Mbugua 1989). Furthermore, if the woman\'s infertility is caused by an
STD, she may be stigmatized by her community since **such** diseases are
identified with the violation of norms associated with acceptable sexual
behavior in a particular cultural context (Green, 1994).

The literature about Sub‑Saharan African abounds emphasizing children as
a mark of prestige and wealth. For example, Kuper (1950) describes for
the Swazi that wives and children are a man\'s greatest asset. A
woman\'s status is enhanced by the regular birth of children;
childlessness or few children may subject her to scorn and ridicule.
Acsadi and Johnson‑Acsadi (1990) describe how the African woman is
encouraged to follow the cultural ideology to bear large numbers of
children and may be labelled a deviant if she demonstrates behavior that
breaches accepted norms. A woman without a child is considered not to be
fully adult and is often seen to be of minimal economic and social value
in terms of household wealth or lineage continuity (Caldwell and
Caldwell, 1990).

[Hypothesis I:]{.underline}

I hypothesize that women suffering from infertility will undergo
predictable social and material stress as a result of loss of access to
resources and social stigmatism.

a\. Infertile women are expected to have low levels of prestige in their
community.

b\. High divorce rates, loss of spousal support and weakening of
exchange and support networks are expected when a woman is not achieving
the fertility objective for her husband and his lineage. Even if her
spouse does not initiate a divorce, I predict that infertile women will
receive fewer resources than her more fertile co‑wife and will be
expected to suffer economically.

c\. Sub‑Saharan African ethnic groups typically do not value or support
individualism and autonomy. I predict that women\'s infertility will be
seen as deviating from the group efforts of her husbands lineage,
resulting in ostracism and stress.

d\. The degree of stress may vary depending on whether the woman has any
matrikin locally resident who may be of assistance (less stress) as
compared to the infertile woman who does not have matrikin locally
resident (more stress). Women with local wealthy maternal kin will be
able to use strategies such as market integration which will allow
infertile women other opportunities to modify some of the negative
effects of infertility and gain some level of economic autonomy.

[II. Labor Stress:]{.underline}

Children affect women\'s production because of their labor contribution.
The value of children in African women\'s lives may be a critical
explanatory factor of sustained high fertility rates (Cleaver and
Schreiber 1994; Kamuzora 1994). In Sub‑Saharan Africa, women are the
primary subsistence food producers and they perform the majority of food
storage, food processing, marketing, and the care of domestic animals
with often few, if any modern tools (Dankelman and Davidson 1988).
Children may provide relief from the work load, and may provide certain
economic and related social security measures, especially in old age,
making increased fertility a way of gaining additional labor to help
women meet their multiple and increasing production and household
management responsibilities (Caldwell, 1976).

There are competing theoretical arguments attempting to explain the
relationship between the economics of demand and value of children and
costs of children: intergenerational wealth flow theory and behavioral
ecology\'s parental investment. Intergenerational wealth flow theory
(Caldwell 1976) has been most commonly employed to explain and predict
demographic transition. Caldwell\'s theory focuses on the economic value
of children, specifically the enormous labor services, such that
infertile women would suffer in terms of high work loads. This theory
argues that wealth flows from younger to older generations where
demographic transition has not occurred, creating a demand for children.
If the net wealth transfer from children to parents is positive then
parents are expected to desire as many children as possible because
their wealth will increase as a function of the number of children they
produce. Caldwell\'s wealth flow theory is applicable in sub‑Saharan
African countries where the labor of many children in a
horticultural/agricultural subsistence society is argued to increase the
wealth of the family.

Behavioral ecology\'s parental investment theory, on the other hand,
argues that wealth flows travel in the opposite direction, from older to
younger generations, making children an overall net cost (Kaplan, 1994;
Turke, 1989). Parental investment assumes that individuals act to
maximize their inclusive fitness. However, like Caldwell, parental
investment explains how the increased costs of children encourage
demographic transition. Behavioral ecology would assume that children
pose net costs on their parents and that childless women should not be
labor stressed when compared to other women with children.

[Hypothesis II:]{.underline}

Two alternative hypotheses with contrasting predictions are presented. I
would expect in societies where extensive agriculture is practiced that
women will be labor stressed without the help of children. This view
arises from Caldwell\'s model that children provide enormous labor
resources to their parents, specifically their mothers, such that
childless women would suffer in terms of high work loads. Conversely, if
the behavioral ecologists model is more appropriate, I would expect
children to pose net costs on their parents, making childless women not
as labor stressed as compared to women with children. This can be tested
by comparing the work loads of women of different ages with different
fertility levels in a Mtwara village.

a\. I argue that the relationship between a woman\'s fertility level and
labor stress must be analyzed in phases of the life cycle, since a woman
with younger children will be additionally labor stressed because of
child care as compared to the infertile woman without childcare
responsibilities or the woman who has older children which can help with
childcare and other responsibilities. As children get older they will
provide significant labor to their mother and may contribute to any
business ventures a woman may attempt to undertake.

**[Literature Review]{.underline}**

For Western women there is an enormous amount of literature
demonstrating the psychological and social distress which occurs when
infertility is discovered yet few studies have examined the affects of
infertility on women\'s lives in developing countries. This review will
first cover the literature which has studied the effects of infertility
on Western women and will primarily include literature from the United
States. The second part of the review will include the literature
examining the effects of infertility on African women.

[1. The Effects of Infertility on Western Women]{.underline}

Literature for the Western woman focuses on the infertility experience
of the white, middle class because these are the women who are
socioeconomically capable of affording the biomedical interventions for
infertility. Typically, women undergoing diagnosis and treatment for
infertility are the ones located for infertility studies. Ironically, it
is women who are least advantaged who have a higher incidence of
infertility due to the higher rates of STDs among this socioeconomic
group and due to their lack of health care access (Hirsch & Mosher,
1987; Mosher & Pratt, 1987). The U.S. Congress, Office of Technology
Assessment (1988) states that in 1982 black women were 1.5 times as
likely to be infertile as white women, and that women having less than a
high school education were also more likely to be infertile.
Unfortunately, little is known how other racial and ethnic groups
experience infertility with minority women either being excluded or the
few that are interviewed are lumped in with the white middle class
responses (Warnke, 1993).

Several authors have labelled the emotional distress that infertile
women experience as the \"crisis of infertility\" (Bresnick and Taymor,
1979; Cook, 1987; Forrest and Gilbert, 1992). The discovery of
infertility when fertility is desired is usually seen as a challenge or
loss of the primary life goal of motherhood (Forrest & Gilbert, 1992).
Burns (1987) describes the crisis as being \"so acute, severe, and
overwhelming that the family system is blocked, immobilized, and
incapacitated\" (360). Menning (1982) argues when infertility occurs
when fertility is desired becomes a condition exacting a heavy toll on a
woman\'s physical and psychological well‑being as well as on the quality
of her life. Infertility can become a chronic crisis because it can last
an indeterminate length of time, often with no identifiable onset or
solution, and is often a series of crisis events (Whiteford & Gonzalez,
1995; Butler & Koraleski, 1990).

Butler and Koraleski (1990) describe reactions exhibited by the
infertile as being typical to crisis and grieving. Behavioral
disturbances commonly seen are anxiety, disorganization, moodiness,
distractibility, unpredictability, and fatigue. The infertile experience
extreme tension and stress, and so headaches, stomach problems, and
other demonstrations of physical turmoil are common (Butler & Koraleski,
1990). Walling‑Millard (1993) postulated that stress response to
infertility would be similar to stress responses found in Post Traumatic
Stress Syndrome. Her research results confirmed the existence of what
she terms Infertility Stress Syndrome (ISS). She measured and compared
infertility stress with published trauma norms for other significantly
stressful life events. Walling‑Millard found that ISS produced results
which were *higher* than rape, family trauma and illness, and life
threatening events. Loss of significant other was only marginally higher
than ISS.

Some authors have described the distress women experience as identity
and role failure. The discovery of involuntary childlessness may cause
some women to experience \"spoiled identities\": they felt incomplete,
diseased, and experienced catastrophic role failure (Whiteford &
Gonzalez, 1995; Greil, et. al., 1988). R. Matthews & A. M. Matthews
(1986) argue that a woman has many identities, each woman placing these
identities into a \"salience hierarchy\". Those who place a greater
emphasis on a particular identity such as motherhood are the women whose
identities are most threatened by infertility (p. 645). A woman can
potentially go into \"identity shock\" when she discovers her
infertility and is unable to achieve the highly desired identity and
role of biological motherhood (R. Matthews & A. M. Matthews, 1986).

Several authors have focused on the stigmatizing affect of infertility.
Miall\'s work (1989) discovered that childlessness, whether it is
involuntary or voluntary, is viewed as a form of deviant behavior and
discredits or stigmatizes a woman. It is not uncommon for women who have
not had a biological child to be publicly reprimanded or rebuked by
women who have children, causing them to feel like they had been
personally diminished by words of others (Miall, 1985). They are
frequently treated by women with children as second‑class citizens and
report feeling that they are being misunderstood, excluded, devalued,
and/or rejected by others (Abbey, et. al., 1991; Warnke, 1993; Whiteford
& Gonzalez, 1995). Failure to reproduce appears to disqualify them as
members of the in‑group of mothers and demonstrates how society uses
social sanction and social control to encourage reproduction (Miall,
1985). Sandelowski (1993) describes involuntarily childless women as a
marginally deviant group, being both inside and outside of accepted
society: they conform and are motivated to want children but are deviant
because they violate behavioral norms by not having them.

The desired pregnancy often becomes a focal point in the infertile
woman\'s life in that it may overflow into other life domains including
work, finances, and social life (Abbey, et. al., 1992; Kraft, et. al.,
1980). Career plans and social relationships are often put on hold or
placed as low priority to the critically timed tests and procedures
(Mazor & Simons, 1984). For some women, the yearning for children can
make everything they work for seem meaningless; material comfort or the
accomplishment of career goals cannot fill the abyss caused by the
absence of a wanted child (Butler & Koraleski, 1990). They feel that
they lack dominion over their lives, feeling frustrated in their
attempts to meet various psychosocial needs because they can neither
experience parenthood nor fully seek alternative sources of satisfaction
as fulfilling (Callan, 1987).

It is not uncommon for women experiencing involuntary childlessness to
suffer relationship losses in the extended family and among friends
(Kraft, et. al., 1980; Forrest & Gilbert, 1992; Burns, 1987; Mahlstedt,
1985). Sibling relationships are especially vulnerable. Mahlstedt (1985)
believes that these breaks usually occur because of well‑intentioned but
insensitive remarks by others which leave the infertile woman feeling
unacceptable, misunderstood, unloved, or ashamed.

Several studies have indicated that the infertility experience may be
more devastating for women who express more traditional gender roles and
perceive fewer benefits of a childfree life­style, whereas the reverse is
true for \"nontraditional\" women who prefer to remain childfree
(Warnke. 1993). R. Matthews and A. M. Matthews (1986) describe a
hypothesis that women who have a large network of persons (family and
friends) supporting the motherhood identity are most likely to be
inclined towards motherhood and are the ones most likely to be affected
by a threat to that identity.

[2. The Effects of Infertility on African Women:]{.underline}

Feldman‑Savelsberg\'s (1994) research in Cameroon is one of the few
studies of infertility\'s effects on African women\'s quality of life.
Feldman‑Savelsberg (1994) demonstrates that through the use of culinary
metaphors Bangangte women present anxiety associated with infertility
which reflects material concerns of female poverty. Feldman‑Savelsberg
asserts that infertility and child loss become a cause of rural female
poverty among Bangangte women, putting a woman at greater risk of
becoming poor and diminishing her exchange and support networks.

Devisch (1993) examines ritual practice to understand the symbolic
meanings and cosmology of the Yaka of Zaire and how ritual is a healing
process for gynecological illness. Devisch acknowledges the stress
infertility plays not only in women\'s lives but in the lineage as well
since gynecological problems are seen as having their origin within
disruption of the kinship network and thus involves the social fabric.

Inhorn\'s (1994a, 1996) work in Egypt examines how infertility affects a
woman\'s life within the social and psychological context, demonstrating
that infertility makes women vulnerable in several areas of their social
lives. Inhorn\'s (1996) study focuses on urban infertile women living in
Alexandria and explores the various ways infertility affects an urban
Egyptian women. Inhorn explores how infertility permeates into every
aspect of an Alexandrian woman\'s life, causing stigma and ostracism,
friction within the kinship and community network, fear of divorce or
polygyny, conflict with her identity and social role, and the influence
of patriarchy and Islam on an infertile woman\'s perception of herself.
Inhorn (1994a) demonstrates to what extremes these infertile women from
urban Egypt will undertake to overcome infertility, showing how
infertile women seek help from both biomedical doctors and traditional
doctors. Inhorn\'s work demonstrates the many overlapping similarities
that women in Egypt share with Western women.

The only other literature dealing with infertility in Africa tend to
deal with the epidemiology and prevalence rates of infertility and the
closely related STDs such as Ericksen and Brunette (1996), Ericksen, et
al. (in press), and Larsen (1996, 1994,1989). Ericksen and Brunette use
World Fertility Surveys (WFS) and Demographic Health Surveys (DHS) from
twenty‑seven African countries to demonstrate the variation in
infertility rates within a country. They argue that social, behavioral
and cultural differences help explain the diversity of infertility and
childlessness rates between ethnic groups. Certain risk factors are
recognized as making individuals more susceptible to STDs, and they
assert that more ethnographic studies must be done to evaluate these
difference between groups. Ericksen, et al. study in Malawi puts this
argument to test, examining the social factors causing variance between
in risk factors between ethnic groups. Although the Malawi study focuses
primarily on the group differences for STDs, the study emphasizes how
STDs can lead to PID, infertility, and fetal loss due to spontaneous
abortions and stillborns.

Larsen\'s work also uses various fertility surveys to assess levels of
infertility in Africa. Larsen (1989) uses WFS surveys analyze sterility
in Cameroon, Kenya and the Sudan. She discusses risk factors associated
with sterility with an emphasis of risk factors associated with STDs.
Larsen (1994) uses WFS and DHS surveys to analyze sterility rates in the
African countries where these surveys are available. Again, certain risk
and behavioral factors are discussed. Larsen concludes that sterility is
so substantial in sub‑Saharan Africa that it must be considered a public
health issue. Larsen (1996) is especially pertinent to this proposal.
This study uses Tanzania\'s National Demographic Survey (1973) and
1991‑1992 DHS to analyze the degree of infertility in the twenty regions
of Tanzania.

Larsen, Ericksen and Brunette, and Ericksen et al. all add valuable
information about regional and cultural patterns predisposing women to
infertility along with dealing with epidemiology of infertility in
Africa, but they do not address how infertility may affect women in
other spheres in their lives. Devisch adds valuable information to how
an African society deals with infertility through ritual, but he also
does not address the multifactorial areas that infertility can affect a
woman\'s life. Feldman‑Savelsberg demonstrates the anxiety women feel
about infertility and acknowledges a relationship between infertility
and poverty, yet does not provide a systematic study to how this
conclusion is reached. Inhorn provides the most complete view of how
infertility affects women\'s lives in Egypt, but does not empirically
study if infertility can affect women economically.

**[The Research Setting]{.underline}**

This research will be conducted among the WaMakonde in the Mtwara region
of southeastern Tanzania. The region is known for its poverty which is
attributed to its geographic isolation from mainstream development, both
during the colonial period and postcolonially (Liebenow 1971). The
Mtwara region is considered to be a neglected region in terms of
academic and professional research. Compared to other regions of
Tanzania, academic dissertations, papers and books are scant for the
region (Koponen, 1994).

The WaMakonde are the third largest ethnic group of the 120 ethnic
groups found in Tanzania. However, their numbers do not represent the
relationship to their economic, social, and political development. The
WaMakonde were originally characterized as a matrilineal group, but like
other matrilineal Eastern Tanzanian peoples, they have shifted towards
patrilineal tendencies by reducing matrilineal loyalties and inheritance
claims and women\'s rights to their brother\'s property (Liebenow 1971;
Beidelman 1967; Dias 1961; Swantz 1985; Vuorela 1987; Wembah­Rashid,
1995). Along with inheritance patterns, practices such as marital
residence shifted from avunculocal to patrilocal tendencies. By the
1950\'s brideservice became uncommon and bridewealth became the
practice. These social transformations have been explained by the
coinciding of several historical forces which include Islam\'s
patrilineal emphasis, the impact of colonialism, cash cropping, and
labor migration. Although the WaMakonde have been Muslim for several
centuries, the impact of these forces with Islam encouraged the
transformation towards patrilineal tendencies to the advantage of men.
Few studies have focused on the WaMakonde and these studies concentrated
on wider sociopolitical aspects involving men, excluding women\'s
perspectives. Borgerhoff Mulder\'s and Swantz\'s 1993 observations among
the WaMakonde found that uterine relatives may still be an important
source of support to divorced women and children, suggesting the
possible reemergence of matriliny (personal communication). I was
informed by Dr. Wembah‑Rashid that the coast shows stronger patrilineal
tendencies and as one moves to the interior regions of Mtwara
matrilineal tendencies still persist. This has important theoretical
implications for understanding the mechanisms generating stress of
infertile women.

The WaMakonde provide an ideal research population to study for several
reasons. First, the emphasis of this study is to compare differential
levels of fertility with the focus being how variable levels of
fertility affect a woman\'s status, prestige and access to resources. A
population with a suspected high level of infertility is required to
obtain a suitable study sample. Larsen (1996) reports that infertility
is particularly high in Mtwara with the region being further
distinguished as having the lowest total fertility rate (TFR) according
to the 1991‑1992 Tanzania Demographic and Health Survey. Despite only a
2 percent use of contraceptives, Larsen (1996) reports a TFR of only 3.9
children. Larsen also reports that the Mtwara region is known to suffer
from higher levels of STDs than most other areas of Tanzania.

Second, the influence of Islam allows for quick divorces and polygynous
marriages, two common consequences that infertile women may find
themselves. In a traditional African society where gender ideologies
emphasize marriage and motherhood, the combination of high infertility
levels, low status and prestige, and difficult access to resources sets
a stage for behavioral and psychological studies to how women and their
community react to different levels of fertility.

I conducted a pilot study during the summer of 1996. Through the
interviews I conducted on twenty‑six women who perceived themselves as
infertile I discovered that five of the twenty-six women under the age
of 36 reported being in their third marriage, the youngest being 24
years old. One 29 year old woman reported being in her fourth marriage.
Several of the 26 women reported that infertility was the cause of their
divorce or their husband taking another wife. Several women expressed
that if they had children they could be more successful economically
because they would 1) be able to venture into business opportunities, 2)
their children could help in any already established business while they
carried other activities. One woman stated that her father had given her
coconut and cashew trees on his farm, but she was too busy with her
marital responsibilities to benefit from the potential economic
advantages. She declared that if she had children, they could help her
with some of her responsibilities so that she could go to her father\'s
farm to harvest her trees. Many women also took in other\'s children.
Almost all of these children were from the woman\'s natal family. Not
one woman expressed fostering as being a satisfactory alternative,
saying that the child can leave to go back to its mother and that she
would not have a child to be with her when she was old and sick.
Although most of these women reported that fostered children helped with
labor in some way, others said the children were too young to help. The
potential for these women to utilize natal kin for resources varied
since some had families living close by and others did not. There was
also variability to whether the couple lived near the husband\'s parents
and this reflected in the variability of family dynamics and stress that
women felt from the husband\'s family.

District Medical Officers (DMO) and doctors working in the region
confirmed that there is a high incidence of STDs and PID. Several
doctors expressed the high number of women who have approached them with
infertility problems. My research ideas have sparked the interest of the
medical community along with the Finnish development agency, RIPS (Rural
Integrated Participatory Support), a component of Finnagro.
TorLundstrom, RIPS program manager has been most supportive, a definite
advantage since RIPS wields prominent political influence in the region.
J.A.R. Wembah Rashid and Maria Liisa Swantz, two distinguished
anthropologists specializing in Tanzanian ethnic groups, are both
employed by RIPS and have lent their support. Finally, I have made
contact with Mama Mwangata, a WaMakonde herself, who is a retired
Maternal and Child Health Regional Coordinator. She has expressed her
interest and support for my project and may serve as my research
assistant. Other contacts include professor Chris Kamuzora from the
University of Dar es Salaam, former director of demography for Tanzania.

**[Applied Significance]{.underline}**

This study is important for 7 reasons. The first is that this study will
add to the integrated understanding of infertility\'s impact on women\'s
lives outside of the Western setting. Second, infertility is high in the
Mtwara region yet little is understood about the high infertility rate.
Third, this will be the first study in Africa integrating the
multifactorial effects that infertility can potentially cause in a
woman\'s life, especially the relationship between social consequences
and economic resources. Fourth, it allows a testing of two opposing
theories to determine if children are a net cost or a net gain as labor
resources for women. The fifth is to demonstrate that the concern about
high fertility in sub‑Saharan Africa is not the only problem that
African women face. Typically demographers concern themselves with why
demographic transition is not occurring in many areas of Africa. Answers
from this study could help explain why high fertility is desired,
especially in an area with high rates of infertility. Sixth,
opportunities for applied intervention given my association with RIPS
and their support and interest in my project. RIPS has conducted applied
work in the Mtwara region for over 20 years and has had active
participation in village life. Finally, Larsen (1996) concludes her
paper on Tanzania stating in concordance with my view that infertility
has many other implications besides women\'s health, including economics
of households, communities and regions, and the psychosocial effects.
Larsen appeals to researchers to examine these other influences on
infertile African women\'s lives.

**[Research Design and Methods]{.underline}**

Data Collection:

Several levels of data collecting and analysis will be employed to test
the predictions listed above which will include two samples of women.
Each level of data collection will be done on 6 months intervals. The
first sample of women will be the large sample representing each woman
in the selected village and will comprise the first 6 months. The second
sample will be taken from first and will be selected to represent
different fertility levels during the second 6 months. The third six
month interval is described here although funding is not being requested
for this part of ­the study at this time.

I.  First 6 months: Sample one:

```{=html}
<!-- -->
```
A.  The following information will be collected for each woman in the
    first sample:

1\. Reproductive and sexual history: to include dates of all live births
and their fates. miscarriages‑ how far along in the pregnancy did they
occur, age of menarche, first sexual contact, number of sexual partners,
use of contraceptives.

2\. Marital history: date(s) of marriages and divorces. Wife order in
marriage, number of co‑wives. This information will be cross‑related
with reproductive history to determine the relationship between
fertility levels and divorce and/or polygyny.

3\. Household composition: Fostered children, parents, siblings, etc.
Temporary or permanent member.

4\. Household economics: Size of farms, amount of land under cultivation
(with specific note to land that could be under cultivation), number of
domestic animals, crops (subsistence and cash) and if they are divided
by gender, management of income, income derived from fishing, additional
costs (ie, school fees for children).

5\. Opportunities to alternative income: Crafts, making and selling of
local foods *(mandazi ‑* a sweet fried bread, *kashatta ‑* a peanut
candy), tea shops, and other market integration strategies.

6\. Distance from natal family (for both husband and wife): This
information will help to understand family dynamics and will include how
long the husband and wife have lived in the village and where they
originated. This data will help to analyze the relationship between a
woman\'s opportunity to resort to matrikin for economic resources and
opportunities.

B. During the same period that this first sample data is being
collected, I will also conduct wealth, status and prestige rankings for
the women in the village. Informants will be asked to rate various
community members by pile‑sorting with cards labelled with various
community members so that ordinal scale data of community ranking may be
obtained and tested statistically against other variables. This has two
implications:

1\. Economic productivity and wealth: to compare my results from the
data collected from the first survey with the emic perception of wealth
in the community. I can then test this against fertility levels. 2.
Status and prestige: to test if there is a correlation between the emic
perception of status and prestige in the community and fertility levels.

II Second six months: Sample 2:

A. During my absence from the field, information from the first sample
will be analyzed and then a subsample reflecting different levels of
fertility will be selected. The second sample will compose of a
selection of six groups of women: women with high fertility, medium
fertility and low fertility, with and without husbands. The sample will
be controlled for age and fertility levels throughout a woman\'s life
span. The sample will be broken down into four age distributions: 40
years and older, 30‑39 years, 20‑ 29 years, and 15 to 19 years. This
will represent different phases of a reproductive and post‑reproductive
woman\'s life so as to test how differential levels of fertility affect
a woman\'s quality of life both psychosocially and economically.

1\) A more detailed survey will include additional questions regarding
women\'s ownership or managership of property. Land allocation will be
measured for these women to test what resources women in polygynous
marriages, monogamous marriages, and women who are head of households
receive in relation to their fertility levels. This will entail detailed
retrospective analysis of property acquisition (where they have received
various resources‑husband, lineage?). What do they own and what happens
(or has happened) in the case of a divorce or death?

2\) Health history: Specifically questions related to impaired
fertility. Women will be asked if they exhibit the clinical symptoms
associated with STDs/PID.

B.  With the use of the second sample, time allocation studies with the
    use of spot observation (Borgerhoff Mulder and Caro, 1985) will be
    conducted to determine how women in each of these groups spend their
    time and to determine how much help they receive from their
    children. Women will be questioned about where they have received
    various resources (husband, lineage, etc.). Children will be
    included in the time allocation study to determine the labor
    resource that children provide and how division of labor may be
    affected by the woman\'s age and the age of her children. The time
    allocation study will be performed by randomly visiting a stratified
    sample of households with different fertility levels over a period
    of six months to capture different activities during different
    seasons. Households will be visited up to four times per week, on
    different days for two weeks of each month. Time of day and where
    and when households will be visited will be determined by using a
    random numbers table. This part of the research will establish the
    relationship between the number of children a woman has, her access
    to land, other economic opportunities and the economic benefits she
    derives from her children\'s labor. Once a month, interviews will
    briefly include how she fared on her economic activities ‑sales,
    cash income, expenditures.

III Third six months:

A. Community reaction to differential levels of fertility:

1\. Participant observation will examine how the study population reacts
to childless women as compared to women with several children.

2\. Unstructured and semistructured interviews will be conducted to
determine how the community perceives childless women.

B. Infertile women\'s responses to how they view their predicament:

1\. How does their infertility affect their place in the community and
their access to economic resources. Case studies of childless women\'s
lived experience will be the focus, examining how these women construct
a space for themselves, allowing this silenced and disadvantaged group
to have a voice.

2\. Through participant observation and unstructured interviews I will
determine what strategies childless and subfertile women use to improve
their economic situation, i.e. networking with maternal kin and market
integration.

3\. How is infertility treated? Women will be asked where they seek help
for their infertility and what this treatment entails. Do they go to a
traditional healer, a biomedical doctor, maternal kin? Is there ritual
involved that helps them psychologically?

C. Interviews with traditional healers will help establish the emic
categories for infertility and illnesses and conditions related to
sexual intercourse along with the ethnomedical treatment for such
conditions.

Analysis:

1\. With the use of logistic regression analysis from data collected in
the demographic and economic surveys, different levels of fertility will
be tested against multiple independent factors and covariates on a
dependent variable. This will enable the assessment of the validity of
whether there is a difference between fertility levels and access to
economic resources.

2\. Results from the wealth, prestige and status ranking will be tested
against the demographic and socioeconomic surveys to determine if the
emic categories coincide with differential levels of fertility.

3\. Number of observations for various activities for both women and
children will be calculated and a the frequency for each activity will
be calculated to determine how much time women and children spend
working. This will allow the evaluation of women\'s work loads and
fertility levels.

4\. The results from participant observation and semistructured
interviews of the community\'s perception of infertile women and
infertile women\'s narratives will be analyzed against the statistical
findings from the above analyses.

**[Research Time Table]{.underline}**

*Note: This project is expected to take 18 months to complete, not
including time to return to the U.S. The full research schedule is noted
here although only 12 months of assistance is being requested.*

Feb ‑March 1998: Travel to Dar es Salaam, Tanzania. Establish and
re‑establish university, government official and RIPS contacts; travel
to field site; choose neighborhood base and make arrangements for living
accommodations; hire Makonde research assistant/interpreter; March‑Aug
1998: Intensive study of Swahili; with help of assistant, test
questionnaires developed prior to departure and revise accordingly,
conduct demographic and economic surveys, perform wealth, status and
prestige rankings. Aug. 1998: Return to the United States; analyze data;
select a subsample for behavioral and economic monitoring for the
following 12 month period, and select subsample for the qualitative data
collection. (While in the U.S., support is not required). Oct.
1998‑April. 1999: Return to Tanzania and to field site. Reestablish ties
within the community. Begin time allocation studies. Once a month
conduct interviews with woman of the house on her economic activities
for the month. Continue in depth interviews with subsample. April 1999:
Return home; process data, computer analysis, formulation of findings.
Begin writing proposals for final 6 months of research. (Support not
required for this period).

Final 6 months of research: When funding has been located then
unstructured and semistructured interviews along with participant
observation will be conducted among infertile women and community along
with interviews with traditional healers.

**REFERENCES CITED**

Abbey, Antonia, Frank M. Andrews, and L. Jill Halman

1991 Gender\'s Role in Responses to Infertility. Psychology of Women
Quarterly 15(2): 295­316.

Acsadi, George, and Gwendolyn Johnson‑Acsadi

1990 The Demand for Children and for Childspacing. *In* Population
Growth and Reproduction in Sub‑Saharan Africa. G. Acsadi, G.
Johnson‑Acsadi, and R.A. Bulatao, eds. Pp. 155‑185. Washington D.C.: The
World Bank.

Ardener, E.

1962 Divorce and Fertility: An African Study. London: Oxford University
Press

Beidelman, T. O.

1967 The Matrilineal Peoples of Eastern Tanzania. London: International
African Institute.

Betzig, Laura

1989 Causes of Conjugal Dissolution: A Cross Cultural Study. Current
Anthropology 30(5): 654‑676.

Borgerhoff Mulder, Monique

1988. Kipsigis Bridewealth Payments *in* Human Reproductive Behavior.
      Edited by L.L. Betzig, M. Borgerhoff Mulder, and P.W. Turke, pp.
      65‑82. Cambridge: Cambridge University Press.

1989. 1989 Early Maturing Kipsigis Women Have Higher Reproductive
      Success Than Late Maturing Women and Cost More to Marry.
      Behavioral Ecology and Sociobiology 24: 145‑153. 1995 Bridewealth
      and Its Correlates. Current Anthropology 36 (3): 573‑603.

Borgerhoff Mulder, and Tim Caro

1985 The Use of Quantitative Observational Techniques in Anthropology.
Current Anthropology 26 (3): 323‑330.

Bresnick, Ellen, and Melvin L. Taymor

1979 The Role of Counseling In Infertility. Fertility and Sterility
32(2):154‑156.

Burns, Linda Hammer

1987 Infertility as Boundary Ambiguity: One Theoretical Perspective.
Family Process 26:359‑372.

Butler, Robert R., and Stephanie Koraleski

1990 Infertility: A Crisis with no Resolution. Journal of Mental Health
Counseling 12(2): 151‑163.

Caldwell, John C.

1976 Toward a Restatement of Demographic Transition Theory. Population
and Development Review 2: 321‑366

Caldwell, John C., and Pat Caldwell

1990 Cultural Forces Tending to Sustain High Fertility. *In* Population
Growth and Reproduction in Sub‑Saharan Africa. G.T.F. Acsadi, G.
Johnson‑Acsadi, and R.A. Bulatao, eds. Pp. 199‑214. Washington D.C.: The
World Bank.

Callan, Victor J.

1987 The Personal and Marital Adjustment of Mothers and of Voluntary and
Involuntary Childless Wives. Journal of Marriage and the Family
49:847‑856.

Cleaver, Kevin M., and Gotz A. Schreiber

1994 Reversing the Spiral: The Population, Agriculture, and Environment
Nexus in Sub‑Saharan Africa. Washington, D.C.: The World Bank.

Cook, Ellen Piel

1987 Characteristics of the Biopsychosocial Crisis of Infertility.
Journal of Counseling and Development 65:465‑469.

Dankelman, Irene, and Joan Davidson

1988 Women and Environment in the Third World: Alliance for the Future.
London: Earthscan Publication Ltd.

Devisch, Rene

1993 Weaving the Threads of Life: The Khita Gyn‑Eco‑Logical Healing Cult
Among the Yaka. Chicago: University of Chicago Press.

Dias, A. Jorge

1961 Portuguese Contribution to Cultural Anthropology. Johannesburg:
Witwatersrand University Press.

Ericksen, Karen Paige, Cynthia Brantley, and Eta E. Banda

In Press Women\'s Reproductive Health and Disease in Social Context: The
Case of STD Histories in Urban Malawi. Social Science and Medicine.

Ericksen, Karen, and Tracy Brunette

1996 Patterns and Predictors of Infertility Among African Women: A
Cross‑National Survey of Twenty‑Seven Nations. Social Science and
Medicine 42(2):209‑220.

Feldman‑Savelsberg, Pamela

1994 Plundered Kitchens and Empty Wombs: Fear of Infertility in the
Cameroonian Grassf\~elds. Social Science and Medicine 39(4):463‑474.

Forrest, Linda, and Mary S. Gilbert

1992 Infertility: An Unanticipated and Prolonged Life Crisis. Journal of
Mental Health Counseling 14(1): 42‑58.

Fortes, Meyer

1962 Introduction in Marriage in Tribal Societies, ed. M. Fortes, Pp.
1‑13, Cambridge: Cambridge University Press.

Goody, Jack

1973 Bridewealth and Dowry in Africa and Eurasia. In Bridewealth and
Dowry, ed. J. Goody and S.J. Tambiah, Pp 1‑58. Cambridge: Cambridge
University Press

Green, Edward

1994 AIDS and STDs in Africa: Bridging the Gap Between Traditional
Healing and Modern Medicine. Boulder: Westview Press.

Greil, Arthur L., Thomas A. Leitko, and Karen L. Porter.

1988 Infertility: His and Hers. Gender and Society 2(2): 172‑199.

Hakansson, T.

1988 Bridewealth, Women, and Land. Uppsala Studies in Cultural
Anthropology 10.

Hirsch, Marilyn B. and William D. Mosher

1987 Characteristics of Infertile Women in the United States and their
Use of Infertility Services. Fertility and Sterility 47(4): 618‑625.

Inhorn, Marcia C.

1996 Infertility and Patriarchy. Philadelphia: University of
Pennsylvania Press.

1994a Quest for Conception: Gender, Infertility and Egyptian Medical
Tradition. Philadelphia: University of Pennsylvania Press.

1994b Interpreting Infertility: Medical Anthropological Perspectives.
Social Science and Medicine 39(4):459‑461.

Jiggins, Janice

1994 Changing the Boundaries: Women‑Centered Perspectives on Population
and the

Environment. Washington D.C.: Island Press.

Joseph, Suad

1993a Gender and Relationality Among Arab Families in Lebanon. Feminist
Studies 19(3): **465‑486.**

1993b Connectivity and Patriarchy among Urban Working‑Class Arab
Families in Lebanon. Ethos 21(4): 452‑484.

Kamuzora, Chris

1994 The Value of Children. Unpublished Manuscript.

Kaplan, Hillard

1994 Evolutionary and Wealth Flows Theories of Fertility: Empirical
Tests and New Models. Population and Development Review 20 (4): 753‑791.

Kraft, Adrienne D., Joseph Palombo, Dorena Mitchell, Catherine Dean,
Steven Meyers and Anne Wright Smidt

1980 The Psychological Dimensions of Infertility. American Journal of
Orthopsychiatry 50(4): 617‑628.

Koponen, Juhani

1994 Baseline Data on Mtwara and Lindi Regions in Tanzania.
RIPS/Finnagro Kuper, Hilda

1950 Kinship Among the Swazi in African Systems of Kinship and Marriage.
eds A.R. Radcliffe‑Brown and D. Forde Pp.86‑110. London, Oxford
University Press.

Larsen, Ulla

1996. Childlessness, SubLertility, and Infertility in Tanzania. Studies
      in Family Planning 27 (1): 18‑28

```{=html}
<!-- -->
```
1994. Sterility in Sub‑Saharan Africa. Population Studies 48:459‑474.

1989 A Comparative Study of the Levels and the Differentials of
Sterility in Cameroon, Kenya, and Sudan. *In* Reproduction and Social
Organization in Sub‑Saharan Africa. R.J. Lesthaeghe, ed. Pp. 167‑211.
Berkeley: University of California Press.

Liebenow, J. Gus

1971 Colonial Rule and Political Development in Tanzania: The Case of
the Makonde. Evanston: Northwestern University Press.

Mahlstedt, Patricia P.

1985 The Psychological Component of Infertility. Fertility and Sterility
43(3): 335‑346.

Matthews, Ralph, and Anne Martin Matthews

1986 Infertility and Involuntary Childlessness: The Transition to
Nonparenthood. Journal of Marriage and the Family 48: 641‑649.

Mazor, Miriam D., and Harriet F. Simons, eds.

1984 Infertility: Medical. Emotional. and Social Considerations. New
York: Human Sciences Press, Inc.

Meillassoux, Claude

1981 Maidens, Meal and Money: Capitalism and the Domestic Community.
Cambridge University Press: New York.

Menning, Barbara

1982 The Psychosocial Impact of Infertility. Nursing Clinics of North
America 17(1): 155‑163

Miall, Charlene E.

1985 Perceptions of Informal Sanctioning and the Stigma of Involuntary
Childlessness. Deviant Behavior 6: 383‑403.

Mosher, William D., and William F. Pratt

1987 Fecundity, Infertility and Reproductive Health in the United
States, 1982. DHHS Pub. No. (PHS) 87‑1990, Vital and Health Statistics,
Series 23, No. 14. Hyattsville, MD: National Center for Health
Statistics.

Oboler, Regina Smith

1985 Women, Power, and Economic Change. Stanford: Stanford University
Press

Ogbu, J. O.

1978. African Bridewealth and Women\'s Status. American Ethnologist
      5:241‑62 Paige, K.E. and J. M. Paige

1981 The Politics of Reproductive Ritual. Berkeley: University of
California Press.

Pebley, Anne R., and Wariara Mbugua

1989 Polygyny and Fertility in Sub‑Saharan Africa. *In* Reproduction and
Social Organization in Sub‑Saharan Africa. R.J. Lestheaeghe, ed. Pp.
338‑364. Berkeley: University of California Press.

Radcliffe‑Brown, A.R.

1950 Introduction in African Systems of Kinship and Marriage. eds. A.R.
Radcliffe‑Brown and D. Forde, Pp. 1‑85. London, Oxford University Press.

Sandelowski, Margarete

1993 With Child in Mind: Studies of the Personal Encounters with
Infertility. Philadelphia, PA: University of Pennsylvania Press.
Schneider H. K. 1964 A Model of African Indigenous Economy and Society.
Comparative Studies in Society and History 7:37‑55

Swantz, Marja‑Liisa

1985 Women in Development: A Creative Role Denied? New York: St.
Martin\'s Press.

Turke, Paul W.

1989 Evolution and the Demand for Children. Population and Development
Review 15(1): 61­ 90.

U.S. Congress, Office of Technology Assessment

1988 Infertility: Medical and Social Choices (OTA‑BA‑358). Washington
D.C.: U.S. Government Printing Office.

Vuorela, Ulla.

1987 The Women\'s Question and the Modes of Human Reproduction: An
Analysis of a Tanzanian Village. Transactions of the Finnish
Anthropological Society, No. 20. The Finnish Society for Development
Studies.

Walling‑Millard, Maryl

1993 Infertility Stress Syndrome: Trauma Exacerbated by Gender
Differences (A Study of Preadoptive and Adoptive Parents). Dissertation
for The Professional School of Psychology, San Francisco, CA.

Warnke, Melanie A.

1993 Women\'s Reproductive Life Cycle Issues. *In* Women, Relationships,
and Power: Implications For Counseling. E.P. Cook, ed. Pp. 179‑210:
American Counseling Association.

Wembah‑Rashid, J.A.R.

1995 The Southeastern African Bantu Matrilineal Tradition: The Case of
Fertility Regulation and Child Spacing Beliefs and Practices. Journal of
Asian and African Studies 50: 43‑58.

Whiteford, Linda M., and Lois Gonzalez

1995 Stigma: The Hidden Burden of Infertility. Social Science and
Medicine 40(1):27‑36.