The social and cultural consequences of being childless in poor-resource areas

Approximately 70-80 million couples world wide are currently infertile (Bos et al., 1995; Boivin et al., 2007) and it can be estimated that tens of millions of couples are primary infertile or childless. For most people, having children is immensely important; not being able to have children is a major life problem. There is also a large group of women and men, who have children, possibly form a previous relationship, who desperately wants to have another child. A considerable body of research in Western countries has shown that involuntary childlessness has strong psychological consequences (see for reviews: Greil, 1997; Brokvich and Fisher, 1998). Most of the studies carried out in this domain are quantatitative and some are qualitative. Both kind of studies, point in the same direction: there are various psychological and psychosomatic effects, and especially women are affected. The most frequently mentioned effects are distress, raised depression and anxiety levels, lowered self-esteem, feelings of blame and guilt, somatic complaints, and reduced sexual interest. For a small minority of women and men in the Western world these effects are at a clinical level or can be considered extremely serious (Greil, 1997). It is interesting that social and cultural consequences are seldom mentioned in the reports on these studies. When these aspects are considered, they are often related to studies about elderly people without children, regardless of the reason for being childless. It is stressed in the reports of these studies that frail old people without children have less social support (cf., Johnson, 2006) and a less robust network for independent living compared to old people with children (cf., Wenger et al., 2009). Wirtberg and co-workers (2007) however, carried out a study that is unique in the sense that it aims at elderly involuntarily childless women. They reported on 14 women, and described that in all cases but one sexual life was affected negatively and that half of these elderly childless women were separated. Some studies, report the difficulty that childless couples have in communicating with friends who do have children. They describe negative (although sometimes well-meant) remarks within the couples' social worlds, for instance at birthday parties and other social gatherings; however, supportive reactions are also mentioned very often (Greil, 1991; van Balen et al., 1996; Schmidt, 2006). It is possible for childless couples to participate in the 'world of children', especially if couples have good friends or relatives who have children. They are able to participate in the lives and activities of the children of their friends and relatives by, for instance taking care of the children for a part of the week or when the parents are on holiday; taking the children to school, music lessons or sports activities; or going to games or shows in which the children participate. An early study on childlessness found that about ten per cent of couples had chosen this strategy as a way of coming to terms with their childless life (van Balen, 1991) Also, recently Wirtberg and colleagues (2007) described this as typical coping strategy for childlessness. It appears that in the West childless people are not formally excluded from being involved with raising children. In the 1990s, studies were published about the effects of childlessness in developing countries. The focus of these studies was different from studies carried out in the West. Although psychological effects are described, the main concerns are social and cultural effects (van Balen and Inhorn, 2002). This paper presents a review and an analysis of the results of the studies done to date in poor-resource areas regarding the social and cultural effects of being childless.