MARY NGHI NGO
Society-level expectations and attitudes have been shown to impact women in many ways. For example, body image dissatisfaction, especially among women, has been linked by various qualitative studies to factors including the media and societal expectations of female body image [1,2]. This societally-influenced dissatisfaction can have further impacts on behaviour and health. For example, negative body image has been found to be positively correlated with sexual avoidance, depression, anxiety, and eating disorders . Given the impact of societal factors on women’s body image, which can in turn impact their health and well-being, it is worth exploring the impacts of other societal factors. This article will examine societal attitudes and expectations regarding reproduction as factors impacting women’s health and well-being. What follows is an argument that pronatalism (or natalism) and related social attitudes that promote childbearing are societal factors that influence women’s health. Discussed below are the countries of Israel, Zimbabwe, and Nigeria as case studies of pronatalist and patriarchal ideals that create a detrimental norm of childbearing.
Israel is a multicultural society where there is a near omnipresence of militarist and patriarchal attitudes, both of which facilitate pronatalist beliefs. Israeli militarism lies in the political unrest between Israel and Palestine. For Israeli women of either Jewish or Palestinian ethnicities, the ongoing and unending conflict between their nations presents an uncertainty of progeny survival. The likelihood of their children perishing as a result of political conflict is a source of pressure for women to have as many children as possible . In this manner, Israeli militarism driven by political unrest creates a climate of natalism within the population.
Pronatalism is further perpetuated by the patriarchal attitudes that pervade throughout the Israeli population. These attitudes designate women as mothers, assigning them the role of giving birth to and taking care of children. In this and other similar societies, women are at a lack of alternative choices, frequently opting for motherhood .
The population of Zimbabwe share similar beliefs with regards to birth-promotion and the maternal roles of women. However, pro-childbearing attitudes exist here in a different form. The cosmological views of the Shona ethnic group consider life to be linked to collective identities and emphasize the individual’s role in reproduction. The female reproductive tract is treated like a temple solely for creation . This ideology mirrors the aforementioned patriarchal maternal expectations of women in Israel in its objectification of female reproductive systems (and female bodies) as baby-creating machines. Childlessness is seen as unnatural, unholy and unworthy—compared to fertility and childbearing, which are the norm. These sentiments are exemplified by the presence of certain funeral rituals that single out childless individuals .
Interviews and focus groups with Zimbabweans have explored various perceptions pertaining to reproduction. When asked to describe what they considered “reproductive successes,” it was found that having five living children was considered successful. Additionally, women in rural regions were expected to procreate until menopause, when they are no longer able to bear children. In Harare, Zimbabwe’s capital, interviews and focus groups found that middle-aged couples viewed having three children as a reproductive success, while younger couples viewed that having one was successful enough . While reproductive expectations may vary throughout the country in terms of quantity, the underlying demand to procreate is still ubiquitously present.
Nigeria is another example of patriarchal societal attitudes impacting childbearing. However, instead of the attitudes being with regards to maternal expectations, they pertain to the gender of the child. A 2008 study of national birth history data found patrilineality to correlate with birth spacing. A majority of the Nigerian ethnic groups surveyed had child gender preferences in favour of boys. When these preferences remain unmet, birth intervals shorten due to an increase in childbearing to meet gender preferences . In this case, child gender preference is another way patriarchal attitudes pressure women to keep bearing children.
Returning to the case of Israel, this population’s societal emphasis on reproduction and growing the family is further demonstrated by state-sponsored healthcare decisions. Israel houses a marked gap between conception/prenatal services and contraception/postnatal services. As of 2017, the country has an In-Vitro Fertilization (IVF) policy that allows nearly unlimited rounds of this therapy, making IVF ten times more accessible in Israel than the global average. Additionally, access to antenatal screenings has increased to ensure low rates of infant mortality. In contrast, women’s agency is limited when it comes to contraception. Women seeking abortions must petition for and await the decision of a four-person committee of physicians and social workers. Furthermore, should women end up giving birth (of their own accord or not), there is a reported lack of adequate long-term health services following . This disparity demonstrates policy and care that emphasizes and prefers childbearing.
IVF is part of a larger family of Assisted Reproductive Technologies (ART). In their use to remedy infertility and allow childbearing, ART are not only a testament of pronatalist sentiments but are also a perpetuant of them [3,6]. Scholars have argued that ART, while beneficial, challenge current understandings of kinship and parents, as well as commodify reproduction [6,7,8]. For example, surrogacy—wherein a third party gestates and carries a fetus to term—is a form of ART that has been argued to commodify women as babymakers, a notion similar to the pro-natalist views present in Israel, Zimbabwe, and Nigeria [6,7]. It is further important to note that the global spread of ART is a result of biotechnological eurocentrism and the assumption that western countries are determiners of modernity . As the creators of ART to remedy infertility, western countries also uphold fertility norms and are not immune to perpetuating pronatalist-like ideals.
These pressures for women to conceive and give birth (parity) have implications for women’s physical health. Increased instances of parity have been linked to long-term health detriments including all-cause mortality. An Israeli study examining 40,454 women (who gave birth to 125,842 children) found that high parity, quantified as six or more pregnancies, is linked to an increased risk of death from cancer, coronary heart disease, and circulatory disease, among many others .
Parity pressures also have further impacts on the emotional and mental well-being of women. Due to the childbearing expectations brought on by pronatalist and patriarchal attitudes, there is ample stigma in these societies towards infertility. In Israel, infertility is treated as a disease, which has an immense emotional impact on women who find themselves unable to conceive . Further discussion with the Zimbabwean focus groups revealed that women having trouble conceiving must endure unpleasant traditional treatments, strict IVF protocols, and scrutiny of their reproductive organs, among others . Furthermore, interview and focus group participants in Zimbabwe reveal that there are external expectations of childbearing from family members and friends, potentially resulting in a loss of support systems should these expectations not be met .
In addition to the abovementioned maternal and women’s health implications, studies by the Pan-American Health Organization of 35,000 infant deaths show that infant mortality increases at higher birth orders (that is, at greater nth birth) . There are also studies that suggest that smaller birth intervals, the time between a previous birth and conception,—which often occurs as a result of wanting more children—increase both neo- and post-neonatal mortality [3,10].
Regardless of the location and society, the idea that women are purposed for procreation pervades in many forms. It is upheld by a variety of societal factors, including attitudes, expectation and technologies. These factors create a norm of fertility that promotes childbearing, indiscriminately shames women for childlessness and pressures them into having children, all of which have negative impacts on their physical health and mental well-being.
 Bedford, J.L. & Johnson, C.S. (2008). Societal Influences on Body Image Dissatisfaction in Young and Older Women. Journal of Women and Aging. 18(1), 41-55. https://doi.org/10.1300/J074v18n01_04
 La Rocque, C.L. & Cioe, J. (2011). An Evaluation of the Relationship between Body Image and Sexual Avoidance. The Journal of Sex Research. 48(4), 397-408. https://www.jstor.org/stable/41319002
 Granek, L. & Nakash, O. (2017). The Impact of Militarism, Patriarchy and Culture on Israeli Women’s Reproductive Health and Well-Being. International Journal of Behavioural Medicine, 24, 893-900. https://doi.org/10.1007/s12529-017-9650-7
 Runganga, A.O., Sundby, J. & Aggleton, P. (2001). Culture, Identity and Reproductive Failure in Zimbabwe. Sexualities, 4(3), 315-332. https://doi.org/10.1177/136346001004003003
 Fayehun, O.A., Omolulu, O.O., Isiugo-Abanihe, U.C. (2011). Sex of preceding child and birth spacing among Nigerian ethnic groups. African Journal of Reproductive Health / La Revue Africaine De La Santé Reproductive, 15(2), 79-89. Retrieved November 1, 2020, from http://www.jstor.org/stable/45120807.
 Inhorn, M.C., Birenbaum-Carmeli, D. (2008). Assisted Reproductive Technologies and Culture Change. Annual Review of Anthropology, 37, 177-196. Retrieved November 1, 2020, from http://www.jstor.org/stable/20622620
 Anderson, E.S. (1990). Is Women’s Labor a Commodity? Philosophy & Public Affairs, 19(1), 71-92. Retrieved November 1, 2020, from https://www.jstor.org/stable/2265363
 Resnik, D.B. (1998). The commodification of human reproductive materials. Journal of Medical Ethics, 24(6), 388-393. doi:10.1136/jme.24.6.388
 Dior, U.P., Hochner, H., Friedlander, Y., Calderon-Margalit, R., Jaffe, D., Burger, A., Avgil, M., Manor, O., Elchalal, U. (2013). Association between number of children and mortality of mothers: results of a 37-year follow-up study. Annals of Epidemiology, 23(1), 13-18. https://doi.org/10.1016/j.annepidem.2012.10.005
 Winikoff, B. (1983). The Effects of Birth Spacing on Child and Maternal Health. Studies in Family Planning, 14(10), 231-245. doi:10.2307/1965748