“Either stay grieving, or deal with it”: the psychological impact of involuntary childlessness for women living in midlife

Fieldsend, Megumi and Smith, Jonathan A. (2020) “Either stay grieving, or deal with it”: the psychological impact of involuntary childlessness for women living in midlife. Human Reproduction 35 (4), pp. 876-885. ISSN 0268-1161.

Abstract

Study question: What is it like for women to be involuntarily childless in midlife? Summary answer: Involuntarily childless women may be suffering from prolonged grief due to its ambiguous and intangible nature; however, they are also striving to find ways of dealing with their internal pain in order to live with their loss. What is known already: Many studies examining issues around human reproduction have tended to place childlessness in the realm of medicalised infertility and report generalised mental issues, such as depression and psychological distress, existing among women undergoing fertility treatments. Few studies, however, have focused on the individual with regard to the experiential significance of involuntary childlessness and living beyond the phase of trying for a baby. Study design, size, duration: A phenomenologically oriented person-centred qualitative design was used. In-depth semi-structured interviews were conducted with 12 White British women, who identified themselves as involuntarily childless, recruited via three leading childless support networks in the UK. Participants/materials, setting, methods: In order to retain an idiographic commitment to the detailed account of a person’s experience, a homogeneous and purposive sampling was used applying the following criteria: women aged between 45 and 55, in long-term heterosexual relationships with no adopted children, step-children, or children of a partner from a previous marriage or relationship, and no longer trying to have a child. Considering the homogeneity of ethnic background, and wishing to respect cultural differences, this study focused on White British women living in the UK. Of the 12, one woman was found to not meet the criteria, and therefore, the experiential data of 11 interviews were used for the study and analysed using interpretative phenomenological analysis (IPA). Main results and the role of chance: Two higher order levels of themes that illustrate intrapersonal features were identified: the intrapersonal consequences of loss, and confronting internal pain. The former explicated the depth of internal pain while the latter revealed ways in which the participants deal with it in their everyday lives. The important finding here is that both themes are co-existing internal features and dynamically experienced by the participants as they live with the absence of much-hoped-for-children. Limitations, reasons for caution: Given the homogenous sampling and the small number of participants, which is consistent with IPA, we want to be cautious in generalising our study findings. Wider implications of the findings: This study offers the view that there might be potential mental health issues surrounding involuntary childlessness that are currently overlooked. Particularly because the loss of hope cannot be pathologised, and the grief is ambiguous and intangible, it might make people’s grieving process more complicated. An ongoing sense of uncertainty also may persist in that involuntarily childless people may develop symptoms similar to those diagnosed with Prolonged Grief Disorder (PGD). The overall findings elucidate the need for clinicians, counsellors and health professionals to be aware of the possible association with PGD, and promote long-term support and care in helping to maintain psychological well-being for people dealing with involuntary childlessness. Furthermore, this research points to an educational application for younger people by offering information beyond an explanation of infertility and fertility treatment, helping to understand the lived experience of involuntary childlessness. Study funding/competing interest(s): No funding was obtained for this study. The authors have no conflicts of interest to declare. Trial registration number: Not applicable. Key words: involuntary childlessness / grief and coping / psychological well-being / interpretative phenomenological analysis / qualitative research

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