Key Social Norms Take-aways Infertility-related stigma in Malawi is deeply embedded in gendered social norms, shaping not only how infertility is understood but also how individuals are treated based on perceptions alone. Infertility, even if only suspected, disrupts normative pathways to adulthood, identity, and social status. Women are especially burdened by stigma, blamed for infertility due to moralized assumptions about contraception and sexual history, while men face emasculation and status loss. This stigma profoundly influences reproductive decision-making for all—regardless of actual fertility—by reinforcing early childbearing and discouraging contraceptive use. Addressing this stigma requires community-level change that challenges entrenched gender roles and collective perceptions.
Objectives This study aimed to examine how infertility-related stigma is produced and experienced at both the individual and community levels in rural Malawi, with a focus on how social norms and gender roles shape perceptions, labels, causes, and consequences of infertility.
Methods The study utilized 12 sex-stratified focus group discussions with 104 participants (men and women aged 15–49) conducted in rural villages in Malawi from July to September 2018. Discussions explored community perceptions of fertility, infertility, and reproductive expectations. Data were analyzed using thematic coding guided by Link and Phelan’s stigma framework, which identifies mechanisms such as labeling, stereotyping, exclusion, and status loss.
Results Infertility was found to be highly stigmatized, and stigma was enacted through three primary mechanisms: labeling individuals as infertile using derogatory terms, attributing infertility to stigmatized behaviors (e.g., contraceptive use, abortion, promiscuity), and reinforcing consequences such as social exclusion, discrimination, and marital instability. Women faced intense scrutiny and were seen as failing in their expected roles if they did not bear children soon after marriage, while men were mocked for perceived lack of virility. Stigma also affected individuals who were not infertile but feared being perceived as such, leading to risky reproductive behaviors to avoid suspicion.
Conclusions Infertility stigma in Malawi is not only personal but collective, driven by entrenched gender norms and community expectations about fertility. It alters the context in which reproductive decisions are made, affecting both men and women through exclusion, diminished social status, and disrupted relationships. Interventions must go beyond addressing individual experiences and instead target the social structures and normative beliefs that perpetuate stigma. Integrating infertility into broader sexual and reproductive health strategies and including both men and women in stigma-reduction efforts are critical steps toward achieving reproductive equity.