A Study Of Women Living Without Children After Infertility PDF
Preview A Study Of Women Living Without Children After Infertility
University of Pennsylvania ScholarlyCommons Doctorate in Social Work (DSW) Dissertations School of Social Policy and Practice Spring 5-14-2012 Recovery From Traumatic Loss: A Study Of Women Living Without Children Afer Infertility Marni Rosner Recovery From Traumatic Loss: A Study Of Women Living Without Children Afer Infertility Abstract RECOVERY FROM TRUMATIC LOSS: A STUDY OF WOMEN LIVING WITHOUT CHILDREN AFTER INFERTILITY Marni Rosner Ram A. Cnaan, Ph.D., Dissertation Supervisor Infertility, from a mental health perspective, is known to have a profound efect on the lives and identities of women. Although many women resolve their infertility by incorporating non-biological children into their conception of family, some women are either unable or unwilling to do so, and live without children. Tis qualitative study focused on the long-term transition to living without children afer pursuing treatment for infertility, and the impact living without children afer infertility has had on marriages, relationships with family and friends, and identity. In-depth interviews were conducted with 12 women, aged 35-54, who pursued treatment for infertility, are now living without children (either biological, conceived through third- party reproduction, or adopted), and have not pursued treatment for at least three years. Findings include themes of experiencing trauma; actively deciding to end treatment; moving into living without children; a sense of profound loss and grief; processing the grief; acceptance and choice; reestablishing identity and turning toward the future; growth and opportunity; improved spousal relationships, and enduring issues. Like most stage models, progressing through these phases was not systematic. Findings suggest that it took, on average, 3-4 years for the women to fully emerge from feeling like being infertile was their primary identity. Implications for clinical practice and future research are also discussed. Degree Type Dissertation Degree Name Doctor of Social Work (DSW) First Advisor Ram A. Cnaan, Ph.D. Second Advisor Lina Hartocollis, Ph.D. Tird Advisor Marilyn S. Paul, Ph.D. Keywords infertility, trauma, childless, post treatment, identity, post-traumatic growth Tis dissertation is available at ScholarlyCommons: htp://repository.upenn.edu/edissertations_sp2/20 Subject Categories Social and Behavioral Sciences Tis dissertation is available at ScholarlyCommons: htp://repository.upenn.edu/edissertations_sp2/20 RECOVERY FROM TRAUMATIC LOSS: A STUDY OF WOMEN LIVING WITHOUT CHILDREN AFTER INFERTILITY Marni Rosner A DISSERTATION in Social Work Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Social Work 2012 _____________________________ Ram A. Cnaan, Ph.D. Supervisor of Dissertation Professor and Associate Dean for Research and Doctoral Education _____________________________ Richard J. Gelles, Ph.D Dean, School of Social Policy and Practice Dissertation Committee Lina Hartocollis, Ph.D. Marilyn S. Paul, Ph.D. RECOVERY FROM TRAUMATIC LOSS: A STUDY OF WOMEN LIVING WITHOUT CHILDREN AFTER INFERTILITY Copyright 2012 Marni Rosner Dedication This dissertation is dedicated to all of the women who participated in this study. You not only gave your time, but revisited a painful period of life in a wish to help others. It was an honor to meet all of you, and a privilege to hear your stories. Because of you, this project was far more gratifying than I ever imagined it would be. We must be willing to let go of the life we have planned so as to have the life that is waiting for us. -Joseph Campbell. iii Acknowledgments I would like to thank my dissertation chair, Ram A. Cnaan, Ph.D., for his unwavering support, guidance, and encouragement throughout this process. His style of urging me forward while granting me just enough autonomy, along with his playfulness, could not have been a better personal fit. To Lina Hartocollis, Ph.D., I am grateful. She has been consistently available for questions, feedback, and support, and has been a steadfast leader as Director of the DSW program. Her quick responses to my needs were reassuring during stressful times, allowing me to remain focused and disciplined. I have always felt Marilyn S. Paul, Ph.D., by my side, supporting and encouraging me. She has helped to keep me accurate and methodical in my research. I would also like to thank all the teachers in the DSW program who helped to make this experience extremely rewarding. Jeffrey Applegate was particularly outstanding; he conveyed his love of our profession in a unique way, and served as a role model for excellence in teaching. Leslie Alexander instilled in me a love and appreciation for qualitative research for which I am grateful. I have been enriched in so many ways, both personally and professionally, from this program. My cohort, as well, contributed to this. We began as strangers, and ended as family. I owe a great debt of gratitude to Pamela Tsigdinos, who generously contributed her time and effort in assisting with recruitment of study participants. Pamela beautifully and accurately christened infertile women the “silent sorority”, and then changed the rules. Through her blog, she continues to influence, challenge, and question...well, everything. I am lucky to count her as a friend. iv My family and longstanding friends have been wonderful. My mother has always been my biggest fan; my brother and his family often provided me with a respite and a lift when I most needed it. Christina read, edited, discussed, and indulged me to no end. Estelle read and edited, often on a moment’s notice. I could not have done this without the constant support of Rich Daniele; he has, for years, been a supervisor, colleague, and friend. Finally, I would like to thank my husband, Jay, who never stopped believing in me. From him, I learned about love, kindness, and acceptance. He is my rock. Traveling through life with him by my side brings me the greatest happiness. v ABSTRACT RECOVERY FROM TRAUMATIC LOSS: A STUDY OF WOMEN LIVING WITHOUT CHILDREN AFTER INFERTILITY Marni Rosner Ram A. Cnaan, Ph.D., Dissertation Supervisor Infertility, from a mental health perspective, is known to have a profound effect on the lives and identities of women. Although many women resolve their infertility by incorporating non-biological children into their conception of family, some women are either unable or unwilling to do so, and live without children. This qualitative study focused on the long-term transition to living without children after pursuing treatment for infertility, and the impact living without children after infertility has had on marriages, relationships with family and friends, and identity. In-depth interviews were conducted with 12 women, aged 35-54, who pursued treatment for infertility, are now living without children (either biological, conceived through third-party reproduction, or adopted), and have not pursued treatment for at least three years. Findings include themes of experiencing trauma; actively deciding to end treatment; moving into living without children; a sense of profound loss and grief; processing the grief; acceptance and choice; reestablishing identity and turning toward the future; growth and opportunity; improved spousal relationships, and enduring issues. Like most stage models, progressing through these phases was not systematic. Findings suggest that it took, on average, 3-4 years for the women to fully emerge from feeling like being infertile was their primary identity. Implications for clinical practice and future research are also discussed. vi Table of Contents Dedication .......................................................................................................................... iii Acknowledgments.............................................................................................................. iv Abstract .............................................................................................................................. vi Chapter I.............................................................................................................................. 1 Infertility: Statistics, Culture, and Society .......................................................................... 1 Introduction ..................................................................................................................... 1 Definitions and Statistics ................................................................................................ 2 Who Seeks Treatment ..................................................................................................... 3 Environmental and Economic Influences on Fertility .................................................... 5 Age and Fertility ............................................................................................................. 6 Length and Impact of Treatment..................................................................................... 8 Pronatalist Ideology ........................................................................................................ 9 Idealization of motherhood and biology. .................................................................... 9 Brief history of pronatalism. ..................................................................................... 11 Pathologizing infertility. ........................................................................................... 12 The Voluntary Childfree ............................................................................................... 13 Reflection, thoughtfulness, and ambivalence. .......................................................... 14 Actively choosing to be childfree. ............................................................................ 15 Perceptions of women without children. .................................................................. 17 The Involuntarily Childless........................................................................................... 18 Transitioning to living without children after treatment. .......................................... 19 Post-treatment. .......................................................................................................... 20 Summary. .................................................................................................................. 25 Social Support ............................................................................................................... 26 Complicated and Disenfranchised Grief ....................................................................... 28 Chapter II .......................................................................................................................... 31 Theoretical Framework, Literature Review, and Research Questions ............................. 31 Identity Formation and Development ........................................................................... 32 Erik Erikson and psychoanalysis. ............................................................................. 32 Communication studies and social psychology. ....................................................... 33 Goffman’s “facework”. ............................................................................................. 34 Relational-Cultural Theory ........................................................................................... 35 Relationships and development of a sense of self. ................................................... 35 Envy and self-care..................................................................................................... 37 Stigma Theory ............................................................................................................... 39 Sociocultural impact. ................................................................................................ 39 Everyday experiences. .............................................................................................. 42 Kohut: The Selfobject and Mirroring Needs ................................................................ 42 Resolution ..................................................................................................................... 44 Growth After Infertility Treatment ............................................................................... 45 Posttraumatic growth. ............................................................................................... 46 Meaning-making. ...................................................................................................... 46 vii
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