The Responsibilization of Fertility

As someone who was on a prolonged fertility journey, one of the things that surprised me the most was how damn responsible I felt to fix our fertility problem. Even though my partner and I were in it together, I took month after month of negative pregnancy tests deeply to heart. What was I doing wrong? How come I couldn’t just figure it out? When was I finally going to find the secret that was going to lead us to our baby? I charted my cycle, changed my diet (a bunch of times), adjusted my exercise routine, switched out all my personal care products, went to the doctor… I tried acupuncture, nutrition therapy, naturopathy, fertility yoga, reiki, visualization, prayer, spells. I tried everything that was accessible to me. And in the end, when nothing made a dent, our doctors didn’t have the answers, and no baby came, I felt defeated and like a personal failure. And sadly, I’m not the only one. 1 in 6 couples opposite-sex couples will struggle with fertility and same-sex partners hoping to conceive a child have their own unique challenges to build their families. For people experiencing fertility struggles, this can take a significant toll on their mental health which is often made worse by the sense we sometimes feel that it’s all our fault – we must just not be doing enough.

A person presses their hand to a window, looking out onto a rainy day.

Responsibilization is a social process whereby individual people are made responsible for things that aren’t entirely under their control and without attention to their social context. In the case of fertility, this means that individual people feel responsible for solving their fertility problems, despite the very real obstacles on their path that simply are not under their control. Yes, we can do our best to eat right and have sex at the right times, but we can’t force our body to make a baby. Responsibilization often puts pressure on people to do everything ‘right’ and to have everything figured out even though there are barriers that get in the way. The standards to which people are held are often unrealistic (ex: never being exposed to environmental toxins). Even when we acknowledge that these standards are unrealistic, this often isn’t enough to eliminate the expectation that people at least strive to meet them. Responsibilization exists on the spectrum of social control, in which people are taught to govern their own behaviour in socially acceptable ways. When you feel responsible for something – like not getting pregnant is somehow your fault – you put all the expectation to fix things on yourself. And when the people who are struggling are responsibilized, their struggles are seen with less empathy and compassion by people around them who have not encountered these difficulties.

As a ‘fertility warrior’ and sociologist, even though I knew this was what was happening to me, I still felt the full weight of that pressure on myself. And responsibilization is rife in fertility spaces. Responsibilization can look like assuming that fertility struggles between men and women are the sole responsibility of women (both “she is the problem” and “she is the solution”). It can also look like expectations that people will undergo significant lifestyle changes to enhance their fertility regardless of the means to do so and despite there being significant factors affecting our fertility that should be the responsibility of regulatory oversight and not individual consumers (ex: endocrine disrupting chemicals in many household items). People going through fertility treatments also take on the added responsibility for doing their own injections, managing medical appointments with work schedules, and paying for it even in places where access to health care is enshrined in our legislation. Finally, one way that I see responsibilization show up in fertility spaces is through this idea about manifestation. “Just relax and it will happen,” “stay positive and don’t give up,” “stress causes infertility”… what all these messages have in common is that they tell people who are struggling that they are the cause of their own problems and they have to just get out of their own way, not realizing that if people could so easily solve their problems, they’d be solved by now.

For those of you walking your own fertility journey right now, I want you to know that your struggles are not your fault. While there are things inside of our control that we can choose to work on because it feels better to do something than do nothing, your struggles to conceive are very, very rarely attributable to something simple you should be doing. Fertility is complex. And if you’re having trouble balancing the healthy habits you’re working on with everything else, please know that there is always place for you in my practice. I’ve been there, and I’d love to be there with you to help you find a balance that truly works for you.

For folks who are serving people on fertility journeys in their practice, it’s important that we think critically about the recommendations we give to people who are trying to conceive. While we do want to empower the people we work with to care for themselves holistically and know that this can help move them closer to bringing home a baby, we also need to be mindful of the undue pressure that is placed on individuals to solve a complex problem without sufficient help and the additional social barriers that some may face as they attempt to meet their goals. Of import, we need to recognize that social inequalities play a significant role in who is able to access the supports they need to finally build their families and who does not. Not everyone makes enough money to pay for alternative care providers or assisted reproductive technologies. Not everyone’s jobs permit them to take time off work for treatment or has flexible work options. Not everyone has the money to overhaul their diet (ex: eating all organic foods). Not everyone lives in a place where specialist medical care is even available (some people have to travel long distances for treatment). And some people, depending on their social location, are actively discouraged from pursuing fertility treatment because of the biases of their health care providers. We should be striving to the part of the solution – which includes educating the public about holistic fertility care and lifestyle as well as advocating for equitable access to reproductive health care and technologies – not yet another person who makes people struggling feel alone and weighed down. It’s pretty much my mission, and I hope you all will join me.