#OTalk 13th August 2019 – Breaking the silence: involuntary childlessness in the occupational dark shadows

Alice Hortop @LaughingOT Senior Occupational Therapy Lecturer The University of the West of England (UWE Bristol) is hosting the weeks OTalk, here’s what she had to say.

According to the NHS (2017), 1 in 7 UK couples have trouble in conceiving a child. The charity Fertility Network UK (2019) disputes the NHS figure as an underestimation and proposes a more realistic figure is 1 in 6, equating to infertility affecting 3.5 million people in the UK. The World Health Organisation (WHO, 2019) state that female infertility is graded the 5th greatest, serious global disability in populations under 60. They describe infertility as a disease, a medical condition and disability, which means access to healthcare in relation to infertility, sits under the ‘Convention of the Rights of Persons with Disability’. In addition, Schmidt (2010) refers to infertility as a ‘social situation’; moving beyond the WHO medicalised definition. Childlessness is a major life theme deemed as a chronic stressor associated with low control and long lasting negative social and psychological consequences (Schmidt, 2010). Zandi et al (2017) support the need for health care to treat infertility broadly beyond the ‘mere’ individual and biological dysfunction.

Child bearing is an expected transition into adulthood both socially and politically, imperative to humankind survival. For many the failed aspiration to establish a family is an intense, recurring, chronic sorrow for an intangible loss (Tufford, 2009). Involuntary childlessness associates with emotional problems with higher depression scores over a 2-year period with a greater tendency towards catastrophizing. Both men and women reveal higher levels of depressive symptoms, women report highest levels (Kraaij, Garnefski and Vlietstra, 2008). 42% of people experiencing infertility describe feeling suicidal with 90% sharing feeling of depression and describing their experiences as traumatic (Fertility Network UK, 2019). People try to access parenthood through alternative means such as adoption reported higher depressive symptoms than those who chose not to.

In order to understand the lived experience of people who are involuntarily childless it is useful to identify if there is a shared understanding of their needs by health professionals. If their needs are understood and further addressed appropriately. Half of 129 gynaecologists interviewed recommended offering psychological counselling to clients following unsuccessful fertility treatment (Wischmann, 2007). The majority (90%) of women in a post fertility treatment follow up survey felt psychological counselling ought to be offered, particularly at the point of stopping treatment (Hammarberg et al, 2001). Health professionals demonstrate a significant underestimation of psychological need and the timing of its delivery. Psychological counselling and infertility treatments dominate literature for the intervention options in health and social care. The author’s experience of failing to access IVF, fostering and adoption did not include any signposting or offers of talking therapies, even when actively sought. If the lived experience of childless people was more fully understood would signposting to charities such as Fertility Network UK be more prevalent. Fertility Network UK offer a support line, support groups and a downloadable ‘More to life’ self-help guide.

This section examines if the research is relevant to occupational therapists and if so how. Occupational therapists are concerned with the occupations that people engage with, the influence of occupations on their identity and their roles in their lives. Being unable to experience being a mother or father may influence the variety of occupations engaged with, the roles played in the individual’s life and occupational identity. Twinley (2013) discusses the dark side of occupation, advocating occupational therapists need to understand occupations in the shadows. Twinley (2013) suggests historically occupational therapists focussed on the positive influences of occupations on health and wellbeing. The background literature indicates involuntary childlessness strongly associates with grief, alienation and loss. She argues a need for exploration into occupations not considered beneficial for health and wellbeing, that if understood would enable working effectively with diverse populations. Or in this case occupations associated with parenthood that are missing that need to be understood to realise their effect on health and wellbeing. This begins with understanding the lived experience of people who are involuntarily childless.

The host hopes to share insights into the lived experience of involuntary childlessness on people’s roles, occupational identity and occupational engagement. The profession needs to consider their role in addressing childlessness in their interactions, therapeutically and practically.

Post chat updates:

Online transcript Healthcare Hashtags Transcript

PDF Transcript #OTalk Healthcare Social Media Transcript August 13th 2019

The Numbers


#OTalk Participants


Davidson, S. (2016) Factsheet: Employment Issues [online] available at: http://fertilitynetworkuk.org/wp-content/uploads/2019/02/Employment-Issues.pdf (accessed on 02/03/2019)

Hammarberg, K., Astbury, J. and Baker, H. (2001) Women’s experience of IVF: a follow-up study. Human Reproduction, 16, pp 374-383

Kraaij, V. Garnefski, N. and Vlietstra, A. (2008) Cognitive coping and depressive symptoms in definitive infertility: A prospective study. Journal of Psychosomatic Obstetrics and Gynecology, 29 (1) pp 9 -16

NHS (2017) Overview infertility. [online] available at: https://www.nhs.uk/conditions/Infertility/ (accessed 6/10/2018)

Schmidt, L. (2010) Psychological consequences of infertility and treatment. In: Carrell, D. and Peterson, M. (eds) Reproductive Endocrinology and Infertility. Switzerland: SpringerLink pp 93-100.

Tufford, L. (2009) Healing the pain of infertility through poetry, Journal of Poetry Therapy, 22 (1), pp 1-9

Twinley, R. (2013) The dark side of occupation: A concept for consideration. Australian Occupational Therapy Journal, 60, pp 301-303

Wischmann, T., (2009) Implications of psychosocial support in infertility-a critical appraisal. Journal of Psychosomatic Obstetrics and Gynecology, 29 (2), pp 83-90

Zandi, M., Mohammadi, E., Vanaki, Z., Shiva, M., Lankarani, N. and Zarei, F. (2017) Confronting infertility in Iranina clients: a grounded theory. Human Fertility, 20 (4), pp 236-247

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