849526

research-article2019
GASXXX10.1177/0891243219849526Gender & SocietyBell / GENDER, IDENTITY, AND THE BODY

“I’m not really 100% a Woman if I

can’t have a Kid”:

Infertility and the Intersection of Gender,

Identity, and the Body

Ann v. Bell
University of Delaware, USA

Despite establishing the gendered construction of infertility, most research on the subject has
not examined how individuals with such reproductive difficulty negotiate their own sense of
gender. I explore this gap through 58 interviews with women who are medically infertile and
involuntarily childless. In studying how women achieve their gender, I reveal the importance
of the body to such construction. For the participants, there is not just a motherhood mandate
in the United States, but a fertility mandate—women are not just supposed to mother, they are
supposed to procreate. Given this understanding, participants maintain their gender by deny-
ing their infertile status. They do so through reliance on essentialist notions, using their bod-
ies as a means of constructing a gendered sense of self. Using the tenets of transgender theory,
this study not only informs our understanding of infertility, but also our broader understand-
ing of the relationship between gender, identity, and the body, exposing how individuals
negotiate their gender through physical as well as institutional and social constraints.

Keywords: body; infertility; reproduction; identity; gender

D espite variations in mothering desires and an increase in voluntarily

childfree women, pronatalism remains a dominant ideology in U.S.
culture (Blackstone and Stewart 2012; Gillespie 2003; McQuillan et al.

AUTHOR’S NOTE: The research was funded through grants from the University of
Michigan Department of Sociology, University of Michigan Center for the Education of
Women, and the University of Michigan Rackham School of Graduate Studies. Thank you
to Asia Friedman and Karin Martin for their knowledge and advice, and thank you to the
reviewers and editors for helpful constructive feedback. Correspondence concerning this
article should be addressed to Ann V. Bell, University of Delaware, 325 Smith Hall,
Newark, DE 19716, USA; email: avbell@udel.edu.

GENDER & SOCIETY, Vol 33 No. 4, August, 2019  629­–651

DOI: 10.1177/0891243219849526
© 2019 by The Author(s)
Article reuse guidelines: sagepub.com/journals-permissions
630  GENDER & SOCIETY/August 2019

2008). As Parry (2005a, 338) described, within a pronatalist society,

“motherhood is considered the defining element of true womanhood.” For
women desiring children and struggling with their reproduction, such
ideological notions are especially troublesome. Indeed, as a “cultural dis-
order,” infertility not only threatens a woman’s familial aspirations but
also her gendered sense of self (Kitzinger and Willmott 2002; McQuillan
et al. 2012; Sandelowski and de Lacey 2002, 36).
Given this context, how do women maintain their gender in the wake
of infertility? Despite a well-established understanding of the gendered
construction of infertility, there are surprisingly few studies that have
directly explored this question (Greil, Leitko, and Porter 1988; Greil,
McQuillan, and Slauson-Blevins 2011). In an effort to do so, this study
reveals a rather simple answer—women uphold their gender by rejecting
the notion that they are infertile. Ironically, despite meeting the medical
definition of infertility, women use the medicalization of infertility,
including its reductionist claims around the body and ever-optimistic
notions of hope, to deny that diagnostic label. In other words, women
preserve their womanhood through reliance on essentialist notions of gen-
der. Thus, exploring this question bridges three understudied areas in
infertility: gender, in terms of how women construct and negotiate its
maintenance; the body and its production of meaning; and the process of
self-identifying as infertile. Going beyond infertility, however, I extend
current feminist theorizing around the (often contentious) relationship
between gender, identity, and the body and demonstrate the necessity for
a “fuzzy” or more encompassing approach to gender that integrates
physical embodiment with the self and socially constructed aspects of
identity (Nagoshi and Brzuzy 2010; Tauchert 2002).

Gender, Identity, and The Body

Despite putting “the body on the intellectual map,” feminist theory has
been hesitant to study the body, particularly its relationship to gender and
identity (K. Davis 1997, 1). Much of this hesitancy resides in its concep-
tualization of gender. From “distinctionists” who argued for the sex/gen-
der system, to postmodernists who collapsed such a distinction, “the
female body has posed a problem for feminists” across the theoretical
spectrum (K. Davis 2007, 52).
In an effort to move away from the biological determinism that was
often used to justify women’s subordination, feminist theorists strove to
separate biological sex from socially constructed gender (K. Davis 2007).
 Bell / GENDER, IDENTITY, AND THE BODY  631

Beginning with G. Rubin’s (1975) application of the sex/gender distinc-

tion to critique essentialism, feminist theory maintained the idea that sex
is a biological object separate from subjectivity and cultural gender
(Schrock, Reid, and Boyd 2005). Still rooted in binary gender categories,
and what many argue “biological imperatives,” some theorists, particu-
larly postmodern theorists, questioned such a sex/gender split (E. C. Davis
2008, 98). Instead, they proposed to destabilize gender categories, often
claiming that gender overwrites sex, and that sex, too, is a malleable
social construction (Butler 1990; Hird and Germon 2001).
These positions, though distinct, both contributed to feminism’s
“marked ambivalence” towards the body and its relation to gender (K.
Davis 1997, 15). In their effort to disconnect from biological determinism,
theorists supporting the sex/gender distinction developed a “somatopho-
bia,” or fear that any mention of the body would result in relegating back
to a deterministic position (K. Davis 2007). In turn, women’s biological
bodies were left undertheorized.
Similarly, postmodern theorists left out the material reality of the body
through their inversion and collapsing of the sex/gender relationship.
Drawing on Foucault’s notion of power, scholars such as Butler (1990)
understood the female body as a text on which gender and power relations
were written (K. Davis 1997). By claiming that bodies themselves are
cultural by-products, this line of thinking did not acknowledge the physi-
cality of bodies (Schrock, Reid, and Boyd 2005). The focus is on the
surface of the body and how culture becomes imprinted on it, rather than
on bodies “with an ‘inside’” (K. Davis 2007, 54). While conceiving the
body as a purely cultural construct provided an enhanced understanding
of the role of power in shaping it, such conceptualization left little room
for women’s individual agency and thus their construction of a central
sense of self (K. Davis 2007; Nagoshi, Brzuzy, and Terrell 2012).
Despite this history, recent work in transgender and intersex studies
illuminates the intersection of gender, identity, and the body. Transgender
individuals certainly destabilize gender categories; however, as scholars
reveal, such disruption is still wrapped within the physical bounds of the
body and its associated hegemonic expectations (E. C. Davis 2008;
Prosser 1998). For transgender people, the body is an important compo-
nent of gender—they use their bodies as a resource for its construction
(Dozier 2005; Schrock, Reid, and Boyd 2005). As Dozier (2005, 300)
described, “gender is not simply conceptual but real, and experienced in
the body. . . . Particular body characteristics are not important in them-
selves but become important because of social interpretation.” In essence,
632  GENDER & SOCIETY/August 2019

transgender individuals demonstrate the paradox that gender is socially con-

structed yet simultaneously embodied and “real” (H. Rubin 2003). As such,
these studies reveal that gender resides not only through social interaction
but also within individuals (Dozier 2005; West and Zimmerman 1987).
As “natural allies,” intersexuality studies similarly explore the inter-
play between gender, identity, and the body (Turner 1999, 471). Like
transgender people, intersex individuals disrupt the sex/gender binary and
often do so through the body. As Hausman (1995, 14) described, “we . . .
need to recognize the body as a system that asserts a certain resistance to
(or constraint upon) the ideology system regulating it.” With bodies out-
side the boundaries of the sex binary, intersex people challenge and illu-
minate its social construction (G. Davis, Dewey, and Murphy 2016).
To capture these experiences, it is important to understand the complexity
of the body as a simultaneously socially constructed entity, and a lived, mate-
rial experience. Put simply, we need to combine the distinct approaches
previously described (K. Davis 1997). Beauvoir (1961) introduced this
“combined” approach more than 50 years ago when she asserted that subjec-
tivity is always embodied (counter to distinctionists’ claims that the body is
separate from subjectivity), and that bodies are physically material and can
shape one’s experience (counter to postmodernists’ claims that cultural dis-
course can overwrite biology) (Schrock, Reid, and Boyd 2005).
Transgender theory has adapted this frame in contemporary times “by
explicitly incorporating ideas of the fluidly embodied, socially con-
structed, and self-constructed aspects of social identity, along with the
dynamic interaction and integration of these aspects of identity within the
narratives of lived experiences” (Nagoshi and Brzuzy 2010, 432). Shotwell
and Sangrey’s (2009) “relational model” is an example of such theorizing.
Their model encompasses two components—embodiment and self-con-
structed aspects of identity. Nagoshi and Brzuzy (2010) extended this
model with a third facet—that of the social influence on identity. As
Butler (1990) asserted, culture shapes social identity by enforcing expec-
tations and bounds to individuals’ enactment of identity categories. In
other words, there is a restricted fluidity to gender and its embodiment (E.
C. Davis 2008). In sum, transgender theory is reflective of Tauchert’s
(2002) “fuzzy” approach to gender in that it allows for the recognition of
an individually driven sense of identity that comes from the body yet is
restricted by the confines of its social construction.
I apply this theoretical stance beyond transgender and intersex populations
to examine experiences of infertility. Infertility is an ideal case in which to
explore the interaction of gender, identity, and the body because of its physi-
cal, yet social, experience. Like gender theory broadly, however, current
 Bell / GENDER, IDENTITY, AND THE BODY  633

understandings of infertility tend to silo gender, identity, and the body rather
than explore their relationship. Research on the gendered aspects of infertility
is pertinent, because, as Throsby and Gill (2004, 345) noted, infertility “takes
place in the context of gender relations.” Like other reproductive health
issues, infertility is stereotyped a woman’s problem (Bell 2015; Culley,
Hudson, and Lohan 2013). As such, many (involuntarily childless) women
experience infertility as a direct strike against their self-identity, in contrast to
men who experience infertility more indirectly and externally (Clarke,
Matthews, and Matthews 2006; Greil 1991; Greil and Johnson 2014).
Numerous studies have demonstrated the “devastating” effects infertility has
on a woman’s sense of self, leading to “spoiled identities,” a “negative psy-
che,” and a “jeopardized sense of being a complete woman” (Clarke,
Matthews, and Matthews 2006; Greil, Leitko, and Porter 1988; Scritchfield
1989). Yet, researchers also have cautioned that it is “necessary to problema-
tize the view that infertility automatically becomes an individual’s master
status” (Letherby 2002, 279). In other words, how might women attempt to
overcome these ideas in an effort to maintain a gendered sense of self?
While research has clearly established the inherent gender relations in
infertile experiences, it has yet to fully explore how individuals negotiate
their own sense of gender. Ironically, despite the paucity of literature on
men’s experiences of infertility compared to the wealth of studies on wom-
en’s experiences, we know more about how men maintain masculinity in
light of infertility than how women maintain femininity (Culley, Hudson,
and Lohan 2013; Greil, Slauson-Blevins, and McQuillan 2010). Frequently
highlighting the emasculating effects on men, studies have looked to deter-
mine how men overcome such effects (e.g., Barnes 2014; Bell 2016; Dolan
et al. 2017). The literature that examines womanhood and infertility, how-
ever, often does so in terms of how women’s gender is threatened (rather
than preserved) or studies women’s gender negotiations secondarily.
Such indirect examination of women’s maintenance of gender is evi-
dent in the research on coping with infertility, which offers a glimpse into
how women negotiate with ideologies such as pronatalism. For instance,
Parry (2005b) found that women expand their notion of family, and
Czarnecki’s (2015, 718) work on religion’s effect on infertility revealed
how women attain a “moral femininity” in an effort to “construct alterna-
tive maternal identities.” Riessman’s study (2002) on South Indian
women is one of the few that directly examined how women with infertil-
ity negotiate their womanhood. Through a study of three older women’s
narratives, Riessman found that women manage their gender through
deflection of blame, maintenance of other identities, and flexible concep-
tualizations of parenting.
634  GENDER & SOCIETY/August 2019

Understanding identity is particularly important in the case of infertil-

ity. As a medicalized entity seeped in images of gender and family, infer-
tility is especially prone to questions of identity (Todorova and Kotzeva
2006). Given this significance, it is not surprising that there is some schol-
arship that explores how infertility affects identity (Greil, McQuillan, and
Sanchez 2016; Loftus and Namaste 2011; McQuillan et al. 2003).
However, there is little exploration of the identity of infertility itself (i.e.,
whether women identify or perceive themselves as infertile).
Understanding this self-perception is important, as studies have shown
that identification as infertile is associated with negative outcomes, such
as increased distress and relationship dissatisfaction (Exley and Letherby
2001; Greil et al. 2018; Todorova and Kotzeva 2006). There is a budding
empirical literature that is beginning to examine such implications and the
significance of the infertile identity (e.g., Johnson and Fledderjohann
2012; Leyser-Whalen et al. 2018; Loftus 2009).
Olshansky’s (1987) research was one of the first to study the “identity of
self as infertile.” Although importantly highlighting the experience of infer-
tility, Olshansky’s research tends to conflate such experience with claims of
identity. Her participants described infertility as all-encompassing, so it is
unsurprising that Olshansky (1987, 54) would conclude that participants
“take on a central identity of themselves as infertile.” But in reality, it is not
identity the participants are describing; rather, it is the experience and sig-
nificance of infertility in their lives. As Johnson and Fledderjohann (2012,
890) demonstrated, however, it is important to distinguish the two: “Women
may be impacted by various factors . . . about men’s and women’s respon-
sibilities in childbearing and childrearing. While many of these factors may
contribute to fertility-related distress, they do not necessarily mean that
women automatically self-identify as an infertile person.”
Indeed, researchers have consistently found that women do not like
the highly signified term of “infertility.” Greil’s (1991) classic study
found that infertility represented permanent childlessness and was thus
a “spoiled identity” compared to the preferred liminal state of “not yet
pregnant.” Similarly, Sandelowski (1993) distinguished the women’s
telling semantic use of “I have” infertility as opposed to “I am” infertile.
To manage this distinction, women must engage in significant emotion
work (Exley and Letherby 2001). Such efforts demonstrate women’s
active participation in managing their identities to best suit their needs.
This often involves multiple, shifting identities throughout the infertility
experience (Blenner 1990; Leyser-Whalen et al. 2018). While these
studies are important in highlighting the significance and complexity of
self-perception and infertility and demonstrating the impact of infertility
 Bell / GENDER, IDENTITY, AND THE BODY  635

in women’s lives, we need further investigation of individuals identify-

ing explicitly with “infertility” itself and of the nuance behind how and
why women reject the term.
Contained within this identity process is women’s relationship to their
bodies. Indeed, theorists have highlighted the importance of the body to
the process of self-identity (Budgeon 2003; Giddens 1991). The relation-
ship between the body and identity is especially potent in experiences of
infertility, as Greil (2002, 101) described, “the simultaneously biological,
personal, and social drama of infertility is played out in the woman’s
body.” Additionally, researchers have aligned the medicalization of infer-
tility with other medical procedures, such as plastic surgery and diet
regimes, that go beyond merely managing bodies, making them central to
one’s identity (Budgeon 2003).
The bodily aspects of infertility are also informed by gender (Johnson
and Fledderjohann 2012). This is unsurprising given that historically
the body, particularly reproductive capacity, has been used as a way to
distinguish women as different from men (Daniels 2006). The medi-
calization of infertility perpetuates this essentialist distinction by focus-
ing its procedures on the woman’s body (Halcomb 2018). In turn,
men’s physical experiences of infertility are not only left out, but in
doing so the medical establishment also reinforces men’s traditional
roles of being the “rock” for women’s emotions and the voice of reason
in decision making (Bell 2015).
Despite its significance, there is scant infertility literature that centers
the bodily experience. Bodies, in general, are often theorized as neutral
surfaces on which meaning is ascribed rather than how bodies them-
selves are used to construct meaning (Budgeon 2003). In turn, research
often focuses on the meaning behind the experience of infertility rather
than the physicality that shapes that meaning. Extending the facets of
transgender theory to infertility exposes how individuals negotiate gen-
der through physical as well as institutional and social constraints, in
turn, revealing gender as a fuzzy combination—between the distinction
and the deconstruction—in which the body and subjectivity interact to
inform each other.

Methods

This research is based on data from 58 in-depth interviews with women

struggling with their ability to reproduce. As part of a larger study on
infertility in the United States, all participants met the medical definition
636  GENDER & SOCIETY/August 2019

of infertility in that they were unable to achieve pregnancy or carry it to

term after 12 months of unprotected intercourse (Zegers-Hochschild et al.
2009). Additionally, all participants were involuntarily childless and had
taken measures to actively become pregnant. It is necessary to include
both aspects of infertility in its conceptualization, as “intent” shapes the
experience (Greil and McQuillan 2010; Greil, McQuillan, and Sanchez
2016). The majority (83 percent) of participants responded negatively to
my inquiry (asked of all respondents) as to whether or not they consider(ed)
themselves to be infertile. This predominant lack of identification is strik-
ing given that all participants were both involuntarily childless and medi-
cally infertile. Moreover, only two of the women were in a partnership
with “male-factor” infertility, as the majority experienced “unexplained”
or “female-factor” infertility.
In addition to their fertility status, women had to be between the ages
of 18 and 44 to participate in the study. Limiting the ages to such child-
bearing years restricts participants to those who are currently infertile or
have recently experienced infertility. I recruited women through flyers
posted at public venues who had experienced “involuntary childlessness
for at least one year due to the inability to conceive or carry a child to
term.” Phrasing recruitment in this way allowed me to interview women
who met the medical definition of infertility, while not outwardly labeling
the women as infertile.
The participants were in their early 30s on average, and all but one self-
identified as heterosexual. They were relatively diverse with 41 women of
low and 17 women of high socioeconomic status (SES). As part of a larger
study on infertility, I purposefully and strategically sought racial diversity
among the women of low SES because it allowed for comparison of
women marginalized within infertility stereotypes (e.g., low-income
women and women of color) to women enmeshed within such stereotypes
(e.g., white, high-income women). Thus, the women of low SES in this
study were 51 percent black and 49 percent white, and 5 percent of them
completed college. All of the women of high SES are white and 76 percent
of them were college educated.
Interviews lasted an average of ninety minutes and covered the spec-
trum of infertility experiences, from why women want to mother to how
they resolve their reproductive struggles. The women completed a
demographic questionnaire and received a $10 gift card. The interviews
were transcribed verbatim. I inductively analyzed the data, creating
codes as I read the transcripts, similar to a grounded theory approach
(Charmaz 2014). I entered the codes into a software program and refined
those codes into hierarchical coding schemes. I then formed a more
 Bell / GENDER, IDENTITY, AND THE BODY  637

thematic analytical approach, ultimately identifying patterns in

responses. All of the quotes in this article are the most illustrative exam-
ples among many of the participants with similar experiences. I only
included data that were commonplace across women in the various
demographic groups. All names are pseudonyms, and this study was
approved by the Institutional Review Board.

Infertility and The Intersection of Gender,

Identity, and The Body

In the findings that follow, I explore how women with infertility nego-
tiate their gender. I first demonstrate the necessity of such negotiation
given the women’s construction of womanhood as inherently connected to
the ability to reproduce. I then examine one way the women overcome
such a construction, namely, through drawing from their physical bodies
within socially defined parameters.

“What a Woman’s Supposed to Be”: Constructing Gender

Infertility goes against the mainstream1 pronatalist definition of what it
means to be a woman. Such ideological thinking was resoundingly pre-
sent throughout the women’s narratives.2 For instance, Tiffany, a black
woman of low SES, said that being infertile “is like being half of a woman
. . . if you can’t have kids, you ain’t a full woman to me.” These ideas have
become embedded through processes of socialization. Jessica, a white
woman of low SES, reflected such normalization when she stated, “We’re
bred from babies that as girls that’s what you do is you get married, you
grow up, you have kids, you know.” Importantly, it is not just motherhood
but the ability to become mothers, through reproductive capacity and pro-
creation, that is tied into their identities as women. As Paula, a black
woman of low SES, relayed:

And it’s—it’s extremely hard as a woman to realize that you may never be
able to have a kid. And it’s—it’s kind of that thing that that’s what makes a
woman a woman. It’s kind of like the message we’ve been taught our entire
lives and that part of me says, “Yeah, that’s true. I’m not really 100% a
woman if I can’t have a kid.”

As both Jessica and Paula allude, women are taught throughout their
“entire lives” that inherent in womanhood is having children. And if they
are unable to do so themselves, their gender is called into question.
638  GENDER & SOCIETY/August 2019

The women internalized these ideas, connecting their identities to the

dominant ideals. Carla, a black woman of low SES, discussed this connection:

Maybe it’s as a woman, it makes me feel less of one because you can’t—it’s
like that’s what I’m supposed to do. I’m supposed to procreate—I’m sup-
posed to be able to have kids and, you know, you can’t—it just makes me
feel—I’m real big on I don’t like to feel like I’m failing at anything. I
can’t—that is like one I feel like I’m failing at. As a woman, I’m like, you
know, as your wife—now I mean you— you know, you’re saying you want
one. I can’t give you that, you know. So I feel like I’m failing at that really.
And that is one thing that nobody can probably get out of my system . . . I
feel like I am failing as a woman to not be able to do it.

The participants internalized the idea that having children is what women
are “supposed” to do. More specific than just motherhood, however,
women are “supposed to procreate.” When they are unable to achieve this
fertility mandate, the participants feel like they are “failing” at woman-
hood.
It is precisely their physical capability to reproduce that women con-
nect to their gender. Heather, a black woman of low SES, reiterated this
essentialist notion:

Well, the thing that separates women from men is, you know, the ability to
have a kid. That’s what makes us special, and that’s something that I can’t
do. And so that kind of makes you less—it makes you feel like you’re less
than a woman or what a woman’s supposed to be.

By connecting womanhood to reproductive capacity, the participants are

drawing on the most basic, essential constructions of gender. As Heather
suggested, the ability to have children is what “separates women from
men.” As a result, when that ability is called into question, so too, is a
woman’s gender. Constructing womanhood in such a way is a clear con-
flation of sex and gender, with women defined (in opposition to men)
based on their biological capabilities.
Because of this conflation, the body is a key element in the participants’
understandings of womanhood. Indeed, in addition to linking fertility to
gender, the participants connected the female reproductive body to ideas
of what it means to be a woman. As Laura, a white woman of low SES,
demonstrated, the body is connected to the women’s sense of self:

Just the emotional (pauses) feeling how, you know, (pauses) your body’s
supposed to do this. You know, for most women it does. And why isn’t it
 Bell / GENDER, IDENTITY, AND THE BODY  639

working for me? What’s wrong with me? You know, what’s wrong with my
body that I can’t conceive? . . . It’s like I wasn’t good enough and that just
added to it, you know, like I couldn’t—couldn’t do what my body was sup-
posed to be doing.

Laura expressed feeling abnormal since her body cannot conceive as it

does “for most women.” But not only is Laura’s body different from oth-
ers, she also sensed that she, herself, “wasn’t good enough,” ultimately
intertwining the body with her conception of self—attaining an “embod-
ied identity” (Budgeon 2003, 46). In asking “what is wrong with my
body,” Laura simultaneously asked, “what is wrong with me.” Stephanie,
a white woman of high SES, echoed Laura’s comments:

And yet, you know, your body is not doing its job, you know, that you
would expect it to. You’re, you know, you’re a woman, you’re born—
you’re born with all of the parts. You are supposed to be able to do the
things that it’s created to do. And when it’s not able to, then, you know, it’s
just—a whole different dynamic.

To Stephanie, being a woman is directly correlated to having “all of the

parts,” relying on reductionist ideas that her gender is rooted in and
dependent on her sex and biological capacity. When that capacity is not
living up to normalized “expectations,” her sense of self is in disarray, so
much outside the mainstream that it requires “a whole different dynamic.”
While Stephanie highlighted having “all of the parts,” many partici-
pants specify certain body parts necessary for womanhood. For instance,
Courtney, a white woman of high SES, discussed the importance of men-
struation and eggs for gender achievement:

You know, I was—I was angry and disappointed that my body wasn’t doing
what it was meant to do. Do you know what I mean? As—as far as, you
know, women have cycles for a reason. It’s because that’s what it takes to
make a baby. You produce an egg, a man produces sperm and that’s—it
wouldn’t be there if that’s what we weren’t supposed to do with it.

Courtney reflects on pronatalist ideas, implying that women’s purpose is

to have children as dictated by their reproductive capacity. Infertility was
not allowing her to fulfill what she “was meant to do,” both physically and
ideologically.
In addition to eggs and menstruation, many participants highlighted
pregnancy as the epitome of one’s womanhood. As Becca, a white woman
640  GENDER & SOCIETY/August 2019

of high SES, asserted, “You feel less, you know, less like a woman because
this is like, you know, the one thing you should be able to do. You should
be able to get pregnant.” The experience of Nan, a white woman of high
SES, also relayed the importance of pregnancy to a woman’s sense of self:

And, you know, for me, I think that even more—more than grieving the loss
of the biological child for some reason for me was a lot of grieving not
being able to experience pregnancy and childbirth. Because I tied that so
much into my identity as a woman. . . . The biggest thing for me was the
grieving of the—the kind of having to sort through what it means to be a
woman and how much is childbirth and pregnancy tied up in that.

While women face a motherhood mandate, women’s gender goes beyond

motherhood to the core of maternity—that of pregnancy and childbirth.
Such notions reflect Letherby’s (1999) assertion that there is a hierarchy of
motherhood with bio-social motherhood at the top. Within such a fertility
mandate, womanhood is often reduced to biological processes.
As the women’s narratives attest, the participants take on what
Garfinkel (1967, 123) calls a “natural attitude toward gender.” In this
biologically deterministic framework, the women’s construction of gen-
der is inherently connected to the ability to reproduce. In other words,
fertility (as opposed to infertility) is a sign of womanhood and such capac-
ity is rooted within the body.

“I Am Fine. I Am Fertile”: Maintaining Gender

Given this understanding, how, then, do women with infertility maintain
their gender? They do so quite simply by achieving their conceptualization
of womanhood: they deny their infertile status and notions of bodily failure
and instead construct themselves as both fertile and physically capable. As
Snow and Anderson (1987) theorized in their foundational study, individu-
als often achieve their desired self-conceptions through distancing from
their assigned social identities. Indeed, the majority (83 percent) of women
in the study rejected the idea that they are infertile, despite all participants
being both involuntarily childless and medically defined as infertile. As
Iris, a white woman of high SES, declared, “I didn’t want to like define
myself as that [infertile].” And after I asked Ruby, a white woman of low
SES, if she thought she was infertile, she told me:

Oh, after eight years, I would think that’s probably up there. Maybe. Maybe
with a plus, plus after it. I don’t know. I mean not even a miscarriage. Come
on now. Nothing. Nothing has happened at all.
 Bell / GENDER, IDENTITY, AND THE BODY  641

Despite actively trying to become pregnant over a period of eight years

with “nothing happening,” Ruby still cannot bring herself to claim the
infertile status. Her qualification (“plus, plus”) of “maybe” indicates her
recognition, yet hesitant rejection, of fully identifying with infertility.
To achieve such distancing from the infertile identity, the women
ironically draw on notions of medicalization—hope and references to the
body. In other words, they make the claim that they are fertile by arguing
that their bodies work, ultimately maintaining their constructions of wom-
anhood rooted in such components. Reflective of other research, most
women in the study viewed infertility in hopeless and negative terms
(Leyser-Whalen et al. 2018; Loftus 2009). For instance, Courtney claimed
that infertility “feels so definitive . . . and sounds like such a blaming
word.” Julie, a white woman of low SES, concurred that infertility means
“that I need to stop trying.” The “definitive” nature of infertility and the
necessity to “stop trying” reflects women’s hopeless characterization of
the ailment.
This hopeless conceptualization of infertility plays out in women’s rejec-
tion of the label. If they have not yet given up hope themselves, then they
cannot claim the status. Maureen, a white woman of high SES, employed
this logic, as she “just didn’t feel that hopelessness,” so did not consider
herself infertile. Likewise, Donna, a black woman of low SES, still main-
tained this hope, saying she “won’t give into that thinking.” Attaining the
infertile identity is not just a simple label; rather, it is a concept that is
imbued with closure, giving up, and loss. When the women do not experi-
ence those characterizations, they reject the notion that they are infertile.
For many women, the medicalization of infertility is the mechanism
that allows them to maintain their reproductive hopes. Much of the litera-
ture on the effects of medicalization finds that the process often increases
such optimistic expectations (e.g., Madden and Sim 2006). In the case of
infertility, medical treatments keep women on an “infertility treadmill”
because of their anticipated positive outcome (Harwood 2007). Although
there are a limited number of procedures available to treat infertility, those
procedures can be repeated until either funds run out or a woman can no
longer handle the emotional and physical intensity they require. The expe-
rience of Sarah, a white woman of high SES, demonstrates this hopeful
effect; in responding to whether or not she considers herself infertile, she
replied, “I feel like I need to exhaust my options to some degree before I
really say I am.”
Nadia’s experience reflects on the innumerable “A to Z” options avail-
able to treat infertility and how each provides a new glimmer of hope. A
white woman of high SES, Nadia is in what Franklin (1992) described as
642  GENDER & SOCIETY/August 2019

a “matrix of determination” in which the failure and hope for success is a

defining feature of medicalized solutions for infertility. Nadia reflected:

It’s usually in the beginning, you know, you’re kind of—you’re very upset
but you’re also hopeful. You’re frustrated and bitter but you still have that
hope and you’re like, “Hey, it’s just a matter of time. You know, I’ve just
got to control.” And then you wait and wait and it doesn’t happen. “Well,
next cycle. You know, they say that this is just the first, you know, because
there’s—we’re on plan B. You know, there’s like A to Z. And this didn’t
work, no problem. We’ll go to C and we’ll go to D.” So you keep going
through that and, you know, you try to not get discouraged.

As Nadia’s story demonstrates, the possibilities for medically treating

infertility are numerous. And with each new procedure, the women’s hope
is maintained and their infertile identity held at bay. Ironically, seeking
treatment for infertility maintains women’s hope of fertility—it is not just
women doing gender, but reiterating medical discourse.
The participants also resisted the infertile identity and upheld their
womanhood through references to the body. Like hope, the medicalization
process reinforces these references through its emphasis on biology
(Martin 1987; Webster 2002). This is particularly true for women, as the
medialization of infertility excludes men from its treatment. In turn, the
female body takes center stage, resulting in women taking responsibility
for infertility regardless of diagnostic status (Halcomb 2018). Brooke, a
white woman of high SES, rejected the notion that she is infertile as a
result of her biological capacities:

I am not infertile. I ovulate every month. I have perfectly wide open tubes.
I have a normally shaped uterus. I have a fantastic progesterone level and
so I don’t have any kind of luteal phase defect. No. I am fine. I am fertile.

Brooke’s adamant denial of her infertility status is based on her biological

functioning. Drawing on nearly every reproductive organ and their “fan-
tastic,” “normal,” and “perfect” states relayed to her through medical
tests, Brooke is able to consider herself “fine (and) fertile.”
Reflective of their gender constructions, most women do not require all
reproductive capacities to consider themselves fertile; oftentimes just one
or two will uphold their status. Being able to produce eggs was sufficient
evidence of fertility for many participants. As Erin, a white woman of low
SES, relayed, “I don’t consider myself infertile just because I have some
eggs that are still good. I just think I’m fertility challenged.” Similarly, in
 Bell / GENDER, IDENTITY, AND THE BODY  643

asking Deborah, a black woman of low SES, if she considered herself

infertile, she responded, “No, because I see—I am actually seeing the
signs that I am not—that doesn’t mean that I am dropping perfect ones.
But at least I am doing it so now I feel like a normal woman.” Because
Deborah is “dropping” eggs, she does not identify with infertility. This
single biological process not only reaffirms her fertility, but in doing so it
also allows her to maintain her gender as a “normal woman.”
For some women, such as Jocelyn, a black woman of low SES, the
presence of eggs alone is enough to uphold her fertility status, even when
those eggs do not ovulate or “drop.” In asking her if she thought she was
infertile, Jocelyn responded, “No, I don’t. The thing is I’m, I am fertile but
the thing is I’m not ovulating . . . what happens is that the egg is not drop-
ping. . . . So if I can get that (snaps fingers) going on, I’d be like I’ll be
flying and I’ll be good.” Despite not menstruating for years due to anovu-
lation, Jocelyn considers herself “fertile.” To her, having eggs, the foun-
dational basis for a pregnancy, makes such an event possible. This was
also the case for Carrie, a white woman of low SES. She said, “Well, I’m
not infertile. I just haven’t got pregnant yet. Like I don’t, I mean, I would
consider myself infertile if I did not produce eggs . . . but I just haven’t
gotten pregnant yet.” Jocelyn, Carrie, and many other women in the study
reduce the reproductive process and their fertility status down to a single
biological entity. In this case, the production of eggs is enough to allow
the women to perceive themselves as fertile, in turn rejecting the label of
infertility. Fertility is not pregnancy, rather it is the potential to become
pregnant, which eggs provide. In essence, hope and biology collide.
For many participants, however, pregnancy is the core of one’s fertile
(and gendered) status. The experience of Maureen relays its importance.
When I asked whether she considers herself infertile, Maureen replied:

No, I don’t actually. I don’t think that—I mean if somebody were to say
to me, you know, if—if I were looking at a form that said, “check one:
fertile or infertile,” I would think, “Well, I got pregnant, so I must be
fertile, you know?” . . . And so no, I don’t feel infertile . . . and I guess as
long as I can continue to get pregnant, that to me seems like the defining
aspect of fertility.

Despite experiencing several miscarriages, Maureen does not consider

herself infertile since she has achieved pregnancy, “the defining aspect of
fertility.” Indeed, Jewel, a white woman of low SES, had eight miscar-
riages, yet she told me, “I don’t think I am infertile because I am getting
pregnant a lot.”
644  GENDER & SOCIETY/August 2019

To the women, their physical capacities represented their ideological

ones—they were fertile, fine, and feminine if they had eggs, ovulated,
and/or became pregnant. In other words, their bodies constructed their
meaning. Despite not carrying a baby to term, a component of the medical
definition of fertility, the women achieved their own markers of the status.
By rejecting their infertility and upholding their physical capacities, the
women were able to adhere to their notions of gender based in such ideas.

Conclusion

These findings have important implications for the areas of gender, the
body, and identity, demonstrating their interrelationships. The women’s use
of their bodies is integral to their construction of gender. Often, gender
scholarship (e.g., Bordo 1993; Kwan and Trautner 2009) examines how
culture shapes the body rather than the reverse—how the body shapes
gender. Feminist researchers have successfully examined how bodies come
to acquire certain meanings, but, in turn, often fail to question how bodies
themselves construct those meanings. While fear of essentializing may
contribute to this gap, it is imperative that the significance of the body to
gender be revealed (K. Davis 2007). This study adds to our theories of
gender by not only revealing such significance but also demonstrating how
the body is used in such meaning-making. Gender is not separate from sex,
nor is it collapsible within it; rather gender is a “fuzzy” in-between in
which its subjectivity is both corporeal and embodied (Tauchert 2002).
Transgender studies are clearly part of this revelation, examining how
the body is constructive of the gendered experience. Through its critiques
of the way the social construction of gender dismisses the body when it
sets aside sex, this literature reminds us that the body is both culture and
nature (Annandale and Clark 1996). Rather than subordinating the body
as an object of culture, we must interrogate how bodies themselves con-
tribute to social relations and the culture in which they are situated
(Budgeon 2003). For instance, Nan in this study showed that the process
of being pregnant not only represented her female reproductive capacity
but also her “identity as a woman.”
Indeed, infertility is not merely “an experience of the failure of body
and self” (Greil 2002, 113). Rather, medical treatment allows women to
flip the script by revealing the opposite—the capabilities of women’s bod-
ies, and thus their gendered selves. Research often describes medicine’s
reinforcement of the Cartesian mind-body dualism in which the self is
considered separate from the body (Berg and Akrich 2004). As Martin
 Bell / GENDER, IDENTITY, AND THE BODY  645

(1987) described in her work, such separation is particularly evident

around issues of reproduction, such as pregnancy (L. Goldberg 2002).
However, as this study demonstrates, the process of medicalization can
allow women to use their bodies in claims of self-identity.
The findings also blur the binary definition of infertility, demonstrating
its elementary representation of the experience. There are not simply fer-
tile versus infertile reproductive categories (Greil and McQuillan 2010;
Letherby 1999; Leyser-Whalen et al. 2018). Similarly, the medical defini-
tion of infertility does not reflect women’s self-definitions of the term.
Acknowledging this complexity is necessary, as it influences the reporting
and accuracy of the prevalence of infertility. Moreover, it shapes experi-
ences of reproduction, as authors have shown that claiming an infertile
status uniquely affects how it is lived (Greil et al. 2018).
In essence, as the findings reveal, “identity is a social and contextual
phenomenon” (Todorova and Kotzeva 2006, 125). Women situated in a
medicalized context, confronted with hopeful prospects and knowledge of
working body parts, are able to deny an infertile status and embrace a
gendered sense of self. Indeed, while more than 80 percent of the sample
did not identify with the infertility label, the subset that did claim infertil-
ity was entirely composed of women of low SES who did not seek medi-
cal treatment for their childbearing difficulties.3 Such a contrast speaks to
the power of medicine in shaping identity. Medicine’s incitement of hope
and focus on the bodily aspects of the experience were critical to women’s
denial of infertility and maintenance of gender.
Given this contextuality, it is important to acknowledge that the find-
ings in this study simply offer one explanation of how women with infer-
tility negotiate their gender. Even within these findings, it is evident that
women utilize many tactics to construct their sense of self. Likewise, we
must recognize that these results are specific to involuntarily childless
women. As McQuillan and colleagues (2008, 478) noted, despite the cen-
trality of motherhood within contemporary gendered expectations, women
vary in the importance of motherhood in their lives. Many women remain
voluntarily childfree, purposefully rejecting dominant norms. As research-
ers (e.g., Blackstone and Stewart 2012; Maher and Saugeres 2007) have
demonstrated, however, in doing so, the women are forced to confront
such norms given their cultural embeddedness, managing stigma through
identity work. These divergent experiences further the notion of the fluid-
ity and contextuality of gender.
Despite its inherent complexity, women’s negotiations with gender and
infertility could never be simpler—they uphold their womanhood by
denying that they are infertile. By distancing from the status that takes
646  GENDER & SOCIETY/August 2019

away their “hallmark of femininity,” the women are able to maintain that
pinnacle, or at least the hope of reaching it (A. E. Goldberg, Downing, and
Richardson 2009, 950).

Notes

1. These notions are reflective of mainstream social ideologies. They are not,
however, indicative of how all women desire motherhood. As other researchers
(e.g., Gillespie 2003; McQuillan et al. 2008) have demonstrated, many women do
not prioritize motherhood and/or purposefully do not adhere to dominant norms.
2. All women in this sample are involuntarily childless. So, while the views
expressed in the findings are commonplace across participants, they are not gen-
eralizable to all women.
3. All women of high SES in the study sought medical treatment for their
reproductive struggles, and many women of low SES did as well.

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Ann V. Bell is an associate professor of sociology at the University of

Delaware. Her research, centering on the intersection of gender and
health, specifically examines inequalities of reproductive health. Her book,
Misconception: Social Class and Infertility in America, was published by
Rutgers University Press in 2014.