Understanding Why Starting a Family Can Feel Overwhelmingly Stigmatized for Some Women

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For many Australians, fertility treatment is a personal decision supported by medical professionals. However, for women from culturally and linguistically diverse (CALD) backgrounds, beginning a family can carry a heavy load of silence and, sometimes, profound shame.

Rhea Abraham is all too familiar with this burden.

Of Indian descent and brought up with strong cultural and religious traditions, Rhea found herself tackling not just the physical and emotional hurdles of fertility treatments but also the layered expectations from her family and community.

“When I first met my then-husband, he clearly expressed his desire to be a father,” she said.

“I recall thinking on our first date that, if I wanted to be with him, motherhood was inevitable for me. At that time in my life, this was a completely foreign thought.”

Their joy upon conceiving soon turned to sorrow when their daughter June, diagnosed with a terminal condition, was lost at 14 weeks.

Rhea Abraham identifies as a bereaved mother and has transformed her grief into advocacy for CALD women facing fertility challenges and pregnancy loss. Source: Supplied

In the years that followed, Rhea experienced multiple miscarriages and underwent IVF.

She even considered international surrogacy in her longing to become a mother and fulfil her partner’s dream of fatherhood.

But it wasn’t just the physical and emotional toll of fertility treatment that Rhea struggled with; it was also the stigma.

“What I wasn’t prepared for was the religious and cultural language around women being ‘blessed’ with children,” she said.

“Language that, unfortunately and unintentionally, made me feel that I was cursed because I couldn’t bear them.

“The stigma attached to not being able to bear a child was insurmountable.”

A need for better care

According to Karina Bosetti, director of nursing at Connect IVF, Rhea’s story is not uncommon.

She says stigma around fertility runs deep in many migrant communities.

“It may be taboo or not spoken about in their community, and they may not know how to address their concerns,” Bosetti said.

“In some migrant communities, patients are more hesitant to utilize donor services, potentially leaving them unable to start families and ending up childless. This can also result in marital strain for some migrant couples due to the intense pressure to start a family.”

With fertility already a complex medical and emotional journey, for some migrant women, these added cultural layers delay the decision to seek help — and with fertility, timing is crucial.

“Taking longer to seek help, then delaying treatment, always runs the risk of being unsuccessful with treatment,” Bosetti said.

“It may discourage them from seeking treatment or discussing issues with their GPs because of cultural biases. These couples may find themselves without information or direction to begin fertility treatment. This also implies that some couples may have underlying medical conditions impacting fertility that remain untreated or undiagnosed, as they are not offered suitable solutions.”

Australia’s IVF success rate has steadily improved

According to research from UNSW, in 2021, 37.1 per cent of women who completed their first full cycle of assisted reproductive technology had a baby, with a cumulative live birth rate of more than 53 per cent after three cycles.

That same year, more than 20,000 babies were born from IVF treatment, accounting for one in every 18 babies born in Australia.

But despite these advances, national data sets like the Australian and New Zealand Assisted Reproduction Database do not currently report on IVF outcomes by migrant background.

This leaves a significant evidence gap when it comes to understanding who is accessing fertility treatment and who is missing out.

More barriers for migrant women

At the same time, migrant women are overrepresented in certain pregnancy complications.

Women born in Southern and Central Asia, South-East Asia, North Africa, the Middle East and North-East Asia were between 1.4 and 2.2 times as likely to be diagnosed with gestational diabetes.

They are also more likely to experience barriers to timely antenatal care.

According to Migrant and Refugee Maternal and Perinatal Health, “over one-third of all birthing people in Australia are migrants, and many face additional risks during pregnancy due to language barriers, health system inaccessibility, and stigma around reproductive health”.

Scientific director at Connect IVF, Lauren Hiser, says clinics have a role to play in bridging that gap.

“We need to provide more culturally directed information for all migrant communities, also addressing specific concerns,” she said.

“It’s important to bring culturally sensitive conversation to the forefront and give communities a voice and place to ask questions, to know what is acceptable within their cultural limitations.”

For Rhea, the experience has shaped her into an advocate for better grief literacy in CALD communities, founding Dark Horse International, a media company dedicated to amplifying the voices of CALD communities, domestic and family violence survivors and child safety advocates.

“I live vicariously now as a proud, typical Indian aunty,” she said.

“What I am blessed with are friends and family who remember my baby girl June, who will always live on in my heart.”

Griefline provides confidential support on 1300 845 745 and via griefline.org.au