
































Infertility: Invisible Disability 

Review by Naomi M. McPherson

Cosmopolitan Conceptions: IVF Sojourns in Global Dubai

by Marcia Inhorn

Duke University Press, 2015

This book begins with a lengthy prologue, a verbatim transcript of an interview conducted by Marcia

Inhorn with  Rahina,  who relates  her  story of  marital  infertility  and her  quest  for  conception.  The

individual  stories  in  this  book  are  situated  within  larger  cultural  contexts  that  both  inform  and

enlighten. Rahina and her husband live a middle class life in the UK having left their East African

cultures of origin, but not the pressures from their cultures of origin to have (many) children. As it is

for most of the couples we meet here, reproduction is socially mandated and very much entangled with

concepts of womanhood, manhood and patriarchy. A wife who does not or cannot birth several children

to her husband’s patriline is considered a less than fully competent adult woman who can be (and often

is) set aside, divorced or made to endure a polygamous marriage if her husband marries a second,

hopefully  fertile  wife.  As  Inhorn  notes,  infertile  women  endure  “many  forms  of  harm,  including

medical  mistreatment,  verbal  abuse,  social  ostracism,  divorce,  economic  abandonment,  domestic

violence, and even torture” (p. 151). Rahina’s inability to conceive is due to chlamydia, a sexually

transmitted infection (STI) that leaves fallopian tubes obstructed by scar tissue. She considers herself to

be “invisibly disabled.” While causally invisible, her infertility is entirely too visible to kin and clan

whose “bullying” pressure on her and her husband to reproduce is a constant source of ongoing despair

and desperation.

Marcia Inhorn has spent decades studying and writing about infertility and assisted reproduction, much

of her work focused in North Africa and countries of the Middle East. Grounded in that long term



research, this current study is based on six months of intense fieldwork in 2007 (plus several follow-

ups to 2013), during which she interviewed 125 married couples from some 50 different countries,

whose  quest  brings  them  into  the  caring  hands  of  Dr.  Pankaj  and  his  staff  at  Conceive,  an

internationally renowned fertility clinic in the United Arab Republic (UAE), near the border of Sharjah

and Dubai. Stories are the core of ethnographic research and these stories of the quest for conception

are exceptionally intimate glimpses into the marital relationships these couples have created and the

sacrifices they are willing make in order to have children.

The  analysis  is  organized  around  five  “key  tropes:”  reprotravel  stories,  global  assemblages,

reproscapes, reproflows, and reproductive constraints. The married couples we meet are reproductive

travellers or “reprotravellers,” a descriptor preferred by all respondents adamant that what they are

going through is  not  reproductive  “tourism,” not  fun in  the  sun,  not  a  holiday.  Respondents  have

accumulated  huge  debt,  spending  thousands  on  travel,  accommodation,  medical  treatments,  and

‘cycles’ in the hope that they can become one of the lucky “18-25 per cent” (p. 224) who “take home” a

baby.

Reprotravellers  are  decidedly  “cosmopolitan”  as  they  travel  the  globe,  crossing  and  recrossing

international  borders  searching  for  facilities  practicing  cosmopolitan  medicine—western,  urban,

scientific, biotechnological medicine—that offers hope to overcome infertility. Citing Collier and Ong,

Inhorn  discusses  this  cosmopolitanism  as  comprising  a  global  assemblage,  a  multiplicity  of

phenomena, such as “technoscience, circuits of licit and illicit exchange, systems of administration or

governance,  and  regimes  of  ethics  or  values”  (p.  22),  which  coalesce,  assemble,  disassemble  in

particular places, spaces and time to become a “global assemblage.” Inhorn then expands Appadurai’s

theory of “scapes” to include a medical or bioscape “of moving biological substances … and body

parts” in  those global  assemblages that,  in  this  instance,  become part  of a  reproscape “combining

globalization and global flows” (p. 20) of people, technology, bodies. This swirl of movements, bodies,

technologies, commercialism, and border crossings fueled by despair  and hope conjures up quite a

surreal  images.  Mobile  biological  substances  and  bodies  constitute  reproflows,  that  is,  “flows  of

reproductive  actors,  reproductive  technologies,  and  reproductive  substances,”  including  of  course,

those reproductive bodies “required for the processes of assisted conception” (p. 24).

But  reproflows  are  not  without  reproductive  constraints,  which  can  be  “structural,  sociocultural,

ideological, and practical obstacles and apprehensions” (p. 25) that impede the quest for conception.



Inhorn  groups  these  reproductive  constraints  include  resource  categories  include  such  things  as

finances  and  travellers’ lost  wages,  the  high  cost  of  treatments,  which  may  or  may  not  “take,”

availability  of  specific  treatments,  access  to  clinics,  waiting  lists.  Many  countries  have  legal  and

religious  prohibitions  on  certain  procedures  and  on  categories  of  persons  eligible  for  procedures.

Hindu, Muslim and Christian religions have a variety of prohibitions, not least on surrogacy, adoption,

donor gametes, and pregnancy reductions; some countries have age constraints such that women (but

not men) “age out” of ART eligibility. The “medical horror stories” and too frequent iatrogenic harm (p.

255) emphasise the importance of choosing a clinic that provides safe, quality care and good success

rates. Sociocultural issues are always paramount as clinic staff and clinic clientele come from many

cultural  and  linguistic  backgrounds,  a  cosmopolitan  fact  than  can  lead  to  social  barriers  and

miscommunication on many levels. Issues of privacy, even secrecy, are critical to reprotravelers, whose

immediate families and extended kin have no idea they are undergoing these treatments, and because

some  couples  travel  for  procedures  that  contravene  legal  and  religious  constraints  of  their  home

countries.

This culturally complex and detailed ethnography is only possible because of Inhorn’s long term study

of infertility in the Middle East and contiguous countries. Her awareness of the cultural and religious

complexities enveloping her respondents meant she was able to approach this extremely intimate topic

with  compassion  and sensitivity  to  elicit  a  rich  story of  married  couples’ desires  and needs  for  a

biologically related child. Marcia Inhorn has gifted us with a very challenging book that is impossible

to condense to a few words here. This ethnography challenges what we thought we knew about human

fertility, the causes and consequences of marital infertility, and how women and men each come to

grips with their “invisible disability” within their cultural construction of gendered reproduction. The

global  number  of  infertile  persons  and  of  women  experiencing  secondary  infertility  (inability  to

conceive a second child) is probably incalculable. But there are “many millions” of infertile persons,

with “estimates ranging widely” from about 49-186 million; with infertile males contributing to more

than half of “all  cases of childlessness” (p. 107). She has also challenged the way in which much

gendered  research  is  undertaken  in  separate  spheres,  particularly  when  researching  topics  of  sex,

sexuality and marital relations, with women interviewing women and men interviewing men. Inhorn

rejects that practice, which often results in one-sided analyses, to engage in “marital ethnography,” that

is, interviewing couples together.

Finally, when I think about what I have read, it occurred to me that feminism, writ large, has failed



infertile women. Feminism is about choices. Many cosmopolitan women choose childlessness; many

women in noncosmopolitan countries have no such choices and have more children than they want.

The majority of women in the global south have no options for careers or alternate lifestyles; without

children they have nothing and they are nobody, particularly in patriarchal, patrilineal societies where

they are not members of a lineage. Feminist analyses of assisted reproduction technologies (ARTs)

have long decried the “highly gendered” bioscape, whereby reproductive technologies are “enacted on

women’s  and  men’s  bodies  in  highly  differentiated  ways”  (p.  24).  And  there  are  the  structural

inequalities of who can and cannot access ARTs and the potential for exploitation of poor women as

surrogates or gamete donors.  While fighting for women’s rights to make reproductive choices,  for

contraception and abortion, and to not have children, feminists have not engaged equally strongly with

a woman’s right to have children and to access ARTs in order to overcome their own or their husband’s

infertility in order to have biological children. There is often an unacknowledged whiff of eugenics by

default  when  talking  about  infertility  in  so-called  less  developed  countries  that  are  deemed

overpopulated by cosmopolitan countries. Hence, there is little sympathy for or resources allocated to

reproductive assistance for infertile women who bear the social and cultural brunt of infertility and

whose  lives  are  made  a  living  hell  because  they  are  childless.  Inhorn  closes  with  a  plea  for

“reproductive justice.” There needs to be more work and thought put into the prevention of infertility

by treating sexually transmitted infections that “play havoc with male and female reproductive organs”

(p. 302). There needs to be more “support of the infertile” starting with destigmatizing fertility and

offering more support to infertile women and men, especially in “societies where parenthood is socially

mandated”  and not  a  matter  of  choice (p.  303).  This  could entail  increasing  education  and career

opportunities and providing choice; albeit changing cultural concepts of appropriate gender roles is

easier said than done. And finally, infertility treatments need to be less costly. No surprise that Inhorn’s

activist  passion  is  vested  in  the  movement  for  low-cost  IVF (LCIVF)  to  “make  safe,  affordable,

effective IVF accessible to everyone who needs it, but primarily to people in the global South” (p. 303).

This  book  truly  does  take  the  reader  into  the  “womb”  of  a  cosmopolitan  IVF  clinic  and  the

reprotravelers who are its clientele. It is a must read for students of anthropology, medicine, women’s

history, whether or not they are involved in research on human reproduction. This is a must read for

NGOs, ministries of health, medical practitioners, and others who are deeply committed, particularly in

noncosmopolitan states, to working for the improvement of women’s maternal and reproductive health.

I highly recommend this enlightening, ethnographically rich and deeply compassionate book.



References Cited

Ahmed, Sara

2006. Queer Phenomenology: Orientations, Objects, Others. London: Duke University Press

HadžiMuhamedović, Safet

2016.  Waiting  for  Elijah:  Time and Encounter  in  a  Bosnian Landscape.  PhD diss.,  Goldsmiths,

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Sharma, Aradhana and Akhil Gupta (eds.)

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University Press

Naomi M. McPherson is a cultural anthropologist and Associate Professor Emeritus at the University

of British Columbia. She has returned six times between 1980 and 2009 to Bariai, West New Britain,

Papua  New  Guinea  where,  among  other  topics,  she  has  studied  concepts  of  gender  and  gender

relations, gendered violence, ethno-obstetrics, and women’s maternal and reproductive health. Selected

publications include:  Modern Obstetrics in a Rural Setting: Women and Reproduction in Northwest

New Britain (1994);  Women, Childbirth and Change in West New Britain,  Papua New Guinea,  P.

Liamputtong,  ed.  (2007);  Sik  AIDS:  Deconstructing  the  Awareness  Campaign in  Rural  West  New

Britain,  PNG.  R.  Eves  and  L.  Butt,  eds.  (2008);  Anthropology  of  Mothering.  M.  Walks  and  N.

McPherson, eds. (2011); Black and Blue: Shades of Gendered Violence in West New Britain, PNG. C.



Stewart, ed. (2012); Missing the Mark? Women and the Millennium Development Goals in Africa and

Oceania. Naomi McPherson, ed. Demeter Press, February 2016.

© 2016 Naomi M. McPherson


