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Childless Until Proven Parenting

I finally put my finger on what bothered me so much with the coverage of that study (and assumptions within the study itself): that all infertile people are childless until proven parenting.

Some will be comfortable with that assertion — they are going through treatments or are in the process of adopting, but they have no children yet so they’re fine with being called childless.  But others will be put off by the reductive at best (and cruel at worst) nature of stating that all people without children are childless.

To begin, I feel — personally — as if I were in a different state once I began treatments vs. when we first started trying to conceive.  In the former state, I had made a decision without any hardship in sight.  In the latter, I now had to decide how badly I wanted to reach that goal.  Was it worth the physical pain of treatments?  The financial pain of treatments?  What was the worth of my emotional state?  I was a different sort of person once I had to think through those questions; a pre-parent that I (and look carefully, I’m discussing myself, not everyone) don’t believe I was at first.  I was making parenting decisions even though there were no children in sight.  Because all of those decisions you make when you are undergoing assisted conception or the adoption process are parenting decisions for a hypothetical-until-actual child.

Which is not to say that there weren’t parenting decisions even before we were diagnosed as infertile.  When I started taking folic acid and went off my cholesterol medication prior to conceiving, I was making a parenting decision, trying to create the best environment for my child.  But the decisions I made during treatments were a notch above what I made prior to infertility.  I went above-and-beyond what the average woman needs to consider pre-parenting.  And for that reason alone, my childless state prior to parenting was different pre-infertility and during infertility.  Therefore, it would make sense that childlessness after infertility is different from childlessness during infertility.

Because to think otherwise is to misunderstand that living child-free after infertility looks and feels the same as being in the throes of infertility (or, even worse, being in a limbo state within infertility) and that simply isn’t the case.  Perhaps that is why living child-free after infertility (LCFAI; apologies that I need to reduce this to an acronym, but it’s getting difficult to type it so many times) is so misunderstood.  LCFAI has more in common with parenting after infertility than it does to those going through treatments.  Both are on the same side of the resolution divide, if we can really call it a divide at all.

LCFAI is a mindful decision, not a default position.  And perhaps if people recognized it as such, they wouldn’t spend so much time trying to convince those living child-free to try one more thing or begin sentences with “have you considered…”  They would see it as a viable choice, one that takes into account a plethora of factors that makes it the best choice for some and anathema for others, in the same way that treatments, adoption, surrogacy, donor gametes, or trying unassisted is the best choice (or anathema) for others.

While I don’t have experience personally in living child-free after infertility (and hopefully people who do will chime in via the comment section), I cannot imagine that it feels the same as infertility based on the fact that life situations rarely feel the same pre-decision and post-decision even though the only thing that has changed in your life is the making of a decision.  Doesn’t engagement feel different from dating?  And I would assume that divorce feels different from the dissolution of the marriage.

The decision to live child-free is not passive; it’s an active solution, a way of resolving infertility.  And so I really didn’t appreciate the researchers who used soft numbers, simply looking at who was alive or dead who had registered for IVF between 1994 – 2005, because numbers don’t tell the real story.  In that pool of people, there were some who were infertile and treating their infertility, and there were others who had resolved their infertility and were living child-free, and to lump them together reinforces the myth that LCFAI is the same as being in the throes of infertility.  And when you reinforce that myth, you remove it as a possible solution from people’s minds.

After all, how many would choose to resolve their infertility by living child-free if they believed that they’d be in the emotional hell that is infertility indefinitely?  Not many.  But how many people would choose to reframe their life and choose living child-free if they believed they would be supported in that decision?  If the message was reinforced that LCFAI is different from treating infertility and these are the ways in which they differ.  I know I’ve internalized the ways they differ via a multitude of blog posts I’ve read (obviously enough that I can state that I see the two places in life as different), but it could be enormously helpful for people to state in a roundup of posts (since all personal experiences will be different) “this is how I felt during infertility and this is what it is like now after resolving infertility via LCFAI.”  How helpful would that be for people attempting to make the decision: to read, internalize, and understand?

Beyond those LCFAI, this concept of childless until proven parenting is incredibly dismissive — not to mention offensive — to all people who have lost a child, regardless of the gestational or birth age of said child.  Just because the child isn’t crawling through the physical world doesn’t mean that the child never existed, and it is a special kind of hell to be mourning someone that no one else got a chance to know.  There is no reminiscing, no shared memories, no new things to learn, no understanding from the general population. (Though, even that is fairly minimal.  Despite the fact that everyone will experience loved ones dying, humans are awful at comforting those who are grieving — especially long-term vs. short-term comfort.)  You are alone with that grief or sharing it with a very small circle of people.

But you can hardly be lumped in with all people who are not parenting who would like to parent.  Within those soft numbers, can they see who conceived but lost the pregnancy?  Those who conceived but their child was born still?  Who carried to term but experienced neonatal death?  I haven’t read the full study so I can’t know how much information the researchers had when coming to their conclusions.  But I can say that if they didn’t consider all those possibilities, they missed the nuances of the population they were studying.  And in missing those nuances, they did the population a disservice.

Good science is about pinpointing the specific not making sweeping generalizations.  Therefore I find the approach of childless until proven parenting confusing.  And by confusing I really mean disappointing with frustrations on the damage that studies like these do for bridging the gap between the infertile experience and the general population.  Whether you are surrounded by ghost children, amalgamations of Cycles Past and Cycles Future; viewing infertility as a temporary state you need to pass through to reach parenthood; living child-free after infertility; grieving a missing child; or at the beginning of a diagnosis, wondering which direction to walk, you know that there are many shades of infertility and the state each of us are in within this community.

And that’s why I can’t reduce us into two categories like the researchers did in that study.  It’s more complicated than are or aren’t; childless and with children.  There’s a much bigger story than the simplistic childless until proven parenting.

16 comments

1 gwinne { 12.11.12 at 9:49 am }

Hmmm. Hmmm. Hmmmm. I need to think about this one. I mean, I’d have to agree about your bottom line about there needing to be more than two categories. But to my mind parenting is a verb that requires the presence of a real-live child that you care for, in all its complexity. (One of my favorite short stories, by Marly Swick, called “A Hole in the Language” has a quote about there not being a word for the mother of a dead child, which is precisely right.) I wasn’t a “mother” after I had my first miscarriage and had dreams/hallucinations of a little boy who followed me around all day long. I didn’t have to take care of him. I didn’t clean up his vomit and stay up with him at 3:00 in the morning when his ear hurt or play with him at dawn. I longed for him. But I was a fertility patient, a woman who desperately wanted to be a mother, but not one yet, and that hurt like hell. I might have misread, as I’m taking a quick break between writing projects, so I’ll come back to this….

2 Lollipop Goldstein { 12.11.12 at 9:57 am }

Certainly it isn’t the SAME as parenting (didn’t mean to scream, but there doesn’t seem to be a way to italicize in the comments). I think the last paragraph gets to my main concern: that I just don’t see it as an are or aren’t; that there are shades of grey, backstories that need to also be considered, especially in research like this (hence why I don’t think a soft number study was useful at all).

It reminds me of that great Jay Neugeboren line: “A wife who loses a husband is called a widow. A husband who loses a wife is called a widower.
A child who loses his parents is called an orphan. There is no word for a parent who loses a child. That’s how awful the loss is.” From “An Orphan’s Tale” (1976).

3 a { 12.11.12 at 11:31 am }

When you’re data mining, though, it’s easy to ignore all the subtleties that make up the whole picture.

4 Aerotropolitan Comitissa { 12.11.12 at 12:21 pm }

It’s not just easy to ignore when data-mining, it’s what you have to do. You start with the screening test, then if you get a result you get to look into it further.

Is this because certain types of infertility are associated with certain types of diseases later in life? Should we screen people more if we know they have this type of infertility, especially if it is severe enough to prevent conception despite IVF?

Is this more of a social problem? What should society be aware of, and what policies can we introduce to try and resolve these sorts of social problems?

Etc etc. You don’t have the luxury of distinguishing between all the sub groups at this stage. You just have to prove that something is going on that needs to be looked in to.

Man, I have some catching up to do on your blog. I have just scrolled through to where I left off and, well. I will try and work through as much as possible! Looks like some interesting posts there.

5 Aerotropolitan Comitissa { 12.11.12 at 12:28 pm }

And I should say that breaking it up by those with living children after infertility and those without gives important information, by itself. So you know (the researchers are no doubt acutely aware) that some of those in the “childless” group will have achieved pregnancy, made parenting decisions, etc. So the results suggest the hypothesis that the association may have something to do with raising living children, or perhaps having full-term pregnancies. So then they can chase that hypothesis, find out if there’s anything to it. And it not (or simultaneously) they (or someone else) can take a different angle, according to a different hypothesis.

I know the media reporting has got mixed in to the argument here (motto: never get science news from mainstream media) but actually I think this is the type of study infertile men and women should be welcoming.

6 Katie { 12.11.12 at 1:52 pm }

Well said, Mel. So many things bothered me about this study, and you put them all into much better words than I was able to do. Thank you.

7 Lori Lavender Luz { 12.11.12 at 3:36 pm }

I’m seeing the path into and out of IF differently now, thanks to this post. There are points along the path — decision points — that nuance how the subjects, as data points, should be treated by researchers.

“LCFAI is a mindful decision, not a default position.”

The mindfulness, the conscious decisions on either side of the pursuit of parenthood, that’s what makes the difference.

8 Pepper { 12.11.12 at 7:03 pm }

I cry every time I read your posts these days. I don’t know why but I think it’s for all the women out there I didn’t think about… those making mindful decisions I never had to make. And I also think that if it’s too hard to get to the nuances of a situation in a study (meaning, too difficult to include all the sub-categories, etc), then maybe that itself makes it not a study of value. I understand research needs to have certain criteria, but I also understand that just having criteria doesn’t make all research valid.

9 Aerotropolitan Comitissa { 12.11.12 at 8:42 pm }

“The mindfulness, the conscious decisions on either side of the pursuit of parenthood, that’s what makes the difference.”

But is it? That’s the unanswered question this study starts to try to address. Of course it makes a qualitative difference, we know that. It makes a difference to our psychological perspective – and that is often missed by the general public who mark the start of parenting from the birth of the first live, take-home baby.

But we’re talking about mortality rates here, and what might really make the difference is lifelong treatment with aspirin, or increased screening for certain cancers. Or, yes, it might be a something more psychological/social. Or chance.

“I also think that if it’s too hard to get to the nuances of a situation in a study (meaning, too difficult to include all the sub-categories, etc), then maybe that itself makes it not a study of value”

Actually, stratifying too heavily within a data set (especially a retrospective data set) can destroy the value of a study.

PhD comics on the science news cycle:
http://www.phdcomics.com/comics/archive.php?comicid=1174

xkcd on media reporting of tests of statistical significance:
http://xkcd.com/882/

Harvard edx free online course about public health and epidemiology, which should be compulsory for all science reporters as well as those with an interest in reading scientific studies for their personal use:
https://www.edx.org/courses/HarvardX/PH207x/2012_Fall/about

I wish I could get a link to the original study. The problem with these studies is usually the fact that people (including reporters, who should know better) don’t read them accurately or understand the nature of the inferences made.

My husband also recommends that everyone get themselves the firefox plug-in that replaces all Daily Mail links with pictures of kittens.

And for science news in other press, may I recommend only reading as much of the article as you need to track it down either a) in the original paper or b) at a site dedicated to discussing scientific papers in a scientific fashion. Then when your Aunt Jane brings these things up over the dinner table you show her to these sources and tell her to come back to you when she has read the actual research or a valid discussion of it.

10 Alexicographer { 12.11.12 at 9:36 pm }

@Aerotropolitan Comitissa (and anyone else who wants it) I can send you the whole study, if you’d like. Actually I didn’t realize until tonight (accessing it from my home) that the link Mel provided to it (which I originally accessed from work) doesn’t provide full text unless you are at a subscribing institution. Which I was when I was at work. So.

Mel — I agree with your basic point, but also with @Aerotropolitan Comitissa’s. Yes, absolutely, it matters whether one is LCFAI or still in the trenches, and it would be great now to take these data (which are numerous in terms of those seeking treatment, though — thank goodness — with very few deaths) and look at that. But heck, I was impressed that the researchers incorporated information about adoptive parents (the difficulties/shortcomings involved in that inclusion, in terms of research design, notwithstanding). But I do believe (as I said earlier) that it also does matter that infertility that doesn’t respond to treatment is predictive of an increased risk of death, and worth publishing in its own right.

Part of the research process, after all, is for one scientist (or team) to generate and report a finding, and for others to question it (its validity, its generalizeability, the particulars of its occurrence) and for someone (the original team, a different team) to do further research. That process is here underway, at least at the questioning stage. The corresponding (study) author’s email is provided on the abstract, if one wanted to ask whether further analysis of these data has been done…

11 Mali { 12.11.12 at 11:27 pm }

Hmmm. So much to think about here.

First – I agree with the comment you made on your first post, but which I never got around . If they’re looking at deaths, how many people are dying only a maximum of about 15 years and as little as only 7 years after starting infertility treatment? So the deaths are quite drastically outside the norm anyway. It’s hardly in “later life” – but looking at women’s deaths in their 30s, 40s, and 50s. Still, I for one am very aware that – like nuns – our cancer risks are elevated because we have never borne or breastfed children. This isn’t new news.

I do totally agree that living without kids after infertility is very different to being in the midst of infertility, its treatments and uncertainty. Likewise, I can say that the first year or even two years of coming to terms with living without kids is very different to how you feel five or ten years later. (I’m not quite at the ten year time frame.) I felt hope when going through infertility treatments (but also found the uncertainty to be very stressful). I felt hopeless during those first months and first year after learning I would not have children. And then I felt (and feel) hope again – just hope for something different.

So yes, I guess I am agreeing that it is very simplistic to just look at two groups – those with kids and those without – in a short time frame after inferility, because there are so many more divisions that could be made. But whilst it is interesting to think about these issues, I have to admit that when I hear about these studies, I just roll my eyes and shrug. Perhaps I’m no different to the parents who roll their eyes and don’t believe studies that have negative conclusions about being parents. None of us like to be told that our lifestyles have negative fall-out. I guess the difference – as I’ve written before – is that living without kids is not always a chosen lifestyle. (I maintain that choosing to embrace a lifestyle without children is different to choosing to be childfree).

12 Pepper { 12.11.12 at 11:42 pm }

@Aerotropolitan

“Actually, stratifying too heavily within a data set (especially a retrospective data set) can destroy the value of a study.”

Agreed. And I understand your point from a purely scientific point of view but I think the value of a study like this specifically is more than just the basic science. I don’t believe that all aspects of our existence can be studied in a purely scientific manner.

13 Aerotropolitan Comitissa { 12.12.12 at 12:07 am }

@ Pepper

“I don’t believe that all aspects of our existence can be studied in a purely scientific manner.”

Very true – which is a good reason to keep science in its place and for its purpose. Probably this is the biggest mistake the mainstream media makes in its reporting. You have to read a study like this with the limitations of what science can possibly tell us or mean to us (and this study specifically) in mind.

14 Aerotropolitan Comitissa { 12.12.12 at 12:08 am }

@ Alexicographer – yes please. You can email me at infertilefantasies at gmail dot com.

15 kateanon { 12.12.12 at 11:24 am }

As someone LCFAI, I hate these things. I don’t fully believe I resolved to this, or chose this. There are a number of factors, but I stand by the feeling that this life of mine is a result of many things, but not necessarily a choice. Any study that chooses to view some results and not take into consideration all the other issues that would contribute just makes me crazy,

16 adoptchange { 12.13.12 at 2:52 pm }

Well said! Thanks for voicing your opinion!

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