Childlessness (not) by choice, how to deal with it

The child wish. It is such a complicated topic because everyone experiences it differently. The different emotions and experiences depend on your age, your knowledge of the topic, the person, what you have already experienced in life, and how far along the coping process you are. If you are dealing with pain or grief, a well-meaning question like “Do you have any kids yet?” can be seen as quite harsh. At another time that same question can be seen as interest.

We spoke with Cobie about not being able or not willing to have children and asked her all about it. 

How many people cannot have children or have difficulty having children?

“We speak of reduced fertility when for more than 12 months a pregnancy fails to occur despite unprotected sex. About 1 in 6 couples experience subfertility according to this definition. About 5% of couples end up remaining involuntarily childless. So, you are definitely not an exception to the rule if things don't work out right away.”

Why is it our expectation pattern that women especially should have children?

“Among other things, this expectation pattern has to do with the primal instinct; it is an expression of our urge to reproduce. From nature's point of view, women are supposedly created to reproduce. It is a standard that belongs to the female body. When you deviate from a standard, you stand out.

This can create painful situations in strict religious cultures, such as Islam or the Reformed church where there is a culture of shame. For example, women with fertility challenges can be labeled as unsuitable ‘marriage material’. But in every culture, it appears that women who are involuntary or voluntary childless may feel left out because they ‘deviate from the norm’.”

Why is it mostly women who criticize other women for not having children?

“I think it is a vicious cycle. Women without children are more likely to feel hurt by frustration and intense grief. And (especially younger) women stigmatize being a woman. When you are young, you often don't take into account that not wanting to have or not being able to have children is also an option. It’s only when you get older that you hear about setbacks and that you realize that having children is not for everyone. In addition, it is human nature to remember the negative things, which sometimes makes it seem to women with fertility struggles that they are being called out for their childless existence. For example, if you are at a party and eight people have not asked about your desire to have children and one has, that one is the bogeyman.

Obviously, it also depends on the moment, who is asking, and the tone when asked. At another time you could think: ‘They are interested in my child wish, how nice’. Due to the hurt reaction of women with fertility challenges those around her decide not to ask any more questions afterwards. People often do not dare to ask further questions or raise sensitive topics for fear of evoking someone's grief. This is precisely why women with a desire to have children often feel lonely and unsupported. It is a challenge for women with a child wish to indicate when and how they want to talk about this wish. This way she can vent her heart and those around her know how to deal with it.

On the other hand, it is also very important to realize that it is a very painful confrontation when you long to have a child and you are non stop confronted with it. Other people do not know this feeling, so these people also frequently run into misunderstanding and struggle with feelings of loneliness, intense sadness and helplessness.

Lastly, there is the group of people who do not have a child wish. This too is often difficult for those around them to understand. This group is smaller than the group that does want children. And then there is the social pressure. Especially as a woman, people often look at you strangely when you say you don't want children. People expect you to want them.”

What is the most common reason for not being able to have children?

“Involuntary childlessness has so many reasons for both men and women. For example, for a woman the cause could be a hormonal imbalance, the effects of cancer, the age of the woman, an abnormal shape of the uterus or ovaries, the effects of endometriosis or genetic diseases. For a man the cause could be dead semen or semen of poor quality, the effects of cancer, and genetic diseases. The official figures: The most common causes of reduced fertility are ovulation disorders (24%), severely reduced sperm quality (20%), disorders in the interaction between sperm and cervical mucus (15%) and 25% of subfertility for women is caused by endometriosis.”

Thereby, an unmet child wish can be divided into several facets:

• Involuntary childlessness. This means that you cannot have children (yet).

• Definitive involuntary childlessness. This means permanently unable to have children - think of someone who is menopausal.

• Secondary involuntary childlessness. This means that there is one child, but there is no success in having a second one. You are often told: ‘Be glad you already have a child,’ while that grief can also be enormous.

When do women with fertility problems come to you?

“All of the women who I treat with fertility problems were referred to me by their gynecologist. They come to me because of burnout symptoms, born out of frustration and losing hope. They usually report feeling depressed, anxiety symptoms, or trauma-related symptoms. The age and stage the women are in varies. For example, they can be young women who are in a medical process because of their fertility problems. They can also be women around forty who have been told that they are out of IVF treatment in the Netherlands or who have entered menopause because of their age while still having a desire to have children. The fertility process is often a bit like the survival mechanism during a war. When you are in the war, you don’t have the time to think about what you are going through. It is not until the end of the war that you have time to process what exactly happened to you. It is the same for the fertility (IVF) process. You have to keep going in order to survive, and it isn’t until you are told that there are no more options left that you realize just how difficult the process was. It is a natural process, but it would be much easier if you could stop in between. To process is an active verb and you work on it your entire life. So, when a woman has a child wish, research shows that that child already exists more or less in her head. Once the fertility process is done, you have to say goodbye to that child. That is comparable to a mourning process.”

When do women decide to stop their fertility process?

“Oddly enough, that moment is the same for almost everyone. Almost all of the women who I meet secretly hope for a miracle. It’s because of all of the 1 in a million success stories pushed by the media. Only when women enter menopause or have had to have their uterus removed can women begin to come to terms with it. It is often said that the child wish has to be closed. I think that it is not possible to do so, because the wish, the desire to have children still exists. Like I mentioned before, it is a mourning process. You have to learn to get used to the sadness and the pain to make it bearable and so it is not always persistently in the foreground. In all stages of life are people with involuntary childlessness confronted with moments of loss and pain. It requires a deep process of coping and a huge adjustment in existence.

In addition, in the Netherlands we are bound to certain rules and possibilities. For example, in the Netherlands you will be reimbursed for three IVF treatments and the limit on placing eggs back is 42 years of age. The age limit abroad is higher, by the way, and there you can continue IVF treatments on your own account. But because of the high costs, this is not for everyone.”

Statement: almost no woman without children, actually does not want children. There is always an underlying thought involved.

“That’s a very sensitive topic, but I understand the theory behind it. But I’ve treated plenty of women who really do not want to have children. A child wish is a personal desire influenced by all kinds of factors, such as relationship, social environment, need for meaning, culture, desire for unconditional love, fear of growing old lonely, and the choice of how to fill in the rest of life. There are also differences between the child wish of men and women.” 

‘I’ve treated plenty of women who really do not want to have children.’

“It is important to see if there are no underlying thoughts as to why someone doesn’t want to have children. For example, there are women with a little more testosterone so they don't experience that primal feeling. Or women with trauma who do not want to pass that on to children. That does not mean that the desire has not been there, but they have then chosen to make the decision of not having children. And that's totally okay. Society could be more understanding of people who decide not to have children. That is also just an option, just like wanting to have children.”

Do you have any tips for women with fertility problems on where to go?

“I always advise my clients to look at Freya or Cycle.care. A website where women can find support from women. It comforts you and shows you that you are not alone. I also want to advise women - who are in the fertility process and do not yet have found someone to talk with - to find an expert they can talk with if they experience any long-term symptoms such as depressive feelings, anxiety, or burnout and feel stuck in this. This does not have to be a heavy or long process, but it would be nice to bring some order to these feelings of depression which arise from disappointment, frustration and desire. The more you push the pain away the more powerful it returns. Besides that, self-care is very important. Make sure that you eat healthy, exercise plenty, have some distraction and relaxation. These things will really help you feel better.”

“Last but not least, communicate with those around you and allow things to affect you. Write your own instruction manual, so that it is clear to those around you what you expect from them and what you need. In it, state what you like, but also what you don't like. I can well imagine that when you are dancing with a drink you would rather not talk about your desire to have children. Bring up the subject yourself. Be honest and state that things are not going so well or simply that you have chosen not to have children.”