Arab-American Academic: The Topic of Infertility is Taboo
Zena Hamdan is an Arab-American academic and public health administrator based in Dearborn, Michigan. She wrote her PhD on the perceptions of infertility in the Arab-American community in Dearborn and in that thesis she writes that for a culture so focused on family and home life, infertility “is considered a dishonor for any married couple.” Ms. Hamdan, who is the director of health education for the Dearborn non-profit C-ASIST and is on the adjunct faculty at both University of Detroit Mercy and Capella University, spoke with MFA’s Ginanne Brownell about infertility and the Arab-American community in Dearborn, Michigan. EXCERPTS:
Tell me a bit about your background?
I was born and raised in Kuwait. I'm originally Lebanese. So I spent most of my childhood in Kuwait. I moved to Lebanon in 1996 during my high school years and I did my first master’s there. I then got married and moved to the US in 2005. I got another master’s here in toxicology followed by a PhD in public health education and health promotion.
How did you decide to do your PhD on infertility in Dearborn’s Arab-American community?
I got really interested in the topic because I had a friend who had two kids at that time. She was really insisting to have the third but now she was around 40. When all this was happening, I was just starting my second year doing my doctorate. So I was not really sure what my research will be about. My friend at first tried naturally because that is how she had her first and the second kids. She tried for four years naturally, and then she tried IUI. And then IVF three times. And she was still insisting with no luck at all with the IVF. And I was wondering, “You already have two kids and they are grown up, now a pregnancy could be risky.” I’d like to know why, what was the actual reason behind it. So that got me thinking about the concept of infertility in the Arab-American population. The largest in all of the United States.
How did you start your research on this as it sounds like it could be a tricky subject?
I started looking up how Arabic-speaking individuals think about infertility. And I started realizing that it is one of the most sensitive topics that they don't like to talk about freely. A lot of their decision-making is basically impacted by their culture, their social beliefs, their values, religion, so a lot of health determinants are basically impacting their decision-making, especially when it comes to infertility. So my research question was, basically I would like to understand fertility perceptions among Arabic-speaking woman in Dearborn, especially those who are actually immigrants. Did those perceptions change over time? Did moving to a totally new geographic space change their way of thinking?
How did you do that research?
I had to do interviews with females seeking treatments so I was visiting private clinics in Dearborn. And try to basically get their approval if they would like to have me interview them regarding their infertility status. And it was so funny, some of the interviews, the husband would not allow his wife, to answer the questions by herself. He wanted to be there. And though it was about five years ago now, I didn’t forget one case where [the husband] was answering the questions instead of her.
So this is quite a taboo subject?
Correct, basically the topic of sex in general is taboo. It is the way they have been raised. It is something that is a shame to talk about. We don't teach [sex education] to our kids in schools [in many Arab countries]. So it starts from here, something that is hidden from the beginning. So when you talk about pregnancy, basically, it's through having intercourse, right? And if something has to do with infertility, and specifically, [it could] mean it has to do with something with an ability to do something, right? And it [can be something] related to males. That means he is not is not a man, right? That is [what many] believe. And for females, she's not complete if she cannot have kids. Motherhood is something that will complete the female. So this is how they look at it. That's why it is a very sensitive topic. Plus, basically for females, it's a topic of insecurity. It will put their marriage at risk. If a woman is infertile, that means it will open a door for their spouse to find another wife, because the purpose of marriage is to make a family and have kids.
But infertility, as we know, is nothing to be ashamed of. It’s a disease and something that one has no control over.
It is always how the community you're targeting perceives it. Do they perceive it as a disease? Do they perceive it as a curse? Or they perceive it as something that has no cure? Basically, some communities think that it is a punishment from God. You know, maybe the woman is not good enough. That's why God is punishing this woman by not actually allowing her to have kids. And with an infertility diagnosis, both men and women should [be checked]. But believe it or not, for this community, I'm specifically talking about the Arabic population, they will blame the woman first. Without even knowing the reason.
Is this the view of immigrant populations versus Arab-Americans born and raised in Dearborn?
Immigrants carry their beliefs, their values with them. And they will basically pass it to their kids and their grandkids. It is actually a very interesting question, an essential question that we can actually do research on to get these answers: are these new generations that are born here trying to change these perceptions or are they different in the way they're thinking right now? I don't have an answer.
So how does the community go about changing this view on infertility?
It something that is really complicated because it is not being addressed the right way. We are not bringing it up more, we're not talking more about it. Maybe if we actually raise the voice, talk louder about it in the community, maybe have discussion circles, seminars, workshops, it will be more heard. The community in Dearborn is actually growing bigger and bigger in size. We have refugees from Syria, Iraq, Yemen, so a lot of diverse populations coming in right now. And definitely they suffer from the same exact health disparities, that means we will be seeing inequalities and inequities receiving the health care that they need. We can do that through education and raising awareness, letting them know that it is okay to be infertile. Let them know that by seeking help, and the right health service, they could basically overcome this health issue. Not just stay quiet about it, this is not a solution. Encouragement from other people who are sharing the same health issue, talking about it more and feeling that you are not the only one in that boat. A lot of other people are in the same boat and they will actually be happy hearing about your story, because they have their own story as well.