Involuntary Infertility: Understanding a Concept

There are various ways of understanding or defining infertility. Basically, infertility can be understood as reproductive impairment or a socially constructed reality.Footnote ² As a reproductive impairment, infertility is a failure to conceive a child after twelve months or more of exposure to regular unprotected sexual intercourse.Footnote ³ Infertility can be understood from a clinical, demographic, and epidemiological perspective, or as a disability.Footnote ⁴ The clinical, demographic, and epidemiological definitions offer variations on the basic understanding of infertility.Footnote ⁵ Infertility is a complex reality that goes from the inability to conceive to being incapable of carrying a pregnancy to its term, and it includes nonviable pregnancies (e.g., ectopic pregnancies), miscarriages, and stillbirth.

Infertility when seen as a disability means that a function (the reproductive tract of a person) is impaired. The use of the term disability leads to a further distinction between simple impairment and disability. The latter is increasingly perceived as socially constructed. The socially constructed reality of infertility includes perceptions about fertility, the human body, and the meaning of life and is made manifest by “the absence of children in a home.”Footnote ⁶ An example of social infertility is the understanding in some societies that having one child or only female children is to be childless.Footnote ⁷ The notion of disability provides a link between the biomedical and the social understanding of infertility. Indeed, “perceptions of disability are influenced by historical circumstances and prevailing interests.”Footnote ⁸ Our understanding of infertility will include both realities, namely, medical and social.

Infertility can be termed primary or secondary. Primary infertility is the “inability to have any live birth,” whereas secondary infertility refers to the “inability to have a second live birth.”Footnote ⁹ Those two types are generally attributed to women, since they are the ones who can bear children. This emphasis could be problematic, especially in patriarchal contexts where women are mostly blamed for infertility. However, both men and women are equally affected by involuntary infertility.Footnote ¹⁰ Since 1990, the secondary infertility rate has increased (10.5 percent of women) while the primary infertility rate has declined (1.9 percent of women).Footnote ¹¹ These rates need to be considered with caution, however, because (1) they are based on self-reporting and (2) men in the developing world—especially in sub-Saharan Africa and the Middle East—tend not to report their infertility.Footnote ¹²

Overall, infertility is on the rise. In 2010, 48.5 million couples worldwide were unable to conceive a child—of which 19.2 million were affected by primary infertility and 29.3 million by secondary infertility. South Asian and sub-Saharan Africa are among the regions most affected, with 14.4 million and 10 million couples affected, respectively.Footnote ¹³

Being Childless in Africa

Contemporary Africans experience two paradoxes. On the one hand, their societies are pronatalist—they encourage procreation.Footnote ¹⁴ On the other hand, their governments, under the pressure of international donors, promote artificial birth control. The second paradox derives from the fact that “many African communities that have high levels of infertility [as in countries of Central Africa] are also known to have high rates of fertility.”Footnote ¹⁵ It comes as no surprise that in West African countries such as Cameroon and Nigeria, infertility does not appear to be a government concern.Footnote ¹⁶

In general, it is difficult to meet someone who is childless by choice outside of consecrated Christians.Footnote ¹⁷ Procreation is expected from everyone, and especially from married couples. I have personally witnessed that even in places such as Nairobi, Kenya, where marriage tends to be unpopular among young women, the latter insist on having their own child. Being childless creates a dissonance in a “tradition of abundant life,” to borrow from the title of a book by Laurenti Magesa.Footnote ¹⁸

In addition, infertile people have to live in a communitarian environment. Congolese theologian Bénézet Bujo rightly points out the importance of interpersonal relationships within African communities.Footnote ¹⁹ Indeed, “in order to exist one must belong to a community where one feels accepted and where one also accepts the others and shares in their integral development.”Footnote ²⁰ Various authors recognize the primacy and centrality of community in an African worldview.Footnote ²¹ In return, a true community flourishes where there is mutuality and reciprocity between its members: “One must give life to the other in such a way that each one gives birth to the other.”Footnote ²² Tanzanian theologian Laurenti Magesa calls this the principle of “participation-sharing.”Footnote ²³ This communitarianism can simultaneously be an asset or a burden for infertile people. It can be an asset in the sense that the community offers comfort and support to the infertile. It can be a nuisance because of the social pressure to conceive and/or the ostracism of the infertile.

The case of Ghanaian theologian Mercy Amba Oduyoye, herself a childless married woman, is enlightening in that regard.Footnote ²⁴ She first notes her struggles even to mention the issue, because in her Akan culture, as in most African cultures, involuntary childlessness is a taboo.Footnote ²⁵ In pronatalist societies, childlessness is a shameful experience, particularly for women.Footnote ²⁶ Oduyoye describes her painful journey through the hands of traditional and modern doctors, the pressure she experienced from both families—her own and her in-laws—to get pregnant, her husband's support, and the community's reaction.

The studies by Philip Teg-Nefaah Tabong and Philip Baba Adongo in Ghana and Susan Weinger in Cameroon shed further light on the struggles of infertile people in West and Central Africa.Footnote ²⁷ According to local perceptions, childbirth generally validates the union, and confers prestige upon both spouses. Indeed, “one is never really a full and faithful person until one has a child.”Footnote ²⁸ All these expectations create a sense of failure and inadequacy in many infertile people. Hence, it comes as no surprise that sorrow, isolation, urgency, guilt, and powerlessness plague childless couples.Footnote ²⁹ Infertile couples also experience depression and frustration because of the prescription of remedies by allegedly concerned people, whom Oduyoye labels “friends of Job.”Footnote ³⁰

In the African worldview visible and invisible forces constantly intersect. This is the reason why an event always has more than a material explanation. This affects the understanding of the causes of infertility and the search for a cure. As described above, there are a variety of biologically and physiologically based causes of infertility for women and men in sub-Saharan Africa that must be taken into account.Footnote ³¹

African societies suggest the following as causes for infertility: God's will, malicious curses, witchcraft, STDs (gonorrhea especially), moral fault/sin (promiscuity, adultery, and so on), bad blood or incompatibility of blood, male-related causes (quality of sperm and sexual weakness), and lack of inner peace.Footnote ³² Preternatural causes (such as God, witchcraft, and curses) tend to be the most prominent explanations.Footnote ³³ This explains why infertile women and men go to traditional/native doctors or religious leaders in hope of a cure. Researchers have observed that infertile people tend to visit more than one service provider and try more than one type of cure—sometimes simultaneously.Footnote ³⁴ Thus, infertility creates financial stress, because couples will go to any length to become pregnant. Moreover, biomedical treatments, and especially infertility services, are not always available and remain unaffordable for the majority of women in Africa.Footnote ³⁵

In addition, a childless marriage is a cultural embarrassment to the extent that laws prohibiting adultery can be broken in order to have children. Traditionally, communities such as the Bassa of Cameroon would allow the wife to have sex with the husband's relative if he is suspected to be the source of the problem. However, such practices have become uncommon nowadays as a result of HIV/AIDS and urbanization. Infertility is perceived as one of the major causes of marital instability. Indeed, “having a child is clearly more important than loyalty to one's spouse.”Footnote ³⁶

Infertility affects men and women differently. Both suffer from bias, exclusion, and derogation. In northern Ghana, childless men are described as people with rotten testicles or with a dead penis.Footnote ³⁷ Sexual activity usually decreases and drinking increases, especially among men. Childless men in rural settings are excluded from leadership roles. Childless women have to bear verbal abuse and are often exclusively blamed for a couple's childlessness.Footnote ³⁸ Marriages can end up in divorce or polygamy.Footnote ³⁹ Contrary to popular belief, the initiative for divorce or separation most of the time comes from the woman.Footnote ⁴⁰ Men can separate, but do so usually for reasons other than a wife's infertility.

One would think that childless women would be free to use their time and resources as they wish. To the contrary, there is a kind of “punitive taxation” that the community exacts from childless persons.Footnote ⁴¹ Society demands that childless women be “child-friendly.”Footnote ⁴² In addition, “childless women are given societal dictates that their life, time, and money should not be their own. They have limited legitimacy to attend to their own needs because their personal worth is minimal.”Footnote ⁴³ Additionally, infertile women complain about the lack of support they receive from their male partner in their attempt to remedy the situation.Footnote ⁴⁴ Indeed, “combined with the widespread lack of insurance coverage, seeking fertility care often means a lonely path for women wishing to conceive.”Footnote ⁴⁵

In the absence of community support, coping strategies for childless people are mainly individual and personal. Some of the strategies, such as indulging in alcoholism (mostly men) or multiplying sexual partners to test one's fertility (more socially tolerated for men than women), are unhealthy.Footnote ⁴⁶ Other coping strategies for women involve social isolation, a drive for excellence, defense against verbal abuse, caring for social children, faith, social conformity, and the cultivation of a positive mind-set and attitude.Footnote ⁴⁷ Overall, childlessness exacts a heavy toll on people's well-being.

Involuntary Childlessness in the Tradition of the Church

It is important for the church to offer a pastoral response and to suggest sets of practices for individuals and communities confronted with infertility. I will seek such a path in Scripture and recent magisterial documents. Given space constraints, I will point only to select key areas in which local communities and concerned groups can develop context-specific responses.

Within the church and particularly in West Africa, childless people see God's hand behind their condition, on the one hand, and use faith as a coping mechanism, on the other hand.Footnote ⁴⁸ Since children are perceived as a gift from God, infertile people consider that it is God's will that they are in a childless condition.Footnote ⁴⁹ This fosters acceptance in some as well as a sense of powerlessness. Acceptance is facilitated by religion, especially through the Bible.Footnote ⁵⁰

Infertility in the Bible

The Bible offers many stories about the childless: Sarah and Abraham, Rebecca, Rachel, Samson's parents, Hannah, and Zechariah and Elizabeth. Generally, there is a happy ending to these stories with an eventual childbirth. For many people, however, this is far from always being the case. False hopes should not be nurtured for desperate people, as fertility treatments have a low rate of success, and untested medical and traditional procedures can be very risky.

Two trends observable in the Bible find an echo in African cultures. The first is the affirmation of “God's control of conception.”Footnote ⁵¹ God is the author of life and the one who gives or denies the ability to have children. The second is the tendency of the patriarchal biblical texts to see infertility primarily as a “female phenomenon” (see Gen 25:21; Judg 13:2; Luke 1:7).Footnote ⁵² This does not mean that men cannot be infertile (Lev 20:20; Deut 7:14).Footnote ⁵³ The figure of the eunuch is the personification of male inability to impregnate a woman and have children.

Infertility is perceived as a curse and is in contradiction to the divine command in Genesis to “be fertile and multiply” (Gen 1:28). Infertility is associated with fruitlessness, desolation, and being dead.Footnote ⁵⁴ Infertility “for both women and men was considered a grave misfortune.”Footnote ⁵⁵ In that context, one can understand the distress of the matriarch Rachel, who says, “Give me children or I shall die” (Gen 30:1).

At the same time, prophetic and wisdom literature make the point that the childless can be the object of God's favor (Isa 54:1, 56:4–5; Wis 3:13–14; Sir 16:3). The barren woman and the eunuch—“two traditional images of the accursed”—are “blessed because of their moral integrity.”Footnote ⁵⁶ It is in that strand that one should understand biblical characters who are voluntarily childless: Jesus of Nazareth, Miriam, Jeremiah, Esther, John the Baptist, Mary (sister of Lazarus), Martha, John, James, and Paul.Footnote ⁵⁷

However, human reproduction is not as large an issue in the New Testament, where even family ties—which are essential in a communitarian society—are relativized (Mark 3:33–35). Barrenness symbolizes the fruitlessness of Christians who fail to live in accordance with the values of the kingdom of God (Mark 4:19; Titus 3:14).Footnote ⁵⁸ In addition, the New Testament seems to emphasize the unitive function of marriage (Mark 10:8–9; Matt 19:5–6; 1 Cor 7:2–3, 9). Paul goes as far as to advise spouses to remain continent (1 Cor 7:5) and the unmarried and widowed not to marry (1 Cor 7:8) because of the imminent return of the Lord.

Infertility in the Recent Magisterial Documents

Following Augustine of Hippo, the church has considered procreation as marriage's primary goal and good, but this good is balanced with the union of spouses and the indissolubility of marriage.Footnote ⁵⁹ Childlessness, on the other hand, has rarely been addressed. In 1930, Pope Pius XI quoted Augustine that a wife's childlessness is no ground for divorce.Footnote ⁶⁰ In its section on marriage, the Second Vatican Council's 1965 Pastoral Constitution on the Church in the Modern World mentions childless couples in just one line, reaffirming the validity of marriage despite infertility.Footnote ⁶¹ In the 1981 apostolic exhortation, Familiaris Consortio, Pope Saint John Paul II briefly mentions childless couples. He reaffirms the value of conjugal life despite infertility, and also the “services to the life” that childless couples should be carrying.Footnote ⁶²

Donum Vitae (1987) is actually the first official document of the magisterium to deal extensively with involuntary childlessness.Footnote ⁶³ It addresses the issue in relation to the burning topic of medically assisted procreation (MAP). The Sacred Congregation for the Doctrine of the Faith acknowledges the legitimacy of the desire to have a child, but affirms that marriage does not give spouses a right to have a child. A child is a gift, not an object to be possessed. DV acknowledges the suffering that childless couples endure, advises the Lord's cross as a source of fruitfulness, and invites scientists to find a solution. In addition, DV asserts that infertility does not justify the recourse to methods of MAP, which contradict the teaching of the church. Two criteria need to guide the discernment of appropriate methods: respect for human life and the transmission of life through the conjugal act (DV, Introduction). DV suggests infertile couples should be at the service of life through adoption, educational work, and outreach to the needy and vulnerable (DV II, 8).

Dignitas Personae (2008) is an attempt to update DV in light of the development of new technologies such as cloning and stem cell research.Footnote ⁶⁴ It reiterates the teaching of DV, and adds an additional criterion—which was implicit in DV—for the evaluation of MAP: the unity of marriage (DP §12). It clarifies DV by stating that the appropriate methods are those that act in support of the conjugal act and its fertility (DP §12). It not only indicates appropriate approaches to infertility (hormonal treatments, surgery for endometriosis, unblocking or repair of the fallopian tubes) but also suggests adoption as a solution for childless couples (DP §13). As understandable as the longing for a child can be, the suffering of infertility does not justify the use of techniques that violate the sanctity of marriage and the integrity of human life (DP §16).

Amoris Laetitia (2016) treats the question of infertility in several paragraphs (§§178–80) in chapter 5 entitled “Love Made Fruitful.”Footnote ⁶⁵ It reaffirms the points made in earlier documents: infertility as suffering, marriage not limited to procreation, parenthood as more than biological, and the reality of adoption. Pope Francis clearly makes the argument that adoption is an act of generosity and love, and reminds that it puts the interest of the child at the center. AL §181 clearly teaches the faithful that “procreation and adoption are not the only ways of experiencing the fruitfulness of love,” and it invites families to find ways of expressing love toward the larger society.

The report of the preparatory meeting of the Symposium of Episcopal Conferences of Africa and Madagascar (SECAM) on the family mentions infertility and infertile couples. The African bishops ask that the church practice “a pedagogy of presence” toward couples who seek medically assisted procreation.Footnote ⁶⁶ A pedagogy of presence is a way of helping interested couples to discern the proper means of using MAP—that is, means that are consistent with the church's principles. The African bishops focus mostly on the issue of adoption and call for the adoption of abandoned children, the respect of the rights of adopted children, and a clear demarcation of rights and duties between biological and adopted parents.Footnote ⁶⁷ At the same time, they express the wish that infertile people convert their desire for biological children into a desire for spiritual fertility.Footnote ⁶⁸ They offer the witness of consecrated Christians as examples that infertile couples could emulate.Footnote ⁶⁹ They also acknowledge the particular suffering of women, although they remain vague and general in their statement.Footnote ⁷⁰

How the magisterium analyzes the particular case of women is also of interest. Motherhood is presented as the essential vocation of women, either married women or consecrated religious (see Dignitatem Mulieris). The same is not true for men. The emphasis on motherhood as a vocation—even spiritual—puts even more pressure on women who cannot conceive. Moreover, it places the infertile married woman in a “quandary,” since she “is neither a perpetual virgin like Mary nor a biological mother.”Footnote ⁷¹

The magisterial texts suggest adoption as a possible option, but that creates other issues in the African context. Then there is the question of adoption. Oduyoye's case and the studies mentioned above show that many infertile women have “social” children—in contrast to what Oduyoye calls “womb-children.”Footnote ⁷² Having these children, generally from relatives, eases the pain of some childless women.Footnote ⁷³ However, women recognize that having “social” children is not the same as having “womb-children,” and the child's identification with and longing for his or her biological parents are difficult to swallow.Footnote ⁷⁴ In addition, there will always be people to remind the child that she or he does not really belong to that particular family. Given that one does not need to be a biological parent to be called “father” or “mother,” because the words “aunt,” “uncle,” “cousin,” “niece,” and “nephew” are nonexistent in many African languages, it seems strange that these societies emphasize biological offspring. Adoption may be an interesting solution in the West, but in Africa, where the majority of households host members of the extended family in both rural and urban settings, the concept does not translate so easily. The growing Westernization of African cultures, urbanization, and the emphasis on the nuclear family could explain the resistance to adoption and the emphasis on having biological children.

Oduyoye observes that it is strange that “a church that … [upholds] celibacy (and thereby relativize[s] the importance of biological progeny) could not develop a theology that would help the enforced childlessness of many who are married.”Footnote ⁷⁵ She notes how unsupportive pastors and congregations blame childless women for irresponsible and promiscuous behavior, or for pursuing social achievement (through long years of study and a professional career) at the expense of marriage and family life. In that respect, Christianity has reinforced rather than counteracted West African traditional beliefs vis-à-vis childlessness.

Finally, church documents do not examine childlessness in itself but only in the context of other issues, such as the indissolubility of marriage, procreation, or MAP. They do not offer a full-fledged theology of infertility (e.g., how it affects people or what resources are available within the Christian community to deal with the issue). One of the main shortcomings of church documents is that the responsibility and support of the Christian community is barely mentioned. Childless couples are left on their own to figure out how to cope with their situation.

Reading Aquinas in the Context of Childlessness

How can one appropriate Aquinas’ theology to build a sound theology and spirituality of childlessness, given the fact that Aquinas never addresses the issue as such? Aquinas, in the context of marriage, emphasizes procreation and the education of offspring. In the context of virginity, he speaks of voluntary childlessness. The latter substantively differs from infertility, as it is freely chosen. Appropriation of Aquinas’ theology is valuable for strategic reasons. Aquinas is among the most studied and well-respected figures among African Catholic clergy. Moreover, Aquinas offers a theological method that draws from non-Christian sources (Aristotle and Averroes, for instance) and is valuable in a context where reference to African traditions is usual.

When Aquinas writes on Jesus’ lifestyle (ST III, q. 40, a.2, ad 2), he barely dwells on Jesus’ celibacy and childlessness. His commentary on gospel passages such as Matthew 19 (the issue of eunuchs) or 22 (the Sadducees’ story about the seven childless brothers and their wife) does not yield much fruit because of his use of allegory.Footnote ⁷⁶ Nonetheless, I have decided to construct a theology of childlessness, especially for women, by looking at the proper nature of marriage as outlined by Aquinas and then by recovering some elements of voluntary childlessness present in his theology. Before continuing, it is important to underline the main ideas of marriage in Aquinas’ thought.

Marriage in Aquinas’ Thought

Marriage is simultaneously a function of nature and a sacrament.Footnote ⁷⁷ As a good of nature, it is ordained to the perpetuity of the human species.Footnote ⁷⁸ As a sacrament, “it consists in the union of a husband and wife purposing to generate and educate offspring for the worship of God.”Footnote ⁷⁹ Procreation appears as the primary purpose of marriage. As such, marriage contributes to the good of the whole community.Footnote ⁸⁰ As a sacrament, it is also a remedy against sin, which in this case is concupiscence, and it fosters the virtue of temperance.Footnote ⁸¹ As a sacrament, it is a sign and points to a deeper reality, namely, the mystery of the union of Christ and the church.Footnote ⁸² As it mirrors this reality, it should be held indivisibly and faithfully. Hence, the two other goods of marriage are fidelity and indissolubility.

Marriage is a sacrament ordained to the good of bodily life.Footnote ⁸³ As such, it has “less participation in the nature of the spiritual life.”Footnote ⁸⁴ Marriage in Aquinas’ architectonic structure of sacraments comes in last position.Footnote ⁸⁵ It is not simply because Aquinas’ anthropology gives priority to the soul over the body. To the contrary, Aquinas’ sacramentology is grounded “in the complexity and historicity of human existence.”Footnote ⁸⁶ This does not mean that it does not contain spiritual elements (as noted, marriage is a remedy for sin and a sign of a deeper reality).

Marriage is a structure of grace, which is the proper environment for a mature loving relationship to flourish. Grace is a gift freely bestowed on human beings by God.Footnote ⁸⁷ Grace produces the following effects in the person: it heals the soul, fosters the desire for the good, carries out the good, perseveres in the good, and reaches glory.Footnote ⁸⁸ Grace unites the person to God and allows him or her to cooperate in God's project.Footnote ⁸⁹ However, the reception of grace in a sacrament should not be seen “as an isolated and isolating production of sanctification but as a bonding of believers with Christ in the unity of his Mystical Body.”Footnote ⁹⁰

The Proper Nature of Marriage

Procreation appears to be the main goal of marriage for Aquinas.Footnote ⁹¹ However, procreation is not limited to biological reproduction. He insists on the proper upbringing of children.Footnote ⁹² Conception and childbirth are not enough; nurturing and caring for children are important. Although Aquinas shares the gender bias of his time, he makes a good point by affirming the necessity of having both parents for the education of children.Footnote ⁹³

Outside of procreation, Aquinas offers a full-fledged reflection on marriage and its other goods. In the fourth book of his Commentary on the Sentences of Peter Lombard, subquestion 1 of distinction 27, he affirms the unitive function of marriage and that marriage is nothing else but a union. He acknowledges that the union of man and woman in marriage is the highest form of union, because it is a union of souls and bodies.Footnote ⁹⁴ He goes on to state that marriage is not only ordained to procreation but also to a single domestic life. In subquestion 2, he considers three aspects of marriage: the essence (a union), the cause (the act of getting married), and the effect of marriage (procreation). In subquestion 3, he holds that marriage is ordered to a common life within a household.

Aquinas declares that marriage is natural because it is accomplished through free will (libero arbitrio) in two ways: the good of offspring and the mutual aid of spouses.Footnote ⁹⁵ Regarding the good of offspring, he clearly states that procreation is not sufficient, but is completed by education and upbringing of the offspring until they reach the perfect state of the human being—being capable of virtue. Concerning the mutual aid of spouses, he advocates the complementarity (without using the word) of man and woman.

Aquinas maintains that consent makes the reality of marriage come true.Footnote ⁹⁶ Consent is not only manifested by external words, but has to be internal for a marriage to be true.Footnote ⁹⁷ Hence, it is not the conjugal act that causes the union, but consent. Marriage is simultaneously spiritual and material, a sacramental and a social reality. Thus, mutual and genuine acceptance expressed in words and perfected by actions grounds marriage.

In distinction 31, Aquinas reviews the goods of marriage, namely, procreation, fidelity, and indissolubility.Footnote ⁹⁸ As a function of nature and an act of virtue, marriage is ordained to two things: one that is required from the point of view of the agent (intention of an appropriate goal), and the other from the point of view of the act itself (faith). Procreation is located at the first level of intentionality. Offspring should be desired before being effected concretely. Further, the spouses’ fidelity is part of the integrity of marriage. Aquinas suggests that indissolubility is more important than the two other goods of marriage.Footnote ⁹⁹ Indissolubility is superior because it belongs to marriage as a sign of grace, while the two other goods belong to marriage as a sign of nature. Furthermore, he maintains that indissolubility is essential to marriage, while procreation and faith are just actualizations of the marital bond that presuppose indissolubility. A marriage could exist without fidelity or offspring, but not without indissolubility. Still, procreation and fidelity are caused by marriage, and provide the conditions for a genuine marriage, even if one thinks in terms of the intention to procreate and the fidelity to honor one's commitment. Nonetheless, indissolubility is part of natural equity, because a husband cannot leave an infertile or unattractive wife, or vice versa.Footnote ¹⁰⁰

The indissolubility of marriage sheds light on the nature of the relationship: a friendship between the spouses that goes beyond sexual intercourse. “For [the spouses] are united not only in the act of fleshly union, which produces a certain gentle association … but also in the partnership of the whole range of domestic activity.”Footnote ¹⁰¹ Friendship is key, because “the greater [it] is, the more solid and long-lasting will [the marriage] be.”Footnote ¹⁰² Moreover, indissolubility is absolute. Hence, only death ends it.Footnote ¹⁰³ Even if someone would be ready to dissolve marriage on the grounds of adultery, as the Reformed churches do, childlessness would not qualify as a motive for ending the relationship. It is not even listed among the possible impediments to marriage by Aquinas.Footnote ¹⁰⁴ The inability to conceive children does not destroy the ability to love and to be in a loving relationship. If this were the case, the marriages of the elderly would be illicit.

To sum up Aquinas’ argument, marriage creates an everlasting bond, and procreation is more than just having children. Regarding procreation, Aquinas seems to suggest that the intention to procreate is enough. Offspring as a good of marriage goes beyond simply giving birth and means raising one's children until they become adults. Thus, being a parent is not only a biological reality, but also entails taking care of one's children on a daily basis. People have to understand that offspring alone are not enough to guarantee a happy marriage. Moreover, even people who do not have biological children can still nurture and raise children.

Aquinas’ Insights into Voluntary Childlessness

For Aquinas, as for many in the Christian tradition, virginity is superior to marriage. When compared to virginity, a counsel, marriage is a lesser good.Footnote ¹⁰⁵ Here, it is interesting to consider how Aquinas responds to the criticism that consecrated virgins violate God's command to go and increase (Gen 1:28).Footnote ¹⁰⁶ One of the objections leveled is that if everyone were to follow this virginal path, it would lead to the extinction of the human race.Footnote ¹⁰⁷

Aquinas affirms that God's command to procreate (Gen 1:26) has been confirmed by Jesus’ injunction “What therefore God has joined together, let no man put asunder” (Matt 19:6).Footnote ¹⁰⁸ Aquinas puts forth arguments to justify voluntary childlessness that could be used more or less for involuntary childlessness. First, procreation “is ordered to the common good.”Footnote ¹⁰⁹ In other words, it is for the good of the whole species not merely for the individual.Footnote ¹¹⁰ It follows that everyone is not obliged to procreate. If procreation is vital for the whole species, then it is not necessarily vital for the particular individual. Sexual intercourse is a need that promotes personal wholeness, but it is not as important as breathing, eating, drinking, or sleeping. The same could be said about procreation. People can still survive and be happy without it, as we see in the case of so many consecrated people and childless couples.

Second, procreation is given by Divine Providence, but people are not obliged to use this ability.Footnote ¹¹¹ The fact that everyone can procreate does not mean that everyone should. Aquinas takes as an example the organization of society where the ability to do something does not necessarily lead one to use it. Third, voluntary childlessness brings awareness about nonmaterialistic values.Footnote ¹¹² Reality is both spiritual and material reality. Spiritual reality transcends and gives meaning to other realities. Likewise, a childless couple should be counseled that there is more to marriage than simply procreation. A healthy childless couple can help other members in a community to question themselves about the ultimate meaning of matrimony. Fourth, the command to procreate is no longer necessary to increase the people of God, since the latter are multiplied by a spiritual generation in the new covenant.Footnote ¹¹³ The emphasis is no longer on physical procreation, but on spiritual procreation. If consecrated celibates can be considered to be spiritual parents, this can be said of childless couples who undertake the task of raising children. Moreover, in Christ, the real family is not the biological one, but the spiritual one: “Anyone who does the will of God, that person is my brother and sister and mother” (Mark 3:35).

We can draw some inferences from Aquinas’ explanations of the situation of infertile couples. If procreation is important to humanity as a whole, it is not as vital for the individual. People should not feel pressured to procreate. Procreation in the new economy of salvation is not an obligation. Hence, if procreation is a gift from Divine Providence, infertility—from birth or from life's contingencies—should not be seen as a curse. Remaining in a childless relationship shows that marriage is not limited to biological procreation. There are other goods and values attached to marriage: fidelity, friendship, and love. Godly relationships, not procreation, provide an avenue for childless couples to create bonds outside their original community. Aquinas provides a voice from tradition that upholds childless couples’ essential dignity and offers a rereading of the experience that can be helpful for the situation of childless couples in West and Central Africa today.

Striving for Happiness

Childlessness often gives rise to a sense of failure, or even the idea that the union is imperfect. Yet, if it is understood in Aquinas’ sense, childless couples can continue to strive for happiness in a context of infertility. The grief of childlessness can lead people into self-destructive patterns,Footnote ¹¹⁴ and affect their self-esteem. Striving for happiness means working to achieve a good life. Striving for happiness is a way of acknowledging the agency of the subject and giving him or her the confidence to aim for what is good. The local church and Christian community must participate in this process. Until now, there have been only occasional declarations by local African bishops, but no serious pastoral program to sustain their words.Footnote ¹¹⁵ In addition, some pastoral approaches are limited in their scope, since they are only preventive and do not offer concrete care to infertile couples.Footnote ¹¹⁶

Happiness is the proper end of human beings, and in its perfect state consists in union with God.Footnote ¹¹⁷ While we wait for perfect happiness after this earthly life, there is room for imperfect happiness, which is a participation in perfect happiness.Footnote ¹¹⁸ Imperfect happiness can be attained through the person's natural powersFootnote ¹¹⁹ wherein humans are perfected by virtue.Footnote ¹²⁰ The perfection of charity (love of God and love of neighbor) is essential to happiness.Footnote ¹²¹ Since charity is the “mother and the root”Footnote ¹²² of all other virtues, we shall see here how it can illuminate the infertile couple and the Christian community in their search for a good life. Exploring love as a hermeneutical principle can uncover for local Christian communities in West and Central Africa the deeper meaning of marriage and can offer a holistic response to childless couples.

As Aquinas claims, “In the love of our neighbor, as in the love of God we may observe a twofold perfection: one without which charity is impossible, and consisting in one's having in one's affections nothing that is contrary to the love of one's neighbor; and another without which it is possible to have charity.”Footnote ¹²³ This second level could be considered in three ways: (i) the extent of love, which may spread to one's enemies; (ii) the intensity of love, shown by abnegation and acceptance of hardship for one's neighbor's sake; and (iii) the effect of love, through which one surrenders temporal good and even one's life for one's neighbor's sake.Footnote ¹²⁴

We shall consider this three-tiered second level of charity under three different but equally important power dynamics—namely, the Christian community, the infertile couple, and the individual. These three power dynamics shape the existence of the infertile. Our conviction is that a person does not exist in a vacuum, but in a dependent network of relationships, especially in communitarian societies. The inclusion of the Christian community is vital, because infertility is a social problem, as pointed out earlier. It is important to distinguish between the infertile couple and the individuals within that couple for two reasons. First, there are gender differences in the way men and women experience infertility, and the way they react to it.Footnote ¹²⁵ Second, spouses may find themselves in different places emotionally, spiritually, and personally.Footnote ¹²⁶

The Extent of Love

The extent of love highlights the necessity of inclusivity. At the individual level it starts with self-love. Far from being an appeal for narcissism and egotism, the call for self-love is located at the heart of Christian revelation. The horizontal dimension of the great commandment states: “Love your neighbor as yourself” (Mark 12:31). In other words, there cannot be healthy love of neighbor without proper love of self. Aquinas, in his ordo caritatis, reminds us that genuine self-love is grounded on the love a person has for God.Footnote ¹²⁷ Stephen Pope, commenting on Aquinas, opines: “Self-love is embedded in human nature by God.”Footnote ¹²⁸ Pope's insight that self-love is a gift from God provides an important dimension to understanding self-love properly. Charity requires an appropriate love of self and care of one's own body.Footnote ¹²⁹ For Aquinas, the key distinction is not “between self-love and neighbor love as such but between proper and improper self-love and proper and improper neighbor love.”Footnote ¹³⁰

The infertile couple has to practice inclusivity at two levels. First, there is internal inclusivity, in which each partner opens to the other through communication. Second, the spouses should not live in isolation, but also be ready to welcome others.

The starting point of the community's concern for infertile couples is found in Paul's words in 1 Corinthians 12:26a: “If one part is hurt, all the parts share its pain.” Inclusivity at this level means acknowledging the other (the infertile) and making room for them within the community. This can be in liturgy, in teaching, or in ministry outreach. For example, in liturgy, it could be through including petitions for the infertile in the prayers of the faithful or through preaching. The marriage ritual needs to make explicit the possibility of involuntary childlessness.Footnote ¹³¹ Certain areas of the theology of marriage can be reformulated.Footnote ¹³² People need to be sensitized to these issues, because community life in Africa is vital for any individual.

The Intensity of Love

The intensity of love probes the genuineness of love. Since the love of neighbor is tied to proper self-love and self-care, one needs to look at those attitudes that foster or hinder the latter. Infertility creates a crisisFootnote ¹³³ that leads to unhealthy and risky attitudes (promiscuous sex, isolation, binge drinking) that show improper self-love. It can also produce an erosion of self-esteem. People may feel inadequate, unfulfilled, or useless.Footnote ¹³⁴

The behavior of individual spouses affects the integrity of marriage. The conjugal act a symbol of this integrity. When there is infertility, this act tends to lose its spontaneity and becomes more like a task to be performed.Footnote ¹³⁵ Thus, ironically, when performed in such a manner the marital act, which symbolizes the love of spouses, does not fulfill its unitive role, and love is removed from it. Or the frequency of sexual intercourse tends to diminish. In addition, the intimacy of the couple may be invaded by friends, relatives, and/or doctors.Footnote ¹³⁶ Their varied advice may actually do more harm than good to the married couple.

At the level of the community, one needs to distinguish well-meaning attitudes from bad practices. Concerning the latter, the Christian community needs to consider ways in which it partakes in negative aspects of local social culture. The society at large aggravates an already painful situation by stigmatizing the childless and excluding them from crucial social roles. It plays a disruptive role in an already fragile marriage by suggesting the rupture of the marital bond, or even polygamy.

The Christian community must engage society and challenge the patriarchal vision of marriage as well as “cultural and religious notions regarding childlessness.”Footnote ¹³⁷ Special attention should be paid to childless women, who are the ones who suffer the most and often get the exclusive blame for childlessness, regardless of social status.Footnote ¹³⁸ Christian communities are often complicit in such situations through their silence in face of such injustices. It is the duty of the Christian community to challenge its own way of dealing with childlessness and its specific discriminatory and demeaning social practices against childless women.

The attitudes of “friends of Job,” who tend to lecture the infertile, may be well meaning, but such “friends” are not helpful. Christian communities should adopt a more humble attitude. “The experience of infertility is a grief process.”Footnote ¹³⁹ It takes time for the infertile to accept their situation, and their grieving process may take various forms. People sometimes need to be heard, to voice their anger and frustration, and to know that they are not alone in their “journey” through infertility.Footnote ¹⁴⁰ The primary attitude of the community ought to be accompaniment, compassionate listening, and support for the couple.

The Effects of Love

This is the level of grace or healing grace. Infertility is an experience of brokenness.Footnote ¹⁴¹ Only divine grace can heal brokenness and restore human nature. What are the structures of grace that can help infertile couples?

The most important thing for couples is friendship. True friendship is aimed toward the person we love and to whom we wish good.Footnote ¹⁴² However, well-wishing is not enough, it has to be accompanied by communication understood as communion.Footnote ¹⁴³ Mutual support is one form this communication can take. The quality of conversation between partners must rise to the level of genuine and open communication.

Infertility strains a marriage and communication between spouses.Footnote ¹⁴⁴ The couple should recognize this and realize how negatively each spouse is affected. Moreover, each spouse should acknowledge his or her own brokenness and embrace it.Footnote ¹⁴⁵ It is a humbling experience to realize that one has flaws, and that one hurts and needs help. The infertile couple needs help from outside, either through a priest or pastoral counselor or through a support group.Footnote ¹⁴⁶

The Christian community must offer support to childless couples and create concrete structures to welcome them. There are various structures of grace that the Christian community can put in place to accompany and show compassion to infertile couples.Footnote ¹⁴⁷

I see two types of concrete support. The first can be modeled on support groups for HIV patients; thus in an infertility support group all members should be infertile people or couples. This aspect is important, because support groups are intended to counteract the isolation that its members experience on their own. Participation in a support group is also cathartic, strengthening and encouraging individual members as they share their experiences with others who are facing the same problem. The second type of support could be facilitated by the inclusion of infertility in the apostolate of families. Infertility should be among the top issues discussed. Listening to testimonies will help sensitize Christian groups to the experiences of those coping with infertility and lead these groups to adopt proper attitudes toward the infertile.

In addition to church teaching, and to consulting thinkers such as Aquinas, to correct attitudes and beliefs the Bible must be read in a more balanced way. Indeed, the focus “on biological parenthood potentially ignores the Christian claim that we are all brothers and sisters in Christ, responsible for each other, and that relationships based on discipleship are not subordinate to biological familial relationships.”Footnote ¹⁴⁸ Revisiting childless figures in the Bible with a more concrete and appealing message (e.g., Miriam, Samson, Jeremiah, Judith, Jesus of Nazareth, Paul of Tarsus) would help empower childless people. On a continent where the Bible plays an important role in shaping people's worldview, these inspiring examples could prove decisive in changing mentalities.

The story of Tabitha (also known as Dorcas) in Acts 10:36–42 can illustrate this. Tabitha is resuscitated by Peter. She is not mentioned as wife or mother.Footnote ¹⁴⁹ She is primarily praised in virtue of what she does for the Christian faith.Footnote ¹⁵⁰ “Tabitha was not lauded for the typical female virtues of chastity, motherhood, or domesticity. Her good works were not described as being directed toward her husband or children, but on behalf of others beyond family and relatives.”Footnote ¹⁵¹ Remarkably, Tabitha is the only woman in the entire New Testament to receive formally the title of “disciple,” although the use of the phrase “a certain female disciple” suggests that there may have been other women “disciples.”Footnote ¹⁵² Nevertheless, “by naming Tabitha a disciple, the narrator designates that she was someone who was an exemplary follower of” Jesus Christ.Footnote ¹⁵³ This is confirmed by the fact that she performed “good deeds and acts of charity” (Acts 10:36b). Hence, Tabitha is important not because of offspring, but because of the good works she performs.