by Rosemarie Nave-Herz and Corinna Onnen-Isemann

Today, medicine not only provides reliable contraception, but also ensures through artificial insemination that the number of childless marriages in industrialised countries does not increase any further. The reasons why wives expose themselves to so-called IVF treatments (in vitro fertilisation), which are rarely successful, often only after a long period of contraception, are mostly due to a traditional family image, the fulfilment of which is often postponed for too long. This is one of the findings of a research project on "Reproductive medicine from a sociological perspective".

Remaining fatefully childless in a marriage has always been perceived as something "unnatural", "deviant". De facto, in all European cultures of the past, the aim of marriage was basically to produce offspring, so that entering into marriage was so naturally linked to having children that childlessness was not even a possible choice. Those who wanted to and/or should remain childless were already excluded from marriage, e.g. the temple virgins of the ancient Egyptians or Germanic tribes, the nuns and monks of Christian and Buddhist monasteries, as well as certain people for whom public marriage bans applied at certain times, such as servants, journeymen, officers etc. Childlessness in a marriage was therefore - as far as we can see from the history of mankind - generally due to medical reasons, and it was usually met with openly expressed or concealed contempt. Women in particular were blamed for childlessness in a marriage and were the most likely to be ostracised. In many cultures, childlessness in a marriage was also seen as grounds for divorce or as an opportunity to disown the woman.

Even in the Bible, infertility was described as a punishment from God (e.g. Genesis 20:29 and 31), and the devaluation of childless wives through the valorisation of mothers is documented by the example of Sarah and her maid Hagar, who had a child by and for Abraham instead of Sarah and disregarded Sarah for it.

This one-sided attribution of blame was common in our country until well into this century, although fertility disorders in men were already described in ancient Egyptian and ancient Indian medicine as well as in the Talmud, and medical writings from 1647 testify that even then people had very detailed knowledge of marital sterility caused by the husband.

The many superstitious recommendations and "medical" remedies also show how fearful and unfortunate the threat of childlessness in a marriage was, especially for women: magic rites, magic potions, pilgrimages, herbs, bathing cures and much more were supposed to provide relief.

The devaluation of childlessness and the associated devaluation of unmarried women was still very widespread in the last century. Even the representatives of the first women's movement adhered to the "destiny of women" as mothers. For example, Helene Lange, Gertrud Bäumer and other leading women of the first bourgeois women's movement clearly placed the future mother at the centre of education. This is why many representatives of the bourgeois women's movement tried to pave the way for childless and unmarried women to achieve "spiritual motherhood" - as they called it at the time - i.e. to create opportunities for gainful employment with regard to those academic appointments for which "maternal qualities" were necessary: Teacher, social worker, kindergarten teacher, etc. At the same time, this sent a very clear signal: Women could almost only gain recognition by being mothers - be it in biological terms or in a figurative way (= "spiritual motherhood").

Single and childless women were particularly devalued - especially in the form of pity - after the Second World War. As a result of the disproportionate population structure in relation to the sexes, the old prejudices and labels of the "old maid" were revived, namely about women who had missed the real purpose of a woman's life, namely to be a mother. This development was only possible because after the war the family was accorded a particularly high value, not only in Germany, which was probably due to the long separation between family members and the many grades of hardship and anxiety caused by the war. People longed for peace, security and understanding, for values that were ascribed to the family. However, the high valorisation of the family and thus of being married and having children automatically led to the devaluation of the alternative status of "childless". The extent to which this ideology prevailed into the 1950s can be seen in the results of an opinion poll. When asked whether they considered single and childless people to be "excluded from happiness", 78% agreed in 1953; in 1972, 32% answered the question "Do you believe that a woman must have children in order to be happy?" in the affirmative and only 23% in the negative in 1984.

The New Women's Movement brought about a change, some of whose representatives are still opposed to women taking on the role of mother, as the data from a study we conducted on the reasons for the use of high-tech reproductive medicine shows.

Since the end of the last century, the proportion of childless marriages has been steadily increasing in almost all industrialised countries, especially in Germany. In 1989, 8.4 % of marriages remained childless; today the figure is 18 %. According to model calculations, the proportion of marriages concluded after 1970 that will ultimately remain childless is even expected to reach 20%. The increasing childlessness in Germany can be seen even more clearly in cohort-specific analyses of all women: While only 9 % of women born in 1935 remained childless, this applies to 20.5 % of women born in 1955 and to around 25 % born in 1961, with the trend continuing to rise.

The reasons for childlessness can be of a medical or psychosomatic nature. As we have already established in an earlier project, deliberately chosen voluntary childless marriage appears to be rare in Germany; on the other hand, temporary childlessness, i.e. the desire to have children is postponed, has increased significantly. However, this desire is often only made possible by medical reproductive technologies. If they had not been developed and used, the proportion of childless marriages would have continued to rise. In the last 10 years, the number of high-tech reproduction centres in Germany alone has increased tenfold.

While initially only surgical and/or medicinal methods were available for the treatment of childlessness, as well as the possibility of artificial insemination, "in vitro fertilisation", also known as "test tube fertilisation", has also been used in Germany since 1981. This method attempts to artificially induce a pregnancy outside the human body under laboratory conditions. Since then, the treatment canon has expanded to include other procedures: GIFT in 1985, TET/ZIFT in 1986 and microinjections (ICSI-intracytoplasmic spermatozoon injections) in the 1990s. As no standardised terminology has yet been established, the term IVF is used below as a synonym for the methods IVF, GIFT, TET/ZIFT and ICSI.

The research project "Reproductive medicine from a sociological perspective" investigated, among other things, the conditions causing the sharp quantitative increase in IVF treatments from a sociological perspective and looked for theoretical explanations for the increasing use of this highly technical reproductive medicine.

Selected gynaecologists and reproductive physicians were interviewed, and a document analysis was carried out on the arguments put forward by statutory health insurance funds to finance the treatment of infertility. Above all, however, affected women were interviewed. The sample comprises a total of 52 qualitative and 273 written interviews.

Of the women surveyed who had undergone reproductive medical treatment, 62% had postponed their desire to have children for years in this partnership and were then, when they decided to have a child, predominantly at an age when they were less able to conceive. The gynaecologists in the interviews also emphasised that some of their patients had delayed the fulfilment of their desire to have children for too long with the help of contraceptives and were now at an age at which fertility and the ability to conceive were declining. The data from the current study therefore initially confirmed the results of an earlier study, according to which the vast majority of childless people did indeed associate a desire for children with marriage, but had initially postponed having children, particularly because of their high level of professional commitment. The data also showed that for those who had chosen this temporary childlessness, a family life with children should have a certain quality, that the women believed they could only be a good mother if they were no longer employed.

Both value orientations - traditional family orientation and high career commitment - are antagonistic and must lead to decision-making conflicts. However, this can result in temporary childlessness being chosen as a conflict resolution strategy - often even unconsciously - in order to avoid having to decide between divergent value orientations, possibly in the hope of being able to resolve this contradiction at a later date.

The decision conflict between divergent value orientations - career orientation versus traditional family orientation - is ultimately an expression of the fact that for those "temporarily" childless couples, macro-perspective changes become "visible" at the individual action level, namely the different changes in social subsystems. This is because the school, training and professional system has changed for women over time and their professional commitment has increased as a result; the family system, including the definition of the mother's role, has not changed to the same extent for women.

However, the chosen temporary childlessness can then lead to involuntary childlessness due to gynaecological or andrological changes in the meantime, e.g. due to illness (their own or their partner's), age or psychosomatic reasons, as was the case for 62% of the women surveyed who then underwent reproductive medical treatment.

Reproductive medicine has thus had a paradoxical effect: through the development of anticonceptives, it has initially offered the possibility of reliably preventing pregnancy, but for some women at the price that the inability to conceive can now only be reversed with its help.

With enormous personal stress, the interviewees strove for a correction; their wish was to found a "normal family", their own biological child. Adoption was rarely considered. The extent to which the "nuclear family" (= parents with biological children) can still be regarded as the ideal today, despite the plurality of practised lifestyles in our society, and the role of the mother can still have top priority, becomes particularly clear in the case of reproductive medicine patients. Incidentally, it is predominantly the women's desire to have children that acts as the "driving force" behind the desire to treat childlessness.

The data also confirm the findings of other studies: Highly technical reproductive medicine is a stress-inducing and stress-producing life event for the women concerned. In addition, each step of the treatment is associated with renewed uncertainty and, above all, unpredictability of success.

However, the psychological burden is only "one side of the coin"; many women also complain about physical impairments and above all about the organisational "strains". Above all, in some marriages, reproductive medical treatment seems to lead to independence or the instrumentalisation of sexuality for the sole purpose of procreation, which was expressed very clearly in some interviews. But there are also statements to the contrary. Some women reported that IVF treatment had a positive effect on their emotional marital relationship, creating greater closeness and openness.

Due to the great psychological, physical and other stress factors associated with reproductive medical treatment, the question arises as to why women continue with a second, third and sometimes even a fourth treatment, which is paid for by the health insurance company, even after the first treatment has been unsuccessful. In terms of reasons for continuing treatment, the women surveyed cited the fear of later self-reproach in particular, as 79% said "although I am not feeling very well during the individual treatment phases, I will not stop treatment before the end of the possible attempts so as not to reproach myself later". The fear of failure and the hope of success obviously influence the "cost-benefit balance" in favour of renewed treatment if the pregnancy does not occur. In addition, the more "costs" are invested, the more desirable the "benefit" becomes. This is presumably why 77% of respondents said that "every single step (in the treatment cycle) gives me new courage for the next one" - a hope reminiscent of the expectation of luck in the lottery - albeit with slightly greater chances of winning. This is because the success rates of high-tech reproductive medicine for the treatment of childlessness are low overall. The "baby take-home rate" fluctuates between 10 % and 15 % per year.

Nevertheless, traditional family formation with the biological mother remains, as shown, a cultural goal with high priority. In the past, there were other "paths" to family formation, which were also adopted to a much greater extent than today: Adoption of children (e.g. illegitimate ones; but also giving away children from poorer, child-rich families to wealthy childless relatives was not subject to taboos as it is today). These "paths" are hardly "viable" for achieving the cultural goal of "family formation". The opportunities for adoption have radically diminished, but - like foster children - are also not seen by many as a "substitute" for "own" children. This explains why reproductive medicine is sometimes seen as the only remaining form of adaptation to the culturally predetermined goal of "family formation/parenthood", at least as long as this goal itself is not called into question.

The authors

Prof. Dr rer. pol. Dr phil. h.c. Rosemarie Nave-Herz, a sociologist at the Institute of Sociology in Oldenburg, was appointed to the University of Oldenburg in 1975. Her academic career began in 1965 when she became a research assistant at the Max Planck Institute for Human Development in Berlin. This was followed by a first lectureship in Oldenburg (1967-1971) and an academic appointment to a chair of sociology (Cologne 1971-1975). In the summer term of 1985, she was a visiting professor at the University of Sussex, England. She declined further academic appointments. She is a member of numerous scientific commissions and is currently Vice-President of the "Committee on Family Research" of the International Sociological Association (ISA).

Dr Corinna Onnen-Isemann completed her doctorate at the University of Oldenburg, was a scholarship holder at Harvard University/Boston and is currently a post-doctoral candidate in the subject of sociology.