Why Starting a Family Can Feel Overwhelmingly Stigmatized for Some Women

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For many Australians, fertility treatment is a private decision made with clinical support. But for women from culturally and linguistically diverse (CALD) backgrounds, starting a family can come with a heavy burden of silence and, in some cases, deep shame.

Rhea Abraham knows this weight intimately.

Of Indian background and raised with strong cultural and faith traditions, Rhea found herself navigating not only the physical and emotional challenges of fertility treatment but also the layered expectations of family and community.

“When I first met my then-husband, he made it very clear he wanted to be a father,” she said.

“I remember thinking on our first date that, if I wanted to be with him, I would have to become a mother. That was a thought so foreign to me at that stage in my life.”

The couple’s joy at falling pregnant quickly turned to heartbreak when their daughter June, diagnosed with a fatal condition, was lost at 14 weeks.

Rhea Abraham describes herself as a bereaved mother and has turned her grief into advocacy for CALD women struggling with fertility and pregnancy loss. Source: Supplied

In the years that followed, Rhea experienced multiple miscarriages and underwent IVF.

She even considered international surrogacy in her longing to become a mother and fulfil her partner’s dream of fatherhood.

But it wasn’t just the physical and emotional toll of fertility treatment that Rhea struggled with; it was also the stigma.

“What I wasn’t prepared for was the religious and cultural language around women being ‘blessed’ with children,” she said.

“Language that, unfortunately and unintentionally, made me feel that I was cursed because I couldn’t bear them.

“The stigma attached to not being able to bear a child was insurmountable.”

A need for better care

According to Karina Bosetti, director of nursing at Connect IVF, Rhea’s story is not uncommon.

She says stigma around fertility runs deep in many migrant communities.

“It may be taboo or not spoken about in their community, and they may not know how to address their concerns,” Bosetti said.

“Patients in some migrant communities are less likely to engage in donor services, which may lead these patients to be unable to start their families and end up childless. It can also lead to marriage breakdown in some migrant couples as the pressure to start a family is forced upon them.”

With fertility already a complex medical and emotional journey, for some migrant women, these added cultural layers delay the decision to seek help — and with fertility, timing is crucial.

“Taking longer to seek help, then delaying treatment, always runs the risk of being unsuccessful with treatment,” Bosetti said.

“It may delay them seeking the treatment in the first place or asking the questions of their GPs due to cultural biases. It can leave these couples with no information or guidance to start their fertility treatment. It also means that some couples can have significant underlying medical conditions affecting their fertility that they never seek treatment for, or are never suggested the right treatment.”

Australia’s IVF success rate has steadily improved

According to research from UNSW, in 2021, 37.1 per cent of women who completed their first full cycle of assisted reproductive technology had a baby, with a cumulative live birth rate of more than 53 per cent after three cycles.

That same year, more than 20,000 babies were born from IVF treatment, accounting for one in every 18 babies born in Australia.

But despite these advances, national data sets like the Australian and New Zealand Assisted Reproduction Database do not currently report on IVF outcomes by migrant background.

This leaves a significant evidence gap when it comes to understanding who is accessing fertility treatment and who is missing out.

More barriers for migrant women

At the same time, migrant women are overrepresented in certain pregnancy complications.

Women born in Southern and Central Asia, South-East Asia, North Africa, the Middle East and North-East Asia were between 1.4 and 2.2 times as likely to be diagnosed with gestational diabetes.

They are also more likely to experience barriers to timely antenatal care.

According to Migrant and Refugee Maternal and Perinatal Health, “over one-third of all birthing people in Australia are migrants, and many face additional risks during pregnancy due to language barriers, health system inaccessibility, and stigma around reproductive health”.

Scientific director at Connect IVF, Lauren Hiser, says clinics have a role to play in bridging that gap.

“We need to provide more culturally directed information for all migrant communities, also addressing specific concerns,” she said.

“It’s important to bring culturally sensitive conversation to the forefront and give communities a voice and place to ask questions, to know what is acceptable within their cultural limitations.”

For Rhea, the experience has shaped her into an advocate for better grief literacy in CALD communities, founding Dark Horse International, a media company dedicated to amplifying the voices of CALD communities, domestic and family violence survivors and child safety advocates.

“I live vicariously now as a proud, typical Indian aunty,” she said.

“What I am blessed with are friends and family who remember my baby girl June, who will always live on in my heart.”

Griefline provides confidential support on 1300 845 745 and via griefline.org.au