Conceiving strife: Relational vulnerabilities in couples with male infertility in Pakistan

This paper explores the intimate dynamics of male infertility in Lahore, at the intersection of cultural norms, masculinity, and reproductive health in Pakistan. I draw upon in-depth interviews with couples pursuing fertility treatment at a private clinic. Male infertility produces a cascade of relational vulnerabilities flowing from the profound destabilising impact of male infertility on masculine identity. These relational vulnerabilities are within the couple and extend to their wider families, who respond to the couple’s challenges by attributing infertility to the wife, and encouraging divorce or polygamous remarriage. Within couples, I detail the complexities of spousal communication regarding infertility. The couple’s economic and moral interdependence with wider kin adds further layers of relational vulnerability, flowing from the financial challenges of pursuing treatment. I reveal a spectrum of responses to these relational vulnerabilities among couples, ranging from those on the brink of marital breakdown to those whose bonds are strengthened by resilience. I complicate influential recent optimistic readings of the scope for infertility to destabilise hegemonic masculinities and produce new ‘emergent’ masculinities predicated on companionate conjugality. Inequitable, out-of-pocket access to fertility services plays a crucial role in how couples navigate the challenges of infertility. Mediating these impacts necessitates critical public health perspectives underscoring health equity and social justice, requiring an undoing of two-dimensional gender injustices.