Modelling Infertility Stigma in a Pronatalist Context: The Ghana Infertility Stigma Framework

Infertility in Ghana carries consequences that extend well beyond the individual, touching marriage, family standing, and one's place within the community. Studies estimate that more than half of women pursuing fertility treatment encounter stigma, with effects severe enough in some cases to end marriages or trigger partner violence. Despite a substantial body of qualitative evidence documenting that this stigma occurs, the literature has stopped short of explaining its mechanisms, its interaction with pronatalist norms, or its downstream effects. Compounding the problem, the dominant stigma theories were developed in Western settings around conditions such as HIV and mental illness, and they overlook a cultural context in which the extended family, rather than the affected individual alone, bears the social weight of infertility. The authors at the evidence and impact seminar organised by the University of Port Harcourt - Africa Centre of Excellence for Public Health and Toxicological Research(ACE-PUTOR) held on 13th August, 2026 presented the Ghana Infertility Stigma Framework (GISF), an integrative model that draws together four separate theoretical traditions, namely Link and Phelan's account of structural stigma, Earnshaw and Chaudoir's model of internalised, perceived, and enacted stigma, Hatzenbuehler's work on psychological mediation, and Pescosolido and colleagues' structural perspective, and organizes them into a single, empirically testable framework calibrated to Ghana's pronatalist social environment. The framework's four theoretical strands each shape a distinct stage of instrument development for the accompanying Ghana Infertility Stigma Scale (GISS), from initial item generation through a Delphi consensus process, factor analysis, and discriminant validity testing. Because the GISF specifies an explicit causal ordering, moving from theoretical domain to contextual moderation to measurable outcome, it lends itself to confirmation through structural equation modelling once the GISS is fully operationalised. Beyond organizing an otherwise fragmented literature, the GISF is built on the premise that methodological rigor and advocacy for affected women are complementary goals rather than competing ones. Its implications extend to clinical screening and referral, health policy that currently omits fertility care, and third-party reproduction, where concerns about donor anonymity and lineage add further layers of structural and family-level stigma.