Janine L. Barden-O'Fallon, MA, Carolina Population Center, University of North Carolina, CB#8120, University Square, 123 West Franklin Street, Chapel Hill, NC 27599-8120, 919-966-2157, bardenof@email.unc.edu

This study analyzes in-depth interviews with 15 women and 11 men living in a rural Malawian village to examine how fertility problems are identified, attributed and interpreted in a context of high fertility demand. Grounded theory techniques are used to analyze the interview data. Results of the analysis show that community members expect pregnancies to occur quickly after becoming sexually active. Problems are perceived if more than a few months pass without a noticeable pregnancy. Such problems are usually attributed to women, especially if the male partner has proven his fertility with another spouse/sexual partner. First marriages are likely to end if a couple is not able to have children, whereas subsequent marriages appear to be more stable if infertility problems are addressed up front. Before a marriage ends it is likely that the spouses (usually the men) have sought pregnancies with others. In a region where HIV prevalence is high, such behavior presents a significant health risk for these individuals, their partners, and those with whom pregnancies are sought. Community education on variation in the time to conception is needed, especially when perceived infertility leads to unnecessary treatments and risky sexual behavior.

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