For years, researchers have found the social stigma surrounding infertility has negative health implications for women experiencing it and can serve as both a visible and invisible hardship.

A new study by University of Kansas researchers has confirmed these findings, yet they also found that women seeking fertility treatments in online comments themselves tend to challenge and stigmatize pregnant women for their perceived immoral behaviors or a lower social status.

The researchers said the findings provide a link in how societal stigmas surface and insights into the challenges facing pregnancy-related social relationships, especially surrounding motherhood and perceptions of class.

“Issues of fairness and unfairness and whether someone is deserving or undeserving of motherhood consistently appeared in women’s forum postings. While these feelings aren’t necessarily unique to women experiencing infertility, they highlight how stigmatized groups continue to define social norms regarding the ‘proper’ path to motherhood, particularly along social-status lines,” said Jarron Saint Onge, assistant professor in the Department of Sociology.

The study was published recently in the journal Social Science & Medicine. Saint Onge and lead author Natalie Jansen, doctoral student in sociology, examined 432 initial conversation threads posted by women in various stages of the fertility-seeking treatment process in the online forum, Fertile Thoughts.

In response to frequently mentioned experiences of insensitivity or hurtful behaviors, many women appeared to use the forum as a coping strategy, the researchers said. In the anonymous online postings, infertile women frequently appeared to denounce fertile friends and family members, in some cases describing pregnant women as “fat cows, ferts, the fertiles, Fertile-Myrtles or momzillas-to-be.”

The researchers also found several instances of women struggling with fertility issues using remarks to elevate their own positions in comparison, including questioning why “God would give children to such a terrible person” or to a woman “and her cheating hubby.” Posters to the forum also consistently showed that being pregnant and on welfare were perceived as less acceptable than being pregnant with more financial stability, which is a near requisite for fertility treatments, the researchers said.

“Propagating comments about low-income mothers led to common definitions of acceptable and unacceptable behavior,” the researchers wrote.

And by equating low socioeconomic status with undeserving motherhood, women struggling with fertility issues in the posts appeared to be rectifying their own feelings of unfairness in the situation, they said.

Other criticisms from posters focused on fertile women using drugs and alcohol or teenagers or couples who became pregnant outside of marriage.

Jansen said the study is not meant to pass judgment on women experiencing fertility issues but that it’s important to study how stigmas surface in this area because infertility can be one of the most heartbreaking things a person can experience. Having an anonymous online forum allowed infertile women to maintain positive social relationships through their struggles, especially with women having common experiences, she said, which is important because infertility affects nearly 30 percent of U.S. women between the ages of 25 and 44.

“It’s important to note that the women are operating under pre-existing stereotypes about the ‘right way’ to go about motherhood, and these preconceived notions are likely the driving force behind their comments,” Jansen said. “Their own disappointment may be exacerbating it. These stigma dynamics are complex, and while we normally think of one person being stigmatized and another person doing the stigmatizing, in reality people can play different roles depending on the situation they’re in.”

The researchers said the study could hopefully provide more awareness and insight on stigma in general and how certain stereotypes, though possibly not always viewed or often talked about on the surface, can still cause harm.

“Actions toward fertility-treatment seeking women may have unintended perceived effects of stigmatization or marginalization, even if well-intentioned,” said Saint Onge, who also serves in the KU Medical Center’s Department of Health Policy and Management within the School of Medicine. “These actions can have potentially damaging effects on important social relationships.”