探討臺灣女性之不孕污名意涵及其相關因素

Abstract

中文摘要 華人文化中，傳宗接代為核心價值，養育子女為家族與社會延續的保障，因此社會及家庭將生育子女視為婦女的責任。未能生育的女性容易承受來自社會負面不公平 歧視評價與對待。隨著女性教育水準的提升及參與職場比率增加，西方現代社會風潮與思維的影響，臺灣婚育模式亦逐漸轉變，傳宗接代的觀念逐漸衰退，相對地提升婦女生育自主權。近年來，晚婚與遲育比例上升，婦女的排卵功能與受孕率仍隨著年齡增加而衰退，因此需求助人工生殖技術協助生育的夫婦人數愈來愈多。雖然生殖科技已有長足進步，但成功受孕機率仍無法百分之百，也非一次就能順利如願，因此，接受生殖科技治療婦女必須反覆袒露個人最隱私的生殖問題，經歷療程過程中，其所承受治療及家庭社會的壓力對其不孕污名感受與影響，是值得深入探討。當不孕被視為偏離常態則會引發標籤化與貶抑，形塑不孕污名；此一污名既源自家庭與他人的外在壓力，也因內化而轉為自我貶抑，進而導致自責、羞愧與社會退縮等心理社會。 本研究以自我貶抑、社會退縮、周圍人群羞辱及家庭羞辱四個面向探討不孕污名，研究對象為正在接受體外受精技術之已婚成年婦女，旨在分析其不孕污名的主觀感受及影響因素。研究期間為 2024 年 4 月至 2025 年 8 月，採立意取樣於北部一間生殖中心，共收案 101 位。研究工具包括不孕污名量表、中庸思維量表、疾病揭露量表、自尊量表與家庭功能量表。研究結果顯示，年齡較輕、與夫家同住及先生有手足者有較高的不孕污名程度；中庸思維與不孕污名因素中的自我貶抑與社會退縮呈顯著正相關；揭露與自尊則與不孕污名整體及各因素均呈顯著相關；家庭功能則除自我貶抑外，與其餘因素皆呈負相關。逐步回歸分析結果指出，自尊、揭露後淨情緒反應及向特定對象揭露為不孕污名的主要預測因子，整體模型調整後解釋力為 61.3%，顯示高自尊及高揭露程度有較低的不孕污名。 本研究結果及重要發現，在婚育綁定的脈絡下，跨文化比較顯示，臺灣女性的污名型態以內化導向的「社會退縮」、「自我貶抑」為主，並提出「揭露後淨情緒反應」作為「區辨是否揭露」及「是否揭露」的評估指標本研究指出營造安全可信的支持網絡，並促進揭露後的正向感受，可有效減輕不孕婦女的污名與孤立感；建構營造安全可信的支持網絡，由臨床人員系統性識別低自尊與揭露困難者，並評估其社經地位與家庭功能，配合追蹤揭露後的淨情緒反應，及早提供相關支持及協助從而降低污名與孤立感；提升療程適應及療程持續率。

Abstract In Chinese culture, carrying on the family lineage is a core value, and raising children is regarded as essential for the continuation of both family and society. Consequently, both society and family commonly view childbearing as a woman’s responsibility. Women who are unable to conceive often face negative labeling and unfair treatment. With the improvement of women’s educational attainment, increased workforce participation, and the influence of Western modern ideologies, Taiwan’s marriage and fertility patterns have gradually shifted. The traditional notion of lineage continuation has declined, and women’s reproductive autonomy has increased. However, with the rising trends of late marriage and delayed childbearing, ovarian function and fertility rates still decrease with age, resulting in a growing number of couples seeking assistance through assisted reproductive technology (ART). Although reproductive technology has advanced considerably, the success rate of conception remains below 100%, and it is often not achieved in a single treatment cycle. Women undergoing ART must repeatedly disclose their most private reproductive issues and endure the pressures of treatment, family expectations, and social norms. The experiences and impacts of infertility stigma in this context warrant further exploration. When infertility is perceived as a deviation from social norms, it often leads to labeling and devaluation, forming infertility stigma, which arises from both external pressures from family and society and internalized self-deprecation, leading to self-blame, shame, and social withdrawal. This study explored infertility stigma from four perspectives: self-deprecation, social withdrawal, humiliation from others, and family humiliation. The participants were married adult women undergoing in vitro fertilization (IVF). The study aimed to examine their subjective experiences of infertility stigma and its associated factors. From April 2024 to August 2025, purposive sampling was conducted at a reproductive center in northern Taiwan, recruiting a total of 101 participants. Research instruments included the Infertility Stigma Scale, the Zhong-Yong Thinking Style Scale, the Illness Disclosure Scale, the Rosenberg Self-Esteem Scale, and the Family APGAR Index. Results indicated that younger age, living with the husband’s family, and having a spouse with siblings were associated with higher levels of infertility stigma. Zhong-Yong thinking was significantly positively correlated with self-deprecation and social withdrawal. Disclosure and self-esteem were significantly negatively correlated with overall infertility stigma and all subscales. Family function, except for self-deprecation, was negatively correlated with the remaining subscales. Stepwise regression analysis revealed that self-esteem, net emotional reaction after disclosure, and disclosure to specific targets were the main predictors of infertility stigma, with the final adjusted model explaining 61.3% of the variance, indicating that higher self-esteem and greater disclosure were associated with lower infertility stigma. The findings suggest that within a cultural context where marriage is strongly tied to childbearing, cross-cultural comparisons show that Taiwanese women’s infertility stigma is predominantly characterized by internalized forms, namely social withdrawal and self-deprecation. This study also proposes “net emotional reaction after disclosure” as a key indicator in evaluating whether and to whom disclosure is made. It is recommended to foster safe and trustworthy support networks and to promote positive emotional experiences following disclosure to effectively reduce stigma and feelings of isolation among women with infertility. Clinicians should systematically identify women with low self-esteem and disclosure difficulties, assess their socioeconomic status and family function, and monitor their net emotional reaction after disclosure to provide timely support, thereby improving treatment adaptation and continuation rates.