Social Exclusion of Australian Childless Women in Their Reproductive Years

Research suggests Australian childless women are at risk of pronatalism-driven social exclusion. This exploratory, mixed methods, cross-sectional study described and explored the social exclusion of Australian childless women aged 25 to 44 years, and asked: what are the nature and extent of social exclusion of childless women; and do the nature and extent of exclusion vary for different types of childless women? A total of 776 childless female Australian residents aged 25 to 44 years completed a self-administered questionnaire. Quantitative data were collected on childlessness types, indicators of exclusion and perceived stigmatisation and exclusion due to being childless. Data were analysed using descriptive statistics, One Way ANOVAs and Kruskal Wallis Analysis of Ranks. Qualitative data on childless women’s experiences were inductively thematically analysed. Findings suggest societal-level pronatalism drives exclusion of Australian childless women. While exclusion occurs in all domains of life, childless women experience more exclusion, and perceive more exclusion due to being childless, in the social and civic domains than the service and economic domains. Circumstantially and involuntarily childless women, followed by voluntarily childless women, perceive more exclusion due to being childless than undecided and future childed women. Experiences are influenced by the nature of women’s ‘deviance’ from pronatalism.


Introduction
Increasing numbers of Australian women aged between 25 and 44 years have no biological children, rising from 33 per cent in 2006 to 35.5 per cent in 2011 (Australian Bureau of Statistics [ABS], 2007[ABS], , 2012a. Research suggests pronatalism in Australian society places childless women at risk of social exclusion (see for example Graham & Rich, 2012a;Sawer, 2013).
Social exclusion is a multidimensional process driven by unequal power relationships interacting between the societal, community, relationship and individual levels, and manifesting in a continuum of inclusion and exclusion characterised by constraints upon the extent and quality of resources and opportunities for participation in the social, civic, service and economic domains of life (Levitas et al., 2007;Popay et al., 2008). Research suggests societal-level pronatalism drives stigmatisation and exclusion of childless women. Pronatalism constructs women as mothers, manifesting at a societal level in policies, discourses and ideologies designed to promote fertility by representing mother-hood as a moral, patriotic and economic duty, and at community, relationship and individual levels in cultures, beliefs, attitudes and behaviours that assume motherhood is natural, innate and inevitable (Gillespie, 2000;Graham & Rich, 2012a;Veevers, 1979). By constructing motherhood as central to being a woman, pronatalism perpetuates patriarchal power by disempowering women as resource-less mothers, and marginalising 'deviant' childless women (Gillespie, 2000;Park, 2002).
While the extant evidence reveals the complexity and diversity of childless women's experiences, it emerges from disparate studies investigating distinct domains of life and undifferentiated or particular types of childless women. There is no Australian research investigating social exclusion of different types of childless women in their reproductive years from multiple domains of life. This exploratory study aimed to describe and explore the social exclusion of Australian childless women aged 25 to 44 years, and asked: (1) what are the nature and extent of social exclusion of childless women; and (2) do the nature and extent of social exclusion vary for different types of childless women?
While acknowledging the negative connotations associated with terms used to describe women with no children, 'childless' and 'childed' are used to describe women without and with children respectively in this paper.

Methods
The study was conducted in Australia during 2014. Ethics approval was obtained from Deakin University's Human Ethics Advisory Group (HEAG-H 175_2013). The cross-sectional, mixed-methods study employed a fully mixed concurrent equal status design (Leech & Onwuegbuzie, 2009).

Sampling
The target population was childless female Australian residents aged 25 to 44 years who were not pregnant and identified as never having assumed the role or identity of a biological or social mother, for example, of adopted, step or fostered-children. The age range encompassed Australian women's mean age of first birth of 28 years, peak reproductive age of 30 to 34 years, and usual completion of fertility between 40 and 44 years (ABS, 2008(ABS, , 2010a; Australian Institute of Health and Welfare, 2010).
The formula for a binomial distributions k-sample for the chi-square test (Brown et al., 2010) yielded a minimum sample size of 427, including 171 voluntarily childless women, who freely chose not to have children (Veevers, 1979), 64 involuntarily childless women, who wished to have biological children but were unable to achieve a viable pregnancy (Daniluk, 2001), 64 circumstantially childless women, who were unable to have children due to other circumstances such as having no partner, partner infertility, or health issues other than those preventing a viable pregnancy (Cannold, 2005), 64 undecided women, who were unsure about whether to have children, and 64 future childed women, who intended to have biological or social children in future.
In the absence of a sampling frame, participants were recruited by promoting the study through 38 women's health services, 13 blogs and Facebook pages, professional networks and snowball sampling. Of the 1,411 respondents, 631 women who did not click the 'submit' button at the end of the questionnaire were excluded pursuant to the ethics approval as deemed withdrawals; and four whose dates of birth fell outside the target age range were excluded. The total sample size was 776 women, a completion rate of fifty-five per cent.

Data Collection and Measures
A self-administered online questionnaire collected quantitative data on socio-demographic variables, types of childlessness and social exclusion. Indicators of exclusion were measured using the social interaction subscale of the Duke Social Support Index (George, Blazer, Hughes, & Fowler, 1989) and the MOS social support index (Chronbach's α = 0.97; one-year stability α = 0.78) (Sherbourne & Stewart, 1991) in the social domain, participation in community groups, activities and events (ABS, 2010b) in the civic domain, degree of problems accessing and using services (Dermott et al., 2012) in the service domain, and employment status (Melbourne Institute of Applied Economic and Social Research, 2012) and personal income (ABS, 2011) in the economic domain. Data were also collected on stigma consciousness (Chronbach's α = 0.72 -0.74) (Pinel, 1999) and degree of perceived exclusion from domains of life due to being childless. Open-ended questions employing the critical incident technique, which seeks to obtain detailed accounts of participants' experiences of past incidents (Butterfield, Borgen, Amundson, & Maglio, 2005), gathered qualitative data on each domain (see Appendix).

Data Analysis
Aggregate scores were computed for social interaction, social networks, social support, community participation, problems accessing and using services and stigma consciousness (Hughes, Blazer, & Hybels, 1990;Sherbourne & Stewart, 1991). Employment status was computed from items on paid work status, underemployment and unemployment. Personal income ranges were recoded into income levels (ABS, 2012c). Fivepoint scales measuring degree of perceived exclusion due to being childless were collapsed into binary ordinal variables consisting of no perceived exclusion or at least a slight degree of perceived exclusion.
Descriptive statistics examined socio-demographic characteristics, indicators of exclusion and stigmatisation and exclusion due to being childless. One Way ANOVAs and Scheffe's post-hoc tests analysed differences between types of childless women's stigma consciousness. Kruskal Wallis H and Dunn's post-hoc tests analysed differences in social interaction, social support, community participation, problems accessing or using services, employment status, personal income and perceived exclusion due to being childless.

Experiences of Inclusion and Exclusion
Childless women described pronatalism-driven experiences on a continuum of connection and inclusion within, exclusion within, and exclusion from, all domains of life. Each theme or element of a theme was experienced by all types of childless women in all domains of life, unless types of childless women and domains of life are specified. Some women described only connection and inclusion or exclusion, some reported connection and inclusion in some domains and exclusion in others, and some reported inclusion and exclusion in the same domain. Substantially more women reported exclusionary experiences within, than connection and inclusion within or exclusion from, the domains.

Experiences of Inclusion and Connection
Many women described experiences of inclusion and connection arising from their 'deviance' from pronatalism. Experiences of inclusion and connection are subtly different. 'Inclusion' refers to experiences in which childless women feel included by childed people and within childed domains of life. 'Connection' refers to experiences in which childless women have the resources and opportunities to connect and participate, despite the potential for exclusion by childed people or from childed domains of life.
Some women described experiences of inclusion.
For example, some involuntarily childless, circumstantially childless and future childed women received emotional and instrumental support, while some women valued being included in children's lives.
I am fortunate to have some friends around me who invite me to share in their families. I am a godmother and have regularly held nannying roles -it's a privilege to be entrusted with the responsibility of caring for people's kids and for them to tell me they know I'd treat them as if they were my own. (ID 224; undecided; age 32 years) Furthermore, some voluntarily childless, undecided and future childed women reported others' understanding of their priorities and decisions.

Exclusionary Experiences within the Domains of Life
Many women experienced being childless as a stigma-tising attribute, which resulted in exclusionary interpersonal interactions within domains of life, with friends, family, community members, service providers, clients and colleagues. For example, many women described others' assumptions and expectations they had children or would have children. When such expectations were not met, they experienced others' disappointment, invalidation of their worth and pressure to become childed. For example, some involuntarily childless women received unhelpful encouragement to become childed. Some circumstantially childless women felt pressured to settle for 'any man', and many circumstantially childless, undecided and future childed women were pressured to 'hurry up'. In addition, many voluntarily childless and undecided women described others' arguments they would feel different once they met the 'right man' or had children, were 'missing out', or were unqualified to decide not to have children.
Voluntarily childless and undecided women also felt others pathologised their choices. Many women also described being stereotyped and judged by others. Women who were perceived as making choices that contributed to being childless felt stereotyped as child-hating, career-focused, materialistic and selfish.
There is a perception you are selfish (so what if you are?!), a baby-hater, have something wrong with you or are ruthless. Your personality is judged by a decision you make about one aspect of your life. (ID 139; undecided; age 33 years) All types of childless women felt judged as incomplete and unfulfilled. Involuntarily, circumstantially and voluntarily childless women who would not or could not ever become childed, felt further judged as defective and failed women. Some involuntarily and circumstantially childless women internalised such judgements.
The pressure to find a man and have a baby [as soon as possible] is huge. I feel it every single day of my life. There is no relief from feeling abnormal, shamed and like a failure. (ID 751; circumstantially childless; age 35 years) Some involuntarily and circumstantially childless women who wanted children felt judged as unhappy and desperate. In contrast, some voluntarily childless, undecided and future childed women felt judged as abnormal and unnatural for not wanting, or not yet having, children. All except involuntarily childless women felt judged as culpable for not having or delaying children.
[W]hen I was 27 I was diagnosed with [polycystic ovarian syndrome] and was then informed by an older female [general practitioner] that I should have considered such diseases before I decided to be single and without a child. (ID 115; future childed; age 31 years) Many women described others' beliefs they lacked knowledge, emotions, abilities and attributes that women acquired only upon becoming childed, including not understanding children and parenting, and being incapable of maturity, happiness, love, empathy and selflessness. Many women experienced invalidation of their views, contributions and expertise as a result of such beliefs.
We live in [an area] for private schools so there's always chatter about whose child goes where. I feel excluded from these discussions because I have no children but I also feel private schools suck money from public schools. Expressing that opinion is unpopular and is normally met with 'well you would think differently if you had kids'. No, I wouldn't. I find that assumption offensive. (ID 556; circumstantially childless; age 38 years) Furthermore, many women felt others perceived their feelings, experiences and needs as less important than those of childed people, and accordingly prioritised the needs of childed people.
Not being granted leave during holiday periods to allow parents to take leave. Not having access to any flexible working arrangements (part time, work from home etc.), which are only granted to parents. Having to work back late to cover people leaving early to pick up kids from school. (ID 011; circumstantially childless; age 33 years) In addition, many women experienced public questioning about their personal reasons for having no children, in response to which they felt required to justify, defend or conceal being childless. Finally, many women felt marginalised, invisible and irrelevant in interactions, activities and spaces dominated by childed people and children.
When I get together with my friends, they always talk about their children, and I sit there and have very minimal to say/input. I then tune out and feel lonely and very depressed. (ID 333; involuntarily childless; age 36 years)

Exclusion from Childed Domains of Life
Some women experienced exclusion from domains of life idealising, prioritising, dominated by or catering exclusively to childed people, or stigmatising childless women. In the social domain, some women experienced exclusion from financial and emotional support from family who prioritised childed relations, and many wom-en experienced exclusion from childed social networks.
Losing several very good friends to the world of 'mummyhood', even when you make all sorts of efforts to keep the relationship close it dies … I feel these relationships would probably have survived and grown if I too had chosen to have children. (ID 119; voluntarily childless; age 36 years) In the service domain, some circumstantially and voluntarily childless women were denied access to contraception and sterilisation procedures because medical practitioners believed they should become childed or would change their minds. Other women experienced exclusion from services that catered exclusively to childed people, or did not understand childless women's needs.
Gynaecological services for women not wishing to get pregnant are hard to access and [obstetric gynaecologists] seem uninterested in childfree woman and have a lack of knowledge about gynaecological problems outside of those relating to childbirth. (ID 017; voluntarily childless; age 35 years) In the economic domain, some women experienced exclusion from employment and promotion opportunities by employers who assumed they would become childed, invalidated their expertise in working with children, or prioritised childed people's employment needs. Further, some involuntarily and circumstantially childless women described financial hardship arising from attempts to become childed, or following divorces from husbands who wanted to become childed.
Due to marital separation with husband after the stress of not having children my material and financial resources have suffered enormously. No longer have a home, struggle to make ends meet. (ID 218; involuntarily childless; age 32 years) Finally, some women engaged in self-regulated exclusion from childed people, activities, groups, events and spaces, in order to avoid stigmatising experiences.
Went to appointment at [a hospital miscarriage clinic]. Same rooms and waiting rooms as pregnant women going for their check-ups. Indicated to sit at chairs facing wall and not towards the pregnant women … I would have gone back to that clinic but it was too difficult due to so many other pregnant women around. (ID 087; involuntarily childless; age 33 years)

Discussion
This exploratory, mixed-methods study was the first to investigate the social exclusion of different types of childless women in their reproductive years, across multiple domains of life in Australian society. This discussion explores the nature and extent of social exclusion of childless women, differences in the social exclusion of types of childless women, and the study's strengths and limitations.

The Nature and Extent of Social Exclusion of Childless Women
The findings revealed a complex picture of the social exclusion of childless women. The qualitative and quantitative findings suggested childless women experienced pronatalism-driven stigmatisation, congruent with studies finding other people stereotyped and stigmatised childless women (Çopur & Koropeckyj-Cox, 2010;Koropeckyj-Cox & Pendell, 2007;LaMastro, 2001). The qualitative findings further suggested pronatalism manifested in a continuum of connection and inclusion within, exclusionary experiences within, and exclusion from, all domains of life. Some women felt being childless resulted in experiences of connection and the freedom to contribute and participate. However, many women experienced exclusion within the domains of life. For example, reflecting previous research that voluntarily childless women experienced pressure from family and friends to become childed (Rich et al., 2011), all types of childless women experienced such pressure in all domains of life. Many women were expected to justify being childless, supporting earlier findings that being childless was a discrediting attribute that women were required to justify or conceal in order to maintain credibility (Bell, 2013;Rich et al., 2011). In addition, confirming and expanding upon research finding childless women felt workplaces prioritised childed people's needs for annual and carers leave, flexible work and work-life balance, and that others doubted their professional credibility (Doyle et al., 2013;Rich et al., 2011), many women experienced subordination of their needs to those of childed people, assumptions they lacked qualities only childed women could possess, and discrediting of their views and expertise, in all domains of life. At the other end of the continuum, some childless women experienced exclusion from resources and participation in domains of life dominated by, prioritising or catering exclusively to childed people. This finding augments existing research revealing involuntarily childless women's exclusion from a childed social world (Loke, Yu, & Hayter, 2012;Malik & Coulson, 2013).
Supporting the qualitative findings, the quantitative findings revealed exclusion varied within and between the domains of life. In the social domain, childless women had moderate levels of social interaction and high levels of social support. While Italian research found that childless women were less likely to receive social support than childed women (Albertini & Mencarini, 2014), it compared childless with childed women. In the civic domain, a new area of research for childless women in their reproductive years, childless women had low levels of participation in community groups, events and activities. In the service domain, childless women had a low degree of problems accessing or using services. However, in the context of qualitative findings that some women felt excluded from mental and reproductive health services, and a United States study finding 22 per cent of childless women had difficulty obtaining healthcare (Bernstein, 2001), the aggregate score may have disguised problems with particular services. In the economic domain, most women were employed and in the upper middle or high personal income brackets, in accordance with the weight of Australian and international research (Debest & Mazuy, 2014;Miranti, McNamara, Tanton, & Yap, 2009;Waren & Pals, 2013).
In relation to perceived exclusion due to being childless, childless women perceived more exclusion in the social and civic domains than the service and economic domains. This may be explained by the implications of pronatalism in different domains. For example, stigmatising experiences may be more salient in the social and civic domains, while freedom to participate may be more pertinent to the service and economic domains. In addition, when considering the continuum of connection and inclusion within, exclusionary experiences within, and exclusion from, domains of life, the qualitative findings revealed substantially more women described exclusionary experiences within domains of life, than experiences of connection and inclusion within, or exclusion from, domains of life. This facilitates an understanding of why the quantitative findings did not consistently reveal exclusion from, or connection and inclusion within, domains of life, by suggesting exclusionary experiences within domains of life are more relevant to childless women.

Differences in Social Exclusion of Types of Childless Women
The findings revealed an equally complex picture of exclusion of types of childless women. In relation to the indicators of exclusion, circumstantially childless women reported lower levels of social support than other types of childless women. There were no statistically significant differences in other indicators of exclusion, suggesting different types of childless women had similar levels of resources and participation. Australia's divergent cultural, social, political and economic context from other countries may explain inconsistencies with United States and French studies, which found voluntarily childless women had higher workforce participation rates and incomes than other childless women (Abma & Martinez, 2006;Waren & Pals, 2013). In rela-tion to perceived exclusion due to being childless, circumstantially and involuntarily childless women, followed by voluntarily childless women, perceived more exclusion than undecided and future childed women. These differences corresponded with findings that involuntarily, circumstantially and voluntarily childless women perceived more stigmatisation due to being childless than future childed women, and involuntarily and circumstantially childless women perceived more stigmatisation than undecided women.
The qualitative findings provided additional evidence of nuanced differences in childless women's experiences of inclusion and exclusion. Such differences were influenced by whether women's 'deviance' from pronatalism was non-volitional (innocent), volitional (guilty), and temporary or permanent. For example, some involuntarily and circumstantially childless women, for whom being childless was non-volitional, received sympathy and support. However, others felt stereotyped as unhappy and desperate, consistent with previous research with involuntarily childless women (McCarthy, 2008). In contrast, women whom others perceived as culpable for choices that 'contributed' to being childless, felt stereotyped as selfish, materialistic and child-hating. Furthermore, women who were permanently childless felt judged as failures. In addition, some circumstantially childless and voluntarily childless women who were permanently childless, and undecided women who were considering becoming permanently childless, experienced divorce or separation from partners who wanted to become childed, building upon earlier research with involuntarily childless women (Bell, 2013).
The findings also supported earlier studies revealing childless women's agency (Doyle et al., 2013;Park, 2002), by suggesting childless women are not simply passive receivers of social exclusion. Rather, their internalised, disempowered or empowered responses influenced experiences of social exclusion. Expanding upon research with involuntarily childless women (Bell, 2013), some involuntarily and circumstantially childless women who perceived themselves as failures, incomplete and unfulfilled, were deeply cognisant of being excluded. Furthermore, while some women inadvertently exacerbated exclusion by avoiding stigmatising experiences, others made empowered choices to build lives in which being childless was valued and affirmed.
The influence of the nature of women's 'deviance' from pronatalism facilitates an understanding of differences in types of childless women's degree of perceived exclusion. Some involuntarily and circumstantially childless women's greater degree of exclusion may have been influenced by permanent, internalised and disempowered non-conformance, despite involuntarily childless women's 'innocent' deviance. In contrast, some voluntarily childless women may have been protected from their volitional ('culpable') and perma-nent deviance by empowered choices. Finally, some undecided and future childed women may have been protected by temporary non-conformance with pronatalism, whereby they were included on the basis of assumptions they would become childed in future.

Strengths and Limitations
The study had a number of limitations. In relation to the qualitative component, neither iterative data collection and analysis nor participant validation was possible in the context of an anonymous questionnaire. In relation to the quantitative component, its crosssectional design precluded an examination of causality. Selection bias may have been introduced by the fiftyfive per cent completion rate, and non-probability sampling limited external validity. Although selfselection was unavoidable due to the absence of a sampling frame, it may have produced a sample that was more likely to experience pronatalism-driven stigmatisation and exclusion. While the sample was not comparable with Australian women, participants' high educational attainment, employment rates, personal incomes and proportion of voluntary childlessness were consistent with research on the characteristics of childless women (Abma & Martinez, 2006;Miranti et al., 2009;Waren & Pals, 2013). Finally, due to its exploratory nature, the study did not control for confounding factors.
Despite its limitations, this study was the first to investigate social exclusion in multiple domains of life of different types of childless women in their reproductive years. Furthermore, the mixed methods approach facilitated a deeper understanding of social exclusion, the large sample provided sufficient power and rich qualitative data, the use of existing and validated scales reduced the potential for measurement bias, and self-administration minimised socially desirable responses. In addition, data immersion, participant quotations, locating the findings within existing research, and researcher reflexivity enhanced the qualitative component's rigour.

Conclusions
This research suggests societal-level pronatalism manifests in a continuum of childless women's connection and inclusion within, exclusion within, and exclusion from domains of life in Australian society, with more exclusion in the social and civic domains than the service and economic domains. Future research using a more comprehensive suite of indicators will further elucidate the nature of social exclusion. The study further suggests circumstantially and involuntarily childless women, followed by voluntarily childless women, perceive more stigmatisation and exclusion due to being childless than undecided and future childed wom-en. Such differences may be influenced by the nature of women's 'deviance' from pronatalism.
Given social exclusion is a firmly established social determinant of health, it is essential to work towards an Australian society in which women's motherhood status is irrelevant to judgements of their worth, such that none would feel excluded in connection with being childless. Inclusive research can contribute to this change by measuring and exploring motherhood status and types of childlessness in health and social research. In addition, practitioners and policy-makers can develop inclusive interventions and policies by ensuring childless women's needs are considered in interventions and policies for all women, directly targeting different types of childless women with support groups, activities and events, and constructing counterdiscourses of being childless as a positive and valued attribute.
Appendix: Open-ended questions used in the data collection instrument.

Topic/domain Question Stigmatisation
Can you think of a time when you felt you felt you were stereotyped or stigmatized because you have no children? If so, please describe the incident in the space provided.
Social domain Thinking about your family and friends, can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided. Thinking about your participation in social and leisure activities, can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided.

Civic domain
Thinking about your participation in community life, can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided.

Service domain
Thinking about your access to and use of services, can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided.

Economic domain
Thinking about your working life (including paid work and unemployment), can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided. Thinking about your material and financial resources, can you think of a time when you had a positive or negative experience related to not having children? If so, please describe the incident in detail in the space provided. General Is there anything else you would like to tell us about being a woman in Australian society who does not have children?