What is Tokophobia? It comes from the Greek roots toko + phobia, meaning “fear of child birth.” By the clinical definition, tokophobia is the irrational fear or anxiety of labor and pregnancy.
In 2007, the Internet Journal of Gynecology and Obstetrics published the article “Tokophobia: Fear of Pregnancy and Childbirth,” claiming that approximately 13% of women have expressed some form of tokophobia and a variable rate of 20-78% of pregnant women have experienced extreme fear of labor throughout their study. They believe that one of the reasons there is a rise in voluntary C-section rates, is due to this fear.
I would like to clarify the inappropriate and insensitive nature of this diagnosis while exploring the assumptions within it as well as suggest a new name for this diagnosis.
The fear of pregnancy, labor and childbirth seems to me like an absolutely rational fear, however, the clinical diagnosis defines it as irrational. Some aspects of pregnancy that, I would think, are in fact quite fearsome are:
- the potential chronic medical problems that one can acquire during pregnancy such as diabetes, hypertension, etc.,
- the short-term but very uncomfortable and not always treatable illnesses such as bacterial vaginosis, urinary tract infection, depression, etc.,
- the loss of control over the body and mind including one’s appetite, cognition, physical growth, etc.,
- the moodiness,
- the physical discomfort, and
- the pain of labor and childbirth.
(Just to name a few….the list does go on….).
Conversely, I believe that the reasons for women who are willing and even eager to face pregnancy, is for irrational reasons: family obligations, emotional reasons or even societal conditioning. These reasons are completely understandable and are valid, but in exploring the logical or rational reasoning, it seems to fail the litmus test.
The assumption that women should desire pregnancy derives from the idea that it is their evolutionary role and purpose in life to gestate, deal with pain and be maternal. Women who choose to live their lives any other way are often pathologized and considered irrational and mentally ill (“What? You don’t want kids? What’s wrong with you? Who doesn’t want to have children?”). In today’s world, evolutionary reasons are no longer relevant for the existence of mankind. Additionally, one does not have to be pregnant to be a mother, there are other options like adoption and surrogacy.
This is a Feminist Issue
Historically, the Western medical and mental health fields have not been kind to women. Diagnoses such as Hysteria1, officially defined as “unmanageable emotional excess,” once was attributed to a sexual dysfunction that required doctors to stimulate the clitoris until the woman reached orgasm in order to be relieved. Fortunately, this diagnosis was debunked at the end of the 19th century. However, the sentiment of “unmanageable emotions and lack of rationale in women” still exists today. It’s not a stretch to see that Tokophobia is a symptom of this philosophy; that women are so feeble-minded that they do not know their own interests or desires better than society does, and that it is best for them to do as they are told through biology, G-d, family, doctors and mental health professionals. In fact, it insists that women who choose to veer from their evolutionary, biological (or God-given, if you are so inclined) role must be mentally ill.
A New Name for Tokophobia
Even though I discredited tokophobia as a diagnosis, I still believe that it is important to validate this fear of pregnancy and labor since it is very real, especially if a woman is pregnant with this fear. An umbrella term that I believe can apply, instead of tokophobia, would be Pregnancy and/or Labor Anxiety (PLA). There should be at least four types to indicate the different reasoning:
- Some form of body dysmorphia, concern about and preoccupation with a perceived defect of their physical features,
- Anxiety about change, loss of control, etc. or
- Anxiety/fearing the pain of labor and childbirth
- combined type
I hope that with this understanding, treatment for PLA will be more available for women who choose to be pregnant and struggle with this anxiety. Similarly, for those women who have made the bold and personal decision to avoid pregnancy and live their lives as they choose, there will be more validation for them and no more need for excuses as to why they don’t want to be pregnant.