Pacific Islanders are renowned for having big, tight-knit families, but this notion can create problems for women who struggle with fertility.
Little is known about the extent of infertility in the Pacific Islands due to under-reporting and a lack of research.
However, one paper in 2018 explored Pacific Islander women's infertility experiences in New Zealand.
It found this marginalised group was often stereotyped as being "hyper-fertile", compounding the stigma attached to the issue of infertility.
Gender, culture and religion also helped reinforce this notion, making matters worse for Pacific Islander women.
'She wastes cassava'
In her early 20s, a routine check-up led Fijian journalist Lice Movono down a path of surgeries and medication in order to have children.
It was a large, painful cyst on her ovary that prompted the treatment and fast-tracked thoughts about having a family of her own — her then-partner already had children that she had "taken to very quickly, very naturally".
However, as she approached her late 20s, Ms Movono said "tongues started wagging" and nasty remarks from family — both immediate and extended — intensified.
"In Fiji, there's a derogatory joke that goes around when a woman can't have children – they say, 'She wastes cassava', meaning food is wasted on her because she's not going to give you children," she said.
"It was, at that time, a source of a lot of tension or friction between my partner and I and, eventually, my in-laws.
'A pretty difficult journey'
Ms Movono used a "little window" of time to try to to conceive.
"At the time, I just couldn't fathom the idea that, if I left it too late, I wouldn't be able to have kids," she said.
Amid the full-time reporting, study and ongoing pain associated with her surgeries, Ms Movono fell pregnant.
Nine months later Esther was born. She was, admittedly, a "huge baby" who made for a challenging and traumatic delivery.
"I had her at about 39 weeks, and she was 4.6 kilograms because, of course, that's what I needed, to have a humungous baby to deal with," she joked.
Despite the arduous journey to become a mother, Ms Movono said Esther was "just the prettiest thing, the easiest baby".
Not long after, Ms Movono fell pregnant again with Esther's brother, Jacob.
"I know a lot of women who will not talk about these issues because they're of a reproductive health nature and it has a taboo element attached to it," she said.
STIs a key driver of infertility
Dr Edith Kariko is a Senior Health Specialist with the World Bank in Port Moresby.
She said infertility stigma also affected women in Papua New Guinea because sexually transmitted infections (STIs) were a leading cause of fertility issues, and few women want to discuss it.
"If you're a woman of reproductive age, you can't speak up about vaginal discharge or pains in the lower abdomen, pain with urination," she said.
Dr Kariko said sexual and reproductive health education in schools was inadequate and needed to be revised to create a "culturally enabling environment" for such conversations to take place.
"Having the awareness on where they can get help, or what is causing particular infertility, even for young people to discuss this openly before they get into relationships is really critical," she said.
'Bride price' exploited
Dr Leeanne Panisi is the only female fertility specialist among a cohort of four in Solomon Islands and works at Honiara's National Referral Hospital.
She said cultural practices such as 'bride price' were being abused in some cases to add pressure on women to conceive.
For the women who had exhausted all fertility options, Dr Panisi said, adoption within families was the next best thing.
"Usually the adoption is from a close relative or family member, but it can be also from somebody from a different culture or a distant relative," she said.
Traditional methods 'aggravate' problems
Lealaiauloto Lia'i Si'itia is the director of the Samoa Family Health Association.
In Samoa today, Lealaiauloto said women who could not afford to see specialists often sought help from traditional practitioners, despite their procedures being known to "aggravate" fertility issues.
"They come very late to family fertility centres because they first seek help from traditional practitioners, caregivers, nurses and sometimes churches," she said.
