Levels and Trends of Infertility and Childlessness (CR50) and Correlates of Secondary Infertility (AS79) An Analysis Brief from The DHS Program

Globally, between 48 million couples and 186 million individuals live with infertility, with half of these couples residing in sub-Saharan Africa and South Asia. The clinical definition of infertility is the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse, while the demographic definition used in this analysis focuses on the absence of a live birth for women who desire a child and have been in a union for at least 5 years. The analyses included in this report focus on 16 USAID Population and Reproductive Health priority countries: Bangladesh, Ethiopia, Ghana, Haiti, India, Kenya, Malawi, Mali, Nepal, Nigeria, Philippines, Rwanda, Senegal, Tanzania, Uganda, and Zambia. The report provides updated prevalence estimates and describes trends in childlessness and infertility over the past 20 years. Childlessness among married women age 20-49 ranges from 0.7% in Malawi to 3.9% in Senegal in the most recent round of surveys, with decreases observed in 11 of 16 countries, increases in 4 countries, and no change in India. Primary infertility is plateauing or decreasing in most countries, except for those in Asia. The average prevalence of primary infertility is 1.7%, a decrease from 2.1% in the first round of surveys. However, primary infertility has increased over time in the Philippines and remained unchanged in India. Secondary infertility, on the other hand, is higher than primary infertility, ranging from 5.5% in Kenya to 36.8% in Bangladesh in the most recent round of surveys. There is no clear pattern in secondary infertility over time, with increases observed in four sub-Saharan African countries, Haiti, and all Asian countries included in the study, while decreases were observed in seven sub-Saharan African countries. The analysis of secondary infertility reveals several key findings. Secondary infertility increases with increasing woman's and partner's age for all surveys, suggesting that while it is biologically possible for men to have children at older ages, there is an increased risk of secondary infertility among older men. Having other children under age 18 in the household who are not the woman's own children increases the risk of secondary infertility in most countries. Higher wealth quintile increases the risk of secondary infertility in several countries, including Bangladesh, Ghana, Haiti, India, and the Philippines. Most women with secondary infertility have 2 or more of their own living children, ranging from 53% in the Philippines to 80% in Ethiopia. Country-specific results also highlight several significant associations between secondary infertility and various factors. Obesity is significantly associated with secondary infertility in India, Nigeria, and Tanzania. Women who terminated a pregnancy in the past have a higher odds of secondary infertility in 6 countries, including Ghana, Haiti, Malawi, Mali, Nigeria, and Zambia. Using any type of tobacco is significantly associated with secondary infertility in Uganda and Zambia. Women with more than one sexual partner have a higher odds of secondary infertility in most countries, except for India, Nepal, the Philippines, and Senegal.