Primary infertility care-seeking and service provision in Bangladesh: a mixed-method study

Background In Bangladesh, infertility is an under-recognized reproductive health challenge, often overlooked amid ongoing efforts to reduce fertility rates. Despite the increasing prevalence of primary infertility from 1.8% in 2000 to 2.4% in 2018, it remains largely absent from national health programs, and access to care is hindered by stigma, financial constraints, and inadequate healthcare infrastructure. This study examines the care-seeking experiences for infertility, the availability of services, and the systemic challenges in providing infertility care in Bangladesh. Methods We employed an explanatory sequential mixed-methods design combining a population-based cross-sectional survey with qualitative interviews. The survey was conducted at two Health and Demographic Surveillance System sites, Matlab and Baliakandi, from which 2,948 married women aged 20-49 were sampled for interview using an age-stratified random sampling method. Among them, 238 were identified as primary infertile women (PIW). The study’s qualitative component included in-depth interviews (IDIs) with 10 PIWs and their husbands, plus key informant interviews with 8 infertility specialists and healthcare providers. Quantitative data were analyzed using descriptive statistics, while qualitative data underwent thematic analysis. Results Ninety-two percent (n=238) of the PIW sought care for infertility. While 73% relied solely on private health facilities, only 6% utilized public facilities. In 88% of cases, both husband and wife participated in decision-making for infertility care. Nearly 90% underwent diagnostic tests, but IDIs revealed treatment dropout due to financial constraints and lack of family support. The key informants reported that the majority of infertility cases could be addressed with first-line care; however, a shortage of trained providers, limited diagnostic facilities, and the absence of a national infertility policy, rendering specialized care largely inaccessible outside Dhaka. Conclusions Infertility care-seeking is common. The low availability of services and the high cost of advanced care appeared to be the primary barriers to effective access to care. Expanding basic infertility diagnostics and treatment to primary and secondary public health facilities, improving provider training, and developing a national infertility action plan are critical to addressing these gaps.