Trends in self-reported reproductive tract infections and treatment-seeking behaviour among Indian women, 2005–2021

Reproductive tract infections (RTIs) are a major source of reproductive morbidity among women in India, but evidence on long-term trends in prevalence and care-seeking behaviour remains limited. This study examines trends in self-reported RTI symptoms and associated care-seeking patterns among Indian women aged 15–49 years from 2005 to 2021, using data from three rounds of the National Family Health Survey (NFHS-3, 2005–06; NFHS-4, 2015–16; NFHS-5, 2019–21). The analysis is based on a pooled sample of 265,497 eligible women. National RTI prevalence remained stable at approximately 11% in 2005–06 and 2015–16, with a modest rise to 12.3% in 2019–21. However, there was substantial variation across states. High-burden states such as Madhya Pradesh and Assam saw declines, while several low- and medium-burden states (e.g., Meghalaya and Himachal Pradesh) experienced notable increases. Only about 40% of women with RTI symptoms sought treatment. Public sector treatment increased from 11.5% in 2005–06 to 19.0% in 2019–21, while private sector reliance declined overall despite some fluctuations. Adjusted odds of reporting RTI symptoms increased over time (AOR 1.29; 95% CI 1.25–1.33 in 2015–16 and AOR 1.52; 95% CI 1.48–1.57 in 2019–21, relative to 2005–06). The likelihood of seeking care from public health facilities increased substantially (AOR 1.47; 95% CI 1.33–1.62 in 2015–16 and AOR 1.88; 95% CI 1.70–2.08 in 2019–21), whereas the likelihood of private-sector use declined in 2015–16 (AOR 0.77; 95% CI 0.72–0.84) but showed no statistically significant difference from baseline in 2019–21 (AOR 0.97; 95% CI 0.90–1.05). Sociodemographic factors, including wealth, education, region, and access barriers, significantly influenced both symptom reporting and treatment-seeking behaviour. Despite modest national changes, treatment-seeking remains low, and persistent state-level disparities highlight the need for context-specific and equitable reproductive health interventions.