Experiences and actions taken by women to address delayed conception in Delhi, India: A qualitative study

One in six people experiences infertility in their lifetime globally, including India. Understanding experiences and actions taken by people with delayed conception requires developing person-centred fertility care interventions. We applied the theory of planned behaviour to explore the experiences and actions of women in couples that failed to conceive in low to lower middle-income neighbourhoods of Delhi, India. This was a qualitative study among 35 women who had failed to conceive after 18 months. Data were collected between February and July 2021 through focus group discussions. Deductive thematic analysis was used to identify themes and sub-themes on illustrating experiences and actions taken, guided by the theory of planned behaviour. Attitudes, subjective norms, intentions, actions, and wider contextual factors played a role in influencing whether women took planned actions geared towards their intention of childbearing. These included perceived benefits of having a child, beliefs of mandated motherhood, pro-birth expectations, stigmatised infertility, compliance with family expectations, and perceived loss of control. Specific actions taken by the individuals included: help and treatment seeking from multiple sources (traditional, formal or internet), and engaging in consistent sexual activity. External factors impacted these behaviours, including the availability and cost of fertility care, interruption of healthcare due to COVID-19 epidemic, and lack of psycho-social support from husbands, family, or peers. Fertility intentions alone are not enough to achieve the desired outcome of becoming a mother. Multiple factors at individual, societal, and structural level affect women's ability to act on their intention of achieving a pregnancy and becoming a mother. Interventions that can modify attitudes, subjective norms, normative beliefs, self-efficacy, and structural interventions to assist women achieve their fertility intentions, include awareness raising on infertility, improving availability and cost of fertility care, and enhancing social and peer support for women experiencing infertility.