Publications Summary

Document Type
Comparative Reports
Recommended Citation
Riese, Sara. 2021. Levels and Trends of Infertility and Childlessness. DHS Comparative Reports No. 50. Rockville, Maryland, USA: ICF.
Download Citation
RIS format / Text format / Endnote format
Publication Date
August 2021
Publication ID

There is no printed copy available to order.


Infertility is a significant reproductive health issue for couples worldwide. The effects of infertility are wide-ranging¬¬— from mental health issues such as anxiety and depression to social issues such as ostracization, intimate partner violence, and divorce. Although infertility affects both men and women, the woman in a couple is most often blamed for the inability to bear children. Despite its importance, infertility is understudied and there are no standard definitions for estimating prevalence. This study aims to update estimates of childlessness, primary infertility, and secondary infertility in 16 USAID PRH focus countries and compare those estimates to previous estimates. Three of four rounds of DHS survey data were compared. Levels of infertility were calculated using a previously tested demographic approach that incorporates desire for a child into the definition to distinguish infertility from voluntary childlessness. In addition, this approach adjusts for incomplete information on contraceptive use arising from non-use of the contraceptive calendar. In most countries, childlessness, defined as never given birth, as measured among women in the 40-44 age group, was low and has decreased slightly, with an average of 1.9% in the first round of surveys and 1.7% in the most recent round. Estimates of primary infertility were low, with ranges from 0.9% in Kenya to 2.9% in Mali in the first round of surveys, and from 0.3% in Kenya to 3.8% in Senegal in the last round. Primary infertility estimates stayed relatively stable over time. Estimates of secondary infertility were higher, with ranges from 8.0% in Rwanda to 25.7% in India in the first round of surveys, and from 5.5% in Kenya to 36.8% in Bangladesh in the most recent round of surveys. Secondary infertility estimates also stayed stable in most countries, although consistent increases were seen in Bangladesh and Nepal, and consistent decreases in Kenya. Concurrent trends in other health or environmental factors may be contributing to these trends in infertility, as well as increasing availability of assisted reproductive technologies in many parts of the world. Even with plateauing or decreasing levels of infertility, the impact of infertility on couples around the world is significant. Where secondary infertility is high or increasing, research into factors that account for these patterns needs to be undertaken to identify appropriate interventions. Further work into how to improve access to infertility care and management programs is required.


Browse for Publications by:

Browse for Journal Articles based on DHS data by: