Infertility in Zambia: Prevalence, Medical and Social Impacts

Abstract

Infertility, defined as the inability to conceive after 12 months of unprotected intercourse, is a major but under-addressed public health issue in Zambia. Despite a high national fertility rate, infertility affects many couples and disproportionately impacts women, who often face greater psychological and social consequences. This study aimed to determine the prevalence of infertility in Zambia and examine its medical and social impacts using a concurrent mixed methods approach. Three studies were conducted: (1) a cross-sectional analysis of the 2018 Zambia Demographic and Health Survey (ZDHS-2018), involving 7,432 married or cohabiting women aged 18–49, to estimate infertility prevalence and associated factors; (2) a hospital-based study of 331 women seeking infertility care to assess causes, knowledge, treatment access, and quality of life; and (3) a qualitative study using a phenomenological approach to explore the lived experiences of infertile individuals. Findings showed that 25.7% of women experienced infertility,1.3% primary, and 24.4% secondary. Primary infertility was associated with previous STIs, while secondary infertility was linked to age, prior abortions, surgeries, and STIs. Clinical causes included tubal/uterine issues, ovulatory dysfunction, endometriosis, and unknown factors due to limited diagnostics. Infertility treatment was largely unavailable in the public sector and limited to private clinics in Lusaka. Misconceptions were widespread, with 77.6% of participants attributing infertility to incorrect or supernatural causes. Women with longer durations of infertility or those who first sought alternative medicine had lower quality of life scores. Qualitative results revealed emotional distress, stigma, and social isolation.In conclusion, infertility is a prevalent and neglected issue in Zambia. Addressing it requires improving public knowledge, expanding diagnostic and treatment services, and providing psychological support to those affected.