Infertility is often talked about as a problem of high-income countries, but the data tell a different story: sub-Saharan Africa has the highest prevalence of infertility in the world. A new study looking at four countries — Burkina Faso, Côte d'Ivoire, Niger, and Uganda — asks a more practical question than prevalence alone: when a woman is struggling to conceive, is there actually a facility nearby that can help her, and does living closer to one change whether she seeks care?
Why STI Testing Is Everywhere but Infertility Care Is Not, in Burkina Faso, Côte d'Ivoire, Niger, and Uganda
The research team, led by lead author Haley L. Thomas, and including the William H. Gates Sr. Institute's (WHGI) Director Philip Anglewicz and Research Director, Caroline Moreau, alongside WHGI's Suzanne O. Bell, and colleagues, linked nationally representative surveys of women aged 15–49 to data on the health facilities serving them, drawing on surveys conducted between 2021 and 2024. Because sexually transmitted infections (STIs) are a well-documented driver of infertility in the region, the team looked at both STI testing and broader infertility services. The gap between the two was stark: STI testing was widely available, offered at 68.5 to 92.6 percent of facilities across the four countries. Infertility services specifically were far scarcer — available at just 28.4 to 44.0 percent of facilities, with Burkina Faso a notable outlier at 78.3 percent.
Who could actually reach these services also varied predictably: women with more education, greater household wealth, and urban addresses had significantly better geographic access. And proximity mattered for whether women actually sought biomedical care for difficulty conceiving — in Burkina Faso and Niger, living within 5 kilometers of STI testing nearly tripled to more than septupled the odds of care-seeking, and in Niger, living within 10 kilometers of infertility services increased those odds more than eightfold.
What Closing the Infertility Care Gap Would Take
The pattern that emerges is one of a service gap layered on top of an access gap: even where infertility care exists, it's concentrated in places wealthier and more urban women are more likely to reach. The study's authors argue this points toward two concrete priorities for governments and NGOs working in the region — continued investment in STI prevention and treatment, since that pipeline already reaches most facilities, and a deliberate expansion of dedicated infertility evaluation and treatment, including referral pathways so women outside major cities aren't left without options. For a region carrying the world's heaviest infertility burden, the finding that so few facilities are actually equipped to address it is a reminder of how much unmet need remains outside standard family planning and STI programming.
