Background: What is the nature of women’s care-seeking for difficulties conceiving in sub-Saharan Africa (SSA), including the correlates of seeking biomedical infertility care at a health facility? Nearly all research on infertility care-seeking patterns in SSA is limited to clinic-based studies among the minority of people in these settings who obtain facility-based services. In the absence of population-based data, we are unable to determine the demand for services and disparities in the use of more effective biomedical sources of care.

Methods: We used cross-sectional, population-based data from the Performance Monitoring for Action (PMA) female survey in eight geographies in SSA, including nationally representative data from Burkina Faso, Côte d’Ivoire, Kenya, and Uganda and regionally representative data from two provinces in the Democratic Republic of the Congo (Kinshasa and Kongo Central) and two states in Nigeria (Kano and Lagos). We employed a multi-stage cluster random sampling design to produce representative samples of women aged 15-49, with samples ranging from 1,144 in Kano to 9,489 in Kenya. We restricted the sample to women who had ever had sex and conducted descriptive, bivariable, and multivariable logistic regression analyses to examine characteristics of those who sought care and factors associated with receipt of biomedical services.

Results: Our study found low levels of care-seeking for difficulties getting pregnant among sexually active women in eight geographies in SSA, ranging from 3.7% (Kenya) to 15.3% (Côte d’Ivoire). Of this, 51.8% (Burkina Faso) to 86.7% (Kinshasa) involved receipt of biomedical services in health facilities. We observed disparities in biomedical care-seeking in several geographies, with the wealthiest women, those with more education, and those residing in urban areas generally more likely to have sought biomedical care.

Conclusions: Infertility and access to appropriate treatment are issues of reproductive health and human rights. It is clear from our results and existing literature that more needs to be done to ensure access to affordable, quality, cost-effective infertility services in SSA.