WHGI Research Area
Infertility
Expanding recognition, research, and care for infertility within comprehensive reproductive health systems
WHGI is closing one of the largest data gaps in reproductive health, developing practical ways to measure infertility in low- and middle-income countries and documenting the stigma, barriers to care, and social consequences that follow it.
What We Study
Infertility affects roughly one in six adults worldwide. Yet despite affecting people in low-, middle-, and high-income countries at similar rates, it remains far less studied, resourced, and understood in many low- and middle-income countries (LMICs).
The William H. Gates Sr. Institute for Population and Reproductive Health (WHGI) studies infertility as both a clinical and social experience, gathering data and expanding our understanding of what "infertility" means to people in communities.
This work, led by WHGI's Dr. Suzanne Bell, began with measurement. This included refining and validating current duration approaches to estimating infertility prevalence, using information on how long women have been trying to conceive at a point in time rather than through costly follow-up.
This has helped to close the data gap in Sub-Saharan Africa using Performance Monitoring for Action (PMA) survey infrastructure.
Our work in this area also looks at the United States, testing whether newer sources like fertility-tracking app data can improve monitoring in the U.S. at a fraction of the cost of traditional study designs.
We have since expanded to study barriers to care-seeking including understanding why women do or do not seek help for difficulties conceiving, and how fear that contraception causes infertility may discourage its use in the first place. And because infertility's consequences extend well beyond the clinical, this research also follows its social toll, the stigma, and isolation it can produce, and its links to intimate partner violence—when a woman's ability or inability to conceive becomes entangled with her social standing and safety.
Why it Matters
This work matters because it shows that infertility is often overlooked—not because it is uncommon, but because it is difficult to measure and often surrounded by stigma.
How infertility is defined has real consequences: it shapes how many people are counted as needing care and whether governments recognize infertility as a public health priority.
Our work shows just how much estimates can vary depending on the population and definition used. Among women actively trying to conceive, 12-month infertility ranged from 8% in Burkina Faso to 30% in Côte d’Ivoire, with even higher estimates when considering the broader population exposed to unprotected sex.
In the U.S., we also showed that a one-time survey can produce estimates comparable to those from far more costly longitudinal studies. Together, these findings point to practical, scalable ways to improve infertility measurement—and to generate the evidence needed to inform policies and services worldwide.
Better measurement, however, is only part of the challenge. People do not always define infertility in the same way researchers or clinicians do. In Uganda, individuals use widely varying personal criteria to decide whether they or others were infertile, while across multiple countries, fear that contraception can cause infertility remains an important barrier to contraceptive use despite no evidence that contraceptive use increases clinical infertility.
These differences in understanding can shape whether people recognize a problem, seek help, or delay care. Care-seeking itself remains limited across much of sub-Saharan Africa and, in many settings, is more likely to involve traditional or religious sources than biomedical services, with marked socio-demographic disparities in who reaches formal care.
The consequences extend far beyond the inability to conceive: infertility is also linked to stigma, social isolation, intimate partner violence, and reproductive coercion.
Taken together, this work shows that infertility is not only a clinical condition to be measured, but a social and health-systems issue that requires attention to how people understand it, where they seek care, and the consequences they face when support is unavailable.
What Comes Next
WHGI’s research agenda in this area responds to a real shift in the field: in November 2025, the World Health Organization (WHO) issued its first-ever global guideline on the prevention, diagnosis, and treatment of infertility, formally establishing infertility as a core component of sexual and reproductive health requiring population-level measurement and prevention, not simply individual clinical care.
In response, WHGI is charting three future directions for this agenda that builds on a growing partnership with the WHO.
One direction looks upstream, toward the causes of infertility in LMICs— the infections, delays in care, and other risk factors that current data cannot explain.
A second looks toward prevention, exploring whether basic (in)fertility-related counseling and care could realistically be delivered through primary care rather than specialist services that are harder to access.
And a third looks toward measurement, strengthening how infertility and related services are tracked — potentially using PMA's survey infrastructure and HMIS data as a testing ground for new indicators — so infertility could eventually be monitored as routinely as other reproductive health outcomes and care.
Key Resources & Publications in This Area
Infertility service availability, geographic accessibility, and use: results from linked facility-female cross-sectional data in Burkina Faso, Côte d’Ivoire, Niger, and Uganda
What to expect when you want to be expecting: time-to-pregnancy expectations and anticipated worry and help-seeking among a nationally representative survey of women in Uganda
Validating the current duration approach for measuring infertility prevalence using novel app data from the USA
Defining infertility: The varied criteria people in two regions of Uganda use to identify infertility in themselves and others
Measuring non-events: infertility estimation using cross-sectional, population-based data from four countries in sub-Saharan Africa
Care-seeking for difficulties conceiving in sub-Saharan Africa: findings from population-based surveys in eight geographies
Meet the WHGI Research Team
Professor and WHGI Research Director
Caroline Moreau is Professor at the Johns Hopkins Bloomberg School of Public Health, Senior Researcher at the French National Institute of Health and Medical Research (INSERM), and Research Director at the William H. Gates Sr. Institute for Population and Reproductive Health. Her work examines how gender, social class, race, and other forms of social inequality shape sexual and reproductive health across the life course.
Professor and WHGI Research Director
Caroline Moreau is Professor at the Johns Hopkins Bloomberg School of Public Health, Senior Researcher at the French National Institute of Health and Medical Research (INSERM), and Research Director at the William H. Gates Sr. Institute for Population and Reproductive Health. Her work examines how gender, social class, race, and other forms of social inequality shape sexual and reproductive health across the life course.
Assistant Professor
Suzanne Bell, PhD, MPH, is an Assistant Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins University Bloomberg School of Public Health, where she received her PhD with a focus in demography.
Assistant Professor
Suzanne Bell, PhD, MPH, is an Assistant Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins University Bloomberg School of Public Health, where she received her PhD with a focus in demography.
In addition to the above WHGI team members, the below individuals have contributed to this WHGI research area:
By the Numbers
Countries
WHGI is involved in research activities related to infertility in seven countries: Burkina Faso, Côte d’Ivoire, Kenya, Uganda, Democratic Republic of Congo (Kinshasa, Kongo Central), Nigeria (Kano, Lagos), U.S.
News on Infertility
Infertility service availability, geographic accessibility, and use: results from linked facility-female cross-sectional data in Burkina Faso, Côte d’Ivoire, Niger, and Uganda
Across four African countries, STI testing is widely available at health facilities, but dedicated infertility services are scarce — and proximity strongly predicts whether women seek care.
Want to know more?
Connect with Us
Learn more about WHGI's infertility work, access available data and publications, or connect with researchers to explore opportunities for collaboration.
Please send an email to gatesinstitute@jhu.edu with the subject line "Infertility Research."
