Abstract
Abstract
Background
Infertility affects millions of people globally, with the highest prevalence in Africa (16%). Despite strong evidence linking sexually transmitted infections (STIs) to infertility in sub-Saharan Africa, evidence on the availability of and accessibility to infertility-related services—including STI testing and broader infertility care—remains limited across the region. This study aims to: (1) assess availability by estimating the proportion of facilities offering STI testing and infertility services; (2) assess geographic accessibility by examining women’s proximity to service-offering facilities; and (3) assess use by evaluating whether geographic proximity is associated with biomedical care-seeking for difficulties conceiving.
Methods
We used nationally representative cross-sectional survey data from women aged 15–49 and the health facilities that serve them in Burkina Faso, Côte d’Ivoire, Niger, and Uganda (2021–2024). We estimated the proportion of facilities offering STI testing and infertility services, the latter being a broad facility-reported measure of the availability of any service, without specification on the type of service. Using geospatial analysis, we linked facility data to women’s residences and calculated the proportion of women living within 5 and 10 km of STI testing and infertility services, respectively. We fit multivariable logistic regression models to examine associations between women’s characteristics and geographic access to services, and between geographic access and women’s biomedical care-seeking.
Results
STI testing was widely available across countries (68.5–92.6% of facilities), while infertility services were limited (28.4–44.0%), except in Burkina Faso (78.3%). Women with higher education, greater wealth, and urban residence had higher odds of geographic access to services. In Burkina Faso and Niger, women living within 5 km of STI testing facilities had increased odds of biomedical care-seeking (aOR 2.94 and aOR 7.19, respectively), and in Niger, women within 10 km of infertility services had increased odds of biomedical care-seeking (aOR 8.46).
Conclusions
Infertility service availability and accessibility remain limited, and women’s proximity to services is associated with biomedical care-seeking, underscoring the importance of service expansion. Governments and NGOs should prioritize investments in STI prevention and treatment and, where feasible, more advanced infertility evaluation and treatment, including referral pathways to higher-level care, to address the region’s unmet need for infertility services.