Primary and secondary infertility in sub-Saharan Africa

Background No previous study has provided national estimates of the prevale nce of primary and secondary infertility in sizeable areas of sub-Saharan A frica. Methods Primary infertility is measured by the proportion childless among w omen who entered their first marriage at least 7 years before date of censo ring. Secondary infertility is measured by the 'subsequently infertile esti mator' from parous ever-married women. Exposure begins at the age of the wo man at the birth of her first child, and exposure ends when the woman is of an age, which is 5 years lower than her age at censoring. These last 5 yea rs are used to determine her status as infertile or fertile at the last obs ervation 5 years before censoring. A woman is considered infertile at last observation if she has had no livebirths during the last 5 years before cen soring, otherwise she is considered fertile. A woman who has not given birt h at age a or later is defined as being 'infertile subsequent to age a'. Th e index of the proportion subsequently infertile at age a is estimated as t he number of women infertile subsequent to age a, divided by the total numb er of women observed at that age. Infertility is estimated for women age 20 -44. Results Primary infertility is relatively low and it exceeds 3% in less tha n a third of the 28 African countries analysed. In contrast, elevated level s of secondary infertility prevail in most countries. Secondary infertility for women age 20-44 ranges from 5% in Togo to 23% in Central African Repub lic. Conclusions It is feasible to gauge national levels of primary and secondar y infertility from population based surveys including a birth history. The prevalence of infertility of pathological origin is so high in sub-Saharan Africa that infertility is not merely an individual concern, it is a public health problem.