Healthcare Seeking Behavior of Women with Primary Infertility in Selected Urban Areas of Bangladesh

Abstract

Background: In Bangladesh, social and cultural expectations place strong pressure on women to conceive soon after marriage, often leading to emotional distress and social stigma when conception does not occur. Despite advances in reproductive healthcare, many women with primary infertility delay seeking appropriate medical care because of limited awareness, financial constraints, and limited access to specialized services. Traditional beliefs and reliance on informal healthcare providers also shape healthcare-seeking pathways. Improved knowledge in this area can support the development of targeted interventions and policies to enhance access to evidence-based fertility care. In light of these gaps, this study aims to assess healthcare-seeking behaviors and identify the key determinants influencing healthcare utilization among women with primary infertility in Bangladesh. Methods: A random sampling design was used. This was a quantitative study with a sample size of 421, conducted among reproductive-aged women aged 15-49 who attended infertility services. Descriptive statistics were used to present the characteristics of the study population. Chi-square tests and cross-tabulations were used to identify factors associated with primary infertility and health care-seeking behavior. Results: A total of 421 Bangladeshi reproductive-aged women were included in this study. Among them, the 20-24 age group (28.5%) is identified as the most fertile period for women. Most women (61.5%) realized difficulty in conceiving within the first 1-2 years, and nearly half (48.2%) sought treatment within one year of recognizing the problem. Most of the respondents (66.3%) reported that they were clinically diagnosed with the causes of infertility; among them, 77.4% had undergone a pelvic examination of the uterus. Most of them had taken a 1- to 2-year gap. 37.9% of them used a family planning method during the gap period. While reporting the reasons for infertility, 41.8% reported irregular menstruation, 27.3% had reported being overweight. Almost all respondents (88.5%) reported “wait and watch” as the primary reason for delaying treatment, while 19.5% cited financial problems and 12.4% were undergoing other treatments. Thirty point nine percent of the participants had a family history of sub-fertility, and 16.9% XIII reported having chronic medical conditions, while 15.4% had pelvic disease or genital infection. When they were asked about delayed initiation of infertility treatment, the majority indicated that they were waiting for a natural pregnancy (44.9%), and nearly half (38.7%) of them reported that they did not feel treatment was necessary. In comparison, 8.4% reported that the treatment was expensive and they could not afford it. Almost all respondents, regardless of treatment number, reported consulting a healthcare provider, but progression through later phases increased with repeated treatments. Women who received more than three treatments were most likely to proceed through subsequent phases, including diagnosis, receiving advice, and using treatment. Moreover, 15.9% experienced psychological violence in the family, whereas 1.2% experienced any physical violence due to infertility. Conclusion: This study explores the healthcare-seeking behavior of women experiencing primary infertility in Bangladesh. It examines the socio-cultural and healthcare system factors that influence their decisions to seek medical care. The research highlights the delay in treatment and the impact of stigma and limited awareness on infertility at all levels. The findings aim to inform policies and interventions to improve access to appropriate reproductive healthcare services for affected women.