Infertility in Central Africa

OBJECTIVES To determine the prevalence and risk factors of primary and secondary infertility in the four Central African countries of Cameroon, Chad, Central African Republic and Gabon. METHODS Primary infertility was approximated by the percentage of women childless after at least 5 years of marriage. The percentage with no birth at least 5 years subsequent to a previous birth was considered to have secondary infertility. Logistic regression and discrete logistic regression models were estimated to determine the risk factors of primary and secondary infertility, respectively. The relatively few women who were defined as infertile and reported using a traditional or modern method of contraception at survey date were considered fertile to reduce bias from falsely classifying effective contraceptive users as infertile. RESULTS The prevalence of infertility was highest in Central African Republic and lowest in Chad: primary infertility ranged from 6.9% to 3.1% and secondary infertility for women aged 20-44 years ranged from 26.5% to 18.9%. Women married more than once vs. only once and formerly married women vs. women living with their husbands had higher odds of primary and secondary infertility. Also, younger cohorts had relatively higher risks of primary (born after 1970) and secondary infertility (born after 1960) compared with women born before 1960. In contrast, place of residence, religion, education of wife or husband and socio-economic status were generally not associated with primary or secondary infertility. CONCLUSIONS Infertility is still prevalent in Central Africa and new interventions aimed at reducing the incidence and social implications of pathologic infertility are needed.