Addressing the causes, prevalence, and sequelae of infertility in developing countries is a critical and
understudied concern in sexual and reproductive health. The consequences of infertility in developing
countries can be severe. For example, an inability to bear children can result in being socially ostracized or
divorced, which may have physical, economic, mental health, and other implications.1 While men and
women are equally likely to be infertile, women are often blamed.2
Fears related to infertility impact
women’s willingness to utilize certain contraceptive methods,3, 4
and impacts of infertility on unsafe sex and
other health outcomes are understudied. Furthermore, having a longer time to conception impacts risk of
adverse pregnancy outcomes, gravid diseases, and later-onset adult disease. 5-8
Improving our ability to more accurately estimate the prevalence of infertility using nationally representative
data is essential. Different estimation approaches have been used to estimate infertility prevalence, making it
difficult to compare across populations and to distinguish true differences from those due to design and data
collection instruments.9-11 Measures of time to pregnancy (TTP) have been proposed for monitoring couple
fecundity, or the biologic capacity of couples to conceive.12, 13 It provides a sensitive indicator of the full
range of fecundity levels – from normal to the complete inability to conceive, but can also be used to
examine standard measures, such as 12-month infertility.14 While prospective cohort studies are often
considered the gold standard for accurately estimating TTP, they are less feasible at a national level. The
current duration approach is an alternative approach that estimates a population-level TTP distribution based
on respondents’ current duration “at risk” of pregnancy at the time of interview. Using this approach,
estimated 12-month infertility prevalence was shown to be consistent with infertility estimates obtained from
prospective cohort studies in the United States.15

In this study, we aim to determine the criteria necessary to apply a current duration approach to measuring
infertility in low- and middle-income countries (LMIC) through the use of Demographic and Health Survey
(DHS) data, which are nationally representative surveys conducted in over 90 LMIC. To our knowledge, the
current duration methodological approach to estimating infertility has not been applied to date in LMIC. In
addition, using sensitivity analyses, we aim to explore the impact of underlying assumptions on infertility
prevalence estimates in the context of a low contraceptive prevalence population, in this case, Nigeria.