Infertility in Uganda: a missed opportunity to improve reproductive knowledge and health

Introduction: Fertility care is an important unmet need in sub-Saharan Africa and considered low priority by donor countries and agencies. Understanding the social context of infertility may increase effectiveness of reproductive health programs. Methods: We conducted a cross-sectional study of fertile and infertile women in Kampala, Uganda, evaluating reproductive knowledge, quality of life (QOL), and infertility-related social morbidity using validated instruments and survey techniques. Results: QOL scores were lower than previously reported scores in Europe (P<0.001). A majority of respondents (53%) reported that they would rather contract HIV than live with infertility. In all, 46.7% of women listed “family planning” or a reversible contraceptive as a cause of infertility. Reproductive knowledge was low, with only 16.7% of women able to give 3 accurate causes of infertility. Infertile women reported higher rates of interpersonal violence, but these differences were not statistically significant. Conclusions: Infertility in Uganda decreases QOL comparably to other severe medical conditions and more than in prior studies. Common beliefs linking infertility to contraception may hinder implementation of family planning, though the infertility evaluation may help correct misconceptions. The connections between infertility, low reproductive knowledge, contraceptive uptake, and violence demonstrated here merit further study and may assist in designing culturally competent basic reproductive health programs in communities with limited resources.