Perceived Infertility Among Young Adults in Balaka, Malawi

CONTEXT: Perceived infertility—an individual's belief that she or he is unable to conceive or impregnate a partner—may lead to contraceptive nonuse and unintended pregnancy, among other concerns, but has not been widely studied in low-income settings. METHODS: A measure of perceived infertility previously used in the United States was included in a 2015 survey of young adults in Balaka, Malawi. The prevalence of potential perceived infertility (i.e., believing it is a little or substantially likely that one is infertile, or would have difficulty getting pregnant or impregnating a partner; PPI) was estimated among the analytic sample of 1,064 women and 527 men aged 21-29. Multivariable logistic regression was used to identify variables associated with PPI; respondents' reasons for PPI and their estimates of the probability of pregnancy after unprotected sex were also investigated. RESULTS: The prevalence of PPI was 8% overall, and 20% among nulliparous women. Factors associated with PPI and reasons for PPI varied by gender. For women, PPI was significantly associated with age, education, an interaction term between age and education, number of sexual partners, feelings if she were to become pregnant next month, parity and contraceptive use. For men, PPI was associated with an interaction term between age and education, number of sex partners and marital status. Respondents tended to overestimate the probability of pregnancy after unprotected sex. CONCLUSIONS: Perceived infertility was lower in Malawi than in the United States, although substantial among certain subgroups. Educational interventions aimed at increasing knowledge about pregnancy probabilities and the return of fertility after contraceptive discontinuation may reduce concerns around perceived infertility.