Risk Factors and Spatial Clustering of Primary Infertility in India

  • Manas Ranjan Pradhan Assistant Professor, Department of Fertility Studies, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
  • Surendra Kumar Patel Senior Research Scholar, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
  • Sunita Patel Senior Research Scholar, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
Keywords: Infertility, Risk Factors, Logistic Models, Cluster Analysis, India


This study aims to (a) understand the level and risk factors of primary infertility, and (b) assess the spatial clustering of primary infertility at the district level in India. Data of currently married women aged 20-49 years married for at least 24 months (n=4,45,499) gathered through the National Family Health Survey-4 (2015-16) was used for this analysis. The NFHS-4 is a nationally representative survey of 601,509 households that provides information for a wide range indicators of health, nutrition, and women's empowerment. Only those respondents who gave consent were interviewed in the survey. Binary logistic regression was carried out to examine the adjusted effect of socio-economic and demographic characteristics on primary infertility. The univariate Local Indicator of Spatial Association (LISA) cluster maps and Moran's I statistics were applied for spatial autocorrelations at the district level. Three percent of the studied women had primary infertility, and the prevalence varies considerably by socio-economic and demographic characteristics. Women marrying at 30+ years (OR: 16.52), with thyroid problems (OR: 1.41), obese women (OR: 1.12), and those from socially backward classes (OR: 1.32) were more likely to have primary infertility. The univariate LISA cluster maps revealed hotspots of primary infertility in most parts of Karnataka, two clusters in Arunachal Pradesh and Tamil Nadu, one cluster each in southern Maharashtra, south-west Odisha, south Chhattisgarh, and north-central Uttar Pradesh. Awareness generation about the preventable risk factors and provision of infertility care services at primary health care facilities will be of use in addressing infertility in India.


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