DHS

Comparative Reports

Infecundity, Infertility, and Childlessness 

in Developing Countries

9
MEASURE DHS+ assists countries worldwide in the collection and use of data to monitor 

and evaluate population, health, and nutrition programs. Funded by the U.S. Agency for 

International Development (USAID), MEASURE DHS+ is implemented by ORC Macro in 

Calverton, Maryland. The opinions expressed herein are those of the authors and do not 

necessarily reflect the views of the U.S. Agency for International Development. 

 

The main objectives of the MEASURE DHS+ project are: 

1) to provide decisionmakers in survey countries with information useful for informed policy choices, 

2) to expand the international population and health database, 

3) to advance survey methodology, and 

4) to develop in participating countries the skills and resources necessary to conduct high-quality demographic 

and health surveys. 

 

Information about the MEASURE DHS+ project is available on the Internet at http://www.measuredhs.com or 

by contacting: 

ORC Macro 

11785 Beltsville Drive 

Suite 300 

Calverton, MD 20705 USA 

Telephone: 301-572-0200 

Fax: 301-572-0999 

E-mail: reports@orcmacro.com

DHS Comparative Reports No. 9 

Infecundity, Infertility, and Childlessness 

in Developing Countries 

Shea O. Rutstein 

ORC Macro 

Calverton, Maryland, USA 

Iqbal H. Shah 

World Health Organization 

Geneva, Switzerland 

September 2004 

World Health Organization 
This report presents the results of a collaborative effort between the MEASURE DHS+ project 

and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and 

Research Training in Human Reproduction. ORC Macro in Calverton, Maryland, USA, implements the MEASURE DHS+ project with funding from the U.S. Agency for International Development. The Special Programme is a part of the Department of Reproductive Health and Research of the World Health Organization in Geneva, Switzerland. 

Editor: Sidney Moore 

Series design: Katherine Senzee 

Report production: Justine Faulkenburg 

Suggested citation: 

Rutstein, Shea O. and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in Developing 

Countries. DHS Comparative Reports No. 9. Calverton, Maryland, USA: ORC Macro and the 

World Health Organization. 
Contents iii

Contents 

Tables and Figures v 

Preface ix 

Acknowledgements xi 

Executive Summary xiii 

1 Introduction 1

2 Definitions and Measurement Problems 3

3 Data and Methodology 5

4 Results 9

4.1 Childlessness 9

4.1.1 Fertile Pregnancies 11

4.1.2 Discussion 11

4.2 Primary Infertility 12

4.2.1 Sexual Experience 12

4.2.2 Pregnancy among Sexually Experienced Women 14

4.2.3 Births among Sexually Experienced Women 14

4.2.4 Observed Primary Infecundity 17

4.2.5 Women Who Do Not Want Children 17

4.2.6 Self-reported Infecundity 19

4.3 Secondary Sterility 22

4.3.1 Prevalence of Secondary Infecundity 22

4.3.2 Estimates of the Number of Infertile Women 

 in Developing Countries 24

5 Trends in Infertility 27

5.1 Trends in No Surviving Children and No Live Birth 

 Based on Data Sets 20 Years Apart 27 

5.2 Trends in Primary Infertility Based on DHS Data 

 from Two or More Surveys 31 

5.3 Trends in Secondary Infertility 41

6 Consequences of Infertility 43

7 Coping with Infertility through Adoption 51

8 Conclusions 53

References 55

Tables and Figures v

Tables and Figures 

Table 1 Characteristics of surveys included in the report 6

Table 2 Childlessness and infertility among women age 40-44 and 

25-49 10

Table 3 Primary infertility (1): No sex 13

Table 4 Primary infertility (2): Sex but no pregnancy 15

Table 5 Primary infertility (3): Sex but no birth 16

Table 6 Women who do not want children 18

Table 7 Self-reported infecundity 20

Table 8 Secondary infecundity 23

Table 9 Regional estimates of childlessness, primary infertility, and 

secondary infertility 25

Table 10 Trends in the proportion of women who have never had 

sex 33

Table 11 Trends in the proportion of currently married women who 

have no living children and who have had no fertile 

pregnancies 37

Table 12 Divorce and separation by childlessness and sterility status 44

Table 13 Primary sterility among never-married women 45

Table 14 Remarriage by childlessness and sterility status 47

Table 15 Polygynous first union by childlessness and primary 

sterility 48

Table 16 Monogamous first union by childlessness and sterility 

status 49

Table 17 Adoption of children by childlessness and sterility status 52
vi Tables and Figures 

Figure 1 Percentage of women who reported themselves infecund, 

by age group and region, DHS surveys 1994-2000 21

Figure 2 Percentage of women age 25-49 with secondary 

infecundity, by region, DHS surveys 1994-2000 24

Figure 3 Percentage of currently married women age 40-44 who 

have been married for at least five years but have no living 

children, WFS and DHS surveys 1975-2000 28

Figure 4 Percentage of currently married women age 40-44 who 

have been married for at least five years but have not had a 

live birth, WFS and DHS surveys 1975-2000 29

Figure 5 Percentage of currently married women age 25-49 who 

have been married for at least five years but have no living 

children, WFS and DHS surveys 1975-2000 30

Figure 6 Percentage of currently married women age 25-49 who 

have been married for at least five years but have not had a 

live birth, WFS and DHS surveys 1975-2000 31

Figure 7 Changes in the percentage of women age 25-49 who have 

never had sex, most recent DHS survey compared with 

previous DHS survey 32

Figure 8 Changes in the percentage of women age 25-49 who have 

had sex but have not been pregnant, most recent DHS 

survey compared with previous DHS survey 34

Figure 9 Changes in the percentage of women age 25-49 who have 

had sex but have not had a live birth, most recent DHS 

survey compared with previous DHS survey 35

Figure 10 Changes in the percentage of women age 25-49 who have 

been married for the past five years but have had no live 

births, most recent DHS survey compared with previous 

DHS survey 36

Figure 11 Changes in the percentage of women age 25-49 who have 

been married for the past five years but have no living 

children, most recent DHS survey compared with previous 

DHS survey 38

Figure 12 Changes in the percentage of women age 40-44 who have 

been married for the past five years but have had no live 

births, most recent DHS survey compared with previous 

DHS survey 39
Tables and Figures vii

Figure 13 Changes in the percentage of women age 40-44 who have 

been married for the past five years but have no living 

children, most recent DHS survey compared with previous 

DHS survey 40

Figure 14 Changes in the percentage of noncontracepting, sexually 

experienced women age 15-49 who have been married for 

the past five years but have had no live births or 

pregancies, most recent DHS survey compared with 

previous DHS survey 41

Figure 15 Changes in the percentage of currently married 

noncontracepting women who have had no live births or 

pregnancies in the past five years, most recent DHS survey 

compared with previous DHS survey 42

Preface ix

Preface 

One of the most significant contributions of the MEASURE DHS+ program is the 

creation of an internationally comparable body of data on the demographic and 

health characteristics of populations in developing countries. The DHS Comparative 

Reports series examines these data across countries in a comparative framework. The 

DHS Analytical Studies series focuses on specific topics. The principal objectives of 

both series are to provide information for policy formulation at the international level 

and to examine individual country results in an international context. Whereas Comparative Reports are primarily descriptive, Analytical Studies take a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending 

on the availability of data sets. Where possible, data from previous DHS surveys are 

used to evaluate trends over time. Each report provides detailed tables and graphs 

organized by region. Survey-related issues such as questionnaire comparability, survey 

procedures, data quality, and methodological approaches are addressed as needed. 

The topics covered in Comparative Reports are selected by MEASURE DHS+ staff 

in conjunction with the MEASURE DHS+ Scientific Advisory Committee and 

USAID. Some reports are updates and expansions of reports published previously. 

It is anticipated that the availability of comparable information for a large number 

of developing countries will enhance the understanding of important issues in the 

fields of international population and health by analysts and policymakers. 

Martin Vaessen 

Project Director 

Acknowledgements xi

Acknowledgements 

The authors would like to express their appreciation to Elisabeth Åhman, Paul F.A. 

Van Look, Sidney Moore, and Justine Faulkenburg for reviewing and editing the 

manuscript. All remaining errors are the responsibility of the authors alone. 

Executive Summary xiii

Executive Summary 

The inability to bear children is a tragedy for many couples, bringing a sense of loss, 

failure, and exclusion. Infertility also has important demographic and health implications. This study utilizes data from 47 Demographic and Health Surveys in developing countries to examine levels, trends, and differentials in women’s inability to bear 

children. Five principal measures were used in the analysis on infertility: childlessness, primary and secondary infertility, self-reported infecundity, and indications of 

secondary infecundity. In addition, levels of sexual experience, pregnancy, and live 

births were measured. Overall, by age 45 to 49, only 3 percent of sexually experienced 

women have not had a birth. Countries with more than 5 percent of sexually experienced women age 45 to 49 without a birth include the Central African Republic, 

Cameroon, Mozambique, Niger, Haiti, Colombia, and Brazil. Some women do not 

desire to have children. For women with no living children and whose ideal is to have 

no children, the countries with the highest percentages are Brazil, Ethiopia, Bolivia, 

Colombia, Turkey, and Nicaragua (4 to 6 percent). 

Self-reports of infecundity include women who say they have never menstruated, 

women who have not menstruated for five or more years, women who are postmenopausal, and women who have had a hysterectomy. Seventeen percent of women age 

15 to 49 report themselves as infecund. Secondary sterility is the inability to have further children after a woman has given birth to one or more children. Its measurement 

is complicated by the use of contraception. In this study, a woman is considered secondarily sterile if she has not had a child in the past five years, although she was continuously married and did not use contraception during that period. Secondary sterility is most common in sub-Saharan Africa. For women age 25 to 49, all eight 

countries except one (Cambodia) with more than 30 percent of women secondarily 

sterile are in sub-Saharan Africa. 

The study estimates that in 2002, more than 186 million ever-married women of 

reproductive age (15 to 49) in the developing countries (excluding China) were infertile because of primary or secondary infertility. This number represents more than 

one-fourth of the ever-married women of reproductive age in these countries. However, using comparable data, the study shows that infertility, both primary and secondary, has declined in most countries. There is no obvious pattern to changes in the 

levels of infertility in the countries most affected by HIV. 

Finally, the study examines some of the consequences and coping mechanisms of 

couples affected by infertility. Women who have never had a child are more likely to 

be divorced or separated, and childless women are more likely to have been married 

more than once. Adoption is an important means of coping with childlessness, and 

childless women are 15 percent more likely to live in households with adopted children than are women with children of their own. In five West African countries, 

more than half of childless couples live in households with adopted children. 

Introduction 1

 1

Introduction 

or many couples, the inability to bear children is a tragedy. The conflux of personal, interpersonal, social, and religious expectations brings a sense of failure, 

loss, and exclusion to those who are infertile. Relationships between couples can become very strained when children are not forthcoming. One partner may seek to 

blame the other as being defective or unwilling. Socially, most societies are organized, 

especially in the developing countries, such that children are necessary for care and 

maintenance of older parents. Even in developed countries with social support systems, children and family are expected to provide much of the care for the elderly. 

Childless couples are also excluded from taking leading roles in important family 

functions and events such as birthdays, christenings, confirmations, bar mitzvahs, and 

weddings of their children. Moreover, many religions assign important ceremonial 

tasks to the couple’s children. 

The incidence of infertility in a population has important demographic and health 

implications as well. Because high infertility has a dampening effect on overall fertility and the rate of population growth, improvements in the ability to bear children 

may impede efforts to lower the fertility rate. For example, it has been estimated that 

a reduction in infertility in sub-Saharan Africa to “normal” levels would increase fertility in that region by 15 percent (Frank, 1983). Similarly, Bongaarts, Frank, and 

Lesthaeghe (1984) found that infertility accounts for 60 percent of the variation in 

total fertility in 18 sub-Saharan countries and that fertility decreases by one birth for 

each increase in 9 percentage points in the proportion of women age 45 to 49 who 

have no children. In Cameroon, a country with an unusually high level of infertility, 

Larsen and Menken estimated that the then current total fertility rate of 5.5 children 

would rise to 7.3 in the absence of sterility (Larsen and Menken, 1989). 

Reports from Demographic and Health Surveys (DHS) data have provided up-todate measurements of levels and trends in fertility in conjunction with data on important fertility determinants, such as first marriage and union, first birth, contraception, 

breastfeeding, and infant and child mortality. Outside of sub-Saharan Africa, no major attention has been paid to the DHS data relating to infecundity, although there is 

no doubt that infecundity is also an important determinant of fertility there. 

F 

The incidence of infertility 

in a population has 

important demographic 

and health implications. 

Definitions and Measurement Problems 3

 2

Definitions and Measurement Problems 

he terms infertility, sterility, and infecundity are often used loosely, without regard to precise definition. Moreover, definitions of these terms may differ substantially between demographic and medical usage and between languages. In English demographic terminology, primary infertility (also called primary sterility) is defined as the inability to bear any children, either due to the inability to conceive or 

the inability to carry a pregnancy to a live birth. In medical studies, however, infertility is usually defined only as the inability to conceive. In English demographic language, the term “infecundity” refers to the inability to conceive after several years of 

exposure to the risk of pregnancy. Inability to conceive within two years of exposure 

to pregnancy is the epidemiological definition recommended by the World Health 

Organization (WHO, 1975; WHO, 2001).1

 Clinical studies often use a one-year period of exposure. It is common in demographic studies to use a period of five years. 

The term “infecundity” is sometimes preferred to “infertility” because in English 

demographic language, “fertility” is the term used to describe the quantity of offspring rather than the physiological ability to reproduce. Both terms will be used interchangeably in this report. 

Secondary infertility, which has been shown to have a high geographical correlation with primary infertility (Mammo and Morgan, 1986), is the inability to bear a 

child after having an earlier birth. 

There are practical measurement problems no matter which definition is used. It is 

difficult to measure continuous exposure to the risk of pregnancy over a period of 

years. A comprehensive measure of exposure requires data on marital status, abstinence, coital frequency and timing, contraceptive use, and the partner’s presence or 

absence for all women for the entire period under consideration. Some but not all of 

these data are provided by the DHS reproductive calendar. However, the calendar 

has been used only in DHS surveys of countries with high contraceptive prevalence. 

Infertility measured on the basis of currently married women may underestimate 

infecundity if couples who are unable to have children are more likely to dissolve their 

marriage or union than are couples with children (see Mtimavalye and Belsey, 1987; 

Sherris and Fox, 1983). However, in countries where there is a high rate of remarriage, Vaessen (1984) states that there would not be a strong bias.2

 

Use of contraception complicates the estimation of infertility and infecundity. On 

the one hand, if couples are using contraception, then the lack of fertility and conception is explained. On the other hand, more fertile couples are more likely to use contraception than are less fertile couples. Including couples who have used contraception during the measurement period, with the assumption that all such couples are 

fecund, biases infertility estimates downward because there is probably some degree 

 

1

 The percentage of women of reproductive age (15 to 49) at risk of pregnancy (not pregnant, sexually 

active, noncontracepting, and nonlactating) who report trying for a pregnancy for two or more years. 2

 The authors believe there still may be such a bias even where the rate of remarriage is high. 

T 

Use of contraception 

complicates the 

estimation of infertility 

and infecundity. 
4 Definitions and Measurement Problems 

of infertility among them, although it may be lower than for couples who have not 

used contraception. Excluding couples who used contraception biases infertility estimates upward because the most fecund are likely to be excluded. These biases become 

important when use of contraception is substantial, especially if use of sterilization is 

high. 

Other biases arise because women who have borne a child during the period of 

measurement may have subsequently become infecund or because women who have 

not borne a child during that period may have had an unreported miscarriage or an 

induced abortion, been temporarily separated from their partner, been ill, failed to 

report contraceptive use, or stopped having intercourse (Vaessen, 1984). One of the 

more serious problems with infertility measures that are based on the fertility of couples at the end of the childbearing period is that these measures do not reflect recent 

trends in infertility. Moreover, most sample surveys include a relatively small number 

of women over age 40 and, therefore, high sampling errors result. Larsen and Menken (1989) have identified two further problems with some of the infecundity measures that were used in the World Fertility Survey: The ages to which the measures 

refer are not specified, and the sensitivity of the estimators to different age patterns of 

sterility is not tested.3

 

 

3

 Larsen and Menken (1989) propose a new measure of subsequent infertility that can be calculated from 

incomplete birth histories and that yields information on current infecundity. This measure cannot be 

used to analyze DHS data because it is appropriate only for countries with negligible contraceptive 

prevalence and because it requires a complete marriage history. 
Data and Methodology 5

3

Data and Methodology 

he data for this report come from 47 surveys conducted in developing countries 

under the Demographic and Health Surveys (DHS) program. These surveys 

were the latest available in each of the countries at the time of tabulation of the data 

in this report. Fieldwork in these surveys took place between 1995 and 2000. This 

report extends similar work for 29 DHS surveys in sub-Saharan Africa by Larsen and 

Raggers (2001) but uses differing measures of infertility. 

The surveys interviewed women between the ages of 15 and 49 and are nationally 

and subnationally representative. Relative to infertility, women are asked about each 

one of their live births, their past and current use of contraception, their marital 

status, and their breastfeeding and abstinence from sexual relations, as well as a host 

of other reproductive health and background information. In 15 of the surveys, information is available from a month-to-month reproductive calendar. The calendar 

was used principally in countries with high contraceptive prevalence. The reproductive calendar collected information on birth dates, pregnancies, non-live-birth pregnancy terminations, use of contraceptive methods, and periods when the woman was 

in a marital union (including informal consensual unions). The surveys examined in 

this report and the number of women in each survey are shown in Table 1. The report includes data from more than 495,000 women. 

Several different measures of infertility are used in this report. The definition of 

the measures depends on whether the reproductive calendar was used in the survey. 

Unless otherwise indicated, the term “married” includes formal and informal consensual unions. In surveys with reproductive calendars, women are considered to have 

been married for the past five years if they were continuously married (or in a consensual union) for each of the 60 months before the date of interview or for the length of 

time for which the calendar has information, whichever is shorter. In surveys without 

reproductive calendars, women are considered to have been married for the past five 

years if they are currently married and their first marriage occurred five or more years 

before the interview. An alternative would be to consider only women who have had 

one marriage. This restriction was thought to be too strict because older women may 

have been married for at least five years in second or subsequent marriages. 

The use of contraception also varies according to whether a reproductive calendar 

was used. In surveys with a calendar, nonuse of contraception refers to no current use 

and no use during the past 60 months or the length of time covered by the calendar, 

whichever is shorter. In surveys without a calendar, nonuse refers to never having 

used contraception. 

T 

In this analysis, the 

definition of measures 

of infertility depends on 

whether the 

reproductive calendar 

was used in the survey. 
6 Data and Methodology 

Table 1 

Characteristics of surveys included in the report 

Region and Country Survey date

 Number of 

respondents 

Type of 

respondent 

Used 

reproductive 

calendar 

Sub-Saharan Africa 

Benin 1996 5,491 All women No 

Burkina Faso 1998/99 6,445 All women No 

Cameroon 1998 5,501 All women No 

Central African Republic 1994/95 5,884 All women No 

Chad 1996 7,454 All women No 

Comoros 1996 3,050 All women No 

Côte d’Ivoire 1998/99 8,099 All women No 

Eritrea 1995 5,054 All women No 

Ghana 1998 4,843 All women No 

Guinea 1999 6,753 All women No 

Kenya 1998 7,881 All women Yes 

Madagascar 1997 7,060 All women No 

Malawi 2000 13,220 All women No 

Mali 1995/96 9,704 All women No 

Mozambique 1997 8,779 All women No 

Niger 1998 7,577 All women No 

Nigeria 1999 8,206 All women No 

Senegal 1997 8,593 All women No 

Tanzania 1999 4,029 All women No 

Togo 1998 8,569 All women No 

Uganda 1995 7,070 All women No 

Zambia 1996 8,021 All women No 

Zimbabwe 1999 5,907 All women Yes 

North Africa/West Asia 

Egypt 1995 14,779 Ever married Yes 

Jordan 1997 5,548 Ever married Yes 

Morocco 1995 4,753 All women Yes 

Turkey 1998 8,576 Ever married Yes 

Yemen 1997 10,414 Ever married No 

Central Asia/South and 

Southeast Asia 

Bangladesh 1999/00 8,982 Ever married Yes 

Cambodia 2000 15,351 All women No 

India 1998/99 90,303 Ever married No 

Indonesia 1997 28,810 Ever married Yes 

Kazakhstan 1999 4,800 All women No 

Kyrgyz Republic 1997 3,848 All women No 

Nepal 1996 8,429 Ever married No 

Philippines 1998 13,983 All women Yes 

Turkmenistan 2000 7,919 All women No 

Uzbekistan 1996 4,415 All women No 

Vietnam 1997 5,664 All women Yes 

Latin America/Caribbean 

Bolivia 1998 11,817 All women No 

Brazil 1996 12,612 All women Yes 

Colombia 2000 11,585 All women Yes 

Dominican Republic 1996 8,422 All women Yes 

Guatemala 1998/99 6,021 All women Yes 

Haiti 1994/95 5,356 All women No 

Nicaragua 1997/98 13,634 All women No 

Peru 2000 27,843 All women Yes 

Total 47 497,054 
Data and Methodology 7

In the measures described below, the definitions refer to surveys with calendars. 

The alternate definitions for marriage and contraception, as given above, are used for 

surveys without calendars. Although the difference in these definitions means that 

the measures are not totally comparable, they are the most precise for the data available for each country. We do not feel that the differences in definition invalidate 

intercountry comparisons. 

Childlessness 

Percentage of women who are currently married, have been so for at least five 

years, and who have no living children. 

Primary infertility 

Percentage of women who have been married for the past five years, who have 

ever had sexual intercourse, who have not used contraception during the past five 

years, and who have not had any births. 

Self-reported infecundity 

Percentage of women who report having had a hysterectomy, or say they have 

gone through menopause, or report not having had a menstrual period in the past 

five years, or have never had a menstrual period. 

Secondary infertility 

Percentage of women with no births in the past five years but who have had a 

birth at some time, among women who have been married for the past five years 

and did not use contraception during that period. 

Secondary infecundity 

Percentage of women with no births and no pregnancies in the past five years but 

who have had a birth or pregnancy at some time, among women who have been 

married for the past five years but did not use contraception during that period. 

Results 9

4

Results 

4.1 Childlessness 

hildlessness at the end of the reproductive years is most effectively studied by 

using women in the oldest age cohort: women 45 to 49 years. However, there 

are well-known reporting problems with this age group that involve both the determination of age and of fertility (for example, see Arnold, 1990; Goldman, 1985; Rutstein, 1985; and Rutstein and Bicego, 1990). Therefore, Table 2 presents data on 

women in the next younger age cohort (40 to 44 years) to measure lifetime childlessness. Using this age cohort instead of the oldest cohort should have little effect because fertility is very low in the oldest age group and first births are rare. The term 

“childless” in this report is defined as having no living children at the time of the survey. Childlessness can be the result of having had no live births or having had all 

children die by the time of the survey. 

The lowest levels of childlessness among women age 40 to 44 who have been married for at least five years occurs in four countries: Kyrgyz Republic (0.5 percent) and 

Uzbekistan (0.9 percent) in Central Asia, Vietnam in Southeast Asia (0.9 percent), 

and Peru in South America (0.9 percent). Thirteen countries have childlessness rates 

between 1.0 and 1.9 percent. In only six countries, all in sub-Saharan Africa, is the 

childless rate 4.0 percent or higher for women age 40 to 44 years (Chad and Niger, 

4.4 percent; Madagascar, 4.7 percent; Comoros, 5.5 percent; Cameroon, 7.3 percent; 

and the Central African Republic, 10.5 percent). 

Childlessness among women age 40 to 44 has declined substantially from the levels reported by the World Fertility Survey (Vaessen, 1984). In his overview, Vaessen 

found no countries with less than 1 percent childless and only two with 1.0 to 1.9 

percent childless, compared with 17 countries with less than 2 percent childless 

among current DHS surveys. At the same time, Vaessen found that the level of 

childlessness exceeded 4.0 percent in 43 percent of the WFS survey countries (12 of 

28). By comparison, a 4.0 percent level of childlessness was reached in only 13 percent of DHS survey countries (6 of 24). 

The second column of Table 2 shows the level of childlessness among women age 

25 to 49. Vaessen (1984) recommends using this age group as an indicator of childlessness because of the problems associated with age-specific data. Specifically, small 

sample size for women in some countries can lead to large sampling errors and omission of children by some of the older women. Comparing two age groups (women 40 

to 44 and 25 to 49) gives an idea of the trends in childlessness. Such trends reflect 

improving or deteriorating health conditions that impact both potential parents and 

children. 

C 

Childlessness among 

women age 40 to 44 has 

declined substantially 

from the levels reported 

by the World Fertility 

Survey. 
10 Results 

Table 2 

Childlessness and infertility among women age 40-44 and 25-49 

Among currently married women age 40-44 and 25-49 who have been married for at least five 

years, percentage who have no living children and percentage who have had no fertile pregnancies, Demographic and Health Surveys 1994-2000 

No living children No fertile pregnancies 

Country Age 40-44 Age 25-49 Age 40-44 Age 25-49 

Sub-Saharan Africa 

Benin 3.2 2.3 2.1 1.4 

Burkina Faso 1.4 2.2 1.0 1.3 

Cameroon 7.3 6.6 3.7 4.4 

Central African Rep. 10.5 9.3 7.3 6.4 

Chad 4.4 3.4 3.0 2.0 

Comoros 5.5 4.2 4.4 3.2 

Côte d’Ivoire 3.7 3.8 2.0 2.2 

Eritrea 1.2 3.3 0.9 1.8 

Ghana 1.1 2.5 0.6 2.0 

Guinea 3.0 4.5 1.9 2.6 

Kenya 1.5 1.6 1.5 1.3 

Madagascar 4.7 4.8 3.3 3.4 

Malawi 2.8 3.8 1.6 1.7 

Mali 3.3 4.3 1.7 2.5 

Mozambique 3.1 6.0 1.9 3.3 

Niger 4.4 4.2 2.7 2.4 

Nigeria 2.1 9.4 1.8 5.2 

Senegal 3.8 2.9 2.1 2.0 

Tanzania 2.8 4.0 2.0 2.8 

Togo 1.4 2.5 0.9 1.7 

Uganda 3.2 4.2 1.9 3.0 

Zambia 2.3 3.6 1.5 1.9 

Zimbabwe 2.7 2.7 2.3 1.6 

North Africa/West Asia 

Egypt 2.8 3.1 2.6 2.7 

Jordan 2.4 2.8 2.4 2.7 

Morocco 2.0 4.5 1.2 3.7 

Turkey 1.8 3.2 1.5 2.8 

Yemen 2.5 2.5 2.2 2.1 

Central Asia/South 

and Southeast Asia 

Bangladesh 1.8 6.0 1.1 4.0 

Cambodia 2.1 2.0 1.8 1.4 

India 2.6 3.1 2.0 2.5 

Indonesia 3.7 3.2 2.9 2.6 

Kazakhstan 2.0 2.1 2.0 2.0 

Kyrgyz Republic 0.5 1.9 0.5 1.5 

Nepal 3.2 3.3 1.4 2.2 

Philippines 1.6 2.3 1.4 2.0 

Turkmenistan 1.3 1.9 1.3 1.5 

Uzbekistan 0.9 1.4 0.8 1.2 

Vietnam 0.9 1.3 0.8 1.1 

Latin America/Caribbean 

Bolivia 1.1 1.2 0.7 0.8 

Brazil 3.3 3.7 2.9 3.4 

Colombia 2.5 2.9 2.3 2.6 

Dominican Republic 3.7 3.2 3.0 2.7 

Guatemala 1.7 1.3 1.5 1.1 

Haiti 3.9 5.3 2.5 3.4 

Nicaragua 1.4 1.8 1.2 1.5 

Peru 1.4 1.5 1.3 1.3 
Results 11

On average, childlessness rates are higher by 0.7 percent for women age 25 to 49 

than for those age 40 to 44. In 16 countries, childlessness is greater by 1 percent or 

more for the 25 to 49 age group. Eleven of these are in sub-Saharan Africa. The 

three countries with the greatest differences are Nigeria (7.3 percent higher for age 

25 to 49), Bangladesh (4.2 percent higher), and Mozambique (2.9 percent higher). It 

is unlikely that some of these large differences are due to understatement of childlessness among women age 40 to 44 because omission of births among these older 

women would make their proportions higher than those of the broader age group. In 

three countries (Central African Republic, Chad, and Comoros) the broader age 

group has a percentage of childlessness that is lower by 1 percent or more. These differences may be due to improving health conditions and the lower exposure to children’s mortality in the broader age group. Some of the smaller differences in childlessness between the two groups could be due to sampling error. 

4.1.1 Fertile Pregnancies 

A more refined measure of the inability to produce offspring is the percentage of 

women who have not had a fertile pregnancy. A fertile pregnancy is a pregnancy that 

ended in a live birth or a current pregnancy that is presumed to end in a live birth, on 

average about 85 percent (Singh, 1989). In columns 3 and 4 of Table 2, the percentages of women without a fertile pregnancy are shown for women 40 to 44 and 

women 25 to 49, respectively. This measure eliminates the effect of children’s mortality on the data. 

Fifty-seven percent of the countries (26 of 46) have percentages of no fertile pregnancies for women 40 to 44 that are below 2 percent. Comoros, at 4.4 percent, and 

the Central African Republic, at 7.3 percent, are the only two countries above 4 percent. Removing the effect of mortality reduces the percentage of childlessness by 0.8 

percent on average. In 16 countries, the reduction is 1 percent or more, but only 2 of 

these 16 countries, Haiti and Nepal, are outside of sub-Saharan Africa. Although the 

effect of mortality is greatest in the Central African Republic and Cameroon, these 

two countries have the highest levels of childlessness at age 40 to 44, even when this 

effect is removed. 

For the broader age group 25 to 49, removing the effect of mortality reduces the 

estimation of childlessness by 1 percent or more in most of sub-Saharan Africa, but 

does so in only three countries outside this region: Bangladesh, Nepal, and Haiti. 

The percentage with no fertile pregnancies among the broader age group is the childless measure that is probably closest to primary infertility. The country with the lowest percentage is Bolivia (0.8 percent), and Bangladesh (4.0 percent), Cameroon (4.4 

percent), Nigeria (5.2 percent) and the Central African Republic (6.4 percent) are the 

countries with the highest percentages in the broader age group. 

4.1.2 Discussion 

Among currently married women age 40 to 44 who have been married for at least five 

years, about 96 percent have one or more surviving children in the majority of countries (40 out of 46). In more than half of the countries (29 of 46), 97 percent or more 

women have at least one surviving child. Of the same women, at least 92 percent 

have had at least one fertile pregnancy, and in 40 countries this proportion is 97 percent or higher. 

Among currently married 

women age 40 to 44 who 

have been married for at 

least five years, about 

96 percent have one or 

more surviving children in 

the majority of countries. 
12 Results 

Among currently married women age 25 to 49 who have at least five years’ exposure to the risk of pregnancy, a similar pattern emerges. In 38 countries, 97 percent or 

more of these women have had one or more pregnancies, and only in the Central African Republic does this level drop below 94 percent. 

4.2 Primary Infertility 

Primary infertility is measured among women who have engaged in regular sexual 

intercourse for five or more years, have not used contraception for that period of 

time, and have not had a live birth. Primary infecundity is measured among the same 

women, but the women have had neither a pregnancy nor a birth in the specified period. We will examine each of the conditions in turn. 

4.2.1 Sexual Experience 

Table 3 shows the proportion of women who have never had sex by five-year age 

groups, for age group 25 to 49, and for all women age 15 to 49 and age 25 to 49 

standardized on the age distribution of Peru. In several countries in North Africa and 

Asia, only ever-married women were interviewed, and questions on sexual activity 

were not asked. In Nepal, the survey was based on ever-married women, but sexual 

activity questions were asked. 

The percentage of women who have not had sexual intercourse in the age group 

15 to 19 ranges from 27 percent in Côte d’Ivoire to 94 percent in Turkmenistan. 

Overall, 59 percent of women in this age group have not had sexual intercourse. By 

age 20 to 24, the mean percentage who are still sexually inexperienced drops to 18 

percent and by age 25 to 29 to 6 percent. By age 45 to 49, only 1 percent of women 

report not having had sexual intercourse at some time in their life. To smooth the 

effects of sampling variation caused by small numbers, women age 25 to 49 are 

grouped together. To further comparability, we have calculated age-standardized percentages for this age group, on the basis of the age distribution of Peru, as shown in 

the last column of Table 3. Overall, only 2.6 percent of women age 25 to 49 have not 

had sexual intercourse. The highest percentage of women with no sexual experience is 

in the Philippines (12.4 percent), where even by age 45 to 49, 6.3 percent have still 

not had intercourse. Other countries with a high proportion of sexually inexperienced 

women age 25 to 49 are Cambodia (9.1 percent), Comoros (6.9 percent), and Peru 

(6.7 percent). The lowest levels occur in sub-Saharan Africa, where 17 of 23 countries have less than 0.6 percent of women age 25 to 29 who have never had sexual 

intercourse. In the Central Asian republics, the percentage of women age 25 to 49 

with no sexual experience ranges from 2.2 to 5.7 percent. In the Latin America/Caribbean region, the percentage is about 4 to 5 percent, except in Peru. 

The overall means and the regional mean for Asia are affected by the lack of information for countries in North Africa, West Asia, and South Asia, where cultural 

tradition makes it difficult to ask questions about sexual activity. 

The percentage of women 

who have not had sexual 

intercourse in the age 

group 15 to 19 ranges 

from 27 percent in Côte 

d’Ivoire to 94 percent in 

Turkmenistan. 
Results 13

Table 3 

Primary infertility (1): No sex 

Percentage of women age 15-49 who have never had sexual intercourse, by age group, Demographic and 

Health Surveys 1994-2000 

Country 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Total 

25-49

Age 

standardized 

15-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Benin 47.0 5.5 0.3 0.2 0.0 0.0 0.0 0.1 11.0 0.1 

Burkina Faso 50.9 3.4 0.3 0.0 0.0 0.2 0.2 0.1 11.5 0.1 

Cameroon 34.9 2.7 0.1 0.1 0.0 0.2 0.2 0.1 8.0 0.1 

Central Afr. Rep. 38.0 3.0 0.9 0.1 0.4 0.0 0.0 0.4 8.8 0.3 

Chad 45.2 4.9 1.0 0.1 0.1 0.0 0.1 0.4 10.7 0.3 

Comoros 83.2 44.6 19.5 6.4 1.4 0.0 0.0 7.5 29.9 6.9 

Côte d’Ivoire 27.3 2.6 0.1 0.0 0.0 0.0 0.0 0.0 6.3 0.0 

Eritrea 62.4 20.8 7.3 4.3 1.5 2.3 1.1 3.6 19.3 3.8 

Ghana 62.2 8.6 1.8 0.2 0.0 0.0 0.0 0.6 15.1 0.5 

Guinea 40.2 6.0 0.7 0.3 0.0 0.2 0.0 0.3 9.8 0.3 

Kenya 56.4 11.1 1.8 0.2 0.0 0.0 0.0 0.6 14.3 0.5 

Madagascar 43.5 8.3 3.1 1.4 0.8 1.1 0.5 1.6 11.7 1.6 

Malawi 42.7 4.3 0.8 0.2 0.0 0.3 0.0 0.3 10.0 0.3 

Mali 34.0 2.7 0.6 0.2 0.2 0.1 0.0 0.3 7.9 0.3 

Mozambique 30.5 2.1 0.1 0.0 0.0 0.1 0.0 0.1 6.9 0.0 

Niger 36.5 8.7 1.6 0.4 0.0 0.2 0.2 0.6 9.7 0.6 

Nigeria 56.9 15.9 4.0 1.1 0.5 0.4 0.0 1.7 15.9 1.5 

Senegal 65.1 29.0 10.9 2.4 0.6 0.2 0.0 3.9 21.3 3.6 

Tanzania 47.4 6.2 1.1 0.8 0.3 0.0 0.0 0.6 11.5 0.5 

Togo 39.3 4.4 0.6 0.1 0.1 0.0 0.1 0.2 9.3 0.2 

Uganda 38.4 3.2 1.1 0.3 0.2 0.0 0.0 0.5 9.0 0.4 

Zambia 41.7 5.2 0.5 0.5 0.1 0.0 0.0 0.3 10.0 0.3 

Zimbabwe 67.7 15.9 2.4 1.2 0.3 0.2 0.0 1.1 17.9 1.0 

North Africa/West Asia 

Egypt u u u u u u u u u u 

Jordan u u u u u u u u u u 

Morocco u u u u u u u u u u 

Turkey u u u u u u u u u u 

Yemen u u u u u u u u u u 

Central Asia/South 

and Southeast Asia 

Bangladesh u u u u u u u u u u 

Cambodia 87.1 44.2 16.3 9.0 6.1 5.1 4.9 8.6 32.1 9.1 

India u u u u u u u u u u 

Indonesia u u u u u u u u u u 

Kazakhstan 82.5 30.3 7.2 2.6 1.9 1.7 2.2 3.2 25.1 3.5 

Kyrgyz Rep. 85.7 19.5 4.2 2.3 0.7 1.2 1.6 2.1 23.0 2.2 

Nepal u u u u u u u u u u 

Philippines 90.9 54.5 24.0 10.9 7.4 7.2 6.3 12.2 36.7 12.4 

Turkmenistan 94.1 52.6 15.2 4.2 2.5 0.8 0.5 5.6 33.0 5.7 

Uzbekistan 87.0 22.7 5.2 1.9 1.2 0.4 1.4 2.3 24.0 2.3 

Vietnam u u u u u u u u u u 

Latin America/Caribbean 

Bolivia 80.3 33.0 8.5 3.9 3.3 2.0 1.7 4.3 25.7 4.4 

Brazil 67.2 26.6 9.9 3.6 4.1 3.1 3.6 5.1 22.3 5.3 

Colombia 59.9 18.9 6.6 4.4 1.9 3.4 2.9 4.0 18.6 4.1 

Dominican Rep. 67.3 26.7 10.3 3.2 3.1 1.5 0.4 4.6 21.8 4.4 

Guatemala 72.6 26.2 9.0 5.6 2.3 4.1 2.2 5.1 23.3 5.1 

Haiti 71.0 25.6 8.6 4.3 1.0 1.9 1.0 3.9 22.1 3.9 

Nicaragua 63.7 23.1 9.9 4.5 2.5 1.6 1.6 4.8 20.5 4.6 

Peru 77.8 34.2 14.7 5.4 4.0 2.5 2.6 6.5 26.8 6.7 

u = Unknown (not available for ever-married samples) 
14 Results 

4.2.2 Pregnancy among Sexually Experienced Women 

Once sexual relations are begun on a regular basis, pregnancy soon follows for the 

majority of women unless contraception is used. Table 4 shows the proportion of 

women who have had sexual relations (any marital status for all-women surveys and 

non-single women for ever-married surveys) but have not had a pregnancy. 

There is a clear decline with increasing age from an overall average of about 40 

percent with no pregnancy at age 15 to 19 to 16 percent at age 20 to 24 to 7 percent 

at age 25 to 29. This rapid decline is probably due to three factors: some adolescent 

subfecundity for sexually active women, particularly at age 15 to 17, a delay in 

establishing regular sexual relations even though a first experience of intercourse 

occurred, and some use of contraception among young women in order to delay the 

first pregnancy. By age 30, almost all sexually experienced women have had a 

pregnancy; the percentage without a pregnancy at age 35 to 49 is about 2.5 percent. 

At age 15 to 19, the countries with the smallest proportion of women who are 

sexually experienced but have not had a pregnancy are the Philippines and Guatemala 

(20.2 and 20.3 percent, respectively). It is interesting that the Philippines has the second highest proportion of women without sexual experience in this age group (Table 

3). At 93 percent and 89 percent, respectively, Turkey and Morocco are the countries 

with the highest proportions of sexually experienced women age 15 to 19 who have 

not had a pregnancy. These percentages are unrealistically high and may indicate 

omission of some pregnancies, or perhaps, more sporadic sex on the part of respondents. These countries also have the highest proportions of sexually experienced 

women without a pregnancy at ages 20 to 24, 25 to 29, and 30 to 34. 

Among women age 25 to 49, the highest proportion of sexually experienced 

women who have not had a pregnancy is in Morocco (17.8 percent, age standardized). Morocco is followed by Turkey (8.9 percent), and Brazil and Colombia 

(both 7.7 percent). In six countries, less than 2 percent of sexually experienced 

women age 25 to 49 have not had a pregnancy: Guatemala (1.2 percent), Vietnam 

(1.7 percent), Burkina Faso (1.8 percent), and Bangladesh, Malawi, and Uzbekistan 

(all 1.9 percent). 

4.2.3 Births among Sexually Experienced Women 

Table 5 shows the proportion of women who have had sexual relations but have not 

had a birth. The data indicate that, overall, 18.8 percent of women age 15 to 49 who 

are sexually experienced have not had a birth. This percentage consists of 13.9 percent who have not had a pregnancy and 4.9 percent who have had at least one pregnancy but who have not brought this pregnancy to term. Some of these women have 

lost the pregnancy through miscarriage and stillbirth, some have had an induced 

abortion, and others are currently pregnant for the first time. By age 25, however, 

most women would have completed their first pregnancy, allowing comparison between countries using the age group 25 to 49 years. Overall, 5.0 percent of sexually 

experienced women age 25 to 49 have not had a birth, compared with 4.0 percent 

who have not had a pregnancy. 

The countries with the highest proportions of sexually experienced women without a birth are Morocco, Turkey, Colombia, Brazil, and the Central African Republic, all over 8 percent; Morocco is highest at 19.1 percent. As with pregnancies, the 

countries with lowest proportions of sexually experienced women without a birth are 

Guatemala, Bangladesh, Burkina Faso, and Malawi, all under 3 percent. 

Overall, 5.0 percent of 

sexually experienced 

women age 25 to 49 have 

not had a birth, compared 

with 4.0 percent who 

have not had a 

pregnancy. 
Results 15

Table 4 

Primary infertility (2): Sex but no pregnancy 

Percentage of women age 15-49 who have had sexual intercourse but have never been pregnant, by age 

group, Demographic and Health Surveys 1994-2000 

Country 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Total 

25-49 

Age 

standardized 

15-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Benin 51.0 20.4 8.4 2.2 1.3 2.2 1.3 3.6 16.6 3.3 

Burkina Faso 48.2 11.1 3.5 1.5 1.6 1.0 0.8 1.9 13.4 1.8 

Cameroon 47.9 21.5 5.4 2.3 3.4 1.9 4.5 3.7 16.2 3.5 

Central Afr. Rep. 35.2 12.1 5.7 3.7 3.8 5.7 5.5 4.8 12.6 4.8 

Chad 29.8 7.9 2.9 2.5 2.5 4.0 4.2 3.0 9.6 3.1 

Comoros 45.8 22.9 11.9 8.6 3.9 4.7 2.4 6.9 18.1 6.9 

Côte d’Ivoire 51.9 18.3 6.2 3.1 1.9 3.4 3.4 4.0 16.6 3.7 

Eritrea 37.7 12.2 7.2 4.4 2.9 2.6 1.2 3.9 12.7 4.0 

Ghana 57.6 24.0 11.0 3.3 1.7 0.5 1.9 4.5 19.2 4.1 

Guinea 37.8 14.8 6.2 3.3 2.2 2.3 2.1 3.6 12.8 3.4 

Kenya 50.9 16.9 5.0 1.7 1.6 1.4 2.3 2.7 15.4 2.5 

Madagascar 35.6 12.4 7.1 5.6 3.3 4.6 4.7 5.3 13.0 5.2 

Malawi 41.1 8.3 2.5 2.3 1.9 1.0 1.2 1.9 11.4 1.9 

Mali 34.1 9.3 3.7 2.5 1.5 1.4 2.3 2.4 10.4 2.3 

Mozambique 42.5 15.7 6.2 3.9 3.3 4.2 5.7 4.8 14.7 4.6 

Niger 32.1 7.7 3.4 2.5 1.4 2.8 5.5 2.9 10.0 2.9 

Nigeria 46.5 25.7 11.8 5.7 2.3 3.3 2.7 6.2 18.1 5.6 

Senegal 36.1 13.4 7.2 2.8 2.2 2.2 1.7 3.7 12.3 3.5 

Tanzania 51.6 11.1 5.4 3.8 2.8 1.9 0.5 3.4 14.9 3.2 

Togo 68.0 34.6 10.1 3.7 2.6 1.6 2.1 4.8 23.5 4.4 

Uganda 30.4 9.2 5.5 4.3 2.9 2.2 2.2 3.9 10.4 3.6 

Zambia 47.4 14.0 6.9 3.3 1.3 1.3 0.9 3.5 14.5 3.1 

Zimbabwe 32.2 11.4 4.1 2.8 2.6 2.0 1.7 2.9 10.6 2.8 

North Africa/West Asia 

Egypt 26.8 10.7 5.3 3.4 3.6 2.4 2.3 3.5 9.8 3.6 

Jordan 23.1 10.2 4.1 3.3 4.2 2.5 2.9 3.5 8.9 3.5 

Morocco 92.5 62.2 40.6 18.9 10.7 4.8 3.4 19.2 42.2 17.8 

Turkey 89.3 47.2 19.3 8.8 5.5 3.5 3.1 9.2 33.1 8.9 

Yemen 39.1 10.9 3.6 2.8 2.0 2.3 1.3 2.6 11.9 2.5 

Central Asia/South 

and Southeast Asia 

Bangladesh 26.9 8.6 3.6 1.2 1.4 1.7 1.2 2.1 8.5 1.9 

Cambodia 36.0 13.6 3.4 2.8 1.8 2.1 2.8 2.5 11.7 2.6 

India 37.3 11.2 4.3 2.8 2.5 2.3 2.3 3.0 11.8 2.9 

Indonesia 30.2 9.4 4.8 3.0 3.0 3.3 2.7 3.4 10.2 3.4 

Kazakhstan 49.9 19.8 7.8 5.1 1.8 2.1 2.2 3.8 16.8 4.1 

Kyrgyz Rep. 31.2 11.6 3.6 2.1 1.6 1.2 0.4 1.9 10.0 2.0 

Nepal 41.6 9.7 2.9 2.7 1.2 1.5 2.8 2.3 12.0 2.2 

Philippines 20.2 7.4 4.3 3.5 1.6 2.2 2.1 2.8 7.4 2.9 

Turkmenistan 25.1 8.1 3.9 1.8 2.0 1.5 0.6 2.1 8.1 2.1 

Uzbekistan 24.9 8.8 4.1 1.5 0.7 1.2 1.3 1.9 8.1 1.9 

Vietnam 26.1 7.2 2.6 2.0 1.0 0.9 1.5 1.6 7.9 1.7 

Latin America/Caribbean 

Bolivia 30.3 15.2 8.5 3.9 2.2 2.0 2.5 4.1 11.8 4.1 

Brazil 41.3 25.8 14.9 7.5 4.7 4.2 4.6 7.5 18.3 7.7 

Colombia 49.4 29.5 14.5 8.3 4.9 3.7 4.3 7.6 20.7 7.7 

Dominican Rep. 25.6 13.4 7.0 4.3 3.2 2.3 1.5 4.1 10.3 4.0 

Guatemala 20.3 4.4 1.2 0.5 1.7 1.4 1.4 1.2 5.8 1.2 

Haiti 48.9 27.0 11.8 4.4 2.7 3.0 4.6 5.7 18.8 5.6 

Nicaragua 23.7 8.2 4.8 2.5 2.0 0.9 1.6 2.6 8.1 2.5 

Peru 39.0 21.1 11.6 5.9 3.1 3.1 2.9 5.6 15.7 5.8 
16 Results 

Table 5 

Primary infertility (3): Sex but no birth 

Percentage of women age 15-49 who have had sexual intercourse but have never had a birth, by age group, 

Demographic and Health Surveys 1994-2000 

Country 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Total 

25-49 

Age 

standardized 

15-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Benin 63.3 23.5 9.3 2.8 1.3 2.2 1.3 4.0 20.1 3.7 

Burkina Faso 58.9 13.0 4.1 1.8 1.6 1.0 0.8 2.1 16.1 2.0 

Cameroon 61.5 30.1 9.4 4.7 5.7 4.3 7.9 6.6 22.4 6.4 

Central African Rep. 54.2 20.4 10.7 6.6 7.1 7.9 8.4 8.3 20.2 8.1 

Chad 45.6 11.1 3.5 2.7 2.5 4.0 4.2 3.3 13.7 3.3 

Comoros 56.3 26.3 12.9 8.9 4.1 4.7 2.4 7.3 21.2 7.2 

Côte d’Ivoire 60.7 20.8 6.8 3.2 1.9 3.4 3.4 4.2 19.0 3.8 

Eritrea 50.0 18.5 9.3 5.3 3.1 2.7 1.2 4.7 17.0 4.8 

Ghana 69.0 33.5 16.1 5.9 3.2 1.1 2.5 7.0 24.8 6.4 

Guinea 46.6 17.8 6.7 3.5 2.2 2.3 2.1 3.8 15.4 3.6 

Kenya 60.3 22.2 5.7 2.5 2.4 1.7 2.6 3.3 18.7 3.1 

Madagascar 45.7 16.4 9.3 6.7 3.7 4.9 4.9 6.3 16.5 6.1 

Malawi 55.7 12.9 3.3 2.9 2.2 1.5 1.9 2.6 15.7 2.5 

Mali 49.1 12.7 5.8 3.2 1.7 2.0 3.8 3.5 14.8 3.4 

Mozambique 56.3 19.4 6.7 3.9 3.3 4.2 5.7 4.9 18.4 4.7 

Niger 42.7 9.7 3.8 2.6 1.6 2.8 5.5 3.1 12.7 3.1 

Nigeria 57.2 33.8 15.0 7.7 3.0 3.7 3.0 7.8 22.7 7.1 

Senegal 47.7 18.0 8.3 2.8 2.3 2.2 1.7 4.0 15.8 3.7 

Tanzania 62.6 16.4 7.0 4.9 3.0 1.9 0.6 4.2 18.7 3.9 

Togo 74.4 38.2 11.3 3.8 2.6 1.6 2.1 5.2 25.7 4.7 

Uganda 44.6 12.5 6.0 4.3 3.2 2.2 2.2 4.2 14.1 3.8 

Zambia 59.1 16.9 7.6 3.4 1.3 1.3 0.9 3.7 17.7 3.2 

Zimbabwe 49.8 17.6 5.4 4.0 3.4 2.5 1.9 3.9 16.0 3.7 

North Africa/West Asia 

Egypt 48.8 21.1 8.4 5.0 4.8 3.3 2.8 5.1 17.4 5.2 

Jordan 51.4 20.7 7.3 5.2 4.9 3.1 3.4 5.1 17.8 5.0 

Morocco 95.1 66.1 43.0 20.3 12.1 5.0 4.2 20.6 44.3 19.1 

Turkey 92.1 53.9 22.8 10.2 6.0 3.8 3.7 10.7 35.8 10.3 

Yemen 55.0 16.2 5.4 3.7 2.2 2.7 1.5 3.4 16.7 3.3 

Central Asia/South 

and Southeast Asia 

Bangladesh 38.2 12.5 4.8 1.9 1.9 1.9 1.3 2.8 12.0 2.5 

Cambodia 57.1 21.4 5.0 3.3 2.1 2.7 3.4 3.3 18.1 3.3 

India 52.5 17.7 6.3 3.6 3.1 2.8 2.9 4.0 16.8 3.9 

Indonesia 47.4 16.7 7.4 4.1 3.6 3.5 3.0 4.5 15.9 4.5 

Kazakhstan 74.8 33.5 12.6 6.6 2.8 3.8 3.6 5.9 25.9 6.3 

Kyrgyz Rep. 55.7 18.7 6.0 3.2 2.4 1.9 1.1 3.1 17.2 3.2 

Nepal 56.3 14.1 4.3 3.2 1.7 1.9 2.9 3.0 16.3 2.9 

Philippines 39.9 15.4 7.7 5.1 2.2 2.7 2.6 4.2 14.0 4.3 

Turkmenistan 55.0 18.7 7.3 2.5 2.7 1.8 0.9 3.3 17.2 3.3 

Uzbekistan 52.0 22.9 6.4 2.4 1.1 1.4 1.5 2.9 17.0 2.8 

Vietnam 54.9 17.4 5.1 2.8 1.2 1.2 1.8 2.5 16.4 2.6 

Latin America/Caribbean 

Bolivia 42.0 18.6 10.0 4.1 2.2 2.0 2.5 4.5 15.1 4.5 

Brazil 56.4 33.1 18.0 9.0 5.9 5.0 5.4 9.1 23.8 9.3 

Colombia 62.3 36.5 17.7 10.7 6.1 4.5 5.4 9.4 25.8 9.6 

Dominican Rep. 43.9 20.4 10.2 6.1 4.5 4.0 2.8 6.1 16.7 5.9 

Guatemala 37.0 8.8 3.0 1.0 1.8 1.5 1.5 1.8 10.5 1.8 

Haiti 62.7 34.5 16.0 6.2 4.4 3.8 5.6 7.9 24.4 7.6 

Nicaragua 39.2 13.2 6.0 2.7 2.5 1.4 1.6 3.1 12.6 3.1 

Peru 52.1 27.0 14.5 8.0 3.9 3.9 3.8 7.2 20.6 7.4 
Results 17

Even though the results may be based on small numbers, it is interesting to consider the group of women at the upper limits of the reproductive age span, 45 to 49 

years. Overall, 3.0 percent of sexually experienced women in this age group have not 

had a birth. The proportions with no births range from 0.6 percent (Tanzania) to 8.4 

percent (Central African Republic). Three other sub-Saharan countries have percentages higher than 5 percent: Cameroon (7.9 percent), Mozambique (5.7 percent), and 

Niger (5.5 percent). In the Latin America/Caribbean region, there are three countries 

in which more than 5 percent of sexually experienced women age 45 to 49 have not 

had a birth: Colombia and Brazil (both 5.4 percent) and Haiti (5.6 percent). 

4.2.4 Observed Primary Infecundity 

The measurement of primary infecundity is complicated by contraceptive use and 

women’s fertility preferences. The determination of infecundity depends on a certain 

amount of exposure to the risk of pregnancy. In demographic studies, the period of 

risk is five years. A woman who fails to give birth during this period, while engaging 

regularly in sexual intercourse and not using any form of contraception nor induced 

abortion, is considered infecund. Marital union is considered to be the indicator of 

regularly engaging in sexual intercourse. Where contraceptive use is low, excluding 

women who have ever used contraception does not substantially bias the estimation 

of infecundity. Where contraceptive use is high, however, exclusion of women who 

use or who have ever used a contraceptive method is selective for infecund women, 

especially if most women use contraception for limiting the number of births. In 

these countries, the estimation of infecundity may be highly biased if contraceptive 

users are excluded from the denominator in calculating the percentage of women who 

are infecund. However, including contraceptive users in the denominator implies that 

they all are fecund and biases the estimate of infecundity downward. Moreover, there 

may be a difference between voluntary and involuntary infecundity. Some women do 

not desire to have any children and use contraception to achieve this desire. Other 

women want children but use contraception to postpone their first and/or subsequent 

births. When some of these latter women are ready to have children, some find that 

they cannot and so are involuntarily infecund. Tabulations that do not take into account the desire for a child may underestimate the level of involuntary infecundity. 

4.2.5 Women Who Do Not Want Children 

The desire for children is not universal. In every region there are countries where a 

considerable number of women do not want to have a child. Table 6 shows this negative desire for children in two ways. Column one shows the percentage of women 

who do not want a child (or another child) among those who have no living children. 

The percentages reach as high as 3.3 percent in North Africa/West Asia, 6.0 percent 

in sub-Saharan Africa, 7.8 percent in Central Asia/South and Southeast Asia, and 

12.0 percent in Latin America/Caribbean. Some of these women have had children 

who died, and may consider themselves too old to have additional children. 

The measurement of 

primary infecundity is 

complicated by 

contraceptive use and 

women’s fertility 

preferences. 
18 Results 

Table 6 

Women who do not want children 

Percentage of women who want no (more) children and percentage who are sterilized among 

women with no living children, and percentage of women whose ideal number of children is zero 

among women with no living children and among all women, Demographic and Health Surveys 

1986-2001 

Women with no living children Ideal number of children is zero 

Country and Survey 

Wants no 

(more) 

children Sterilized Number 

Among women 

with no living 

children 

Among 

all 

women 

Sub-Saharan Africa 

Benin 1996 1.0 0.0 228 0.2 0.2 

Botswana 1988 1.9 0.0 104 1.0 0.4 

Burkina Faso 1998/99 0.3 0.0 365 0.1 0.1 

Cameroon 1998 0.2 0.0 449 0.2 0.2 

Central African Rep. 1994/95 0.9 0.3 570 0.2 0.1 

Chad 1996/97 0.1 0.4 440 0.2 0.1 

Comoros 1996 4.0 0.8 126 0.1 0.5 

Côte d’Ivoire 1998/99 1.1 0.0 163 0.1 0.2 

Eritrea 1995 1.4 0.3 345 0.8 0.7 

Ethiopia 2000 5.4 0.0 802 5.6 3.5 

Gabon 2000 1.1 0.4 379 0.4 0.3 

Ghana 1998 0.8 0.0 222 0.2 0.1 

Guinea 1999 1.7 0.0 453 0.3 0.3 

Kenya 1998 1.7 0.0 251 0.5 0.3 

Liberia 1986 1.7 0.7 395 0.1 0.1 

Madagascar 1997 1.3 0.0 347 0.2 0.1 

Malawi 2000 3.2 1.8 654 0.4 0.1 

Mali 1995/1996 0.9 0.2 666 0.7 0.5 

Mozambique 1997 1.0 0.0 750 0.4 0.4 

Namibia 1992 6.0 2.2 161 1.6 1.2 

Niger 1998 0.8 0.0 628 0.2 0.0 

Nigeria 1999 2.0 0.0 460 1.5 0.8 

Rwanda 1992 1.4 0.0 189 0.1 0.2 

Senegal 1997 0.8 0.0 513 0.1 0.1 

Tanzania 1996 0.4 0.2 408 0.4 0.1 

Togo 1998 1.5 0.2 344 0.1 0.3 

Uganda 1995 1.6 0.0 419 0.9 0.3 

Uganda 2000/01 1.0 1.3 273 0.5 0.2 

Zambia 1996 1.5 0.2 343 0.6 0.2 

Zimbabwe 1999 4.2 0.0 261 1.3 0.6 

North Africa/West Asia 

Armenia 2000 3.3 0.9 160 1.0 0.4 

Egypt 1995 1.0 0.0 953 0.0 0.1 

Egypt 2000 1.1 0.0 861 0.1 0.0 

Jordan 1997 1.1 0.4 333 0.0 0.3 

Morocco 1992 1.3 0.0 451 1.1 0.8 

Turkey 1998 2.2 0.0 453 4.2 1.6 

Yemen 1997 2.6 0.2 915 2.6 4.1 

Central Asia/South and 

Southeast Asia 

Bangladesh 1996/97 1.8 1.5 788 0.1 0.0 

Bangladesh 1999/2000 0.8 0.3 888 0.2 0.0 

Cambodia 2000 2.8 0.2 526 0.3 0.2 

India 1992/1993 1.8 0.9 8,916 0.1 0.0 

India 1998/1999 1.2 0.9 7,620 0.1 0.1 

Indonesia 1997 2.3 0.2 1,751 0.0 0.0 

Kazakhstan 1995 1.1 0.0 134 0.4 0.5 

Kazakhstan 1999 1.7 2.7 157 0.4 0.3 

Kyrgyz Republic 1997 1.2 0.8 146 0.2 0.2 

Nepal 1996 1.1 0.7 811 0.2 0.0 

Nepal 2001 1.2 0.7 784 0.2 0.0 

Philippines 1998 1.4 0.0 378 0.8 0.3 

Thailand 1987 7.8 1.0 511 2.0 1.4 

Turkmenistan 2000 2.7 0.5 215 0.1 0.1 

Uzbekistan 1996 2.2 0.0 142 0.2 0.1 

Vietnam 1997 0.4 0.4 186 0.0 0.0 

Latin America/Caribbean 

Bolivia 1998 8.2 0.0 226 5.0 4.7 

Brazil 1996 9.8 2.4 506 6.3 7.1 

Colombia 2000 6.6 1.1 318 4.7 3.3 

Dominican Republic 1996 2.3 1.1 357 0.0 0.7 

Guatemala 1998/99 12.0 0.0 152 1.8 0.8 

Haiti 1994/95 1.5 0.4 259 0.5 0.2 

Haiti 2000 0.4 0.0 447 0.2 0.1 

Nicaragua 1997/98 4.3 0.6 479 4.0 2.8 

Peru 1996 4.3 0.1 562 0.4 0.3 

Peru 2000 3.6 0.1 569 2.9 2.3 
Results 19

The last two columns of Table 6 show another way to look at women’s desire for 

no children. In the next-to-last column are women whose ideal number of children is 

zero among those who have no living children. For several countries the proportion is 

more than 2.0 percent. From lowest to highest, they are Yemen (2.6 percent), Peru 

(2.9 percent), Nicaragua (4.0 percent), Turkey (4.2 percent), Colombia (4.7 percent), 

Bolivia (5.0 percent), Ethiopia (5.6 percent), and Brazil (6.3 percent). Most of the 

countries with high percentages among women with no living children whose ideal 

number of children is zero are in the Latin America/Caribbean region. The last column shows the percentage of all women whose ideal number of children is zero, irrespective of the number of children they have. The pattern tends to follow that of the 

women with no living children. 

4.2.6 Self-reported Infecundity 

In the DHS surveys, women are not asked direct questions about fecundity or the 

capacity to reproduce. Rather, the information is interpreted from responses to questions on the time since the last menstrual period, reason for not using contraception 

in the future, and desire for the next child. Additionally, women may report that they 

1) have never menstruated, 2) have not menstruated for five or more years, 3) are 

postmenopausal, or 4) have had a hysterectomy. The five-year period is used to assure 

that lack of childbearing is not due to the postpartum effects of amenorrhea. 

These self-reports of infecundity are shown by age in Table 7. There is a curvilinear relationship between age and self-reported infecundity. In the youngest age group 

(15 to 19), an average of 7 percent of women are infecund. The majority of this infecundity is related to not having had their first menstruation (menarche). The lowest 

level of reported infecundity occurs at age 20 to 24 and rises thereafter, slowly at first 

and then more rapidly, until reaching an average of 57 percent among women age 45 

to 49, mostly due to menopause. The overall and regional averages are shown in Figure 1. Among all women age 15 to 49, 17.0 percent reported being infecund. The 

differences between regions are diminished by the overall pattern by age. However, 

there is still substantial variation by country. The highest levels of self-reported infecundity at age 15 to 19 occur in sub-Saharan Africa, where in 14 of 23 countries 10 

percent or more of girls reported that they were infecund. In the other regions, only 

in Cambodia does the percentage who reported themselves infecund at age 15 to 19 

exceed 10 percent. The age-adjusted percentages for women age 25 to 49 who reported themselves infecund vary from a low of 5.4 percent in Senegal to a high of 

35.4 percent in Cambodia. The reader is cautioned that some of the variation between countries may be due to differences in the available information, because direct 

questions were not asked. 

Most of the countries 

with high percentages 

among women with no 

living children whose 

ideal number of children 

is zero are in the Latin 

America/Caribbean 

region. 
20 Results 

Table 7 

Self-reported infecundity 

Percentage of women who report they have not menstruated in the past five years, have never menstruated, 

are postmenopausal, or have had a hysterectomy, by age group, Demographic and Health Surveys 1994-2000 

Country 15-19 20-24 25-29 30-34 35-39 40-44 45-49

Total 

25-49 

Age 

standardized 

15-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Benin 8.5 1.6 4.1 5.5 11.9 27.7 61.3 17.2 14.8 17.2 

Burkina Faso 22.2 2.2 4.6 8.7 12.5 31.9 68.5 19.8 17.7 19.9 

Cameroon 6.7 2.7 4.6 8.3 17.4 34.8 62.7 19.4 17.7 20.5 

Central African Rep. 16.1 3.5 9.6 13.0 22.2 41.2 73.6 25.0 23.0 26.4 

Chad 15.8 3.3 6.5 10.6 19.5 48.2 81.1 25.5 23.2 26.6 

Comoros 3.6 2.3 4.0 9.5 11.4 24.4 46.9 15.0 13.5 15.7 

Côte d’Ivoire 4.2 4.1 10.3 15.2 26.9 46.9 73.6 26.4 24.8 29.1 

Eritrea 14.9 4.1 8.4 13.4 18.0 35.4 69.6 26.6 20.9 23.8 

Ghana 11.1 2.6 7.2 9.2 14.8 25.5 56.8 18.8 16.2 18.6 

Guinea 6.1 5.4 9.9 15.5 20.3 41.7 71.5 26.0 22.9 26.5 

Kenya 14.2 3.0 8.8 13.6 21.1 33.4 62.3 22.0 20.3 23.4 

Madagascar 10.2 3.9 4.5 11.8 14.3 28.2 52.1 17.4 16.1 18.3 

Malawi 11.5 4.3 5.9 11.2 15.4 24.0 48.9 17.0 15.7 17.6 

Mali 10.3 2.8 6.4 11.9 15.7 35.5 68.0 21.4 19.3 22.3 

Mozambique 10.8 5.5 9.6 12.2 19.4 42.6 59.6 23.6 21.1 24.1 

Niger 15.3 3.4 5.7 5.8 12.6 33.1 67.2 18.5 17.3 19.5 

Nigeria 13.3 5.0 9.7 15.2 23.3 42.3 65.0 24.8 23.0 26.3 

Senegal 0.1 0.1 0.2 1.2 2.2 10.0 22.8 4.7 4.5 5.4 

Tanzania 15.8 2.6 5.1 12.1 16.7 24.7 46.4 17.0 15.7 17.7 

Togo 8.5 1.7 3.7 5.6 11.7 25.4 49.6 14.2 13.2 15.3 

Uganda 23.1 21.3 26.2 25.9 30.7 34.2 64.0 31.7 31.1 33.2 

Zambia 9.3 3.2 5.4 8.9 11.8 24.2 56.5 16.0 15.0 17.2 

Zimbabwe 5.1 2.4 6.2 11.7 15.6 31.7 47.5 17.7 16.2 19.0 

North Africa/West Asia 

Egypt 0.4 2.1 4.1 6.8 13.1 23.0 55.6 18.4 13.8 16.3 

Jordan 0.6 2.4 3.7 5.8 10.8 19.6 41.6 13.0 11.2 13.1 

Morocco 0.2 1.5 4.3 7.7 12.8 18.0 44.6 13.8 12.0 14.1 

Turkey 4.2 10.2 10.9 10.5 14.2 21.7 53.0 19.1 16.9 18.6 

Yemen 5.7 8.3 10.2 13.5 18.7 33.2 54.3 21.4 19.7 22.2 

Central Asia/South and 

Southeast Asia 

Bangladesh 2.9 5.7 8.2 10.1 16.7 35.3 64.3 20.4 19.2 22.1 

Cambodia 14.2 9.3 16.4 26.1 35.7 48.9 73.4 37.4 31.1 35.4 

India 2.5 5.7 10.0 15.1 24.3 40.8 64.0 25.9 22.5 26.2 

Indonesia 2.4 8.9 12.2 17.2 23.0 34.2 60.3 26.5 22.3 25.4 

Kazakhstan 1.5 2.4 5.4 7.1 10.8 20.4 50.7 17.1 12.9 14.7 

Kyrgyz Republic 5.9 7.3 9.0 8.3 13.9 21.2 39.7 15.8 14.2 15.8 

Nepal 3.1 4.0 7.8 13.5 19.8 37.9 67.9 24.7 20.8 24.3 

Philippines 2.5 3.8 4.3 8.9 15.1 30.6 58.2 19.3 16.3 18.9 

Turkmenistan 6.0 4.9 7.3 9.2 13.4 23.6 58.5 19.0 16.0 18.2 

Uzbekistan 2.4 2.0 4.5 5.7 11.5 23.9 47.2 14.5 12.7 14.9 

Vietnam 0.0 1.5 2.1 2.7 4.1 12.5 37.9 9.0 7.6 8.9 

Latin America/Caribbean 

Bolivia 1.2 1.1 2.5 4.9 10.9 27.1 61.0 17.1 13.7 16.3 

Brazil 1.0 1.2 2.6 4.9 8.9 18.6 42.8 13.1 10.3 12.2 

Colombia 0.7 0.7 1.6 5.0 7.1 14.6 35.6 10.9 8.4 10.1 

Dominican Republic 3.5 3.3 5.5 9.0 17.0 26.9 46.5 16.9 15.1 17.5 

Guatemala 2.6 2.5 5.2 9.2 14.2 28.2 65.9 20.5 16.6 19.5 

Haiti 7.5 2.9 4.9 8.9 13.2 25.7 58.6 17.9 15.5 17.8 

Nicaragua 3.2 3.4 5.0 6.8 11.5 26.2 57.3 16.3 14.6 16.9 

Peru 2.3 3.5 6.3 7.2 9.2 20.3 53.0 16.4 13.3 14.6 
Results 21

Figure 1 

Percentage of women who reported themselves infecund, by age group and 

region, DHS surveys 1994-2000 

0

10

20

30

40

50

60

70

15–19 20–24 25–29 30–34 35–39 40–44 45–49

Percentage of women infecund

Total Sub-Saharan Africa Near East/North Africa

Asia Latin America/Caribbean
22 Results 

4.3 Secondary Sterility 

Among women who have had one or more live births, the inability to have another 

child is called secondary sterility. Secondary infertility is used to estimate the prevalence of secondary sterility. Secondary infertility is measured by the lack of a birth (or 

a current pregnancy) among women who were married for the past five years and did 

not use contraception during that period. In countries with low contraceptive prevalence where the reproductive calendar was not used, there is no information on nonlive birth pregnancies, marriage, or contraceptive use in the past five years. In these 

countries, time since first marriage greater than five years for currently married 

women is taken as the substitute. Women who have never used contraception are 

taken as the substitute for women who have not used contraception in the past five 

years. Because countries without a reproductive calendar are principally those with 

low contraceptive prevalence, the biases created by excluding women who have used 

contraception are small. Moreover, only secondary infertility can be determined for 

these countries. Secondary infecundity is measured by the lack of any pregnancy, 

whether ending in a live birth or not, among these women and includes women who 

reported themselves as infecund. 

4.3.1 Prevalence of Secondary Infecundity 

Table 8 shows the prevalence of secondary infecundity by five-year age groups, for 

women age 25 to 49 (actual and standardized by age), and for all women age 15 to 

49. In this table, the percentages of women without a birth are calculated from 

women who have been married for the past five years or longer and who did not use 

contraception during this time. Women who used contraception during the past five 

years and currently married women who have been married for less than five years are 

excluded from the numerator but are included in the denominator, implying that they 

are considered fecund during the whole time period.4

 Also included are women who 

reported themselves to be infecund at the time of the survey. 

Averaging the countries together, we see that secondary infecundity increases 

sharply with age, from about 5 percent at age 20 to 24 to about 62 percent at age 45 

to 49, following more or less the pattern of self-reported infecundity, but a little bit 

higher, especially at the older ages. At age 20 to 24, the country with the lowest percentage of women with secondary infecundity is Colombia (0.8 percent) and the 

country with the highest is Uganda (21.6 percent). 

Although we exclude women who presumably are not exposed to the risk of pregnancy, we have not controlled for regularity of sexual intercourse, which may slow or 

stop at longer durations of marriage, at older ages, and after a certain number of children are reached. Terminal abstinence may vary by culture and thus affect comparisons at the higher ages. At age 45 to 49, the countries with the highest levels of secondary infecundity are Chad, Côte d’Ivoire, and the Central African Republic, where 

80 percent or more of all women are secondarily infecund. 

 

4

 In many countries, values for secondary infecundity at age 15 to 19 should be ignored because of the 

small number of women in the age group who have had a live birth. These small numbers are likely to be 

selective and may not represent the majority of women that age in the country. 

Averaging the countries 

together, we see that 

secondary infecundity 

increases sharply with age, 

from about 5 percent at 

age 20 to 24 to about 

62 percent at age 45 to 49. 
Results 23

Table 8 

Secondary infecundity 

Percentage of women who either report themselves as infecund or who, being continuously married for the five years 

preceding the survey and not using contraception during that period, did not have a live birth in the past five years, by 

age group, Demographic and Health Surveys 1994-2000 

Country 15-19 20-24 25-29 30-34 35-39 40-44 45-49 

Total 

25-49 

Age 

standardized 

15-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Benin 8.7 2.5 5.5 8.7 16.0 36.0 67.9 21.3 18.5 22.0 

Burkina Faso 22.7 2.9 5.4 11.2 15.7 36.5 72.7 22.6 20.2 23.2 

Cameroon 7.2 3.9 7.9 12.0 25.1 43.3 66.8 24.6 22.2 26.4 

Cent. African Rep. 16.5 6.9 16.5 21.9 34.4 50.2 79.8 33.7 30.6 35.8 

Chad 16.2 4.8 8.9 15.4 28.1 55.8 86.1 30.8 27.9 32.8 

Comoros 3.7 3.5 7.3 15.9 21.2 39.0 59.3 23.1 20.6 24.7 

Côte d’Ivoire 4.8 6.6 15.4 21.5 35.7 57.5 82.1 33.5 31.3 37.3 

Eritrea 15.2 6.4 10.7 15.1 21.4 37.6 73.6 29.3 23.4 26.9 

Ghana 11.1 3.2 9.5 15.0 21.3 32.4 62.9 24.0 20.6 24.3 

Guinea 7.1 6.8 13.8 19.9 27.4 52.6 76.4 31.8 28.1 33.1 

Kenya 14.3 3.2 9.2 13.8 21.1 33.7 62.3 22.2 20.5 24.0 

Madagascar 10.7 4.9 8.7 19.9 22.8 36.8 62.3 24.8 22.5 26.3 

Malawi 11.5 4.7 8.6 16.0 23.3 33.2 57.0 22.7 20.7 24.1 

Mali 10.5 4.3 9.2 14.8 21.1 43.5 76.6 26.3 23.6 27.9 

Mozambique 12.1 9.0 15.9 26.2 32.9 51.6 68.7 33.8 30.3 35.2 

Niger 15.6 5.5 8.5 10.2 20.7 43.9 77.1 24.9 23.0 26.6 

Nigeria 13.7 6.3 12.3 18.5 27.7 47.6 69.3 28.5 26.3 30.7 

Senegal 0.7 2.3 6.1 9.1 17.5 34.1 53.7 18.4 16.8 20.3 

Tanzania 16.0 3.1 8.7 15.2 23.2 35.0 55.6 22.7 20.6 24.1 

Togo 8.9 2.2 4.7 7.8 15.4 27.7 53.6 16.6 15.3 18.1 

Uganda 23.3 21.6 29.1 30.0 36.0 39.1 68.6 35.8 34.6 37.7 

Zambia 9.6 3.9 8.1 12.8 16.6 29.1 64.1 20.3 18.8 22.0 

Zimbabwe 5.1 2.5 6.4 11.8 15.9 31.9 47.5 17.9 16.4 19.5 

North Africa/West Asia 

Egypt 0.7 2.1 4.5 7.2 13.4 23.2 55.6 18.7 14.0 17.0 

Jordan 1.5 2.6 3.7 6.1 10.9 19.6 41.6 13.1 11.4 13.5 

Morocco 0.2 1.7 5.1 8.2 13.6 18.5 44.9 14.5 12.5 15.2 

Turkey 4.2 10.3 11.1 10.5 14.3 21.7 53.2 19.2 17.0 18.9 

Yemen 8.0 9.3 11.2 14.7 21.1 35.9 57.5 23.3 21.5 24.5 

Central Asia/South 

and Southeast Asia 

Bangladesh 3.7 6.1 8.6 10.4 17.0 35.3 64.3 20.6 19.4 22.7 

Cambodia 14.9 10.6 17.4 28.2 38.0 52.0 77.8 39.8 33.2 38.4 

India 4.9 7.0 11.0 16.1 25.1 41.2 64.2 26.7 23.4 27.5 

Indonesia 2.4 9.1 12.4 17.5 23.5 34.5 60.4 26.8 22.6 26.1 

Kazakhstan 1.5 2.4 6.0 7.1 11.1 20.4 50.7 17.3 13.1 15.7 

Kyrgyz Republic 6.2 7.6 10.5 9.5 14.0 22.0 41.1 16.8 15.1 17.0 

Nepal 6.1 5.7 9.3 15.5 22.3 40.6 69.3 26.7 22.8 26.9 

Philippines 2.6 3.9 4.7 9.6 15.7 30.8 58.2 19.7 16.7 19.8 

Turkmenistan 6.0 4.9 7.5 9.4 13.5 23.8 58.7 19.1 16.1 18.7 

Uzbekistan 2.8 2.6 5.5 7.4 13.3 24.9 48.8 15.8 13.9 16.6 

Vietnam 0.0 1.5 2.4 3.0 4.2 12.8 37.9 9.2 7.8 9.3 

Latin America/Caribbean 

Bolivia 1.3 1.1 2.5 5.7 11.8 28.3 62.1 17.8 14.4 17.5 

Brazil 1.0 1.4 2.9 4.9 8.9 18.6 42.9 13.2 10.4 12.6 

Colombia 0.7 0.8 1.7 5.0 7.1 14.6 35.6 10.9 8.5 10.3 

Dominican Republic 3.5 3.5 5.6 9.1 17.3 27.1 46.9 17.1 15.3 18.1 

Guatemala 2.6 2.6 5.6 9.3 14.8 28.2 65.9 20.7 16.9 20.2 

Haiti 7.7 3.9 7.4 14.3 20.5 35.8 66.5 24.0 20.7 24.5 

Nicaragua 3.3 3.7 5.7 7.0 12.0 26.3 57.5 16.7 15.0 17.7 

Peru 2.3 3.5 6.4 7.3 9.3 20.4 53.0 16.5 13.3 15.7 

Note: Women who were not married for the entire five years preceding the survey or who used contraception during 

that period and who did not declare themselves as infecund are considered fecund. 
24 Results 

As an indicator of overall secondary infecundity, we use the age-standardized percentages for women age 25 to 49. It is interesting to note that neighboring countries 

in Southeast Asia have both the lowest and highest percentages with secondary infecundity of all countries surveyed: Vietnam at 9.3 percent and Cambodia at 38.4 percent, respectively. Other countries with more than 30 percent of women secondarily 

infecund are all in sub-Saharan Africa: Central African Republic, Chad, Côte 

d’Ivoire, Guinea, Mozambique, and Nigeria. 

Figure 2 shows secondary infecundity by subregional average for women age 25 to 

49 (age-adjusted). Middle and Eastern Africa have the highest average levels of secondary infecundity. These subregions are followed by Western Africa, Southern Africa, and South Asia, which have similar levels. The lowest levels of secondary infecundity are in South America. However, there may be some bias in these estimates 

because of the inclusion of contraceptive users in the denominator (implying fecundity). Three of the South American countries—Brazil, Colombia, and Peru—have 

high rates of contraceptive sterilization. 

Figure 2 

Percentage of women age 25-49 with secondary infecundity, by region, DHS 

surveys 1994-2000 

26

30

27

25

18 17

26

23

20

14

0

5

10

15

20

25

30

35

Western Africa

Middle Africa

Eastern Africa

Southern Africa

North Africa/West Asia

Central Asia

South Asia

Southeast Asia

Caribbean/Central America

South America

Percent

4.3.2 Estimates of the Number of Infertile Women in Developing Countries 

As of mid-2002, it was estimated that more than 186 million ever-married women 

age 15 to 49 in developing countries (excluding China) were infertile because of primary or secondary infertility (Table 9). This number represents more than one in 

four ever-married women of reproductive age in these countries. Some 18 million 

were involuntarily primarily infertile without having experienced a birth (about 2.5 

As of mid-2002, it was 

estimated that more than 

186 million ever-married 

women age 15 to 49 in 

developing countries 

(excluding China) were 

infertile because of 

primary or secondary 

infertility. 
Results 25

Table 9 

Regional estimates of childlessness, primary infertility, and secondary infertility 

Regional estimates of the number and percentage of women age 25-49 who are childless, primarily infertile, and secondarily infertile 

Ever-married 

women 

Childless women 

age 25-49 

Women with 

involuntary primary 

infertility 

Women with 

secondary 

infertility 

Women with 

primary or 

secondary infertility 

Region 

Women 

15-49 

in 20021 Percent 

Number 

(thousands) Percent 

Number

(thousands) Percent 

Number 

(thousands) Percent 

Number 

(thousands) Percent 

Number 

(thousands)

World 1,592,006.6 

More developed 147,064.8 

Less developed 1,294,195.1 

China 354,398.4 

LDC–China 939,796.7 77.2 725,192.1 2.7 19,569.3 2.5 18,360.7 23.8 168,190.9 25.7 186,551.6 

Africa 196,852.4 

North Africa 46,924.9 

Sub-Saharan 

Africa 149,927.5 76.8 115,089.1 3.2 3,670.8 2.6 2,953.0 28.2 31,609.8 30.0 34,562.8 

East Africa 60,349.6 75.2 45,355.3 2.3 1,056.8 2.4 1,087.7 27.5 12,178.3 29.2 13,266.0 

Middle Africa2 22,068.3 76.1 16,788.3 4.7 795.6 2.9 481.3 30.2 4,922.9 32.2 5,404.2 

Southern Africa 13,374.2 78.8 10,535.7 2.6 270.5 2.8 293.2 26.7 2,736.7 28.8 3,029.9 

West Africa 54,115.9 78.1 42,279.4 2.0 847.9 2.1 877.3 26.7 11,072.5 28.3 11,949.8 

Asia 980,017.1 

South Central 

Asia 380,440.2 80.2 305,060.0 2.6 8,019.6 2.6 7,852.2 26.4 78,595.4 28.3 86,447.6 

Southeast Asia 145,203.3 70.6 102,557.8 2.2 2,215.8 1.9 1,988.4 22.0 22,149.1 23.5 24,137.5 

West Asia 48,613.1 74.6 36,268.6 1.5 547.8 1.5 545.1 16.5 5,910.5 17.8 6,455.6 

China 354,398.4 

Asia–China/ 

Japan/West 

Asia 599,406.7 77.8 466,347.6 2.5 11,764.9 2.4 11,332.6 25.4 115,694.5 27.2 127,027.1 

Near East/North 

Africa 65,071.5 68.4 44,512.5 2.8 1,260.9 2.8 1,262.6 18.1 7,815.2 20.4 9,077.9 

Middle East 18,146.6 

North Africa 46,924.9 

Latin America/ 

Caribbean3 144,376.3 68.7 99,243.0 2.9 2,872.8 2.8 2,812.4 13.6 13,071.4 16.0 15,883.8 

South America 96,796.0 68.2 66,031.0 3.0 1,976.1 2.9 1,924.6 12.7 8,130.7 15.2 10,055.3 

Caribbean & 

Central 

America3 47,580.1 73.1 34,761.4 2.1 743.4 2.2 767.9 20.2 6,880.0 22.0 7,648.0 

Note: Primary and secondary infertility excludes voluntary infertility (women who do not want children). 

1 United Nations Medium Projection (United Nations, 2003) interpolated by the authors.

2

 Includes Niger and Nigeria 

3

 Includes Mexico 

percent of ever-married women) and 168 million were secondarily infertile (24 percent of ever-married women).5

 

5 Table 9 uses the number of women projected by five-year age groups for each developing country for 

the years 2000 and 2005, according to the United Nations Population Division (United Nations, 2003). 

For countries with DHS surveys, the proportions ever married at age 15-29 were tabulated and weighted 

by the number of women age 15-49 to obtain weighted averages of proportions ever married for world 

subregions. A country with no DHS survey was assumed to have the same proportion ever married as 

the weighted average for its subregion. The number of women age 15-49 in the subregions was then 

multiplied by the weighted average for the subregion to get the estimated number of ever-married 

women. Similarly, weighted averages for subregion proportions of women who were childless, involuntarily primarily infertile, or secondarily infertile, were calculated using the estimated number of evermarried women for the countries with DHS surveys. Again, non-DHS countries in the subregion were 

assumed to have the subregion average value. To get the number of childless and infertile women, the 

estimated proportions who were childless and infertile were multiplied by the total number of evermarried women in the subregion. The subregion numbers were then totaled to get the developing country total number of childless and infertile women (excluding China). 

Trends in Infertility 27

5

Trends in Infertility 

rends in infertility, especially in view of the advent and spread of HIV and advances in assisted reproductive technologies, are of considerable importance. 

Questions are often raised about whether levels of infertility—primary or secondary—have risen because of sexually transmitted infections including HIV, environmental factors, or changes in sexual and reproductive behaviors. A decline may be 

expected with an upsurge in treatment-seeking behavior and increased use of modern 

technologies of assisted reproduction. A valid comparison of information at two or 

more points in time, however, requires common approaches and instruments for data 

collection and analysis. This section reviews levels of infertility from two main data 

sets. First, we compare the percentage of currently married women (age 25 to 49 and 

40 to 44), who have been married for at least five years and report no living children, 

in surveys conducted under the auspices of the World Fertility Survey (WFS) Programme roughly 20 years before the Demographic and Health Surveys included in 

this report. WFS undertook nationally representative surveys of ever-married women 

in the reproductive age range 15 to 49, using questions on fertility similar to those 

used in the DHS surveys. We also consider the trends in the percentage of currently 

married women age 25 to 49 and 40 to 44, who have been married for at least five 

years and reported no live birth (also termed as “fertile pregnancy”). Comparable information was available for 11 countries that participated in both the WFS and DHS 

programs. 

Second, we consider trends using data from the surveys conducted under the auspices of DHS in different countries. Of the 47 countries included in this report, 17 

countries had two surveys, seven had three, and three had four; therefore, trends in 

infertility can be ascertained for 27 countries. Comparison across DHS surveys is 

relatively straightforward but the timeframe is shorter than when DHS and WFS 

surveys are compared. 

5.1 Trends in No Surviving Children and No Live Birth, Based on 

Data Sets 20 Years Apart 

Among currently married women age 40 to 44 who have been married for at least five 

years and who can be assumed to have completed their reproductive life, the proportion reporting no living children in the WFS surveys ranged from 2 percent in the 

Philippines (1978) to about 7 percent in Indonesia (1976) (Figure 3). In the DHS 

surveys about 20 years later in the same set of countries, the proportion ranged from 

1 percent in Peru (2000) to 4 percent in Haiti (1994). In all countries except Jordan, 

the proportion of women age 40 to 44 with no living children declined substantially 

over the 20-year period, especially in Senegal, Indonesia, the Dominican Republic, 

and Haiti. In these countries, women age 40 to 44 with no living children exceeded 6 

percent in the WFS surveys, but dropped to 3-4 percent in the DHS surveys. Countries with 3-4 percent of married women age 40 to 44 having no living children in the 

T 

In all countries except 

Jordan, the proportion of 

women age 40 to 44 with 

no living children declined 

substantially over the 20-

year period. 
28 Trends in Infertility 

WFS surveys also witnessed major declines in the DHS surveys. Having at least one 

living child by age 40 to 44 implies that at least one live birth survived to the time the 

mother reached this age. Therefore, the effect of the prevailing mortality patterns 

cannot be isolated from infertility (that is, not having any pregnancy or live birth). 

Significant gains have been made in mortality reduction since the period when the 

WFS surveys were conducted. 

Figure 3 

Percentage of currently married women age 40-44 who have been married for 

at least five years but have no living children, WFS and DHS surveys 1975-2000 

012345678

Kenya 1978

1998

Senegal 1978

1997

Jordan 1976

1997

Bangladesh 1975

1999

Indonesia 1976

1997

Nepal 1976

1996

Philippines 1978

1998

Colombia 1976

2000

Dominican Republic 1975

1996

Haiti 1977

1994

Peru 1977

2000

Percent

While comparing women who have no living children is a useful measure of infertility, comparing women who have not had a live birth by age 40 to 44 is a more 

meaningful measure for examining changes in infertility. Figure 4 shows a decline 

over the 20-year period covered by the WFS and DHS surveys (all countries except 

Jordan) in the proportion of currently married women age 40 to 44 who have been 

married for at least five years but have had no live births. The trends are consistent 

with those in Figure 3, but the levels are lower because mortality effects are excluded. 
Trends in Infertility 29

Around 5 percent of women in Indonesia and the Dominican Republic report having 

had no live birth by age 40 to 44 in the WFS surveys. In the DHS surveys, the percentage is about 1-2 percent, with the highest levels in Indonesia and the Dominican 

Republic (3 percent each). 

Figure 4 

Percentage of currently married women age 40-44 who have been married for 

at least five years but have not had a live birth, WFS and DHS surveys 1975-

2000 

0123456

Kenya 1978

1998

Senegal 1978

1997

Jordan 1976

1997

Bangladesh 1975

1999

Indonesia 1976

1997

Nepal 1976

1996

Philippines 1978

1998

Colombia 1976

2000

Dominican Republic 1975

1996

Haiti 1977

1994

Peru 1977

2000

Percent

Between the 1970s and the 1990s there was a decrease in the number of women 

age 40 to 44 reporting no surviving children (Figure 3) and no live births (Figure 4). 

The WFS data show that in 7 of 11 countries, 3 percent or more of women reported 

having had no live birth compared with only two countries (Indonesia and the Dominican Republic) in the DHS data. When the percentages reporting no surviving 

children or no live births are compared, the decline is more detectable for women age 

40 to 44 than for women age 25 to 49 because the former group represents women 

who have completed childbearing. 

Between the 1970s and 

the 1990s there was a 

decrease in the number of 

women age 40 to 44 

reporting no surviving 

children and no live births. 
30 Trends in Infertility 

Figures 5 and 6 show similar comparisons for women age 25 to 49. In four countries (Bangladesh, Colombia, Jordan, and the Philippines), there is no decline in the 

percentage of women reporting no surviving child or no live birth over time. Instead, 

some rises are seen, especially in Bangladesh where the proportion of women reporting no surviving child doubled from 3 to 6 percent between 1975 and 1999. The proportion of women reporting no live birth also doubled, from about 2 percent in 1975 

to 4 percent in 1999. In many other countries, the proportion of women reporting no 

surviving child or no live birth declined, except in Colombia, Haiti, Peru, and the 

Philippines where either no change or only modest changes occurred. 

Figure 5 

Percentage of currently married women age 25-49 who have been married for 

at least five years but have no living children, WFS and DHS surveys 1975-2000 

012345678

Kenya 1978

1998

Senegal 1978

1997

Jordan 1976

1997

Bangladesh 1975

1999

Indonesia 1976

1997

Nepal 1976

1996

Philippines 1978

1998

Colombia 1976

2000

Dominican Republic 1975

1996

Haiti 1977

1994

Peru 1977

2000

Percent
Trends in Infertility 31

Figure 6 

Percentage of currently married women age 25-49 who have been married for 

at least five years but have not had a live birth, WFS and DHS surveys 1975-

2000 

0123456

Kenya 1978

1998

Senegal 1978

1997

Jordan 1976

1997

Bangladesh 1975

1999

Indonesia 1976

1997

Nepal 1976

1996

Philippines 1978

1998

Colombia 1976

2000

Dominican Republic 1975

1996

Haiti 1977

1994

Peru 1977

2000

Percent

5.2 Trends in Primary Infertility Based on DHS Data from Two or 

More Surveys 

In 27 countries with two or more surveys conducted under the DHS program, it is 

possible to compare data from the most recent survey with data from the previous 

survey (if there were only two surveys), or with data from the first survey (if there 

were more than two surveys). The interval between surveys varies, so the percentages 

for age groups 15 to 49 and 25 to 49 are age-standardized. 
32 Trends in Infertility 

For most countries, there was no consistent trend in the percentage of women age 

25 to 49 who reported never having had sex (Figure 7 and Table 10). In Colombia, 

the Dominican Republic, and Peru, fewer women reported never having had sex in 

the last survey than in the first survey—23 percent versus 29 percent; 22 percent versus 25 percent; and 27 percent versus 29 percent, respectively. In Bolivia, Nigeria, 

Senegal, and Ghana, however, a greater proportion of women reported never having 

Figure 7 

Changes in the percentage of women age 25-49 who have never had sex, most 

recent DHS survey compared with previous DHS survey 

-8 -6 -4 -2 0 2 4 6

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Indonesia

Kazakhstan

Philippines

Bolivia

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)
Trends in Infertility 33

Table 10 

Trends in the proportion of women who have never had sex 

Percentage of women age 15-49 who have never had sex, by age, Demographic and Health Surveys 1986-2000 

Country 

DHS 

survey 15-19 20-24 25-29 30-34 35-39 40-44 45-49 

Total 

25-49 

Age 

standardized 

25-49 

Sub-Saharan Africa 

Burkina Faso 1992/93 45.9 2.9 0.4 0.1 0.1 0.0 0.0 0.2 10.3 

Burkina Faso 1998/99 50.9 3.4 0.3 0.0 0.0 0.2 0.2 0.1 11.5 

Cameroon 1991 31.5 2.4 0.1 0.0 0.0 0.0 0.0 0.0 7.1 

Cameroon 1998 34.9 2.7 0.1 0.1 0.0 0.2 0.2 0.1 8.0 

Ghana 1988 50.1 3.9 0.8 0.0 0.2 0.0 0.0 0.3 11.5 

Ghana 1993 41.0 4.2 0.8 0.3 0.0 0.0 0.0 0.3 9.6 

Ghana 1998 62.2 8.6 1.8 0.2 0.0 0.0 0.0 0.6 15.1 

Kenya 1989 53.7 6.7 0.3 0.1 0.5 0.0 0.1 0.2 12.8 

Kenya 1993 53.9 10.3 1.1 0.6 0.2 0.2 0.0 0.5 13.6 

Kenya 1998 56.4 11.1 1.8 0.2 0.0 0.0 0.0 0.6 14.3 

Madagascar 1992 46.8 10.5 3.3 1.1 0.9 0.3 1.3 1.6 12.8 

Madagascar 1997 43.5 8.3 3.1 1.4 0.8 1.1 0.5 1.6 11.7 

Mali 1987 26.7 1.8 0.6 0.0 0.0 0.0 0.0 0.2 6.1 

Mali 1995/96 34.0 2.7 0.6 0.2 0.2 0.1 0.0 0.3 7.9 

Niger 1992 39.1 5.2 0.9 0.0 0.1 0.1 0.0 0.3 9.4 

Niger 1988 36.5 8.7 1.6 0.4 0.0 0.2 0.2 0.6 9.7 

Nigeria 1990 45.6 7.5 1.4 0.4 0.2 0.0 0.0 0.6 11.3 

Nigeria 1999 56.9 15.9 4.0 1.1 0.5 0.4 0.0 1.7 15.9 

Senegal 1992/93 64.6 21.5 6.7 2.7 0.4 0.0 0.5 2.7 19.2 

Senegal 1997 65.1 29.0 10.9 2.4 0.6 0.2 0.0 3.9 21.3 

Tanzania 1991 51.5 7.4 1.5 0.6 0.2 0.0 0.2 0.7 12.6 

Tanzania 1999 47.4 6.2 1.1 0.8 0.3 0.0 0.0 0.6 11.5 

Togo 1988 35.6 3.9 0.5 0.0 0.0 0.0 0.0 0.2 8.3 

Togo 1998 39.3 4.4 0.6 0.1 0.1 0.0 0.1 0.2 9.3 

Uganda 1988 37.7 4.8 1.3 0.4 0.5 0.8 0.0 0.7 9.3 

Uganda 1995 38.4 3.2 1.1 0.3 0.2 0.0 0.0 0.5 9.0 

Zambia 1992 39.5 4.3 0.6 0.2 0.0 0.0 0.0 0.3 9.3 

Zambia 1996 41.7 5.2 0.5 0.5 0.1 0.0 0.0 0.3 10.0 

Zimbabwe 1988 67.5 14.9 2.5 0.3 0.2 0.0 0.7 0.9 17.5 

Zimbabwe 1994 70.3 17.3 2.1 0.7 0.3 0.1 0.0 0.8 18.5 

Zimbabwe 1999 67.7 15.9 2.4 1.2 0.3 0.2 0.0 1.1 17.9 

Asia 

Kazakhstan 1995 82.5 30.3 7.2 2.6 1.9 1.7 2.2 3.2 25.1 

Kazakhstan 1999 79.5 23.6 7.7 3.2 2.9 1.2 1.2 3.4 23.4 

Philippines 1993 91.9 53.4 24.4 11.3 6.4 5.1 5.9 12.0 36.5 

Philippines 1998 90.9 54.5 24.0 10.9 7.4 7.2 6.3 12.2 36.7 

Latin America/ 

Caribbean 

Bolivia 1989 74.7 27.8 8.4 3.0 1.6 0.8 1.3 3.6 23.0 

Bolivia 1994 77.1 29.4 8.3 3.8 2.1 1.0 1.9 3.9 24.1 

Bolivia 1998 80.3 33.0 8.5 3.9 3.3 2.0 1.7 4.3 25.7 

Brazil 1986 80.2 35.8 14.1 6.8 4.1 2.8 * 7.6 * 

Brazil 1996 67.2 26.6 9.9 3.6 4.1 3.1 3.6 5.1 22.3 

Colombia 1986 79.8 38.4 15.4 7.2 5.8 3.9 2.3 8.3 28.7 

Colombia 1990 79.0 34.9 15.1 6.9 6.7 2.7 3.1 8.1 27.8 

Colombia 1995 59.9 18.9 6.6 4.4 1.9 3.4 2.9 4.0 18.6 

Colombia 2000 70.4 25.1 8.6 6.3 3.3 3.1 3.5 5.4 22.8 

Dominican Rep. 1986 75.8 34.8 12.5 3.5 1.2 1.6 1.0 5.2 25.3 

Dominican Rep. 1991 73.0 35.7 13.0 4.3 1.3 0.7 1.0 5.5 25.0 

Dominican Rep. 1996 67.3 26.7 10.3 3.2 3.1 1.5 0.4 4.6 21.8 

Guatemala 1987 71.0 26.8 8.3 3.5 3.4 2.2 * 4.8 * 

Guatemala 1995 75.0 28.3 11.2 3.9 3.8 2.2 2.4 5.2 24.3 

Guatemala 1998/99 72.6 26.2 9.0 5.6 2.3 4.1 2.2 5.1 23.3 

Peru 1986 82.2 42.4 17.0 6.6 2.2 1.9 2.0 7.2 29.4 

Peru 1992 81.4 42.5 16.2 6.5 3.5 2.8 2.5 7.4 29.4 

Peru 1996 77.8 34.2 14.7 5.4 4.0 2.5 2.6 6.5 26.8 

Peru 2000 79.7 33.7 13.2 4.5 3.4 2.3 1.9 5.9 26.6 

* Less than 25 cases 
34 Trends in Infertility 

had sex in the most recent survey than in the earlier survey. In other countries, the 

differences were less than two percentage points. Among women who had sex but 

reported no pregnancy, there were no trends in 22 of the 27 countries (Figure 8). In 

Turkey, Morocco, and Togo, the percentage who reported having had sex but no 

pregnancy increased, while in Senegal and Malawi the proportion declined between 

the first and last survey. A similar trend can be seen for the percentage of women 

who had sex but no live birth (Figure 9). 

Figure 8 

Changes in the percentage of women age 25-49 who have had sex but have not 

been pregnant, most recent DHS survey compared with previous DHS survey 

-15 -10 -5 0 5 10 15 20 25 30

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Turkey

Bangladesh

Indonesia

Kazakstan

Philippine

Bolivia

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)
Trends in Infertility 35

Figure 9 

Changes in the percentage of women age 25-49 who have had sex but have not 

had a live birth, most recent DHS survey compared with previous DHS survey 

-10 -5 0 5 10 15 20 25 30

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Turkey

Bangladesh

Indonesia

Kazakhstan

Philippines

Bolivia

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)

Among currently married women age 25 to 49 who have been married for five 

years, fewer women reported no live birth in the most recent survey compared with 

the previous survey. Figure 10 shows relatively modest changes, except in Senegal, 

Nigeria, Cameroon, and Burkina Faso, where the change is one to two percentage 

points. In Senegal, 98 percent reported having had at least one live birth in the last 
36 Trends in Infertility 

survey, compared with 97 percent in the first survey (Table 11). In Burkina Faso, 99 

percent reported having had at least one live birth compared with 97.5 percent in the 

previous survey. In Nigeria, on the other hand, 95 percent reported having had at 

Figure 10 

Changes in the percentage of women age 25-49 who have been married for the 

past five years but have had no live births, most recent DHS survey compared 

with previous DHS survey 

-1.5 -1 -0.5 0 0.5 1 1.5 2 2.5

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Bangladesh

Indonesia

Kazakhstan

Bolivia

Brazil

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)
Trends in Infertility 37

Table 11 

Trends in the proportion of currently married women who have no living children and who have had no fertile 

pregnancies 

Among currently married women age 40-44 and 25-49 who have been married for the past five years, percentage who have no living children 

and percentage who have had no fertile pregnancies, Demographic and Health Surveys 1986-2000 

 No living children No fertile pregnancies 

No living 

children 

No fertile 

pregnancies 

Country 

DHS 

survey 

Age 

40-44 

Age 

25-49 

Age 

40-44 

Age 

25-49 Country 

DHS 

survey 

Age 

40-44 

Age 

25-49 

Age 

40-44 

Age 

25-49 

Sub-Saharan Africa 

Benin 1996 3.2 2.3 2.1 1.4 

Burkina Faso 1992/93 2.1 3.5 1.5 2.5 

Burkina Faso 1998/99 1.4 2.2 1.0 1.3 

Cameroon 1991 7.0 7.4 5.1 5.4 

Cameroon 1998 7.3 6.6 3.7 4.4 

Central Afr. Rep. 1994/95 10.5 9.3 7.3 6.4 

Chad 1996 4.4 3.4 3.0 2.0 

Comoros 1996 5.5 4.2 4.4 3.2 

Côte d’Ivoire 1998/99 3.7 3.8 2.0 2.2 

Eritrea 1995 1.2 3.3 0.9 1.8 

Ghana 1988 1.6 2.7 0.6 1.6 

Ghana 1993 2.8 2.6 2.5 1.9 

Ghana 1998 1.1 2.5 0.6 2.0 

Guinea 1999 3.0 4.5 1.9 2.6 

Kenya 1989 2.1 2.2 1.9 1.6 

Kenya 1993 2.1 1.7 1.9 1.4 

Kenya 1998 1.5 1.6 1.5 1.3 

Madagascar 1992 7.5 6.0 4.4 4.2 

Madagascar 1997 4.7 4.8 3.3 3.4 

Malawi 1992 2.8 4.1 1.8 2.3 

Malawi 2000 2.8 3.8 1.6 1.7 

Mali 1987 5.5 6.3 3.8 3.3 

Mali 1995/96 3.3 4.3 1.7 2.5 

Mozambique 1997 3.1 6.0 1.9 3.3 

Níger 1992 5.6 5.8 4.4 3.2 

Níger 1998 4.4 4.2 2.7 2.4 

Nigeria 1990 5.4 4.5 4.6 3.3 

Nigeria 1999 2.1 9.4 1.8 5.2 

Senegal 1986 5.5 5.2 2.6 3.3 

Senegal 1992/93 4.0 3.8 2.5 2.5 

Senegal 1997 3.8 2.9 2.1 2.0 

Tanzania 1996 2.5 3.5 1.3 2.0 

Tanzania 1999 2.8 4.0 2.0 2.8 

Togo 1988 1.7 2.7 0.4 1.7 

Togo 1998 1.4 2.5 0.9 1.7 

Uganda 1988 7.0 4.9 5.1 3.1 

Uganda 1995 3.2 4.2 1.9 3.0 

Zambia 1992 1.3 2.7 0.9 1.9 

Zambia 1996 2.3 3.6 1.5 1.9 

Zimbabwe 1988 2.4 2.0 1.2 1.4 

Zimbabwe 1994 3.2 2.2 1.9 1.2 

Zimbabwe 1999 2.7 2.7 2.3 1.6 

North Africa/ 

West Asia 

Egypt 1992 3.1 3.5 2.5 2.9 

Egypt 1995 2.8 3.1 2.6 2.7 

Jordan 1990 0.8 2.0 0.8 1.9 

Jordan 1997 2.4 2.8 2.4 2.7 

Morocco 1987 

Morocco 1995 

Turkey 1993 

Turkey 1998 

Yemen 1997

Central Asia/ 

South and 

Southeast Asia 

Bangladesh 1996/97 

Bangladesh 1999/2000

Cambodia 2000 

India 1998/99

Indonesia 1987 

Indonesia 1991 

Indonesia 1994 

Indonesia 1997 

Kazakhstan 1995 

Kazakhstan 1999 

Kyrgyz Rep. 1997 

Nepal 1996 

Philippines 1993 

Philippines 1998 

Turkmenistan 2000 

Uzbekistan 1996 

Vietnam 1997 

Latin America/ 

Carribean 

Bolivia 1989 

Bolivia 1994 

Bolivia 1998 

Brazil 1986 

Brazil 1996 

Colombia 1986 

Colombia 1990 

Colombia 1995 

Colombia 2000 

Dominican 1986 

Dominican 1991 

Dominican 1996 

Guatemala 1997 

Guatemala 1995 

Guatemala 1998/99

Haiti 1994/95

Nicaragua 1997/98

Peru 1986 

Peru 1992 

Peru 1996 

Peru 2000 

4.3 

2.0 

* 

1.8 

2.5 

2.0 

1.8 

2.1 

2.6 

4.2 

4.5 

3.8 

3.7 

2.0 

1.3 

0.5 

3.2 

* 

1.6 

1.3 

0.9 

0.9 

2.4 

1.9 

1.1 

3.8 

3.3 

1.8 

2.4 

2.5 

2.2 

5.5 

4.3 

3.7 

3.2 

1.1 

1.7 

3.9 

1.4 

1.7 

1.1 

1.4 

0.9 

4.4 

4.5 

* 

3.2 

2.5 

7.0 

6.0 

2.0 

3.1 

4.3 

3.7 

2.8 

3.2 

2.1 

2.4 

1.9 

3.3 

* 

2.3 

1.9 

1.4 

1.3 

2.0 

2.0 

1.2 

3.2 

3.7 

2.0 

2.7 

2.9 

2.6 

4.5 

3.5 

3.2 

1.8 

1.3 

1.3 

5.3 

1.8 

1.3 

1.2 

1.5 

1.5 

3.4 

1.2 

* 

1.5 

2.2 

1.4 

1.1 

1.8 

2.0 

3.6 

3.8 

2.8 

2.9 

2.0 

1.2 

0.5 

1.4 

* 

1.4 

1.3 

0.8 

0.8 

1.9 

1.6 

0.7 

3.7 

2.9 

1.5 

2.4 

2.3 

2.1 

4.1 

2.7 

3.0 

2.7 

1.1 

1.5 

2.5 

1.2 

1.5 

1.0 

1.3 

0.8 

3.6 

3.7 

* 

2.8 

2.1 

4.4 

4.0 

1.4 

2.5 

3.4 

2.8 

2.2 

2.6 

2.0 

1.8 

1.5 

2.2 

* 

2.0 

1.5 

1.2 

1.1 

1.5 

1.3 

0.8 

2.6 

3.4 

1.6 

2.2 

2.6 

2.3 

3.1 

2.7 

2.7 

1.3 

1.2 

1.1 

3.4 

1.5 

0.9 

1.0 

1.3 

1.2 
38 Trends in Infertility 

least one live birth in the most recent survey, compared with 97 percent in the previous survey. More women reported having at least one living child in the latest survey 

compared with the previous survey in most countries except Nigeria (Figure 11). Declining percentages of women reporting no live births or no surviving children are 

more pronounced when we consider women age 40 to 44, who have largely completed childbearing (Figures 12 and 13). Only in Jordan did more women report no 

live birth or no living children (2.4 percent) in the latest survey compared with the 

previous survey (0.8 percent). 

Figure 11 

Changes in the percentage of women age 25-49 who have been married for the 

past five years but have no living children, most recent DHS survey compared 

with previous DHS survey 

-3 -2 -1 0 1 2 3 4 5 6

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Bangladesh

Indonesia

Kazakhstan

Bolivia

Brazil

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)
Trends in Infertility 39

Figure 12 

Changes in the percentage of women age 40-44 who have been married for the 

past five years but have had no live births, most recent DHS survey compared 

with previous DHS survey 

-4 -3 -2 -1 0 1 2

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Bangladesh

Indonesia

Kazakhstan

Bolivia

Brazil

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)
40 Trends in Infertility 

Figure 13 

Changes in the percentage of women age 40-44 who have been married for the 

past five years but have no living children, most recent DHS survey compared 

with previous DHS survey 

-5 -4 -3 -2 -1 0 1 2

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Bangladesh

Indonesia

Kazakhstan

Bolivia

Brazil

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)

Among currently married women age 15 to 49 years who are sexually active, not 

using contraception, and have been married for the past five years, the percentage 

reporting no live birth or pregnancy has changed little except in seven countries (Figure 14). In Kazakhstan, the percentage with no live birth or pregnancy declined by six 

percentage points, and in Burkina Faso the decline was five percentage points. Increases of 5 percentage points or more were noted for Peru, the Dominican Republic, 

Colombia, Jordan, and Zimbabwe. 
Trends in Infertility 41

Figure 14 

Changes in the percentage of noncontracepting, sexually experienced women 

age 15-49 who have been married for the past five years but have had no live 

births or pregnancies, most recent DHS survey compared with previous DHS 

survey 

-10 -5 0 5 10 15 20

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Bangladesh

Indonesia

Kazakhstan

Bolivia

Brazil

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)

5.3 Trends in Secondary Infertility 

Choosing an appropriate indicator to assess the trends in secondary infertility is not 

straightforward. Among the various indicators, we have selected the percentage of 

currently married noncontracepting women with at least one pregnancy or live birth 

who reported no birth or pregnancy in the five years preceding the survey. We assume that women who were using contraception or were married for less than five 

years are fecund. Major declines were noted in the percentage reporting no live birth 

or pregnancy in the most recent survey compared with the previous survey, except in 

Turkey, Togo, and Burkina Faso (Figure 15). 
42 Trends in Infertility 

Figure 15 

Changes in the percentage of currently married noncontracepting women who 

have had no live births or pregnancies in the past five years, most recent DHS 

survey compared with previous DHS survey 

-12 -10 -8 -6 -4 -2 0 2 4 6 8

Burkina Faso

Cameroon

Ghana

Kenya

Madagascar

Malawi

Mali

Niger

Nigeria

Senegal

Tanzania

Togo

Uganda

Zambia

Zimbabwe

Egypt

Jordan

Morocco

Turkey

Bangladesh

Indonesia

Kazakhstan

Philippines

Bolivia

Colombia

Dominican Republic

Guatemala

Peru

Percent difference (recent estimate minus previous estimate)

Note: Contraceptive users or those married for less than five years are assumed to be fecund. 
Consequences of Infertility 43

 6

Consequences of Infertility 

he onus of infertility in most societies is placed on the woman. When the couple 

is unable to produce children, the couple may divorce or separate, or the man 

may take another wife if they live in a culture that permits polygyny. The breakup of 

the relationship is therefore both a coping strategy for men and an unfortunate consequence for women. In some cultures, the woman needs to “prove” her fertility before entering into a formal union. In these societies, women may remain unmarried if 

they cannot bear children. Tables 12 to 15 present these relationship consequences 

for women age 30 or older in various subgroups, type of childlessness and infecundity. 

Table 12 shows the percentage of women who were divorced or separated at the 

time of the survey by whether they were childless, primarily sterile, or secondarily 

sterile. The table also shows the difference in marital status between those who are 

and are not childless or sterile. Overall, women who have never had a child or are 

currently childless are more likely to be divorced or separated, 14 percent for primary 

sterility and 12 percent for childlessness. The increased likelihood of divorce or separation due to secondary sterility is 5 percent, much less than the increase for primary 

sterility. By region, the largest difference for primary sterility is in Latin America, 

where 21 percent of women are more likely to be divorced or separated than women 

who are not primarily sterile. This region also has the largest effect for secondarily 

sterile women, with 10 percent being divorced or separated. In three countries, Nicaragua, the Dominican Republic, and Eritrea, more than 40 percent of primarily sterile women are divorced or separated. At the other extreme is Mali, where only 4 percent of primarily sterile women are divorced or separated. 

For women age 30 or older who have had sexual relations, Table 13 shows the 

percentage that never married, by primary sterility status. Overall, women who are 

primarily sterile are 7 percent more likely to have never married than other women. 

At 10 percent, Latin America is the region with the greatest percent difference in 

never marrying, by primary sterility status. In four countries, more than 20 percent of 

sexually experienced primarily sterile women have never married: Côte d’Ivoire (22 

percent), Kenya (25 percent), South Africa (25 percent), and Guatemala (25 percent). 

T 

Overall, women who have 

never had a child or are 

currently childless are 

more likely to be divorced 

or separated, 14 percent 

for primary sterility and 

12 percent for 

childlessness. 
44 Consequences of Infertility 

Table 12 

Divorce and separation by childlessness and sterility status 

Percentage of women who were divorced or separated at the time of the survey, by whether they were childless, primarily sterile, or 

secondarily sterile, Demographic and Health Surveys 1994-2000 

Childless (no living children) 

Primarily sterile 

(ever-married women) Secondarily sterile1

Country No Yes Diff. No Yes Diff. No Yes Diff. 

Sub-Saharan Africa Benin 3.5 16.8 13.3 3.5 15.5 12.0 3.6 3.8 0.2 

Burkina Faso 0.7 6.9 6.2 0.8 (3.8) 3.0 1.1 0.8 -0.3 

Cameroon 8.5 10.5 2.0 8.0 18.7 10.7 6.6 8.9 2.3 

Central African Rep. 13.6 18.8 5.2 13.2 23.3 10.1 10.4 14.2 3.8 

Chad 6.3 25.0 18.7 7.1 8.9 1.8 (1.6) 7.2 5.6 

Comoros 9.7 19.6 9.9 9.9 16.0 6.1 2.5 11.1 8.6 

Côte d’Ivoire 9.6 (29.5) 19.9 9.6 (28.1) 18.5 14.3 10.0 -4.3 

Eritrea 10.1 34.2 24.1 9.6 41.3 31.7 0.0 11.4 11.4 

Ghana 12.5 22.7 10.2 11.7 29.8 18.1 3.3 14.0 10.7 

Guinea 1.7 4.4 2.7 1.6 8.2 6.6 4.3 1.7 -2.6 

Kenya 6.7 28.9 22.2 6.9 18.9 12.0 5.1 8.1 3.0 

Madagascar 14.2 26.9 12.7 14.0 30.1 16.1 5.7 16.1 10.4 

Malawi 10.0 13.0 3.0 9.9 16.4 6.5 6.2 11.1 4.9 

Mali 1.1 5.3 4.2 1.2 3.9 2.7 1.6 1.3 -0.3 

Mozambique 13.1 28.6 15.5 14.0 12.1 -1.9 16.2 13.9 -2.3 

Niger 2.9 11.1 8.2 3.0 13.8 10.8 5.2 3.1 -2.1 

Nigeria 2.9 11.1 8.2 2.9 10.8 7.9 2.7 3.2 0.5 

S. Africa 13.0 15.3 2.3 12.6 18.4 5.8 11.0 14.4 3.4 

Senegal 5.5 14.7 9.2 5.0 24.8 19.8 6.0 5.7 -0.3 

Tanzania 10.3 (26.7) 16.4 10.2 21.9 11.7 6.5 11.5 5.0 

Togo 7.1 27.4 20.3 7.0 23.0 16.0 7.3 7.7 0.4 

Uganda 9.8 24.0 14.2 10.0 22.8 12.8 4.0 11.2 7.2 

Zambia 12.6 25.4 12.8 12.3 28.4 16.1 4.6 14.2 9.6 

Zimbabwe 8.6 24.6 16.0 8.0 28.3 20.3 3.5 11.2 7.7 

Average 11.6 11.5 3.4 

North Africa/West Asia Egypt 2.6 12.7 10.1 2.3 21.9 19.6 0.1 6.6 6.5 

Jordan 1.2 12.3 11.1 1.3 13.2 11.9 0.0 3.7 3.7 

Morocco 3.6 22.2 18.6 3.1 29.5 26.4 0.0 7.5 7.5 

Turkey 2.3 10.4 8.1 1.9 10.7 8.8 0.0 6.9 6.9 

Yemen 2.5 18.3 15.8 2.4 33.9 31.5 0.1 3.7 3.6 

Average 12.0 16.7 6.2 

Central Asia/South and 

Southeast Asia Bangladesh 2.5 23.7 21.2 2.3 21.9 19.6 0.4 6.0 5.6 

Cambodia 4.3 12.3 8.0 3.6 20.8 17.2 0.0 5.4 5.4 

India 1.4 18.8 17.4 1.6 9.7 8.1 0.0 4.9 4.9 

Indonesia 3.0 11.2 8.2 2.8 8.9 6.1 0.0 4.8 4.8 

Kazakhstan 11.3 23.1 11.8 8.3 29.8 21.5 5.7 14.8 9.1 

Kyrgyz Republic 6.5 (42.6) 36.1 5.8 26.6 20.8 1.1 10.0 8.9 

Nepal 1.8 12.5 10.7 1.5 17.2 15.7 0.0 3.6 3.6 

Philippines 3.6 10.1 6.5 3.0 12.6 9.6 0.9 5.2 4.3 

Turkmenistan 5.1 23.7 18.6 4.4 24.1 19.7 1.5 7.9 6.4 

Uzbekistan 3.7 (33.6) 29.9 3.0 25.1 22.1 0.7 6.9 6.2 

Vietnam 3.3 (21.4) 18.1 2.6 16.0 13.4 4.2 0.0 -4.2 

Average 15.4 15.4 5.9 

Latin America/Caribbean Bolivia 8.7 10.5 1.8 7.8 26.2 18.4 3.1 11.5 8.4 

Brazil 10.7 15.8 5.1 10.2 17.4 7.2 7.8 15.3 7.5 

Colombia 20.2 28.4 8.2 18.4 37.8 19.4 13.1 30.0 16.9 

Dominican Republic 19.3 22.6 3.3 17.5 43.1 25.6 15.4 22.5 7.1 

Guatemala 8.2 17.5 9.3 7.0 39.2 32.2 3.9 9.7 5.8 

Haiti 12.2 15.2 3.0 11.2 27.6 16.4 6.3 13.3 7.0 

Nicaragua 21.5 43.4 21.9 20.4 43.5 23.1 13.9 28.5 14.6 

Peru 10.4 23.0 12.6 9.0 31.3 22.3 4.2 16.7 12.5 

Average 8.2 20.6 10.0 

Grand average 11.8 14.3 5.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

1 Includes infertile women and women who report themselves as infecund. 
Consequences of Infertility 45

Table 13 

Primary sterility among never-married women 

Percentage of women age 30 or older who have had sexual relations but have never married, by primary sterility status (never 

given birth), Demographic and Health Surveys 1994-2000 

Primary sterility 

(never-married 

women) 

 Country No Yes Diff. 

Sub-Saharan Africa Benin 0.5 9.2 8.7 

Burkina Faso 0.2 (5.2) 5.0 

Cameroon 2.4 10.8 8.4 

Central African Rep. 3.6 7.1 3.5 

Chad 0.1 2.0 1.9 

Comoros 0.5 0.0 -0.5 

Côte d’Ivoire 3.4 25.8 22.4 

Eritrea 0.3 2.3 2.0 

Ghana 1.2 2.8 1.6 

Guinea 0.4 0.0 -0.4 

Kenya 2.6 27.8 25.2 

Madagascar 2.7 12.1 9.4 

Malawi 0.2 2.8 2.6 

Mali 0.4 2.4 2.0 

Mozambique 1.4 3.7 2.3 

Niger u u u 

Nigeria 2.1 2.4 0.3 

S. Africa 15.4 40.6 25.2 

Senegal 0.8 8.2 7.4 

Tanzania 1.9 7.4 5.5 

Togo 0.9 9.4 8.5 

Uganda 1.2 4.7 3.5 

Zambia 1.1 7.4 6.3 

Zimbabwe 1.5 10.6 9.1 

Average 7.0 

North Africa/west Asia Egypt u u u 

Morocco u u u 

Jordan u u u 

Turkey u u u 

Yemen u u u 

Central Asia/South and 

Southeast Asia Bangladesh u u u 

Cambodia 0.1 0.3 0.2 

India u u u 

Indonesia u u u 

Kazakhstan 2.6 4.6 2.0 

Kyrgyz Republic u u u 

Nepal u u u 

Philippines 0.1 3.9 3.8 

Turkmenistan u u u 

Uzbekistan u u u 

Vietnam u u u 

Average 2.0 

Latin America/Caribbean Bolivia 2.0 18.1 16.1 

Brazil 3.6 6.6 3.0 

Colombia 6.2 20.3 14.1 

Dominican Republic 1.1 5.8 4.7 

Guatemala 0.6 25.3 24.7 

Haiti 0.7 3.3 2.6 

Nicaragua 0.4 2.2 1.8 

Peru 4.1 18.9 14.8 

Average 10.2 

Grand average 7.3 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (not available) 
46 Consequences of Infertility 

Rather than remaining divorced or separated, women who were in an infertile union may remarry and thus be in a second or later marriage at the time of the survey. 

Childless women are 13 percent more likely to have married more than once than 

women with children (Table 14). Primarily infertile and secondarily infertile women 

are 7 and 8 percent, respectively, more likely to be in a second or later marriage than 

are fertile women. By region, sub-Saharan Africa has the greatest difference in percent remarried between childless and nonchildless women (17 percent) and primarily 

and secondarily infertile women (10 percent each). In contrast, in Latin America and 

the Caribbean, childless and primarily infertile women are less likely to have had a 

second or later union than are other women, and the difference for secondarily infertile women is minimal. In nine sub-Saharan countries, the difference is 20 percent or 

more for women with a second or later union between childless women and women 

with children. Outside of sub-Saharan Africa, the difference is 20 percent or more 

only in Morocco, Indonesia, and Uzbekistan. For primary infertility, six countries 

have a difference of 20 percent or more. For secondary sterility, only three countries 

have that large a difference: Central African Republic, Madagascar, and Mozambique. 

Instead of divorcing or separating from his wife when the union is infertile, a man 

may take another wife in those societies where polygyny is allowed. Questions about 

polygyny were only included in the surveys in sub-Saharan Africa and in Jordan, Morocco, Nepal, and Yemen. Whether a man takes another wife if his first wife is childless varies substantially among countries; however, he is much more likely to have 

another wife in Kenya, Jordan, Nepal, and Yemen, with differences by childless status 

of 20, 19, 19, and 15 percent, respectively (Table 15). In these countries, the percentage of nonchildless wives in polygynous unions is relatively low. In some African 

countries, polygyny is quite high even among couples with children. For primary infertility, it is more likely that the fertile couple is polygynous than the infertile couple 

in most countries. This may be because men have divorced or separated from their 

first wife if she is primarily infertile. For Jordan and Nepal, however, primarily infertile couples are 10 percent more likely to take on another wife than fertile couples. 

Because couples and women can experience several competing consequences of 

childlessness and infertility, it is useful to have a summary indicator of the relationship effects. To this end, we tabulated women by whether or not they were living in a 

monogamous first union at the time of the survey, thus taking into account never 

marrying, divorce and separation, remarriage, and polygyny. Table 16 shows the results according to childlessness and infertility status. For some countries, monogamous first union status could not be collected because only ever-married women were 

interviewed. In countries where the wife’s union rank (first wife, second wife, etc.) 

was not asked, it was assumed that there was no polygyny. 

Overall, sexually experienced childless and primarily infertile women are 18 percent less likely to be living in a monogamous first union than sexually experienced 

women with children. Women who have had a child but are unable to have more 

were 12 percent less likely to be living in a monogamous first union. A portion of the 

relationship between secondary sterility and monogamous first unionship may be due 

to the effects of age; older women are more likely to be secondarily sterile and to have 

had more exposure to divorce, separation, and polygyny. 

Instead of divorcing or 

separating from his wife 

when the union is 

infertile, a man may take 

another wife in those 

societies where polygyny 

is allowed. 
Consequences of Infertility 47

Table 14 

Remarriage by childlessness and sterility status 

Percentage of women who have had more than one union, by whether they are childless, primarily sterile, or secondarily sterile, Demographic and Health Surveys, 1994-2000 

Childless 

(no living children) 

Primarily sterile 

(ever-married women) Secondarily sterile 

Country No Yes Diff. No Yes Diff. No Yes Diff. 

Sub-Saharan Africa 

Benin 31.0 51.0 20.0 31.1 44.5 13.4 23.1 31.3 8.2 

Burkina Faso 20.7 38.6 17.9 21.0 (21.2) 0.2 14.6 21.3 6.7 

Cameroon 23.6 59.4 35.8 24.6 48.6 24.0 14.5 26.3 11.8 

Central African Rep. 37.0 65.9 28.9 38.5 53.0 14.5 17.5 39.0 21.5 

Chad 26.7 39.0 12.3 26.9 39.6 12.7 (15.9) 27.3 11.4 

Comoros 44.6 60.8 16.2 44.8 58.0 13.2 31.3 46.6 15.3 

Côte d’Ivoire 26.6 (23.3) -3.3 26.9 (16.4) -10.5 17.1 25.9 8.8 

Eritrea 23.8 27.1 3.3 23.5 32.7 9.2 13.2 24.5 11.3 

Ghana 37.4 38.9 1.5 38.1 26.7 -11.4 29.5 37.0 7.5 

Guinea 22.4 40.9 18.5 22.6 39.5 16.9 20.4 23.3 2.9 

Kenya 7.8 21.9 14.1 8.0 10.8 2.8 4.1 9.5 5.4 

Madagascar 35.6 63.6 28.0 36.5 48.1 11.6 14.9 38.9 24.0 

Malawi 34.8 66.5 31.7 34.8 64.4 29.6 25.5 38.1 12.6 

Mali 18.3 43.3 25.0 18.7 35.7 17.0 15.7 19.2 3.5 

Mozambique 37.0 49.5 12.5 36.8 58.4 21.6 16.0 38.6 22.6 

Niger 37.2 63.7 26.5 37.6 60.6 23.0 u u u 

Nigeria 14.1 31.7 17.6 14.6 16.6 2.0 4.2 16.1 11.9 

S. Africa 10.5 17.7 7.2 10.8 10.6 -0.2 7.6 8.6 1.0 

Senegal u u u u u u u u u 

Tanzania 32.5 (42.3) 9.8 32.3 42.4 10.1 26.2 33.6 7.4 

Togo 31.3 39.5 8.2 31.5 33.5 2.0 27.6 31.3 3.7 

Uganda 31.6 55.0 23.4 32.1 45.9 13.8 26.0 33.1 7.1 

Zambia 32.5 47.5 15.0 32.5 43.0 10.5 20.2 34.5 14.3 

Zimbabwe 16.1 38.5 22.4 16.7 17.9 1.2 11.4 18.1 6.7 

Average 17.1 9.9 10.3 

North Africa/West Asia 

Egypt 5.0 18.7 13.7 5.2 12.6 7.4 u u u 

Jordan 4.0 15.5 11.5 4.1 17.7 13.6 u u u 

Morocco 15.3 39.2 23.9 15.8 27.4 11.6 u u u 

Turkey 3.9 14.2 10.3 3.8 9.0 5.2 u u u 

Yemen 13.8 23.3 9.5 13.9 19.1 5.2 u u u 

Average 14.9 9.5 

Central Asia/South and 

Southeast Asia 

Bangladesh 8.9 25.7 16.8 8.7 24.0 15.3 u u u 

Cambodia 10.1 16.3 6.2 10.2 11.2 1.0 6.8 10.8 4.0 

India 1.9 7.2 5.3 1.9 4.4 2.5 u u u 

Indonesia 16.1 37.8 21.7 16.2 24.9 8.7 11.8 19.1 7.3 

Kazakhstan 14.5 29.2 14.7 13.5 22.0 8.5 12.0 15.9 3.9 

Kyrgyz Republic 13.3 (30.8) 17.5 11.9 37.2 25.3 8.3 15.5 7.2 

Nepal 9.2 16.4 7.2 9.1 17.4 8.3 7.3 11.6 4.3 

Philippines 7.9 9.6 1.7 8.1 5.9 -2.2 6.4 8.5 2.1 

Turkmenistan 7.6 23.7 16.1 6.5 31.4 24.9 4.8 9.6 4.8 

Uzbekistan 6.5 (48.2) 41.7 6.1 25.1 19.0 4.9 8.6 3.7 

Vietnam 3.4 (1.6) -1.8 3.4 3.7 0.3 u u u 

Average 11.9 10.3 4.8 

Latin America/Caribbean 

Bolivia 10.9 9.7 -1.2 11.0 8.8 -2.2 10.0 11.0 1.0 

Brazil 15.2 16.8 1.6 15.6 11.2 -4.4 12.8 16.3 3.5 

Colombia 21.9 14.2 -7.7 22.5 15.0 -7.5 18.6 20.5 1.9 

Dominican Republic 40.4 46.9 6.5 41.2 33.6 -7.6 36.8 41.9 5.1 

Guatemala 13.4 14.9 1.5 13.7 8.5 -5.2 14.2 13.0 -1.2 

Haiti 45.9 53.1 7.2 46.2 45.8 -0.4 36.1 46.8 10.7 

Nicaragua 35.8 24.8 -11.0 36.4 23.9 -12.5 35.9 34.4 -1.5 

Peru 11.8 7.6 -4.2 12.0 7.4 -4.6 10.3 11.1 0.8 

Average -0.9 -5.6 2.5 

Grand average 12.5 7.1 7.6 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (not available) 
48 Consequences of Infertility 

Table 15 

Polygynous first union by childlessness and primary sterility 

Percentage of women who are in a polygynous first union, by whether they are childless or primarily sterile, Demographic and Health Surveys 1994-2000 

Childless 

(no living children) 

Primarily sterile 

(ever-married women) 

Country No Yes Diff. No Yes Diff. 

Sub-Saharan Africa 

Benin 52.3 61.5 9.2 52.5 55.2 2.7 

Burkina Faso 61.6 58.1 -3.5 61.6 (58.9) -2.7 

Cameroon 33.5 37.6 4.1 33.9 31.1 -2.8 

Central African Rep. 27.5 25.4 -2.1 27.5 25.4 -2.1 

Chad 41.9 34.5 -7.4 41.6 41.4 -0.2 

Comoros 26.6 31.4 4.8 27.2 18.0 -9.2 

Côte d’Ivoire 37.3 (21.5) -15.8 36.7 (37.1) 0.4 

Eritrea 7.4 10.6 3.2 7.7 5.4 -2.3 

Ghana 24.4 22.3 -2.1 24.7 19.0 -5.7 

Guinea 60.7 68.4 7.7 61.2 55.6 -5.6 

Kenya 16.5 36.3 19.8 16.9 20.0 3.1 

Madagascar 2.4 3.2 0.8 2.5 2.4 -0.1 

Malawi 18.1 22.6 4.5 18.1 21.6 3.5 

Mali 51.2 57.1 5.9 51.4 51.5 0.1 

Mozambique 26.0 16.0 -10.0 25.8 16.3 -9.5 

Niger 44.0 45.3 1.3 44.0 48.7 4.7 

Nigeria 35.9 43.7 7.8 36.3 31.4 -4.9 

S. Africa 5.9 5.5 -0.4 5.9 5.3 -0.6 

Senegal 52.5 56.8 4.3 53.0 42.0 -11.0 

Tanzania 28.3 32.9 4.6 28.2 35.2 7.0 

Togo 44.9 40.2 -4.7 45.1 36.4 -8.7 

Uganda 29.7 29.4 -0.3 29.6 31.8 2.2 

Zambia 18.2 17.9 -0.3 18.5 12.4 -6.1 

Zimbabwe 13.2 15.7 2.5 13.5 9.1 -4.4 

Average 1.4 -2.2 

North Africa/West Asia 

Egypt u u u u u u 

Jordan 7.3 26.2 18.9 7.7 17.3 9.6 

Morocco 5.1 11.9 6.8 5.4 5.8 0.4 

Turkey u u u u u u 

Yemen 7.6 23.0 15.4 8.0 6.9 -1.1 

Average 13.7 3.0 

Central Asia/South and 

Southeast Asia 

Bangladesh u u u u u u 

Cambodia u u u u u u 

India u u u u u u 

Indonesia u u u u u u 

Kazakhstan u u u u u u 

Kyrgyz Republic u u u u u u 

Nepal 4.8 23.3 18.5 4.9 15.0 10.1 

Philippines u u u u u u 

Turkmenistan u u u u u u 

Uzbekistan u u u u u u 

Vietnam u u u u u u 

Latin America/Caribbean 

Bolivia u u u u u u 

Brazil u u u u u u 

Colombia u u u u u u 

Dominican Republic u u u u u u 

Guatemala u u u u u u 

Haiti u u u u u u 

Nicaragua u u u u u u 

Peru u u u u u u 

Grand average 2.9 -1.2 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (not available) 
Consequences of Infertility 49

Table 16 

Monogamous first union by childlessness and sterility status 

Percentage of women who are in a monogamous first union, by whether they are childless, primarily sterile, or secondarily sterile, 

Demographic and Health Surveys 1994-2000 

Childless (no living children) 

Primarily sterile 

(sexually experienced) Secondarily sterile 

 Country No Yes Diff. No Yes Diff. No Yes Diff. 

Sub-Saharan Africa Benin 29.6 (12.2) -17.4 29.4 22.0 -7.4 41.1 28.1 -13.0 

Burkina Faso 28.7 22.0 -6.7 28.6 (28.0) -0.6 44.7 27.5 -17.2 

Cameroon 38.5 12.4 -26.1 37.9 21.9 -16.0 47.6 35.4 -12.2 

Central African Rep. 33.2 12.5 -20.7 32.7 17.5 -15.2 34.9 31.1 -3.8 

Chad 36.2 13.9 -22.3 35.6 22.3 -13.3 (47.8) 35.1 -12.7 

Comoros 36.0 18.0 -18.0 35.8 22.0 -13.8 48.7 33.4 -15.3 

Côte d’Ivoire 35.6 (35.6) 0.0 36.4 22.5 -13.9 48.3 34.3 -14.0 

Eritrea 59.1 25.1 -34.0 59.6 20.0 -39.6 78.3 57.1 -21.2 

Ghana 37.8 (38.2) 0.4 38.0 35.0 -3.0 47.9 36.4 -11.5 

Guinea 28.3 15.4 -12.9 27.9 26.0 -1.9 35.1 27.5 -7.6 

Kenya 62.0 19.8 -42.2 61.9 40.6 -21.3 71.9 56.0 -15.9 

Madagascar 49.5 24.1 -25.4 49.5 29.5 -20.0 66.5 45.5 -21.0 

Malawi 45.5 15.2 -30.3 45.4 19.3 -26.1 57.9 41.0 -16.9 

Mali 38.4 21.5 -16.9 38.0 30.2 -7.8 47.9 37.3 -10.6 

Mozambique 35.3 19.2 -16.1 34.9 24.5 -10.4 55.3 33.3 -22.0 

Niger u u u u u u u u u Nigeria 50.4 29.5 -20.9 49.6 52.2 2.6 62.2 48.2 -14.0 

S. Africa 53.2 50.4 -2.8 55.4 37.0 -18.4 53.2 53.0 -0.2 

Senegal u u u u u u u u u Tanzania 52.8 (41.8) -11.0 53.7 31.5 -22.2 56.8 51.9 -4.9 

Togo 30.6 16.4 -14.2 30.4 26.7 -3.7 34.2 29.6 -4.6 

Uganda 34.8 12.6 -22.2 34.5 15.1 -19.4 40.2 33.0 -7.2 

Zambia 42.1 23.9 -18.2 42.6 21.2 -21.4 63.2 38.2 -25.0 

Zimbabwe 58.0 25.8 -32.2 58.1 40.8 -17.3 70.5 52.1 -18.4 

Average -18.6 -14.1 -13.1 

North Africa/West Asia Egypt u u u u u u u u u Morocco u u u u u u u u u Jordan u u u u u u u u u Turkey u u u u u u u u u Yemen u u u u u u u u u 

Central Asia/South and 

Southeast Asia Bangladesh u u u u u u u u u Cambodia 76.6 38.9 -37.7 77.5 41.7 -35.8 91.5 72.4 -19.1 

India u u u u u u u u u Indonesia 77.8 49.4 -28.4 78.0 62.4 -15.6 88.0 71.4 -16.6 

Kazakhstan 68.5 48.2 -20.3 72.3 45.7 -26.6 73.8 64.9 -8.9 

Kyrgyz Republic 77.8 (28.0) -49.8 79.9 37.1 -42.8 89.6 71.2 -18.4 

Nepal 86.7 60.0 -26.7 86.9 59.5 -27.4 89.6 83.1 -6.5 

Philippines 85.4 78.1 -7.3 86.1 74.3 -11.8 91.2 82.0 -9.2 

Turkmenistan 81.6 52.1 -29.5 83.2 44.0 -39.2 90.3 75.7 -14.6 

Uzbekistan 87.1 (17.7) -69.4 88.3 43.1 -45.2 94.4 79.6 -14.8 

Vietnam u u u u u u u u u 

Average -28.5 -28.5 -13.3 

Latin America/Caribbean Bolivia 76.5 76.8 0.3 78.1 54.2 -23.9 81.7 73.5 -8.2 

Brazil 70.9 69.3 -1.6 71.3 67.0 -4.3 73.7 66.6 -7.1 

Colombia 55.6 58.0 2.4 57.9 40.9 -17.0 61.7 47.3 -14.4 

Dominican Republic 47.3 37.6 -9.7 48.5 29.1 -19.4 52.9 42.3 -10.6 

Guatemala 74.3 62.9 -11.4 75.6 46.0 -29.6 77.2 73.1 -4.1 

Haiti 46.8 35.7 -11.1 47.3 34.1 -13.2 55.7 44.7 -11.0 

Nicaragua 50.2 38.0 -12.2 51.1 34.6 -16.5 55.4 45.4 -10.0 

Peru 72.8 70.4 -2.4 75.0 52.5 -22.5 78.0 67.6 -10.4 

Average -5.7 -18.3 -9.5 

Grand average -17.7 -17.7 -12.4 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (not available 
50 Consequences of Infertility 

The likelihood of being in a monogamous first union varies by region. Asia has the 

largest differences by childlessness and primary infertility (both 29 percent). In Latin 

America, there is a small difference by childless status (6 percent), but there is a much 

larger difference by primary infertility (18 percent). In sub-Saharan Africa, the difference for being in a monogamous first union is greater for childless women (19 percent) than for women who are primarily infertility (14 percent). 

Seven countries have a difference in monogamous first unionship by childless 

status of 30 percent or more: Uzbekistan (69 percent), Kyrgyz Republic (50 percent), 

Kenya (42 percent), Cambodia (38 percent), Eritrea (34 percent), Zimbabwe (32 percent), and Malawi (30 percent). Eleven other countries have differences of 20 to 29 

percent. For primary infertility, five countries have differences of 30 percent or more: 

Uzbekistan (45 percent), Kyrgyz Republic (43 percent), Eritrea (40 percent), Turkmenistan (39 percent), and Cambodia (36 percent). Ten other countries have differences of 20 to 29 percent. For secondary sterility, four countries have differences in 

being in a monogamous first union that are 20 percent or more: Zambia (25 percent), Mozambique (22 percent), and Eritrea and Madagascar (both 21 percent). 

In summary, childlessness and infertility have consequences for a woman’s chances 

of being in a stable relationship, whether through lowering her chances of entering 

into marriage, raising her chances of being divorced or separated, or increasing the 

chances that her husband will take another wife.6

 

6

 There was no information on the possibility that a woman in union who is childless may seek to obtain 

another husband or partner because her first husband or partner was unable to make her pregnant. 

Childlessness and 

infertility have 

consequences for a 

woman’s chances of 

being in a stable 

relationship. 
Coping with Infertility through Adoption 51

 7

Coping with Infertility through Adoption 

he most important way for couples to cope with infertility is to adopt children. 

The information contained in the DHS surveys can give an insight into the extent of this process. All family members are listed on the household schedule of the 

DHS household questionnaire. For persons under 15 years of age, the biological 

mother and father are identified if they are residing in the household. If not, then the 

survival status of each of the parents is ascertained. Thus, whether a household has 

children whose biological parents do not live in the household can be determined. 

We consider that these children are “adopted,” whether formally or informally. Table 

17 shows the percentage of women living in a household with one or more adopted 

children according to childlessness and infertility status. We cannot definitely determine whether the couple has adopted the child or children if there is more than one 

couple in the household; however, if childless or infertile couples live in households 

with adopted children, we assume that they adopted the children. Table 17 indicates 

that, overall, childless women are 15 percent more likely to live in households with 

adopted children than are women with their own children. The difference for women 

with primary infertility is 7 percent. Interestingly, women with secondary infertility 

are no more likely to live in a household with adopted children than are women who 

can have more children. 

By country, the difference in adoption rates by childlessness is greatest in Turkmenistan (41 percent) and Niger (33 percent). In sub-Saharan Africa, adoption is 

common even among couples that have no fertility impairment. However, childlessness and infertility increase adoption rates on average by 17 and 11 percent, respectively. In five countries in West Africa, more than half of the couples who are childless live in households with adopted children under age 15: Niger (61 percent), 

Guinea (59 percent), Benin (56 percent), Togo (56 percent), and Cameroon (53 percent). 

T 

Childless women are 

15 percent more likely to 

live in households with 

adopted children than are 

women with their own 

children. 
52 Coping with Infertility through Adoption 

Table 17 

Adoption of children by childlessness and sterility status 

Percentage of women living in households with one or more adopted children, by whether the women are childless, primarily sterile, or secondarily sterile, Demographic and Health Surveys 1994-2000 

Childless 

(no living children) 

Primarily sterile 

(ever-married women) Secondarily sterile 

Country No Yes Diff. No Yes Diff. No Yes Diff. 

Sub-Saharan Africa 

Benin 38.0 56.2 18.2 37.9 61.0 23.1 40.4 38.1 -2.3 

Burkina Faso u u u u u u u u u 

Cameroon 30.6 53.3 22.7 31.3 44.6 13.3 23.5 33.2 9.7 

Central African Rep. 31.0 46.1 15.1 31.8 38.3 6.5 37.7 32.0 -5.7 

Chad 22.2 38.5 16.3 22.3 42.5 20.2 (33.0) 22.7 -10.3 

Comoros 26.0 51.0 25.0 26.5 42.0 15.5 36.0 25.6 -10.4 

Côte d’Ivoire u u u u u u u u u 

Eritrea 8.4 24.4 16.0 8.7 15.6 6.9 9.2 9.0 -0.2 

Ghana 20.5 43.4 22.9 21.1 21.1 0.0 19.0 21.4 2.4 

Guinea 40.0 59.3 19.3 40.2 57.6 17.4 49.7 40.3 -9.4 

Kenya 15.5 27.3 11.8 15.7 17.3 1.6 12.6 17.3 4.7 

Madagascar 17.7 40.8 23.1 18.2 31.6 13.4 15.9 19.4 3.5 

Malawi 18.6 32.9 14.3 18.9 25.1 6.2 15.2 20.2 5.0 

Mali 19.5 44.3 24.8 19.9 39.4 19.5 37.0 19.7 -17.3 

Mozambique 27.3 39.9 12.6 27.3 43.8 16.5 28.5 27.9 -0.6 

Niger 28.4 61.3 32.9 29.2 51.4 22.2 22.8 30.4 7.6 

Nigeria 22.9 33.0 10.1 23.2 22.7 -0.5 20.4 23.7 3.3 

S. Africa 18.8 31.4 12.6 19.2 18.4 -0.8 17.4 20.6 3.2 

Senegal u u u u u u u u u 

Tanzania 28.0 (41.8) 13.8 28.2 32.1 3.9 28.9 28.3 -0.6 

Togo 35.0 55.5 20.5 34.9 51.0 16.1 37.2 35.2 -2.0 

Uganda 30.3 47.2 16.9 30.4 48.5 18.1 37.5 30.2 -7.3 

Zambia 29.7 32.7 3.0 29.2 44.4 15.2 30.5 29.7 -0.8 

Zimbabwe 20.6 32.4 11.8 20.9 21.9 1.0 17.4 22.5 5.1 

Average 17.3 11.2 -1.1 

North Africa/West Asia 

Egypt 1.8 7.1 5.3 1.9 4.2 2.3 1.4 2.7 1.3 

Jordan 1.8 5.8 4.0 1.8 5.1 3.3 1.6 2.2 0.6 

Morocco 10.8 20.5 9.7 10.9 19.5 8.6 10.4 12.0 1.6 

Turkey 2.0 2.6 0.6 2.0 2.1 0.1 2.0 2.0 0.0 

Yemen 4.7 14.1 9.4 4.9 6.5 1.6 4.6 5.1 0.5 

Average 4.9 3.6 0.9 

Central Asia/South and 

Southeast Asia 

Bangladesh u u u u u u u u u 

Cambodia 6.8 30.8 24.0 7.3 12.3 5.0 10.2 6.7 -3.5 

India u u u u u u u u u 

Indonesia 4.5 21.3 16.8 4.9 8.2 3.3 3.5 6.0 2.5 

Kazakhstan 3.1 10.0 6.9 3.0 4.8 1.8 2.6 3.7 1.1 

Kyrgyz Republic 5.6 (14.3) 8.7 5.9 4.9 -1.0 2.2 7.6 5.4 

Nepal u u u u u u u u u 

Philippines u u u u u u u u u 

Turkmenistan 3.1 43.7 40.6 3.7 9.2 5.5 3.1 4.5 1.4 

Uzbekistan 1.2 (9.3) 8.1 1.3 2.1 0.8 0.9 1.7 0.8 

Vietnam u u u u u u u u u 

Average 19.4 2.9 1.4 

Latin America/Caribbean 

Bolivia 6.9 21.3 14.4 6.9 10.4 3.5 7.1 7.0 -0.1 

Brazil 8.0 21.6 13.6 8.6 6.3 -2.3 8.0 9.0 1.0 

Colombia 9.4 14.9 5.5 9.5 9.0 -0.5 9.6 9.4 -0.2 

Dominican Republic 19.2 25.7 6.5 19.5 18.1 -1.4 20.3 18.6 -1.7 

Guatemala 8.1 22.4 14.3 8.3 8.1 -0.2 8.7 8.2 -0.5 

Haiti 24.3 39.6 15.3 24.3 34.6 10.3 25.8 24.8 -1.0 

Nicaragua 15.1 20.9 5.8 15.0 18.5 3.5 14.3 16.1 1.8 

Peru 6.9 15.9 9.0 7.0 7.9 0.9 6.7 7.4 0.7 

Average 10.6 1.7 0.0 

Grand average 14.9 7.3 -0.3 

Note: Figures in parentheses are based on 25-49 unweighted cases 

u = Unknown (not available) 
Conclusions 53

 8

Conclusions 

ive measures of fertility impairment are used in this report: childlessness, primary 

infertility, self-reported infecundity, secondary infertility, and secondary infecundity. 

Childlessness varies from less than 1 percent among married women age 40 to 44 

in the Kyrgyz Republic, Uzbekistan, and Vietnam to more than 10 percent in the 

Central African Republic. These levels are lower than those reported by the World 

Fertility Survey. In almost all of the countries included in this report, at least 96 percent of married women can expect to have one or more surviving children. 

Sexual intercourse begins early for most women. By age 25 to 29, 94 percent of 

women have had sexual relations at least once. For women age 25 to 49 (standardized), the Philippines has the lowest proportion of women with sexual experience (88 

percent). The highest proportions occur in sub-Saharan Africa, where almost all 

women age 25 to 49 are sexually experienced. 

Among sexually experienced women age 25 to 49 (standardized), the proportion 

who have not had a pregnancy varies from 2 to 18 percent, with slightly higher percentages for women who have not had a birth. 

Some women do not want to have any children. Among women with no living 

children, those whose ideal is to have no children varies from 3 to 6 percent. 

Self-reports of infecundity vary substantially by age, decreasing somewhat for ages 

15 to 19 and then increasing especially for women over 30. Standardizing for age distributions allows comparison across countries for the broad age group women 25 to 

49. Senegalese women are the least likely to report themselves as infecund in this age 

group (5 percent) while Cambodian women are the most likely (35 percent). 

Women who have borne children can be subject to secondary infertility, indicated 

here by women who have not had a child in the past five years (excluding women 

who used contraception). Overall, secondary infertility increases sharply with age 

from 5 percent at age 20 to 24 to 62 percent at age 45 to 49 years. Vietnam (9 percent) and Cambodia (38 percent) are the countries with the lowest and highest agestandardized levels of secondary infecundity for women age 25 to 49. 

It is estimated that by the middle of 2002, about 186 million ever-married women 

age 15 to 49 were infertile, because of primary or secondary infertility, in developing 

countries, excluding China. 

Assessing trends by using comparable data shows that infertility, whether primary 

or secondary, has declined in most countries. When comparing data on the percentage of women reporting no live births at two points in time roughly 20 years apart, 

fewer women age 25 to 49 reported no live births in the DHS surveys compared with 

the WFS surveys for 11 countries that were included in both survey programs, except 

in Bangladesh. Comparing data from DHS surveys in the same country yields mixed 

results, but for most countries there has been a decline in the percentage of women 

reporting no pregnancy or no live birth in the past five years. Among the countries 

F 

For most countries there 

has been a decline in the 

percentage of women 

reporting no pregnancy or 

no live birth in the past 

five years. 
54 Conclusions 

most affected by the HIV pandemic, no pattern was seen for increases or declines in 

infertility. Overall, reductions in infertility were seen for several countries, but important exceptions were also noted. 

Infertility has consequences for women’s marital status. Women who have never 

had a child are much more likely to be divorced or separated. In Nicaragua, the Dominican Republic, and Eritrea, more than 40 percent of women who have never had 

a child are currently separated or divorced. Childless women are also more likely to 

have married more than once. 

In some cultures a woman needs to prove her fecundity in order to marry. Overall, 

for women age 30 or older who have had sexual relations, those who are primarily 

sterile are 7 percent more likely to have never married or lived in a consensual union. 

This percentage rises to 10 percent in Latin America. 

In cultures where polygyny is allowed, a man may take another wife if his first wife 

is childless. Differences in polygyny by childless status of the first wife vary substantially. In four of the countries discussed, women are at least 15 percent more likely to 

be in a polygynous union if they are childless than if they have a child. 

An important way of coping with infertility is adoption. Childless women are 15 

percent more likely to live in households with an adopted child than are women with 

their own children. In five West African countries more than half of childless couples 

live in households with adopted children. 

An important way of 

coping with infertility is 

adoption. In five West 

African countries more 

than half of childless 

couples live in households 

with adopted children. 
References 55

References 

Arnold, F. 1990. Assessment of the quality of birth history data in the Demographic 

and Health Surveys. In An assessment of DHS-I data quality. DHS Methodological 

Reports No. 1. Columbia, Maryland: Institute for Resource Development/Macro 

Systems Inc. 83-110. 

Bongaarts, J., O. Frank, and R. Lesthaeghe. 1984. The proximate determinants of 

fertility in sub-Saharan Africa. [Unpublished]. Paper prepared for the World Bank. 

Frank, O. 1983. Infertility in sub-Saharan Africa: Estimates and implications. Population and Development Review 9(1): 137-144. 

Goldman, N. 1985. Assessment of fertility data collected in WFS individual surveys. 

Assessment of the quality of data in 41 WFS surveys: A comparative approach. WFS 

Comparative Studies No. 44. Voorburg, The Netherlands: International Statistical 

Institute. 7-20. 

Gregson, S., B. Zaba, and S.C. Hunter. 2002. The impact of HIV 1 on fertility in 

sub-Saharan Africa: Causes and consequences. Presented at the Expert Group Meeting on Completing the Fertility Transition, March 11-14, 2002. New York: United 

Nations Population Division. 

Larsen, U., and J. Menken. 1989. Measuring sterility from incomplete birth histories. 

Demography 26: 185-201. 

Larsen, U., and H. Raggers. 2001. Levels and trends of infertility in sub-Saharan 

Africa. In Women and infertility in sub-Saharan Africa: A multi-disciplinary perspective, 

ed. J. Boerma and Z. Mgalla. Amsterdam: The Netherlands: Royal Tropical Institute. 25-70. 

Mammo, A., and S.P. Morgan. 1986. Childlessness in rural Ethiopia. Population and 

Development Review 12(3): 533-46. 

Mtimavalye, L.A., and M.A. Belsey. 1987. Infertility and sexually transmitted disease: Major problems in maternal and child health and family planning. Paper presented at International Conference on Better Health for Women and Children 

through Family Planning, Nairobi, Kenya, October 5-9, 1987. 

Rutstein, S. 1985. Assessment of the quality of age reports for eligibility and analysis. 

Assessment of the quality of data in 41 WFS surveys: A comparative approach. WFS 

Comparative Studies No. 44. Voorburg, The Netherlands: International Statistical 

Institute. 38-61. 
56 References 

Rutstein, S., and G. Bicego. 1990. Assessment of the quality of data used to ascertain 

eligibility and age in the Demographic and Health Surveys. In An assessment of 

DHS–I data quality. DHS Methodological Reports No. 1. Columbia, Maryland: Institute for Resource Development/Macro Systems. 5-37. 

Sherris, J.D., and G. Fox. 1983. Infertility and sexually transmitted disease: A public 

health challenge. Population Reports, Series L, No. 4. Population Information Program, The Johns Hopkins University, Baltimore, Maryland. 

Singh, V.K. 1989. Estimation of fecundability and risk of foetal wastage from data 

on straddling birth intervals. In Population transition in India, Vol. 1, ed. S.N. Singh, 

M.K. Premi, P.S. Bhatia, and A. Bose. Delhi, India: B.R. Publishing. 401-9. 

United Nations. 2003. World population prospects: The 2002 revision. Vol. 2, Sex and 

age distribution of populations. New York: United Nations Population Division 

(ST/ESA/SER.A/223). 

Vaessen, M. 1984. Childlessness and infecundity. WFS Comparative Studies No. 31. 

Voorburg, The Netherlands: International Statistical Institute. 

Vayena, E., P. Rowe, and P.D. Griffin, eds. 2002. Current practices and controversies 

in assisted reproduction: Report of a WHO meeting. Geneva: World Health Organization. 

World Health Organization. 1975. The epidemiology of infertility. Report of WHO Scientific Group on the Epidemiology of Infertility. Technical Report Series No. 582. Geneva: World Health Organization. 

 

World Health Organization. 2001. Reproductive health indicators for global monitoring: 

Report of the second interagency meeting, 2001. Geneva: World Health Organization.

WHO/RHR/01.19. 
DHS Comparative Reports Series 

1. Westoff, Charles F. 2001. Unmet Need at the End of the Century. 

2. Westoff, Charles F. and Akinrinola Bankole. 2002. Reproductive Preferences in Developing 

Countries at the Turn of the Century. 

3. Rutstein, Shea O. 2002. Fertility Levels, Trends, and Differentials 1995-1999. 

4. Mahy, Mary. 2003. Childhood Mortality in the Developing World: A Review of Evidence from 

the Demographic and Health Surveys. 

5. Westoff, Charles F. 2003. Trends in Marriage and Early Childbearing in Developing Countries. 

6. Rutstein, Shea O. and Kiersten Johnson. 2004. The DHS Wealth Index. 

7. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting 

in the Demographic and Health Surveys: A Critical and Comparative Analysis. 

8. Stallings, Rebecca. 2004. Child Morbidity and Treatment Patterns. 

9. Rutstein, Shea O. and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in 

Developing Countries.