Prevalence and determinants of fertility care-seeking among women with delayed conception in Northern India: a cross-sectional study

Infertility affects a substantial proportion of couples in low- and middle-income countries, yet access to fertility care remains limited. In India, research has primarily focused on psychosocial and biomedical aspects of infertility, with limited attention to care-seeking behaviours. Understanding the determinants of care-seeking is essential to promote equitable access to infertility services. We conducted a cross-sectional study among 1,530 married women, aged 18-30 years, intending to conceive and living in low-to middle-socioeconomic urban neighbourhoods of Delhi who had not conceived after 18 months of participation in a preconception randomized-control trial. Structured interviews captured sociodemographic characteristics, fertility intentions, psychosocial experiences, and care-seeking actions. Care-seeking was categorized as formal (health system providers), informal (family or traditional healers), or mixed. Overall, 69.9% of women sought some form of help for delayed conception and, among them 85.5% consulted both formal and informal sources. Multivariable logistic regressions identified predictors of care-seeking where longer duration of trying to conceive (adjusted odds ratio [aOR] 1.6 per year, 95% CI 1.4-1.7), perceiving conception as taking too long (aOR 3.1, 95% CI 2.1-4.5), feeling isolated (aOR 1.7, 95% CI 1.2-2.4), emotional abuse from husbands (aOR 1.7, 95% CI 1.2-2.4) or family members (aOR 1.6, 95% CI 1.2-2.2), and heavy menstrual bleeding (aOR 1.5, 95% CI 1.0-2.2) were associated with greater odds of care-seeking, while regular menstrual cycles were associated with lower odds (aOR 0.6, 95% CI 0.4-0.9). The negative association of regular cycles with care-seeking was significantly modified by social isolation (interaction aOR 3.78, 95% CI 1.20-11.89). The most common reason for not seeking care was the perception of not having a problem. Nearly seven in ten women with delayed conception sought some form of help, often through mixed care pathways. Findings highlight the need to integrate psychosocial support and fertility education into accessible, affordable infertility services within the public health system.