Understanding and attitudes toward infertility among infertile couples: A multi-hospital survey in Central Java

Background Infertility is a significant reproductive health challenge in Indonesia and is frequently accompanied by social stigma and cultural expectations that influence how couples seek care. Gender norms and unequal access to healthcare resources may further shape treatment-seeking behavior. This study aimed to examine healthcare-seeking behavior among infertile couples and assess gender-related differences in access to infertility services, particularly regarding financial barriers, discrimination, cultural factors, gender sensitivity in healthcare delivery, and knowledge about infertility. Design and methods A cross-sectional survey was conducted among 250 infertile couples seeking treatment in five hospitals in Central Java, Indonesia, between April and June 2023. Eligible participants were couples (women and men) aged 20-45 years who had experienced infertility for more than one year and were actively seeking treatment. Individuals undergoing in vitro fertilization (IVF), those with malignancy, and those who were pregnant were excluded. Data were collected through structured interviews and analyzed using bivariate and multivariable logistic regression with SPSS version 25. Results Bivariate analysis showed that perceived discrimination (p=0.009) and gender sensitivity in healthcare services (p=0.003) were significantly associated with gender differences in access to infertility care. In multivariable analysis, gender sensitivity remained the only factor significantly associated with gender differences in access to infertility services (OR=0.139; 95% CI: 0.020–0.964; p=0.046). Conclusion Gender sensitivity within healthcare services was associated with differences in access to infertility care, although this finding should be interpreted cautiously. Gender-responsive approaches may support more equitable access to infertility treatment.