Narratives and behavioral perspectives: the overlooked role of infertility in reproductive health

Billions of dollars are spent on family planning in low- and middle-income countries each year. Despite this investment, about half of all pregnancies are still unintended. In recent years, there have been indications of progress against closing this gap, including meaningful commitments from country governments, increased investment in reproductive health supplies, and the development of new contraceptive technologies. There is, however, one issue that emerges in almost all research focused on women's needs and preferences related to reproductive health but has been woefully absent from the global agenda: infertility. Quality and accurate data are scarce, but studies suggest that one in six people is affected by infertility globally, with rates as high as 30-40% in parts of Sub-Saharan Africa. What if one of the most promising ways to meet family planning needs and goals was actually by addressing infertility? In a context of declining resources for reproductive health, adding infertility to the agenda may seem daunting. However, if we shift our health systems from treating infertility to preventing infertility we may be able to support more women in preventing and having pregnancies when they want them. Active investment and attention to infertility may also combat the efforts of anti-rights movements to link international actors with population control which can erode reproductive health gains. Challenging times call for unconventional thinking and addressing infertility may be the counterintuitive answer to making progress in family planning as well as more holistically answering the demands of women and families around the world.