Fear of Infertility Among Women in Africa: A Scoping Review of Qualitative Evidence

Fear of Infertility Among Women in Africa: A Scoping Review of Qualitative Evidence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Fear of Infertility Among Women in Africa: A Scoping Review of Qualitative Evidence Katrina Ihebunezie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7919584/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Fear of infertility (FOI) is frequently reported in reproductive health literature, but this topic has rarely been synthesised or reviewed comprehensively. The aim of this scoping review was to explore how infertile women in Africa perceive and experience infertility and to identify the main concepts related to FOI. Given the socio-cultural diversity across African countries, this review specifically focuses on qualitative studies to allow for a deeper understanding of the issue through women’s own voices. Methods Eligibility criteria for this review included qualitative studies reporting on the perspectives of infertile women across Africa, regardless of age. MEDLINE and CINAHL databases were searched for studies published in English from database inception to October 2025 using keywords related to Africa, infertility and fear. Additional studies were identified by hand-searching the reference lists of included articles. Studies were included if they explored the fear of infertility (FOI) and its impact on reproductive health and behaviour. Quantitative studies and those not focused on Africa were excluded. Results Of 248 citations identified, 11 qualitative studies were included. FOI was reported across various groups (e.g.,infertile married and unmarried women as well as religious leaders). Two types of fears emerged: (1) fear of causing infertility through reproductive choices (e.g., using contraception) and (2) fear of the ramifications of infertility (e.g., polygamy, divorce, stigma). Reasons for these fears were rooted in beliefs such as internal accumulation of menstrual blood, ovarian damage and deliberate toxicity. These fears influenced reproductive behaviour, including contraceptive use, help-seeking behaviours and social interactions. Many women expressed fear that infertility would lead to social exclusion. Conclusion The simultaneous desire for and fear of contraception in the African context can be understood within the broader social and economic uncertainties faced by many communities. The findings underscore the need for policymakers to address the fears surrounding modern contraception and its link to infertility. FOI is an important phenomenon that warrants further research to better understand its implications for reproductive health services. Misinformation and cultural distortions surrounding fertility must be addressed through education, sexual and reproductive health policies as well as improved counselling. Infert* Fear of Infertility Africa Qualitative Review Health-Seeking Behaviour Family planning Counselling Figures Figure 1 Lay Summary Parenthood is highly valued across many African cultures, which may lead to fears of infertility among both men and women. This fear, known as fear of infertility (FOI), is an important but often under-explored issue. To better understand this phenomenon, studies on FOI in African countries were reviewed. A total of 11 studies were analysed. These studies revealed that women in different African countries experience FOI in two main ways. First, many fear their reproductive choices, such as using family planning methods, cause infertility. Second, they fear the social consequences of being infertile, such as exclusion from their communities or divorce. These fears can influence their health behaviours, such as not using family planning correctly or engaging in behaviours that may harm their fertility. The review highlights the need for further research to understand why such fears persist and the importance of addressing these fears through education and policy. Background Infertility is defined as a disease of the reproductive system and a failure to conceive after 12 months of regular unprotected sexual intercourse [1;2]. A study initiated by the World Health Organisation, WHO, estimated that 1.9% of women aged 20–44 years old, which equates to 20 million couples, are globally impacted by primary subfertility [4]. In a study combining data from 47 demographic and health surveys in developing countries it was estimated that 186 million ever-married women of reproductive age (15–49) suffered primary of secondary subfertility [5;6]. In sub-Saharan Africa, infertility rates have been reported to range from 30% to 40% [6]. Beyond its medical definition, infertility carries complex sociocultural meanings, especially in African societies where parenthood is closely tied to social status, gender identity and economic security. Fear of infertility (FOI), the apprehension of being or becoming infertile, is a growing concern across reproductive health literature, particularly in Africa, where cultural beliefs and misinformation often shape health and reproductive choices [7;8;9]. FOI is known to influence decisions around contraceptive use, help-seeking behaviours and sexual health practices. These fears are often unsubstantiated but can significantly impact the uptake of modern family planning services [10;11;12;13]. Women living with infertility in Africa often face intense social stigma, exclusion and emotional distress [1]. Studies have linked infertility to mental health problems such as anxiety, depression, low self-esteem and suicidal ideation [14;15;16;17]. In many cases, women are subjected to physical violence, verbal abuse and marital instability. Some are labelled as witches, blamed for childlessness or considered socially ‘useless’ [16;18]. However, the severity of these consequences often varies by social class, educational level, and the presence of gender-supportive institutional frameworks [18]. In coping with infertility, some women turn to informal support networks, while others remain silent out of fear of judgment or further stigma [14;35;20]. Disclosure of infertility can worsen a woman’s image within her community and reinforce her sense of isolation. In Ghana, for example, women often pursue both biomedical and traditional healing pathways, sometimes engaging in harmful or ineffective treatments in their search for a cure [35]. While some report emotional support from partners, there is also fear that spousal support may decline if the infertility persists. Gendered experiences are particularly pronounced, with evidence suggesting that infertile women experience more severe psychological and social consequences than men [17;34]. In a study from the Greater Accra region, women described their infertility experience using terms such as “desperate”, “anxious” and “isolated,” further highlighting the emotional toll [34]. Despite the seriousness of these consequences, FOI remains under-explored in public health discourse [7]. Most existing research focuses on biomedical causes or population-level fertility rates, often overlooking the lived experiences of infertile women, particularly in sub-Saharan Africa [22]. Moreover, little attention has been given to the cultural and psychological dimensions of FOI [7]. A more nuanced understanding is needed to inform reproductive health policies and family planning programmes that are responsive to women’s fears, beliefs and sociocultural realities. This review seeks to address this gap by synthesising qualitative data on FOI among infertile women in Africa. By focusing on women’s own narratives, it seeks to provide deeper insights into how infertility is experienced, map the cultural factors that influence fears of infertility so as to understand how these perceptions shape reproductive health behaviours. Such evidence can support the integration of fertility-related concerns into broader sexual and reproductive health strategies across the continent. A scoping rapid review was conducted utilising a streamlined review process (e.g., condensed database search, restricted search timeframe and exclusion of a critical appraisal) to produce high-quality knowledge synthesis [7;23;36]. A synthesis of qualitative studies was undertaken to explore the meaning different ethnicities of women across Africa attach to FOI using their own words, rather than predefined concepts, so as to provide richer definitions that can be incorporated into practice and policy to support the integration of fertility care in reproductive health policy and services. A scoping review was chosen as it is well suited for exploring broad, under-explored topics like the fear of infertility (FOI), across diverse African contexts. Africa was selected for this review due to the complex sociocultural and economic factors that shape infertility perceptions, including the silence surrounding infertility, limited access to fertility treatments, and cultural taboos that often render infertility stigmatic [25–27]. Additionally, the scarcity of research on the diverse ethnicities and cultural constructions of fertility along with the lack of attention given to infertile populations in African countries, where fertility remains a central cultural value, renders women’s experiences of infertility less visible in local and global health policies [28;29]. These challenges highlight the need for a dedicated review of this issue within the African context. Review aim The aim of this review of qualitative studies was to explore how the experience of infertility is perceived by infertile women across Africa and to identify key concepts related to fear of infertility (FOI). Methods Search strategy Literature searches were conducted on databases such as MEDLINE and CINAHL for studies reported in English from database inception to October 2025 using terms such as fear AND infert* OR childless* OR subfecundity AND Africa OR list of all African countries [Additional File 1]. Additionally, fertility-related journals and the reference lists of included studies were searched to identify further relevant literature. CINAHL and Medline were selected as they are highly recommended for sourcing studies of relevance for a rapid review [7]. The inclusion criteria included: primary qualitative studies that reported on FOI and its impact on reproductive behaviour, ensuring a focus on infertile women of any age in African countries. Given the variability in how fear is expressed or conceptualised across contexts, studies were included even if they did not explicitly use the term "fear of infertility," provided they described behaviours, beliefs or concerns that implied fear, such as anxiety about contraceptive side effects, secrecy around childlessness or social consequences of infertility. This broad conceptual lens was consistent with scoping review methodology and allowed for the identification of FOI themes even where alternative or culturally specific language was used. Studies were excluded where the population was ethnically undefined, unfocused on African countries, did not explore either participant fear of causing infertility or participant fear of the ramifications of their infertility. Quantitative studies (including randomised controlled trials, interventional and surveys) and reviews were excluded. Studies that did not present original data such as review articles were also excluded to maintain a clear focus on in-depth, narrative accounts from participants but their list of references were searched for original research studies that met inclusion criteria. Conference abstracts were also excluded because they provide insufficient details of methodology [Additional File 2]. Study selection After removing duplicates manually or using the duplicate function of Endnote X7.5, the title and abstract of all identified studies from the search will be exported into Excel and inspected (199 records). A further 12 records were found through a hand search reference list. Following full-text review of 97 articles, 29 were excluded due to irrelevant populations, lack of focus on FOI or being systematic reviews. A total of 11 studies met the inclusion criteria [30;31;32;16;33;34;35; 36;12;13;37]. Data extraction The key details about study design, aim, recruitment, questions that related to FOI data, study context (timing, location, experience, severity of mental illness and other conditions), participants characteristics and findings related to FOI were extracted into a Microsoft Word document. A PRISMA flow diagram is used to visually present the study selection process (Fig. 1 ). The charting form was evaluated for comprehensiveness and consistency before data were summarised. Data extraction appeared consistent. Author then summarised the data from full-text articles, as reported in the next section. Critical Appraisal Consistent with scoping review methodology, no critical appraisal of the methodological quality of the included studies was performed [24]. Presentation of data Data were summarised in tables outlining demographic characteristics, study design and findings related to FOI. A narrative summary provided an overview of the main themes identified across the studies, including the types of fears (e.g., fear of infertility and fear of social ramifications) and their impacts on behaviour. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_SCr) checklist was followed [Additional File 3]. Results Study characteristics Phenomena of interest The thematic analysis of the 11 qualitative studies revealed two dominant manifestations of fear of infertility (FOI): Fear that health or reproductive choices may cause infertility Fear of the social ramifications of infertility Study characteristics are summarised in Tables 1 and 2 . Table 1 Characteristics of included studies relating to ‘causing infertility’ Author(s) Region, Country Methods of data collection Participants and Recruitment Focus of study Age (years) A) Qualitative descriptive 1. Otoide et al. 2001 [7] Benin City, Nigeria Focus groups (n = 20) of women (n = 149) that were were sexually active and those who were not sexually active. They were selected by their career • Abortion • Range: 15–24 2. Schuster 2005 [8] Anglophone, Cameroon Interviews and participant observation in hospital with women presenting with complications of unsafe abortions or who have had an induced abortion in their history identified through medical records (n = 58) or a snowball sample (n = 7). • Abortion • Not reported 3. Cover et al. 2017 [19] Gulu District, Uganda Interviews with adolescent women (n = 46) from a clinic and youth centre • Contraceptive self-injection • Range: 15–19 4. Krugu et al. [21] Bolgatanga, Ghana Interviews with women who have experienced pregnancy (n = 20) Recruited through adverts in public buildings (e.g., schools and health centres) • General contraception and Family Planning 5. Ndwamato and Ogunbanjo 2009 [24] Limpopo Province, South Africa Focus groups with multiparous women seen at a local hospital (n = 5) • General contraception and Family Planning • Not reported B) Ethnographic studies 6. Ochako et al. 2015 [26] Kismu, Mobasa and Thika, Kenya Interviews with sexually active women that were users (n = 20) and non-users of contraceptives (n = 11) and purposively selected from the community General contraception and Family Planning 16–19 (n = 13)/20–24 (n = 11) Table 2 Characteristics of included studies relating to ‘ramifications of infertility’ Author(s) Region, Country Methods of data collection Participants and Recruitment Focus of study Age (years) A) Qualitative descriptive 1. Fledderjohan 2012 [35] Accra, Ghana Interviews with women (n = 107) seeking treatment in gynaecological and obstetric clinics • Mean: 33 • Range: 21–48 2. Mabasa 2005 [36] Harare, Zimbabwe Interviews with infertile women (n = 9) infertile couples (n = 10) Recruited through researchers’ networks and snowball sampling • Mean: 36.9 • Range: 25–48 B) Qualitative phenomenological studies 3. Kamau 2012 [41] Nairobi Province, Kenya Interviews with infertile women (n = 10) Recruited though churches • Mean: 40.4 • Range: 29–54 C) Anthropological studies 4. Gerrits 1997 [42] Montepuez, Mozambique Interviews with infertile (n = 34) and fertile women (n = 10), traditional healers (n = 3); midwives (n = 3), physicians (n = 2), nurses (n = 3) from the community • Range: 19–50 5. Feldman-Savelsberg 1994 [43] Bangangte, Cameroon Narrative with infertile women Not provided Not reported Four studies examined FOI related to contraceptive use [34;35;36;37], and two explored the link between FOI and abortion [12;13]. Five studies addressed fears related to the social consequences of infertility [30;31;32;16;33]. Study design Most studies (n = 8) were qualitative descriptive in nature [12;13;35;34;36;16;33;30]. Two studies used anthropological approaches [31;32] and one employed an ethnographic design [37]. Participants Participants in studies relating to the fear of causing infertility were women who were both sexually active and inactive [12;37], those with prior experiences of pregnancy [34;36] or abortion [13]. Studies focused on the ramifications of infertility involved participants with fertility problems [16; 30–32], women attending gynaecological clinics [16], healthcare providers [31] and traditional healers [31]. Geographical Distribution The studies were conducted in Ghana (n = 2) [16;34], Cameroon (n = 2) [32;13], South Africa (n = 2) [36;33], Kenya (n = 2) [30;37], Nigeria (n = 1) [12], Mozambique (n = 1) [31] and Uganda (n = 1) [35]. Data Collection Focus In the FOI studies related to causing infertility, data emerged through questions on family planning [34;36;37], barriers to contraceptive use [37], and reproductive health choices. In studies addressing ramifications, relevant data arose from questions about sociocultural beliefs [30] and personal experiences with infertility [16;33;30]. Framing findings about fear Fears of ‘causing infertility’ studies Four studies described how participants expressed significant concerns that reproductive choices, especially modern contraceptives, could cause permanent sterility (Additional File 4) [12;13;34;36;37]. Across all studies, participants expressed scepticism about the safety of modern family planning methods [12;13;34;36;37]. Hormonal methods, such as oral pills and injectables [12;36;37] and long-acting reversible contraceptives (LARCs) like intrauterine devices and implants [36] were commonly believed to blood accumulation in the womb, ovarian damage, and even womb contamination [12;13;35;36;37]. Abortion was similarly feared for its perceived long-term impact on fertility, especially among younger women who believed repeated abortions would “spoil the womb” [13]. Misinformation and cultural myths played a key role in reinforcing these fears, with women relying on informal networks, peer accounts, or community leaders to assess the risks of modern contraception [12;37]. Fears around the ‘ramifications of infertility’ studies Four studies examined the social and psychological consequences associated with infertility (see Additional File 5). Women feared social isolation, stigma and diminished marital prospects. Participants reported strained relationships, abandonment and divorce, with some cohabiting partners refusing to marry due to family expectations around childbearing [36;30;32]. Infertility was seen to diminish women’s social standing and disrupt their sense of identity as wives and women [13;12;36]. Some women concealed their infertility, fearing judgement and shame from their communities. This secrecy contributed to mental health challenges such as depression, anxiety and loneliness [38;13;12;32]. Others described feeling incomplete or "not truly wives" due to childlessness, even when married [32]. Beliefs that infertility was caused by witchcraft or spiritual punishment further compounded stigma, especially in contexts where unexplained infertility was attributed to supernatural forces [36;30;32]. In these settings, infertility became not only a medical concern but a symbolic marker of misfortune and spiritual vulnerability [32]. Reported Consequences of Fear of Infertility FOI shaped a range of reproductive behaviours. Many women avoided or misused modern contraceptives due to fears of sterility, opting instead for less effective methods or none at all [35;37]. In some cases, women preferred abortion to contraception, believing it was less likely to cause long-term infertility [12]. Additionally, some women deliberately avoided or misused contraceptives either to preserve their perceived fertility or to demonstrate their ability to conceive to their communities [12;13]. Community beliefs further influenced these behaviours. Elders and traditional leaders often discouraged contraceptive use among nulliparous women, warning it would threaten their future fertility. Injectables, however, were more accepted among women who already had children [37]. Partner dynamics were also influential. Husbands often discouraged their wives from using contraception, sometimes exerting reproductive coercion out of fear that modern methods would harm fertility [34]. Some women reported that, in contexts where infertility persisted, their husbands took second wives or ended engagements during cohabitation for fear of disapproval from their families. In response, some women sought extramarital sexual relationships to conceive and secure their marriages, especially when infertility was assumed to be the woman’s fault [36]. However, this was not reported when the husband's infertility was known and acknowledged [36]. In the absence of biomedical solutions, traditional healers and spiritual leaders emerged as important sources of support for women struggling to conceive [36;30;33;31]. This finding is supported by broader literature, which highlights the influential role of religious and traditional leaders in shaping reproductive beliefs and guiding women’s health-seeking behaviours [40–43]. These figures often functioned both as trusted advisors and at times as barriers to contraceptive uptake [40–43;36;30;39;33;31]. Practices, which included prayer, fasting, use of herbal medicines as well as rituals aimed at removing ancestral curses or invoking divine intervention, were often passed down intergenerationally and seen as essential to restoring fertility [40;44;45;30;33;31]. Some women reported using both Western and traditional remedies simultaneously [30;33;31]. However, given the lack of regulation of herbal medicine in many African countries, the use of unverified or counterfeit remedies raised concerns about efficacy, potential harm as well as drug interactions [40]. The psychological burden of FOI was a consistent theme across the included studies. Women reported persistent worry, loneliness, shame and depression [12;32]. Consistent with wider empirical evidence, this review found that some women avoided discussing their struggles, even with family members, out of fear of further stigma or being perceived as spiritually "cursed" or socially "useless" [9;13;46]. The review also highlighted that infertility was viewed as a hidden disability as it appears difficult to conceal yet too stigmatised to discuss openly [32;12] Attempts to present oneself as fertile were often undermined by societal expectations of motherhood, making infertility a socially visible absence. While patterns of FOI were relatively consistent across the included studies, the limited number of studies per country constrained opportunities for in-depth cross-country comparisons. Nonetheless, a shared experience of FOI emerged across African contexts, shaped by intersecting structural and cultural forces such as poverty, restricted access to healthcare, patriarchal gender norms and spiritual beliefs systems [32;47;48;49]. Broader anthropological literature reinforces these findings, suggesting that access to healthcare and education plays a critical in shaping how women perceive and respond to infertility [32;47]. In high-fertility settings, childbearing is viewed as a social accomplishment that demands not only biological capability but cultural knowledge, economic resources, kinship networks and ritual practices [32;47]. Feldman-Savelsberg further notes that post-Cold War political and economic upheavals in Africa disproportionately affected the vulnerability of women living in rural regions, particularly subsistence farmers with limited education, income and mobility [32]. These structural inequalities help explain the heightened prevalence and intensity of FOI in socioeconomically disadvantaged rural regions, where childlessness carries significant social stigma [34;50–52]. children serve as an asset that allows parents to transfer income to old age. From this perspective, parents continue to give birth to safeguard economic support in their old age Conclusion This scoping review identified and explored two interrelated types of fear of infertility (FOI) among African women: the fear that reproductive choices, particularly contraceptive use and abortion, may cause infertility and the fear of the social, relational and spiritual ramifications of infertility. These fears are not isolated psychological responses but are deeply embedded in sociocultural, economic and spiritual frameworks that shape reproductive behaviours and access to health services across the African continent. FOI was shown to influence women’s contraceptive decisions, relationships, psychological wellbeing and help-seeking patterns. It also emerged as a pervasive, under-explored phenomenon with significant implications for sexual and reproductive health outcomes. Despite its widespread impact, infertility remains marginalised in health policy discourse, where the dominant focus has been on reducing fertility rates and increasing contraceptive uptake, particularly in the context of sub-Saharan Africa. While modern contraception has contributed to lowering fertility rates, its association with a fear of fertility has produced unintended consequences. Misinformation, often compounded by historical distrust in biomedical interventions, contributes to the belief that modern contraceptive methods such as hormonal and long-acting options cause permanent sterility. This fear is particularly potent among young, nulliparous women, leading many to avoid effective contraception entirely or rely on traditional methods with limited efficacy [12;13;35;34;36;37]. Equally significant is the fear of the social ramifications of infertility. Across all included studies, infertility was linked to social exclusion, marital instability and psychological distress. Women reported fears of abandonment, polygamy and divorce. Some concealed their condition due to shame. This resulted in isolation, anxiety and loss of identity. Even within marriage, many women internalised these stigmas feeling as though they were “not truly wives” without children [9;13;12]. Motherhood was consistently constructed as a central marker of womanhood, with some participants reporting they had been taught from childhood that their worth lay in bearing children and that without children they are “incomplete” [32]. In several contexts, infertility was interpreted as spiritual punishment or the result of witchcraft, further intensifying the stigma and sense of exclusion [32;40;41;42]. These beliefs could be as emotionally threatening as infertility itself [32]. Empirical evidence highlights that the threat of the stigma and poverty linked to childlessness tends to erode social support networks and therapy management groups over time [48]. An included study highlights that infertility fears were grounded in material realities, especially impoverishment and that infertility functioned as an “idiom of vulnerability” [32]. In this view, children represent not only emotional fulfilment but also markers of competence and as assets that allow a transferral of income to old age [53]. From this perspective, the continued pursuit to conceive becomes an attempt to safeguard economic support in old age as children become important sources of social mobility and protection. FOI also shaped health-seeking behaviour. Many women turned to spiritual and traditional healers rather than biomedical services as an intergenerational practice, seeking fasting, prayer, herbal treatments and rituals believed to restore infertility or protect against ancestral curses [40;44;45;36;30]. These practices reflect not only cultural submission but also a perceived dependency on divine or spiritual intervention to orchestrate their health outcomes, which influenced their approach to facility care [40;44;45]. While some combined these with biomedical interventions, concerns around the safety, efficacy and regulation of traditional medicines remain [40]. In some cases, fear of permanent sterility led to high-risk behaviours, such as engaging in multiple or concurrent sexual partnerships in an attempt to conceive [36]. Studies also highlighted that pregnancy was seen as a prerequisite for marital commitment, with some cohabiting male partners refusing to marry unless fertility was proven for fear of familial disapproval [36]. Beyond behavioural consequences, FOI was reported to have serious psychological effects including chronic worry, shame, diminished self-worth and depression in the included studies. These emotional burdens were often exacerbated by the silence and secrecy surrounding infertility, especially in communities where fertility conferred social value, inheritance rights and future security [32;13;32,33]. A significant limitation in addressing FOI is its near absence in both research and policy. Notably, only one of the 11 included studies had FOI as a primary focus, which may reflect the broader neglect of infertility within African reproductive health agendas. If policies and programmes promote contraceptive use without addressing the fears surrounding it, public health goals may risk being undermined. Particularly among adolescents and young women, ignoring FOI may limit contraceptive uptake and hinder efforts to reduce unintended pregnancies. Engaging with FOI requires a multi-level approach. Firstly, public health messaging must directly confront myths about infertility and contraception. Educational interventions, targeting both service users and providers should clarify the relationship between contraceptive methods and fertility. Notably, some health educators held beliefs in FOI, suggesting that provider education and cultural competency training within healthcare systems is essential [40;7]. This could include merging biomedical health services with Indigenous cultural practices to ensure services are respectful, inclusive and responsive to women’s beliefs and lived experiences [40;54;55]. Secondly spiritual and traditional leaders, are influential figures in many communities who shape reproductive norms. Their engagement is vital for disseminating accurate health information, reducing stigma, and promoting culturally appropriate fertility care. However, it is vital that there is stronger oversight of herbal medicine to ensure safety, prevent harmful interactions and integrate promising remedies with evidence-based care. Pharmaceutical evaluation of commonly used traditional treatments could improve both trust and outcomes. Thirdly, integrating infertility into sexual and reproductive health policy is critical. Infertility should no longer be treated as a secondary issue or a private matter. It is crucial for policies to include prevention (e.g., STI treatment and safe abortion care), early diagnosis, counselling and equitable access to fertility treatment. Infertile individuals, especially women, should be recognised as a priority population for reproductive health services. Support mechanisms such as counselling and peer groups are essential for addressing the emotional toll of FOI. Finally, more empirical studies are urgently needed to explore how FOI is developed, transmitted and sustained. Research could examine the role of gender as well as power and evaluate the effectiveness of interventions aimed at dispelling FOI. Mixed-method and longitudinal studies could help deepen understanding of FOI’s impact over time, In summary, fear of infertility represents a profound yet neglected barrier to reproductive health equity in Africa. It is not merely a by-product of misinformation but reflects deeply rooted cultural, gendered and spiritual anxieties. Addressing FOI requires more than technical solutions, it demands respectful, culturally grounded care and a restructuring of reproductive health priorities to include infertility. Only by explicitly acknowledging FOI within reproductive health programming can we ensure that African women are empowered to make safe, informed and autonomous reproductive choices. Limitations The qualitative focus of this review allowed for an exploration of women's experiences but limited the ability to assess the prevalence or distribution of FOI across regions and populations, insights that quantitative studies could provide. Additionally, while this review offers a thematic synthesis of how FOI is experienced, it does not fully capture the processes by which these fears are formed, transmitted or managed over time. These represent important areas for future empirical investigation. A further limitation of this review was the challenge of identifying all relevant studies on Fear of Infertility (FOI), due in part to the absence of “fear” as a Medical Subject Headings (MeSH) term and the varied terminology used to express fear-related experiences (e.g., “worried” or “anxious”). The scoping review methodology also imposed inherent constraints, including a streamlined search strategy, lack of formal quality appraisal and the exclusion of non-English as well as quantitative studies. This likely led to the exclusion of studies where FOI was present but not explicitly labelled as such. In summary, FOI encompasses two interrelated domains: the fear of causing infertility through reproductive health choices and the fear of the ramifications of infertility, including social exclusion, relationship instability and spiritual distress. Given its influence on contraceptive behaviour, care-seeking and mental health, FOI remains an under-explored yet critical issue that warrants greater attention in both policy and culturally sensitive reproductive health research and programming. Declarations Consent for publication Not applicable as this is a review. Ethics approval and consent to participate Not applicable as this is a review. Funding Not applicable as this is a review Author Contribution KI synthesised the data critically reviewed, discussed and finalised the submitted manuscript, and (will) contribute to all revisions. Author agrees to be accountable for the work and to investigate and resolve any issues related to the accuracy or integrity of the work. Acknowledgements Not applicable as this is a review Availability of data and materials All data generated or analysed during this study are included in this published article [and its supplementary information files] Competing interests Not applicable as this is a review. References Roomaney R, Salie M, Jenkins D, Mutumba-Nakalembe MJ, Volks C, Holland N, Silingile K. A scoping review of the psychosocial aspects of infertility in African countries. 2024; 21:123. 10.1186/s12978-024-01858-2 Zegers-Hochschild F, Adamson D, de Mouzon J, Ishihara O, Mansour R, Nygren K, Sullivan E, van der Poel S. 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Factors influencing adoption of facility-assisted delivery-a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania. BMC Pregnancy Childbirth. 2020;20(1):100–100. Ojih SE, Adeyeye B, Onoja IB, Adesina E, Omole F, Kayode-Adedeji T. Cultural practices and adoption of national family planning communication campaigns on select ethnic groups in Nigeria. Healthcare. 2023;11(4):495. Aziato L, Odai PN, Omenyo CN. Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana. BMC Pregnancy Childbirth. 2016;16:1. Ohaja M, Murphy-Lawless J, Dunlea M. Religion and spirituality in pregnancy and birth: the views of birth practitioners in Southeast Nigeria. Religions. 2019;10(2):82. Dierickx S, Rahbari L, Longman C, Jaiteh F, Coene G. ‘I am always crying on the inside’: a qualitative study on the implications of infertility on women’s lives in urban Gambia. Reprod Health. 2018;15. Bledsoe C. Reproduction and Aging in the Rural Gambia: African Empirical Challenges for the Culture of Western Science. Unpublished MS; 1997. Inhorn M. Quest for Conception: Gender, Infertility, and Egyptian Medical Traditions. Philadelphia: University of Pennsylvania; 1994. Farmer P. Bad blood, spoiled milk: Bodily fluids as moral barometers in rural Haiti. Am Ethnologist. 1988;15(1):62–83. Polis CB, Hussain R, Berry A. There might be blood: a scoping review on women’s responses to contraceptive-induced menstrual bleeding changes. Reprod Health. 2018;15:114. Ackerson K, Zielinski R. Factors influencing use of family planning in women living in crisis affected areas of sub-Saharan Africa: a review of the literature. Midwifery. 2017;54:35–60. d’Arcangues CM, Ba-Thike K, Say L. Expanding contraceptive choice in the developing world: lessons from the Lao People’s Democratic Republic and the Republic of Zambia. Eur J Contracept Reprod Health Care. 2013;18:421–34. Asante-Afari K, Doku DT, Darteh EKM. Transition to motherhood following the use of assisted reproductive technologies: experiences of women in Ghana. PLoS ONE. 2022;17(4):1–13. Lattof SR, Moran AC, Kidula N, Moller AB, Jayathilaka CA, Diaz T, Tunçalp Ö. Implementation of the new WHO antenatal care model for a positive pregnancy experience: a monitoring framework. BMJ Glob Health. 2020;5(6):e002605. Government of Canada. Chapter 3: Care during pregnancy. 2024. https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-3.html#a2 . Accessed 06 Oct 2025. Additional Declarations No competing interests reported. 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This fear, known as fear of infertility (FOI), is an important but often under-explored issue. To better understand this phenomenon, studies on FOI in African countries were reviewed. A total of 11 studies were analysed. These studies revealed that women in different African countries experience FOI in two main ways. First, many fear their reproductive choices, such as using family planning methods, cause infertility. \u0026nbsp;Second, they fear the social consequences of being infertile, such as exclusion from their communities or divorce. These fears can influence their health behaviours, such as not using family planning correctly or engaging in behaviours that may harm their fertility. The review highlights the need for further research to understand why such fears persist and the importance of addressing these fears through education and policy.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eInfertility is defined as a disease of the reproductive system and a failure to conceive after 12 months of regular unprotected sexual intercourse [1;2]. A study initiated by the World Health Organisation, WHO, estimated that 1.9% of women aged 20\u0026ndash;44 years old, which equates to 20\u0026nbsp;million couples, are globally impacted by primary subfertility [4]. In a study combining data from 47 demographic and health surveys in developing countries it was estimated that 186\u0026nbsp;million ever-married women of reproductive age (15\u0026ndash;49) suffered primary of secondary subfertility [5;6]. In sub-Saharan Africa, infertility rates have been reported to range from 30% to 40% [6].\u003c/p\u003e\u003cp\u003eBeyond its medical definition, infertility carries complex sociocultural meanings, especially in African societies where parenthood is closely tied to social status, gender identity and economic security. Fear of infertility (FOI), the apprehension of being or becoming infertile, is a growing concern across reproductive health literature, particularly in Africa, where cultural beliefs and misinformation often shape health and reproductive choices [7;8;9]. FOI is known to influence decisions around contraceptive use, help-seeking behaviours and sexual health practices. These fears are often unsubstantiated but can significantly impact the uptake of modern family planning services [10;11;12;13].\u003c/p\u003e\u003cp\u003eWomen living with infertility in Africa often face intense social stigma, exclusion and emotional distress [1]. Studies have linked infertility to mental health problems such as anxiety, depression, low self-esteem and suicidal ideation [14;15;16;17]. In many cases, women are subjected to physical violence, verbal abuse and marital instability. Some are labelled as witches, blamed for childlessness or considered socially \u0026lsquo;useless\u0026rsquo; [16;18]. However, the severity of these consequences often varies by social class, educational level, and the presence of gender-supportive institutional frameworks [18].\u003c/p\u003e\u003cp\u003eIn coping with infertility, some women turn to informal support networks, while others remain silent out of fear of judgment or further stigma [14;35;20]. Disclosure of infertility can worsen a woman\u0026rsquo;s image within her community and reinforce her sense of isolation. In Ghana, for example, women often pursue both biomedical and traditional healing pathways, sometimes engaging in harmful or ineffective treatments in their search for a cure [35]. While some report emotional support from partners, there is also fear that spousal support may decline if the infertility persists. Gendered experiences are particularly pronounced, with evidence suggesting that infertile women experience more severe psychological and social consequences than men [17;34]. In a study from the Greater Accra region, women described their infertility experience using terms such as \u0026ldquo;desperate\u0026rdquo;, \u0026ldquo;anxious\u0026rdquo; and \u0026ldquo;isolated,\u0026rdquo; further highlighting the emotional toll [34].\u003c/p\u003e\u003cp\u003eDespite the seriousness of these consequences, FOI remains under-explored in public health discourse [7]. Most existing research focuses on biomedical causes or population-level fertility rates, often overlooking the lived experiences of infertile women, particularly in sub-Saharan Africa [22]. Moreover, little attention has been given to the cultural and psychological dimensions of FOI [7]. A more nuanced understanding is needed to inform reproductive health policies and family planning programmes that are responsive to women\u0026rsquo;s fears, beliefs and sociocultural realities.\u003c/p\u003e\u003cp\u003eThis review seeks to address this gap by synthesising qualitative data on FOI among infertile women in Africa. By focusing on women\u0026rsquo;s own narratives, it seeks to provide deeper insights into how infertility is experienced, map the cultural factors that influence fears of infertility so as to understand how these perceptions shape reproductive health behaviours. Such evidence can support the integration of fertility-related concerns into broader sexual and reproductive health strategies across the continent.\u003c/p\u003e\u003cp\u003eA scoping rapid review was conducted utilising a streamlined review process (e.g., condensed database search, restricted search timeframe and exclusion of a critical appraisal) to produce high-quality knowledge synthesis [7;23;36]. A synthesis of qualitative studies was undertaken to explore the meaning different ethnicities of women across Africa attach to FOI using their own words, rather than predefined concepts, so as to provide richer definitions that can be incorporated into practice and policy to support the integration of fertility care in reproductive health policy and services. A scoping review was chosen as it is well suited for exploring broad, under-explored topics like the fear of infertility (FOI), across diverse African contexts. Africa was selected for this review due to the complex sociocultural and economic factors that shape infertility perceptions, including the silence surrounding infertility, limited access to fertility treatments, and cultural taboos that often render infertility stigmatic [25\u0026ndash;27]. Additionally, the scarcity of research on the diverse ethnicities and cultural constructions of fertility along with the lack of attention given to infertile populations in African countries, where fertility remains a central cultural value, renders women\u0026rsquo;s experiences of infertility less visible in local and global health policies [28;29]. These challenges highlight the need for a dedicated review of this issue within the African context.\u003c/p\u003e\n\u003ch3\u003eReview aim\u003c/h3\u003e\n\u003cp\u003eThe aim of this review of qualitative studies was to explore how the experience of infertility is perceived by infertile women across Africa and to identify key concepts related to fear of infertility (FOI).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003eSearch strategy\u003c/p\u003e\u003cp\u003eLiterature searches were conducted on databases such as MEDLINE and CINAHL for studies reported in English from database inception to October 2025 using terms such as fear AND infert* OR childless* OR subfecundity AND Africa OR list of all African countries [Additional File 1]. Additionally, fertility-related journals and the reference lists of included studies were searched to identify further relevant literature. CINAHL and Medline were selected as they are highly recommended for sourcing studies of relevance for a rapid review [7].\u003c/p\u003e\u003cp\u003eThe inclusion criteria included: primary qualitative studies that reported on FOI and its impact on reproductive behaviour, ensuring a focus on infertile women of any age in African countries. Given the variability in how fear is expressed or conceptualised across contexts, studies were included even if they did not explicitly use the term \"fear of infertility,\" provided they described behaviours, beliefs or concerns that implied fear, such as anxiety about contraceptive side effects, secrecy around childlessness or social consequences of infertility. This broad conceptual lens was consistent with scoping review methodology and allowed for the identification of FOI themes even where alternative or culturally specific language was used. Studies were excluded where the population was ethnically undefined, unfocused on African countries, did not explore either participant fear of causing infertility or participant fear of the ramifications of their infertility. Quantitative studies (including randomised controlled trials, interventional and surveys) and reviews were excluded. Studies that did not present original data such as review articles were also excluded to maintain a clear focus on in-depth, narrative accounts from participants but their list of references were searched for original research studies that met inclusion criteria. Conference abstracts were also excluded because they provide insufficient details of methodology [Additional File 2].\u003c/p\u003e\u003cp\u003eStudy selection\u003c/p\u003e\u003cp\u003eAfter removing duplicates manually or using the duplicate function of Endnote X7.5, the title and abstract of all identified studies from the search will be exported into Excel and inspected (199 records). A further 12 records were found through a hand search reference list. Following full-text review of 97 articles, 29 were excluded due to irrelevant populations, lack of focus on FOI or being systematic reviews. A total of 11 studies met the inclusion criteria [30;31;32;16;33;34;35; 36;12;13;37].\u003c/p\u003e\u003cp\u003eData extraction\u003c/p\u003e\u003cp\u003eThe key details about study design, aim, recruitment, questions that related to FOI data, study context (timing, location, experience, severity of mental illness and other conditions), participants characteristics and findings related to FOI were extracted into a Microsoft Word document. A PRISMA flow diagram is used to visually present the study selection process (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe charting form was evaluated for comprehensiveness and consistency before data were summarised. Data extraction appeared consistent. Author then summarised the data from full-text articles, as reported in the next section.\u003c/p\u003e\u003cp\u003eCritical Appraisal\u003c/p\u003e\u003cp\u003eConsistent with scoping review methodology, no critical appraisal of the methodological quality of the included studies was performed [24].\u003c/p\u003e\u003cp\u003ePresentation of data\u003c/p\u003e\u003cp\u003eData were summarised in tables outlining demographic characteristics, study design and findings related to FOI. A narrative summary provided an overview of the main themes identified across the studies, including the types of fears (e.g., fear of infertility and fear of social ramifications) and their impacts on behaviour. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA_SCr) checklist was followed [Additional File 3].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStudy characteristics\u003c/h2\u003e\u003cp\u003ePhenomena of interest\u003c/p\u003e\u003cp\u003eThe thematic analysis of the 11 qualitative studies revealed two dominant manifestations of fear of infertility (FOI):\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFear that health or reproductive choices may cause infertility\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eFear of the social ramifications of infertility\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eStudy characteristics are summarised in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of included studies relating to \u0026lsquo;causing infertility\u0026rsquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(s)\u003c/p\u003e\u003cp\u003eRegion, Country\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMethods of data collection\u003c/p\u003e\u003cp\u003eParticipants and Recruitment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFocus of study\u003c/p\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA) Qualitative descriptive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Otoide et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2001\u003c/span\u003e [7]\u003c/p\u003e\u003cp\u003eBenin City, Nigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFocus groups (n\u0026thinsp;=\u0026thinsp;20) of women (n\u0026thinsp;=\u0026thinsp;149) that were were sexually active and those who were not sexually active. They were selected by their career\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Abortion\u003c/p\u003e\u003cp\u003e\u0026bull; Range: 15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Schuster \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2005\u003c/span\u003e [8]\u003c/p\u003e\u003cp\u003eAnglophone, Cameroon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews and participant observation in hospital with women presenting with complications of unsafe abortions or who have had an induced abortion in their history identified through medical records (n\u0026thinsp;=\u0026thinsp;58) or a snowball sample (n\u0026thinsp;=\u0026thinsp;7).\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Abortion\u003c/p\u003e\u003cp\u003e\u0026bull; Not reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Cover et al. \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2017\u003c/span\u003e [19]\u003c/p\u003e\u003cp\u003eGulu District, Uganda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with adolescent women (n\u0026thinsp;=\u0026thinsp;46) from a clinic and youth centre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Contraceptive self-injection\u003c/p\u003e\u003cp\u003e\u0026bull; Range: 15\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Krugu et al. [21]\u003c/p\u003e\u003cp\u003eBolgatanga, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with women who have experienced pregnancy (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\u003cp\u003eRecruited through adverts in public buildings (e.g., schools and health centres)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; General contraception and Family Planning\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Ndwamato and Ogunbanjo \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2009\u003c/span\u003e [24]\u003c/p\u003e\u003cp\u003eLimpopo Province, South Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFocus groups with multiparous women seen at a local hospital (n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; General contraception and Family Planning\u003c/p\u003e\u003cp\u003e\u0026bull; Not reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eB) Ethnographic studies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Ochako et al. \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2015\u003c/span\u003e [26]\u003c/p\u003e\u003cp\u003eKismu, Mobasa and Thika, Kenya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with sexually active women that were users (n\u0026thinsp;=\u0026thinsp;20) and non-users of contraceptives (n\u0026thinsp;=\u0026thinsp;11) and purposively selected from the community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGeneral contraception and Family Planning\u003c/p\u003e\u003cp\u003e16\u0026ndash;19 (n\u0026thinsp;=\u0026thinsp;13)/20\u0026ndash;24 (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of included studies relating to \u0026lsquo;ramifications of infertility\u0026rsquo;\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(s)\u003c/p\u003e\u003cp\u003eRegion, Country\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMethods of data collection\u003c/p\u003e\u003cp\u003eParticipants and Recruitment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFocus of study\u003c/p\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA) Qualitative descriptive\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Fledderjohan 2012 [35]\u003c/p\u003e\u003cp\u003eAccra, Ghana\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with women (n\u0026thinsp;=\u0026thinsp;107) seeking treatment in gynaecological\u003c/p\u003e\u003cp\u003eand obstetric clinics\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Mean: 33\u003c/p\u003e\u003cp\u003e\u0026bull; Range: 21\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Mabasa 2005 [36]\u003c/p\u003e\u003cp\u003eHarare, Zimbabwe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with infertile women (n\u0026thinsp;=\u0026thinsp;9) infertile couples (n\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e\u003cp\u003eRecruited through researchers\u0026rsquo; networks and snowball sampling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Mean: 36.9\u003c/p\u003e\u003cp\u003e\u0026bull; Range: 25\u0026ndash;48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eB) Qualitative phenomenological studies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Kamau 2012 [41]\u003c/p\u003e\u003cp\u003eNairobi Province, Kenya\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with infertile women (n\u0026thinsp;=\u0026thinsp;10) Recruited though churches\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Mean: 40.4\u003c/p\u003e\u003cp\u003e\u0026bull; Range: 29\u0026ndash;54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eC) Anthropological studies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Gerrits \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e1997\u003c/span\u003e [42]\u003c/p\u003e\u003cp\u003eMontepuez, Mozambique\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterviews with infertile (n\u0026thinsp;=\u0026thinsp;34) and fertile women (n\u0026thinsp;=\u0026thinsp;10), traditional healers (n\u0026thinsp;=\u0026thinsp;3); midwives (n\u0026thinsp;=\u0026thinsp;3), physicians (n\u0026thinsp;=\u0026thinsp;2), nurses (n\u0026thinsp;=\u0026thinsp;3) from the community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026bull; Range: 19\u0026ndash;50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Feldman-Savelsberg \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1994\u003c/span\u003e [43]\u003c/p\u003e\u003cp\u003eBangangte, Cameroon\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNarrative with infertile women\u003c/p\u003e\u003cp\u003eNot provided\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNot reported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFour studies examined FOI related to contraceptive use [34;35;36;37], and two explored the link between FOI and abortion [12;13]. Five studies addressed fears related to the social consequences of infertility [30;31;32;16;33].\u003c/p\u003e\u003cp\u003eStudy design\u003c/p\u003e\u003cp\u003eMost studies (n\u0026thinsp;=\u0026thinsp;8) were qualitative descriptive in nature [12;13;35;34;36;16;33;30]. Two studies used anthropological approaches [31;32] and one employed an ethnographic design [37].\u003c/p\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003eParticipants in studies relating to the fear of causing infertility were women who were both sexually active and inactive [12;37], those with prior experiences of pregnancy [34;36] or abortion [13].\u003c/p\u003e\u003cp\u003eStudies focused on the ramifications of infertility involved participants with fertility problems [16; 30\u0026ndash;32], women attending gynaecological clinics [16], healthcare providers [31] and traditional healers [31].\u003c/p\u003e\u003cp\u003eGeographical Distribution\u003c/p\u003e\u003cp\u003eThe studies were conducted in Ghana (n\u0026thinsp;=\u0026thinsp;2) [16;34], Cameroon (n\u0026thinsp;=\u0026thinsp;2) [32;13], South Africa (n\u0026thinsp;=\u0026thinsp;2) [36;33], Kenya (n\u0026thinsp;=\u0026thinsp;2) [30;37], Nigeria (n\u0026thinsp;=\u0026thinsp;1) [12], Mozambique (n\u0026thinsp;=\u0026thinsp;1) [31] and Uganda (n\u0026thinsp;=\u0026thinsp;1) [35].\u003c/p\u003e\u003cp\u003eData Collection Focus\u003c/p\u003e\u003cp\u003eIn the FOI studies related to causing infertility, data emerged through questions on family planning [34;36;37], barriers to contraceptive use [37], and reproductive health choices. In studies addressing ramifications, relevant data arose from questions about sociocultural beliefs [30] and personal experiences with infertility [16;33;30].\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eFraming findings about fear\u003c/h3\u003e\n\u003cp\u003eFears of \u0026lsquo;causing infertility\u0026rsquo; studies\u003c/p\u003e\u003cp\u003eFour studies described how participants expressed significant concerns that reproductive choices, especially modern contraceptives, could cause permanent sterility (Additional File 4) [12;13;34;36;37]. Across all studies, participants expressed scepticism about the safety of modern family planning methods [12;13;34;36;37]. Hormonal methods, such as oral pills and injectables [12;36;37] and long-acting reversible contraceptives (LARCs) like intrauterine devices and implants [36] were commonly believed to blood accumulation in the womb, ovarian damage, and even womb contamination [12;13;35;36;37].\u003c/p\u003e\u003cp\u003eAbortion was similarly feared for its perceived long-term impact on fertility, especially among younger women who believed repeated abortions would \u0026ldquo;spoil the womb\u0026rdquo; [13]. Misinformation and cultural myths played a key role in reinforcing these fears, with women relying on informal networks, peer accounts, or community leaders to assess the risks of modern contraception [12;37].\u003c/p\u003e\u003cp\u003eFears around the \u0026lsquo;ramifications of infertility\u0026rsquo; studies\u003c/p\u003e\u003cp\u003eFour studies examined the social and psychological consequences associated with infertility (see Additional File 5). Women feared social isolation, stigma and diminished marital prospects. Participants reported strained relationships, abandonment and divorce, with some cohabiting partners refusing to marry due to family expectations around childbearing [36;30;32]. Infertility was seen to diminish women\u0026rsquo;s social standing and disrupt their sense of identity as wives and women [13;12;36].\u003c/p\u003e\u003cp\u003eSome women concealed their infertility, fearing judgement and shame from their communities. This secrecy contributed to mental health challenges such as depression, anxiety and loneliness [38;13;12;32]. Others described feeling incomplete or \"not truly wives\" due to childlessness, even when married [32].\u003c/p\u003e\u003cp\u003eBeliefs that infertility was caused by witchcraft or spiritual punishment further compounded stigma, especially in contexts where unexplained infertility was attributed to supernatural forces [36;30;32]. In these settings, infertility became not only a medical concern but a symbolic marker of misfortune and spiritual vulnerability [32].\u003c/p\u003e\u003cp\u003eReported Consequences of Fear of Infertility\u003c/p\u003e\u003cp\u003eFOI shaped a range of reproductive behaviours. Many women avoided or misused modern contraceptives due to fears of sterility, opting instead for less effective methods or none at all [35;37]. In some cases, women preferred abortion to contraception, believing it was less likely to cause long-term infertility [12].\u003c/p\u003e\u003cp\u003eAdditionally, some women deliberately avoided or misused contraceptives either to preserve their perceived fertility or to demonstrate their ability to conceive to their communities [12;13]. Community beliefs further influenced these behaviours. Elders and traditional leaders often discouraged contraceptive use among nulliparous women, warning it would threaten their future fertility. Injectables, however, were more accepted among women who already had children [37].\u003c/p\u003e\u003cp\u003ePartner dynamics were also influential. Husbands often discouraged their wives from using contraception, sometimes exerting reproductive coercion out of fear that modern methods would harm fertility [34]. Some women reported that, in contexts where infertility persisted, their husbands took second wives or ended engagements during cohabitation for fear of disapproval from their families. In response, some women sought extramarital sexual relationships to conceive and secure their marriages, especially when infertility was assumed to be the woman\u0026rsquo;s fault [36]. However, this was not reported when the husband's infertility was known and acknowledged [36].\u003c/p\u003e\u003cp\u003eIn the absence of biomedical solutions, traditional healers and spiritual leaders emerged as important sources of support for women struggling to conceive [36;30;33;31]. This finding is supported by broader literature, which highlights the influential role of religious and traditional leaders in shaping reproductive beliefs and guiding women\u0026rsquo;s health-seeking behaviours [40\u0026ndash;43]. These figures often functioned both as trusted advisors and at times as barriers to contraceptive uptake [40\u0026ndash;43;36;30;39;33;31]. Practices, which included prayer, fasting, use of herbal medicines as well as rituals aimed at removing ancestral curses or invoking divine intervention, were often passed down intergenerationally and seen as essential to restoring fertility [40;44;45;30;33;31]. Some women reported using both Western and traditional remedies simultaneously [30;33;31]. However, given the lack of regulation of herbal medicine in many African countries, the use of unverified or counterfeit remedies raised concerns about efficacy, potential harm as well as drug interactions [40].\u003c/p\u003e\u003cp\u003eThe psychological burden of FOI was a consistent theme across the included studies. Women reported persistent worry, loneliness, shame and depression [12;32]. Consistent with wider empirical evidence, this review found that some women avoided discussing their struggles, even with family members, out of fear of further stigma or being perceived as spiritually \"cursed\" or socially \"useless\" [9;13;46].\u003c/p\u003e\u003cp\u003eThe review also highlighted that infertility was viewed as a hidden disability as it appears difficult to conceal yet too stigmatised to discuss openly [32;12] Attempts to present oneself as fertile were often undermined by societal expectations of motherhood, making infertility a socially visible absence.\u003c/p\u003e\u003cp\u003eWhile patterns of FOI were relatively consistent across the included studies, the limited number of studies per country constrained opportunities for in-depth cross-country comparisons. Nonetheless, a shared experience of FOI emerged across African contexts, shaped by intersecting structural and cultural forces such as poverty, restricted access to healthcare, patriarchal gender norms and spiritual beliefs systems [32;47;48;49].\u003c/p\u003e\u003cp\u003eBroader anthropological literature reinforces these findings, suggesting that access to healthcare and education plays a critical in shaping how women perceive and respond to infertility [32;47]. In high-fertility settings, childbearing is viewed as a social accomplishment that demands not only biological capability but cultural knowledge, economic resources, kinship networks and ritual practices [32;47].\u003c/p\u003e\u003cp\u003eFeldman-Savelsberg further notes that post-Cold War political and economic upheavals in Africa disproportionately affected the vulnerability of women living in rural regions, particularly subsistence farmers with limited education, income and mobility [32]. These structural inequalities help explain the heightened prevalence and intensity of FOI in socioeconomically disadvantaged rural regions, where childlessness carries significant social stigma [34;50\u0026ndash;52]. children serve as an asset that allows parents to transfer income\u003c/p\u003e\u003cp\u003eto old age. From this perspective, parents continue to give birth to safeguard economic support\u003c/p\u003e\u003cp\u003ein their old age\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis scoping review identified and explored two interrelated types of fear of infertility (FOI) among African women: the fear that reproductive choices, particularly contraceptive use and abortion, may cause infertility and the fear of the social, relational and spiritual ramifications of infertility. These fears are not isolated psychological responses but are deeply embedded in sociocultural, economic and spiritual frameworks that shape reproductive behaviours and access to health services across the African continent.\u003c/p\u003e\u003cp\u003eFOI was shown to influence women\u0026rsquo;s contraceptive decisions, relationships, psychological wellbeing and help-seeking patterns. It also emerged as a pervasive, under-explored phenomenon with significant implications for sexual and reproductive health outcomes.\u003c/p\u003e\u003cp\u003eDespite its widespread impact, infertility remains marginalised in health policy discourse, where the dominant focus has been on reducing fertility rates and increasing contraceptive uptake, particularly in the context of sub-Saharan Africa. While modern contraception has contributed to lowering fertility rates, its association with a fear of fertility has produced unintended consequences. Misinformation, often compounded by historical distrust in biomedical interventions, contributes to the belief that modern contraceptive methods such as hormonal and long-acting options cause permanent sterility. This fear is particularly potent among young, nulliparous women, leading many to avoid effective contraception entirely or rely on traditional methods with limited efficacy [12;13;35;34;36;37].\u003c/p\u003e\u003cp\u003eEqually significant is the fear of the social ramifications of infertility. Across all included studies, infertility was linked to social exclusion, marital instability and psychological distress. Women reported fears of abandonment, polygamy and divorce. Some concealed their condition due to shame. This resulted in isolation, anxiety and loss of identity. Even within marriage, many women internalised these stigmas feeling as though they were \u0026ldquo;not truly wives\u0026rdquo; without children [9;13;12]. Motherhood was consistently constructed as a central marker of womanhood, with some participants reporting they had been taught from childhood that their worth lay in bearing children and that without children they are \u0026ldquo;incomplete\u0026rdquo; [32].\u003c/p\u003e\u003cp\u003eIn several contexts, infertility was interpreted as spiritual punishment or the result of witchcraft, further intensifying the stigma and sense of exclusion [32;40;41;42]. These beliefs could be as emotionally threatening as infertility itself [32]. Empirical evidence highlights that the threat of the stigma and poverty linked to childlessness tends to erode social support networks and therapy management groups over time [48]. An included study highlights that infertility fears were grounded in material realities, especially impoverishment and that infertility functioned as an \u0026ldquo;idiom of vulnerability\u0026rdquo; [32]. In this view, children represent not only emotional fulfilment but also markers of competence and as assets that allow a transferral of income to old age [53]. From this perspective, the continued pursuit to conceive becomes an attempt to safeguard economic support in old age as children become important sources of social mobility and protection.\u003c/p\u003e\u003cp\u003eFOI also shaped health-seeking behaviour. Many women turned to spiritual and traditional healers rather than biomedical services as an intergenerational practice, seeking fasting, prayer, herbal treatments and rituals believed to restore infertility or protect against ancestral curses [40;44;45;36;30]. These practices reflect not only cultural submission but also a perceived dependency on divine or spiritual intervention to orchestrate their health outcomes, which influenced their approach to facility care [40;44;45]. While some combined these with biomedical interventions, concerns around the safety, efficacy and regulation of traditional medicines remain [40].\u003c/p\u003e\u003cp\u003eIn some cases, fear of permanent sterility led to high-risk behaviours, such as engaging in multiple or concurrent sexual partnerships in an attempt to conceive [36]. Studies also highlighted that pregnancy was seen as a prerequisite for marital commitment, with some cohabiting male partners refusing to marry unless fertility was proven for fear of familial disapproval [36].\u003c/p\u003e\u003cp\u003eBeyond behavioural consequences, FOI was reported to have serious psychological effects including chronic worry, shame, diminished self-worth and depression in the included studies. These emotional burdens were often exacerbated by the silence and secrecy surrounding infertility, especially in communities where fertility conferred social value, inheritance rights and future security [32;13;32,33].\u003c/p\u003e\u003cp\u003eA significant limitation in addressing FOI is its near absence in both research and policy. Notably, only one of the 11 included studies had FOI as a primary focus, which may reflect the broader neglect of infertility within African reproductive health agendas. If policies and programmes promote contraceptive use without addressing the fears surrounding it, public health goals may risk being undermined. Particularly among adolescents and young women, ignoring FOI may limit contraceptive uptake and hinder efforts to reduce unintended pregnancies.\u003c/p\u003e\u003cp\u003eEngaging with FOI requires a multi-level approach. Firstly, public health messaging must directly confront myths about infertility and contraception. Educational interventions, targeting both service users and providers should clarify the relationship between contraceptive methods and fertility. Notably, some health educators held beliefs in FOI, suggesting that provider education and cultural competency training within healthcare systems is essential [40;7]. This could include merging biomedical health services with Indigenous cultural practices to ensure services are respectful, inclusive and responsive to women\u0026rsquo;s beliefs and lived experiences [40;54;55].\u003c/p\u003e\u003cp\u003eSecondly spiritual and traditional leaders, are influential figures in many communities who shape reproductive norms. Their engagement is vital for disseminating accurate health information, reducing stigma, and promoting culturally appropriate fertility care. However, it is vital that there is stronger oversight of herbal medicine to ensure safety, prevent harmful interactions and integrate promising remedies with evidence-based care. Pharmaceutical evaluation of commonly used traditional treatments could improve both trust and outcomes.\u003c/p\u003e\u003cp\u003eThirdly, integrating infertility into sexual and reproductive health policy is critical. Infertility should no longer be treated as a secondary issue or a private matter. It is crucial for policies to include prevention (e.g., STI treatment and safe abortion care), early diagnosis, counselling and equitable access to fertility treatment. Infertile individuals, especially women, should be recognised as a priority population for reproductive health services. Support mechanisms such as counselling and peer groups are essential for addressing the emotional toll of FOI.\u003c/p\u003e\u003cp\u003eFinally, more empirical studies are urgently needed to explore how FOI is developed, transmitted and sustained. Research could examine the role of gender as well as power and evaluate the effectiveness of interventions aimed at dispelling FOI. Mixed-method and longitudinal studies could help deepen understanding of FOI\u0026rsquo;s impact over time,\u003c/p\u003e\u003cp\u003eIn summary, fear of infertility represents a profound yet neglected barrier to reproductive health equity in Africa. It is not merely a by-product of misinformation but reflects deeply rooted cultural, gendered and spiritual anxieties. Addressing FOI requires more than technical solutions, it demands respectful, culturally grounded care and a restructuring of reproductive health priorities to include infertility. Only by explicitly acknowledging FOI within reproductive health programming can we ensure that African women are empowered to make safe, informed and autonomous reproductive choices.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe qualitative focus of this review allowed for an exploration of women's experiences but limited the ability to assess the prevalence or distribution of FOI across regions and populations, insights that quantitative studies could provide. Additionally, while this review offers a thematic synthesis of how FOI is experienced, it does not fully capture the processes by which these fears are formed, transmitted or managed over time. These represent important areas for future empirical investigation.\u003c/p\u003e\u003cp\u003eA further limitation of this review was the challenge of identifying all relevant studies on Fear of Infertility (FOI), due in part to the absence of \u0026ldquo;fear\u0026rdquo; as a Medical Subject Headings (MeSH) term and the varied terminology used to express fear-related experiences (e.g., \u0026ldquo;worried\u0026rdquo; or \u0026ldquo;anxious\u0026rdquo;). The scoping review methodology also imposed inherent constraints, including a streamlined search strategy, lack of formal quality appraisal and the exclusion of non-English as well as quantitative studies. This likely led to the exclusion of studies where FOI was present but not explicitly labelled as such.\u003c/p\u003e\u003cp\u003eIn summary, FOI encompasses two interrelated domains: the fear of causing infertility through reproductive health choices and the fear of the ramifications of infertility, including social exclusion, relationship instability and spiritual distress. Given its influence on contraceptive behaviour, care-seeking and mental health, FOI remains an under-explored yet critical issue that warrants greater attention in both policy and culturally sensitive reproductive health research and programming.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot applicable as this is a review\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eKI synthesised the data critically reviewed, discussed and finalised the submitted manuscript, and (will) contribute to all revisions. Author agrees to be accountable for the work and to investigate and resolve any issues related to the accuracy or integrity of the work.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable as this is a review\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\u003cp\u003eAll data generated or analysed during this study are included in this\u003c/p\u003e\u003cp\u003epublished article [and its supplementary information files]\u003c/p\u003e\u003cp\u003eCompeting interests\u003c/p\u003e\u003cp\u003eNot applicable as this is a review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRoomaney R, Salie M, Jenkins D, Mutumba-Nakalembe MJ, Volks C, Holland N, Silingile K. 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Chapter 3: Care during pregnancy. 2024. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-3.html#a2\u003c/span\u003e\u003cspan address=\"https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-3.html#a2\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 06 Oct 2025.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Infert*, Fear of Infertility, Africa, Qualitative Review, Health-Seeking Behaviour, Family planning, Counselling","lastPublishedDoi":"10.21203/rs.3.rs-7919584/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7919584/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eFear of infertility (FOI) is frequently reported in reproductive health literature, but this topic has rarely been synthesised or reviewed comprehensively. The aim of this scoping review was to explore how infertile women in Africa perceive and experience infertility and to identify the main concepts related to FOI. Given the socio-cultural diversity across African countries, this review specifically focuses on qualitative studies to allow for a deeper understanding of the issue through women\u0026rsquo;s own voices.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eEligibility criteria for this review included qualitative studies reporting on the perspectives of infertile women across Africa, regardless of age. MEDLINE and CINAHL databases were searched for studies published in English from database inception to October 2025 using keywords related to Africa, infertility and fear. Additional studies were identified by hand-searching the reference lists of included articles. Studies were included if they explored the fear of infertility (FOI) and its impact on reproductive health and behaviour. Quantitative studies and those not focused on Africa were excluded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOf 248 citations identified, 11 qualitative studies were included. FOI was reported across various groups (e.g.,infertile married and unmarried women as well as religious leaders). Two types of fears emerged: (1) fear of causing infertility through reproductive choices (e.g., using contraception) and (2) fear of the ramifications of infertility (e.g., polygamy, divorce, stigma). Reasons for these fears were rooted in beliefs such as internal accumulation of menstrual blood, ovarian damage and deliberate toxicity. These fears influenced reproductive behaviour, including contraceptive use, help-seeking behaviours and social interactions. Many women expressed fear that infertility would lead to social exclusion.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe simultaneous desire for and fear of contraception in the African context can be understood within the broader social and economic uncertainties faced by many communities. The findings underscore the need for policymakers to address the fears surrounding modern contraception and its link to infertility. FOI is an important phenomenon that warrants further research to better understand its implications for reproductive health services. Misinformation and cultural distortions surrounding fertility must be addressed through education, sexual and reproductive health policies as well as improved counselling.\u003c/p\u003e","manuscriptTitle":"Fear of Infertility Among Women in Africa: A Scoping Review of Qualitative Evidence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-25 18:22:17","doi":"10.21203/rs.3.rs-7919584/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f731699b-255b-4c4c-95d8-ed5eea119ebb","owner":[],"postedDate":"October 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-27T14:44:53+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-25 18:22:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7919584","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7919584","identity":"rs-7919584","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}