Primary infertility and its association with marital disruptions and having co-wives: evidence from a nationally representative survey in India

Abstract Introduction The inability to conceive a child is an issue that affects millions of women around the world. The aftermath of primary infertility in societies that value parenthood may have far-reaching consequences. India, being a diverse country, may help us explore the association of infertility on selected marriage outcomes with the hypothesis that marriage disruption and multiple co-wives are more prominent among women experiencing primary infertility, especially in northern India. Methods The study uses secondary cross-sectional data from the fifth round of the National Family Health Survey (NFHS 5, 2019-21). The sample size is 304,497 ever-married women aged between 20 and 40 years who spent at least 5 years since their first marriage. Bivariate analysis and multivariable logistic regressions were used to test the hypotheses. Results In India, women with primary and secondary infertility are more likely to experience marital disruptions [AOR: 1.61, 1.29 respectively] and have co-wives [AOR: 2.05, 1.17 respectively], compared to those who have given births. The interaction model indicates higher chances of marital disruptions [AOR: 1.85] but lower propensity to have co-wives for primary infertile women in in north [AOR: 0.03], , and west [AOR: 1.82, and AOR: 0.40 respectively] compared to south India. Conclusions Disruptions in women’s marital lives are associated with primary infertility across India. The association is strong in northern and western states compared to the south while infertile women of the south are more likely to have co-wives than the north and west regions. Issues of infertility in the context of marital disruption can be resolved by fertility counselling making infertility care available, accessible and gender-neutral.