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

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