What to expect when you want to be expecting: time-to-pregnancy expectations and anticipated worry and help-seeking among a nationally representative survey of women in Uganda.

BACKGROUND: It is important to understand time-to-pregnancy expectations and when women begin to worry or seek help for fertility-related concerns, particularly in sub-Saharan Africa, where infertility is highly stigmatized and there is considerable pressure to conceive quickly. Yet our understanding of this topic is informed by a small body of literature often involving selective clinic-based samples of those receiving infertility care. This study aims to better understand Ugandan women's expected time-to-pregnancy and their anticipated emotional and behavioral responses to time spent trying as well as its alignment with the 12-month clinical threshold for infertility. METHODS: We use population-based cross-sectional data of women aged 15-49 in Uganda (n = 4227), limiting our analytic sample to women who had ever had sex (n = 3741). Our outcomes of interest were time-to-pregnancy expectations and related worry and help-seeking. We operationalized time-to-pregnancy expectations as a continuous measure, in months, and worry and help-seeking as binary measures, with a 12-month and a 12- and 24-month cut-off, respectively. We fit multivariable Tobit and logistic regression models to identify sociodemographic factors associated with time-to-pregnancy expectations and related worry and help-seeking. RESULTS: Half of women think it typically takes less than one month to conceive. The majority anticipated that they would begin to worry (82.4%) and seek help (77.3%) before reaching the 12-month clinical threshold for infertility. Women with children, with perceived difficulties conceiving, and with longer time-to-pregnancy expectations had decreased odds of worrying or seeking help before 12 months. Over 10% of women anticipated that they would seek help after 24 months of trying, with those who had longer time-to-pregnancy expectations having increased odds of seeking help after 24 months of trying. Time-to-pregnancy expectations, worry, and help-seeking were highly normative, with 27-36% of the variability in these outcomes explained by the woman's geographic community. CONCLUSION: Our study suggests that the clinical threshold for infertility may not align with individuals' expectations and concerns related to delayed childbearing in Uganda. More education about conception and suggested care-seeking timelines, along with early psychosocial support, could help women navigate fertility concerns, especially in cultures where delayed pregnancy leads to stigma and social consequences.