{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T18:40:52Z","timestamp":1776278452447,"version":"3.50.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>This study examines the factors influencing the decision-making of infertile couples to seek healthcare, focusing on socio-demographic characteristics and barriers to accessing care. The study uses a mixed-methods approach, including in-depth qualitative interviews (IDIs) and a cross-sectional survey of women experiencing infertility. A hospital-based cross-sectional study was conducted from July to December 2024, including 269 participants, along with in-depth interviews with 12 women seeking infertility treatment. Qualitative findings showed significant emotional distress among participants, with many feeling judged and inadequate. Social isolation and external stigma were common, worsening the emotional burden. Limited access and inconsistent support further increased the difficulties faced by infertile couples. Of the 269 participants, 43.9% reported primary infertility, and 56.1% secondary infertility. Most had been married for 1\u20135 years and had been delaying treatment for over three years. The main reason for seeking medical treatment was the inability to conceive, followed by family pressure. Financial constraints, lack of access, and social stigma were major barriers to healthcare. Regression analysis indicated that individuals with lower educational levels were less likely to seek healthcare than those with higher levels. Couples in joint families were more inclined to pursue treatment, and primary infertility was a key factor influencing the decision to seek medical care. Community-based awareness programmes are vital to dispel myths surrounding infertility, alongside counselling services to address emotional stress. Healthcare providers should receive training to offer empathetic support tailored to infertile couples. Furthermore, social health protection schemes should consider subsidized treatment or insurance coverage to alleviate financial burdens for low-income families in Pakistan.<\/jats:p>","DOI":"10.1371\/journal.pgph.0006275","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:41:08Z","timestamp":1776274868000},"page":"e0006275","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing infertile couples\u2019 decisions to seek healthcare: A mixed methods study from Islamabad, Pakistan"],"prefix":"10.1371","volume":"6","author":[{"given":"Menahyl","family":"Mahmood","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-4132","authenticated-orcid":true,"given":"Babar Tasneem","family":"Shaikh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1038-0951","authenticated-orcid":true,"given":"Mariam","family":"Ashraf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"pgph.0006275.ref001","doi-asserted-by":"crossref","unstructured":"Gipson JD, Bornstein MJ, Hindin MJ. Infertility: a continually neglected component of sexual and reproductive health and rights. Bull World Health Organ. 2020; 98(7):505\u2013506.","DOI":"10.2471\/BLT.20.252049"},{"key":"pgph.0006275.ref002"},{"key":"pgph.0006275.ref003"},{"key":"pgph.0006275.ref004","doi-asserted-by":"crossref","unstructured":"Jaradat N, Zaid AN. Herbal remedies used for the treatment of infertility in males and females by traditional healers in the rural areas of the West Bank\/Palestine. BMC Complement Altern Med 2019; 19: 194.","DOI":"10.1186\/s12906-019-2617-2"},{"key":"pgph.0006275.ref005","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1472-6874-13-17","article-title":"Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach","volume":"13","author":"K Ried","year":"2013","journal-title":"BMC Womens Health"},{"issue":"1","key":"pgph.0006275.ref006","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1186\/s12906-024-04604-0","article-title":"Complementary, supportive and traditional practice experiences of infertile women in T\u00fcrkiye: a qualitative study","volume":"24","author":"E Keten Edis","year":"2024","journal-title":"BMC Complement Med Ther"},{"issue":"3","key":"pgph.0006275.ref007","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s10815-011-9701-y","article-title":"An introduction to infertility counseling: a guide for mental health and medical professionals","volume":"29","author":"B Peterson","year":"2012","journal-title":"J Assist Reprod Genet"},{"key":"pgph.0006275.ref008","first-page":"100245","article-title":"Relationship beliefs, attachment styles and depression among infertile women","volume":"20","author":"T Mobeen","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"key":"pgph.0006275.ref009","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1742-4755-10-3","article-title":"Understanding the impact of gendered roles on the experiences of infertility amongst men and women in Punjab","volume":"10","author":"Z Mumtaz","year":"2013","journal-title":"Reprod Health"},{"issue":"3","key":"pgph.0006275.ref010","first-page":"189","article-title":"Infertility Stigma: A Qualitative Study on Feelings and Experiences of Infertile Women","volume":"15","author":"M Taebi","year":"2021","journal-title":"Int J Fertil Steril"},{"issue":"4","key":"pgph.0006275.ref011","article-title":"Awareness Regarding Causes of Infertility Among Out-patients at a Tertiary Care Hospital in Karachi, Pakistan","volume":"12","author":"HM Ahmed","year":"2020","journal-title":"Cureus"},{"issue":"2","key":"pgph.0006275.ref012","first-page":"123","article-title":"Socio-Demographic Correlates of Women\u2019s Infertility and Treatment Seeking Behavior in India","volume":"17","author":"S Sarkar","year":"2016","journal-title":"J Reprod Infertil"},{"key":"pgph.0006275.ref013","doi-asserted-by":"crossref","first-page":"978085","DOI":"10.3389\/frph.2022.978085","article-title":"An exploration of treatment seeking behavior of women experienced infertility and need for services in rural India","volume":"4","author":"S Patra","year":"2022","journal-title":"Front Reprod Health"},{"issue":"11","key":"pgph.0006275.ref014","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-042951","article-title":"Economic costs of infertility care for patients in low-income and middle-income countries: a systematic review protocol","volume":"10","author":"P Njagi","year":"2020","journal-title":"BMJ Open"},{"issue":"1","key":"pgph.0006275.ref015","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s13524-011-0078-4","article-title":"Utilization of infertility treatments: the effects of insurance mandates","volume":"49","author":"MP Bitler","year":"2012","journal-title":"Demography"},{"issue":"2","key":"pgph.0006275.ref016","first-page":"123","article-title":"Socio-Demographic Correlates of Women\u2019s Infertility and Treatment Seeking Behavior in India","volume":"17","author":"S Sarkar","year":"2016","journal-title":"J Reprod Infertil"},{"issue":"10","key":"pgph.0006275.ref017","article-title":"Psychological Problems Related to Infertility","volume":"14","author":"A Sharma","year":"2022","journal-title":"Cureus"},{"issue":"4","key":"pgph.0006275.ref018","doi-asserted-by":"crossref","DOI":"10.1016\/j.fertnstert.2014.12.121","article-title":"Cumulative incidence of infertility in a New Zealand birth cohort to age 38 by sex and the relationship with family formation","volume":"103","author":"T van Roode","year":"2015","journal-title":"Fertil Steril"},{"key":"pgph.0006275.ref019","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/1472-6874-14-53","article-title":"Gender: shaping personality, lives and health of women in Pakistan","volume":"14","author":"N Rizvi","year":"2014","journal-title":"BMC Womens Health"},{"issue":"3","key":"pgph.0006275.ref020","doi-asserted-by":"crossref","first-page":"469","DOI":"10.33824\/PJPR.2024.39.3.26","volume":"39","author":"Structures of Pakistan","year":"2024","journal-title":"Pak J Psychol Res"},{"key":"pgph.0006275.ref021","doi-asserted-by":"crossref","first-page":"2134","DOI":"10.1111\/1475-6773.12117","article-title":"Achieving integration in mixed methods designs-principles and practices","volume":"48","author":"MD Fetters","year":"2013","journal-title":"Health Serv Res"},{"issue":"2","key":"pgph.0006275.ref022","first-page":"77","article-title":"Clinical, epidemiological and socio-cultural aspects of -infertility in resource-poor settings. Evidence from Rwanda","volume":"3","author":"N Dhont","year":"2011","journal-title":"Facts Views Vis Obgyn"},{"issue":"12","key":"pgph.0006275.ref023","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_504_24","article-title":"Depression, anxiety, stress, and coping among men with infertility seeking treatment at a tertiary care hospital in South India: A mixed-method study","volume":"66","author":"M Mor","year":"2024","journal-title":"Indian J Psychiatry"},{"issue":"3","key":"pgph.0006275.ref024","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1177\/1557988317695901","article-title":"Assessment on Occurrences of Depression and Anxiety and Associated Risk Factors in the Infertile Chinese Men","volume":"11","author":"B Yang","year":"2017","journal-title":"Am J Mens Health"},{"issue":"2","key":"pgph.0006275.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.36108\/NJSA\/9102\/71(0210)","article-title":"Infertility and treatment seeking behaviour among women in Mushin local government area, Lagos State, Nigeria","volume":"17","author":"CK Okafor","year":"2019","journal-title":"Niger J Sociol Anthropol"},{"issue":"1","key":"pgph.0006275.ref026","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/s12978-024-01858-2","article-title":"A scoping review of the psychosocial aspects of infertility in African countries","volume":"21","author":"R Roomaney","year":"2024","journal-title":"Reprod Health"},{"issue":"6","key":"pgph.0006275.ref027","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.12669\/pjms.326.10828","article-title":"Depression, anxiety and stress among female patients of infertility; A case control study","volume":"32","author":"L Yusuf","year":"2016","journal-title":"Pak J Med Sci"},{"issue":"3","key":"pgph.0006275.ref028","first-page":"248","article-title":"Psychological distress and infertility: a cross-sectional study in Turkey","volume":"38","author":"A Sahin","year":"2017","journal-title":"J Psychosom Obstet Gynecol"},{"issue":"4","key":"pgph.0006275.ref029","first-page":"701","article-title":"Coping mechanisms in infertile men: a cross-cultural perspective","volume":"112","author":"RG Pearson","year":"2019","journal-title":"Fertil Steril"},{"issue":"2","key":"pgph.0006275.ref030","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4103\/jhrs.JHRS_134_17","article-title":"Sociocultural Determinants of Infertility Stress in Patients Undergoing Fertility Treatments","volume":"11","author":"A Patel","year":"2018","journal-title":"J Hum Reprod Sci"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006275","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:41:14Z","timestamp":1776274874000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0006275"}},"subtitle":[],"editor":[{"given":"Anushka","family":"Ataullahjan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0006275","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}