Defining infertility: The varied criteria people in two regions of Uganda use to identify infertility in themselves and others.

Understanding how individuals define infertility is significant given associated stigma and psychosocial consequences, particularly in sub-Saharan Africa where infertility functions as both a medical condition and social phenomenon. Merely being perceived as infertile can trigger repercussions. A better understanding of socially defined infertility in this context will provide insight into related stigma and negative repercussions, as well as opportunities to intervene. In this study, we explore how men and women in two districts of Uganda define infertility and the criteria they use to identify it, examining how these differ by infertility type (primary, secondary) and gender. We conducted 48 in-depth interviews and 8 focus group discussions with reproductive-aged women and men across two Ugandan districts. Participants were purposively selected to balance sex, residence, parity, and infertility experiences. Data were analyzed using thematic analysis with constant comparison to identify patterns, supported by coding, memoing, and regular team discussions. Three key themes emerged: First, infertility was commonly viewed as permanent-conceptually equivalent to sterility-making secondary infertility seem paradoxical to many. Second, temporality in identifying infertility varied widely from months to decades, with notable gender differences. Third, participants employed numerous relational criteria to identify infertility, including partner characteristics, person-dependent factors (age, gender), and peer comparisons. Results suggest Ugandans use diverse and often multiple criteria to identify infertility, reflecting a complex interplay between temporal, contextual, and relational factors. This work describes the nuances of infertility as a socially constructed phenomenon in the Ugandan context, with important implications for future research and programs.