Rising Infertility in Developing Countries: Cameroon as a case study of infectious, health‑system, environmental, and socioeconomic drivers

Infertility is emerging as a significant but under-recognized public health challenge in many developing countries, with profound demographic, psychosocial, and economic consequences. Cameroon provides a compelling case study for examining the multifactorial drivers of rising infertility across sub-Saharan Africa. This paper synthesizes epidemiological evidence to analyze infectious, health-system, environmental, and socioeconomic determinants shaping infertility patterns. Persistent reproductive tract infections including untreated sexually transmitted infections, post-abortal sepsis, and puerperal infections remain leading contributors to tubal factor infertility. Weak health-system capacity, limited access to skilled obstetric and gynecological care, inadequate laboratory diagnostics, and fragmented referral pathways exacerbate delayed diagnosis and treatment. Environmental exposures, including pesticide use, heavy metals, and endocrine-disrupting chemicals associated with rapid urbanization and informal industrial activity, further compound reproductive risks for both men and women. Socioeconomic pressures poverty, gender inequities, stigma, and limited insurance coverage for fertility services intensify barriers to timely intervention and amplify psychosocial distress. The Cameroon case illustrates how infectious burden interacts with structural and environmental vulnerabilities, producing a cumulative risk framework rather than isolated causes. Addressing infertility in similar contexts requires integrated strategies encompassing infection prevention, strengthened reproductive health systems, environmental regulation, male reproductive health inclusion, and financial protection mechanisms. Recognizing infertility as a cross-sectoral development issue is essential for advancing reproductive justice and sustainable population health outcomes in resource-constrained settings.