Key Social Norms Take-aways Social expectations surrounding motherhood strongly shaped women’s experiences of delayed conception and their responses to it. Women described internalizing conventional gender roles that positioned childbearing as central to women’s social value, while family and community expectations to conceive soon after marriage created pressure, stigma, and blame. These expectations encouraged women to pursue fertility treatments and other remedies, while gendered beliefs that infertility is primarily women’s responsibility could discourage male partners from seeking care. The authors argue that addressing infertility requires transforming gendered perceptions of infertility, reducing stigma, shifting subjective norms and normative beliefs, and strengthening family and peer support alongside improvements in fertility services.

Objectives To explore the experiences and actions of women in low- to lower-middle-income neighborhoods of Delhi, India, who intended to become pregnant but had not conceived after 18 months, and to understand factors influencing their fertility-related actions.

Methods This descriptive qualitative study purposively recruited 35 married women who had not conceived after 18 months of participation in a preconception study. Four focus group discussions were conducted in Hindi between February and July 2021. Deductive thematic analysis, guided by the theory of planned behavior, examined attitudes, subjective norms, normative beliefs, perceived behavioral control, intentions, and actions. Social norms were explored qualitatively through women’s perceptions of significant others’ expectations, particularly pro-birth expectations, pressure to become mothers, expectations to conceive within the first year of marriage, and motivations to comply with family and societal expectations.

Results Women universally expressed intentions to have children, but their actions were shaped by perceived benefits of motherhood, beliefs in mandated motherhood, pro-birth expectations, stigma surrounding childlessness, and pressure to comply with family and community expectations. Women reported seeking biomedical, traditional, faith-based, home, and internet-based remedies. Gender norms disproportionately placed responsibility for infertility on women, while concerns about masculinity sometimes contributed to husbands’ reluctance to seek care. Treatment costs, healthcare access, the COVID-19 pandemic, and limited psychosocial support further constrained women’s ability to act. Women without a living child generally experienced greater stigma and social pressure than women who already had a child.

Conclusions Fertility intentions alone were insufficient for women to achieve their childbearing goals. Attitudes, subjective norms, perceived behavioral control, and broader socioeconomic, cultural, and health-system conditions shaped women’s actions. The authors recommend interventions that address attitudes, subjective norms, normative beliefs, and self-efficacy while improving infertility awareness, affordability and availability of fertility care, and social and peer support.