Abstract
BackgroundMany women have inconsistent fertility desires and contraceptive use behaviors. This increases their risk of unintended pregnancies. Inconsistencies may reflect barriers to family planning (FP) use but may also reflect ambivalence toward future childbearing. Using urban data from Kenya, Nigeria, and Senegal, this study examines the role of fertility desires and FP use behaviors on pregnancy experience over a 2-year follow-up period.MethodsData come from baseline and 2-year follow-up among urban women interviewed in Kenya, Nigeria, and Senegal. At baseline (2010/2011), women were asked about their future fertility desires (want child soon, want to delay >2 years, does not want) and current FP use. At midterm (2012/2013), women were asked if they were currently pregnant or had a birth in the 2-year period. We examine the association between baseline fertility desires and FP use with pregnancy experience and desirability of an experienced pregnancy.ResultsIn the 2-year follow-up period, 27–39 % of women in union experienced a pregnancy or birth. In Kenya and Nigeria, 30–35 % of women using a modern FP method experienced a pregnancy/birth; the percentage with a pregnancy/birth was slightly higher among women not using at baseline (41 % in both countries). In Senegal, the distinction between pregnancy experience between users and non-users was greater (16 % vs. 31 %, respectively). In all countries, pregnancy was less common among users of long-acting and permanent methods; only a small percentage of women use these methods. Women not wanting any(more) children were the least likely to experience a pregnancy in the 2-year follow-up period. No differences were observed between those who wanted to delay and those who wanted soon. Multivariate findings demonstrate distinctions in pregnancy experience by fertility desires among modern FP users. Non-users have similar pregnancy experience by fertility desires.ConclusionsFertility desires are not stable; providers need to consider the fluidity of fertility desires in counseling clients. Programs focusing on new FP users may miss women who are the most motivated to avoid a pregnancy and need to switch to a more effective method; this will result in less unintended pregnancies overall.
Highlights
Many women have inconsistent fertility desires and contraceptive use behaviors
This paper focuses on major urban areas in three sub-Saharan African countries to provide insights into fertility experience, unmet need, and gaps in family planning (FP) services in the study urban areas
Future studies with a larger sample size may be able to better measure abortion experience and the contribution of abortion to unintended pregnancies and the fluidity of fertility desires. To conclude, this is the first study to examine the longitudinal association between fertility desires and family planning use with later pregnancy/birth experience in urban African settings
Summary
Many women have inconsistent fertility desires and contraceptive use behaviors. This increases their risk of unintended pregnancies. Contraceptive use reduces the risk of unintended pregnancy while at the same time conveying other benefits including reduced recourse to (often) unsafe abortion, reduced maternal mortality, reduced neonatal, infant, and child mortality, and improved education and employment opportunities of women and men who delay initiation of childbearing [1, 6]. Unintended pregnancies are those pregnancies that are mistimed, that is they came sooner than desired or are unwanted (i.e. were not wanted at all). The high prevalence of unintended pregnancies perhaps reflects the quarter of sexually active women in sub-Saharan Africa who report a desire to delay or limit childbearing but are not using an effective method of FP to meet these needs [9]
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