Abstract
BackgroundFertility desires and contraceptive behavior often change over time. This study examined the influence of change in fertility desires on change in modern contraceptive use over time in three peri-urban communities in sub-Saharan Africa.MethodsThis multi-site study includes baseline and follow up data from 3 sites in the Family Health and Wealth Study. Following a census in each site, a probability sample of at least 500 households was obtained. Generalized linear models were employed.ResultsModern contraceptive use increased in Ipetumodu, Nigeria (29.4 % to 36.7 %), but declined slightly in Sebeta, Ethiopia (66.9 % to 61.3 %) and Asawase, Ghana (12.6 % to 10.8 %). Across sites, at baseline and follow up, women who wanted no more children reported more contraceptive use, compared with those who wanted more children, and were more likely to shift to being contraceptive users in Ipetumodu [aOR(95 % CI):1.55 (1.07,2.26)].ConclusionsWomen’s fertility desires influenced their contraceptive behavior, although there were cross-site differences. Changing contraceptive demand and program factors will be important to enable peri-urban women to frame and act on their fertility desires.
Highlights
Fertility desires and contraceptive behavior often change over time
Fertility desires are personal preferences and do not translate into behavior until after they have been transformed into intentions, described as, “conscious commitments to act in a certain way or to try to achieve a certain goal at some future time” [1]
Researchers have shown that the proportion of women who want no more children can strongly predict contraceptive prevalence and fertility rates [2, 3], suggesting that women who want no more children may be very different, and more motivated to attain their fertility goals, when compared with women with other fertility desires
Summary
Fertility desires and contraceptive behavior often change over time. This study examined the influence of change in fertility desires on change in modern contraceptive use over time in three peri-urban communities in sub-Saharan Africa. Cross-sectional studies conducted in Burkina Faso, Ghana and Kenya [4], two-time point interviews of women in Honduras [5], and a longitudinal study conducted in Morocco [6] suggest that women’s reports of their fertility motivations, desires and intentions are often inconsistent with their contraceptive behavior. Research from both developed [7–9] and developing [4–6] world settings suggests that women may be ambivalent about whether or not to get pregnant, and this affects their contraceptive decision making, as well as choice of method. Fertility preferences of husbands or wives did not differ substantially in monogamous or polygynous unions, possibly because these preferences were largely influenced by attitudes, beliefs, and societal norms, developed over time [10]
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