Fertility desires, family planning use and pregnancy experience: longitudinal examination of urban areas in three African countries

BMC Pregnancy and Childbirth

Peter Lance¹  Ilene S. Speizer¹ 

[1] Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA

关键词: Intentions;    Unintended pregnancy;    Urban;    Africa;    Family planning;    Fertility;   

Others  :  1232707
DOI  :  10.1186/s12884-015-0729-3

 received in 2015-06-12, accepted in 2015-11-03,  发布年份 2015

【 摘 要 】

Background

Many 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.

Methods

Data 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.

Results

In 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.

Conclusions

Fertility 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.

【 授权许可】

   
2015 Speizer and Lance.

【 参考文献 】

• [1]Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012; 380:149-56.
• [2]Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends and outcomes. Stud Fam Plan. 2010; 41:241-50.
• [3]Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plan. 2008; 39(1):18-38.
• [4]Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A. Induced abortion incidence and trends worldwide from 1995 to 2008. Lancet. 2012; 379(9816):625-32.
• [5]Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths averted by contraceptive use: an analysis of 172 countries. Lancet. 2012; 380(9837):111-25.
• [6]Singh S, Darroch JE. Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012. New York: Guttmacher Institute and United Nations Population Fund (UNFPA); 2012. http://www.guttmacher.org/pubs/AIU-2012-estimates.pdf November 5, 2015.
• [7]Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010; 32:152-74.
• [8]Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plan. 2014; 45(3):301-14.
• [9]Bongaarts J. The impact of family planning programs on unmet need and demand for contraception. Stud Fam Plan. 2014; 45(2):247-62.
• [10]Bankole A. Desired fertility and fertility behavior among the Yoruba of Nigeria: a study of couple preferences and subsequent fertility. Popul Stud. 1995; 49(2):317-28.
• [11]Monier A. Fertility intentions and actual behavior. A longitudinal study: 1974, 1976, 1979. Population. 1989; 44(1):237-59.
• [12]Speder Z, Kapitany B. How are time-dependent childbearing intentions realized? Realization, postponement, abandonment, bringing forward. Eur J Popul. 2009; 25:503-23.
• [13]Bankole A, Westoff C. The consistency and validity of reproductive attitudes: evidence from Morocco. J Biosoc Sci. 1998; 30:439-55.
• [14]Gipson JD, Hindin MJ. The effect of husbands’ and wives’ fertility preferences on the likelihood of a subsequent pregnancy, Bangladesh 1998–2003. Popul Stud. 2009; 63(2):135-46.
• [15]Roy TK, Ram RF, Nangia P, Saha U, Khan N. Can women’s childbearing and contraceptive intentions predict contraceptive demand? Findings from a longitudinal study in central India. Int Fam Plan Perspect. 2003; 29(1):25-31.
• [16]Speizer IS, Calhoun L, Hoke T, Sengupta R. Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh India. Contraception. 2013; 88(4):553-60.
• [17]Casterline JB, El-Zanaty F, El-Zeini LO. Unmet need and unintended fertility: longitudinal evidence from Upper Egypt. Int Fam Plan Perspect. 2003; 29(4):158-66.
• [18]Cleland J, Harbison S, Shah IH. Unmet need for contraception: issues and challenges. Stud Fam Plan. 2014; 45(2):105-22.
• [19]Casterline JB, Sinding SW. Unmet need for family planning in developing countries and implications for population policy. Popul Dev Rev. 2000; 26(4):691-723.
• [20]Diamond-Smith N, Campbell M, Madan S. Misinformation and fear of side-effects of family planning. Cult Health Sex. 2012; 14(4):421-33.
• [21]Sedgh G, Hussain R, Bankole A, Singh S. Women with an unmet need for contraception in developing countries and their reasons for not using a method. Guttmacher Institute, New York; 2007.
• [22]Yeatman S, Sennott C. The relationship between partners’ family-size preferences in Southern Malawi. Stud Fam Plan. 2014; 45(3):361-77.
• [23]Withers MH, Tavrow P, Adinata NA. Do ambivalent women have an unmet need for family planning? A longitudinal study from Bali, Indonesia. Womens Health Issues. 2011; 21(6):444-9.
• [24]Brown W, Druce N, Bunting J, Radloff S, Koroma D, Gupta S, et al. Developing the “120 by 20” goal for the global FP2020 Initiative. Stud Fam Plan. 2014;45(1):73–84.
• [25]Jain AK, Mahmood A, Sathar ZA, Masood I. Reducing unmet need and unwanted childbearing: evidence from a panel survey in Pakistan. Stud Fam Plan. 2014; 45(2):277-99.
• [26]Speizer IS. Using strength of fertility motivations to identify family planning program strategies. Int Fam Plan Perspect. 2006; 32(4):185-91.
• [27]Ezeh AC, Kodzi I, Emina J. Reaching the urban poor with family planning services. Stud Fam Plan. 2010; 41:109-16.
• [28]The World Bank. 3.12 World Development Indicators: Urbanization. [Accessed November 5, 2015]. http://wdi. worldbank.org/table/3.12 webcite
• [29]Nigeria Demographic and Health Survey 2013. NPC and ICF International, Abuja, Nigeria, and Rockville, Maryland, USA; 2014.
• [30]Sénégal : Enquête Démographique et de Santé Continue (EDS-Continue 2014). ANSD et ICF International, Rockville; 2015.
• [31]Kenya Demographic and Health Survey 2014: Key Indicators. KNBS and ICF Macro, Rockville; 2015.
• [32]Speizer IS, Corroon M, Calhoun L, Lance P, Montana L, Nanda P, et al. Demand generation activities and modern contraceptive use in urban areas of four countries: A longitudinal evaluation. Glob Health Sci Pract. 2014.
• [33]Gwatkin DR, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-economic differences in health, nutrition, and population (HNP). Washington, DC: HNP/Poverty Thematic Group, World Bank; 2000. http://siteresources.worldbank.org/INTPAH/Resources/IndicatorsOverview.pdf Accessed November 5, 2015.
• [34]Yeatman S, Sennott C, Culpepper S. Young women’s dynamic family size preferences in the context of transitioning fertility. Demography. 2013; 50:1715-37.
• [35]Hall J, Barrett G, Mbwana N, Copas A, Malata A, Stephenson J. Understanding pregnancy planning in a low income country setting: validation of the London measure of unplanned pregnancy in Malawi. BMC Pregnancy Childbirth. 2013; 13:200. BioMed Central Full Text
• [36]Speizer IS, Santelli JS, Afable-Munsuz A, Kendall C. Measuring factors underlying intendedness of women’s first and later pregnancies. Perspect Sex Reprod Health. 2004; 36(5):198-205.
• [37]Grimes DA. Forgettable contraception. Contraception. 2009; 80:497-9.
• [38]Zabin LS. Ambivalent feelings about parenthood may lead to inconsistent contraceptive use – and pregnancy. Fam Plan Perspect. 1999; 31(5):250-1.
• [39]Peterson R, Payne P, Albright J, Holland H, Cabral R, Curtis KM. Applying motivational interviewing to contraceptive counseling: ESP for clinicians. Contraception. 2004; 69:213-7.