Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: a cross-sectional study

Abstract

BackgroundRecent trends in fertility rates indicate declines in total fertility rate (TFR) in some sub-Saharan African countries. However, countries such as Uganda continue to have a persistently high TFR partly attributed to strong preferences for large family sizes. We explored the factors that influence fertility desire among married or cohabiting individuals in Rakai, a rural district in southwestern Uganda.MethodsThis cross-sectional study of fertility desire (desire to have another child) was nested in a cluster-randomized demand-creation intervention trial for the promotion of couples’ HIV counseling and testing uptake among married or cohabiting individuals that was conducted in Rakai district between March 1 and April 30, 2015. A total of 1490 married or cohabiting individuals, resident in three study regions with differing background HIV prevalence, were enrolled into the study. Data were collected on socio-demographic, behavioral and fertility-related characteristics. We used a modified Poisson regression model to generate prevalence ratio (PR) as a measure of association for factors that were independently associated with fertility desire. We adjusted for clustering at community level and used STATA version 14.0 for all analyses.ResultsOverall, fertility desire was high (63.1%, n = 940); higher in men (69.9%, n = 489) than women (57.1%, n = 451). More than three-quarters (78.8%, n = 1174) had 3+ biological children while slightly more than two-thirds (68.5%, n = 1020) reported an ideal family size of 5+ children. Only 30% (n = 452) reported that they had attained their desired family size. After adjusting for potential and suspected confounders, the factors that were negatively associated with fertility desire were: age 30–39 (adjusted prevalence ratio [aPR] = 0.82, 95% CI: 0.78, 0.86) and 40+ years (aPR = 0.65, 95% CI: 0.60, 0.71); having six or more biological children (aPR = 0.88, 95% CI: 0.80, 0.97); being HIV-positive (aPR = 0.86, 95% CI: 0.78, 0.95) and ever use of any family planning methods (aPR = 0.93, 95% CI: 0.87, 0.99). Being male (aPR = 1.19, 95% CI: 1.07, 1.33); having primary education (aPR = 1.21, 95% CI: 1.01, 1.44) and having not yet attained the desired family size (aPR = 4.34, 95% CI: 3.50, 5.38) were positively associated with fertility desire.ConclusionHaving not yet attained one’s desired family size, being male and having primary education were positively associated with fertility desire in this population. Targeting individuals who have not yet attained their desired family size, men and less educated individuals with fertility regulation interventions may help to reduce fertility desire in this population.

Perceived fertility desires of spouses and use of modern contraception among women in Rakai, Uganda

“…This is similar to another study which observed higher fertility desires among men (70%) compared to women (57%) in a similar setting [18]. When discordance in fertility desire was observed, more men compared to women had a desire for a (another) child.…”

Correlates of knowledge of family planning among people living in fishing communities of Lake Victoria, Uganda

“…They establish homes when they move from one shing community to another in search for sh. Also culturally, African men tend to desire to have many children as has been observed in our study and in other studies on FP [1] because many children are associated with prestige, masculinity and respect in society [4]. All these make them prone to engaging in sexual relations which sometimes result into unwanted pregnancies.…”

“…Contraception helps families achieve their desired number of children and is instrumental in child spacing [1]. However, the number of children a couple may have and their child spacing interval tend to be in uenced by their knowledge and eventual use of contraception [2,3].…”

“…Almost all(1,333; 94.5%) the participants were aware or knew at least one FP method(Table 2). Pills (1027; 77%), injectable hormonal methods (1004; 75%), implants (776; 58%) condoms (607; 52%) and IUDs (636; 48%) were the most commonly known methods in both villages.…”

Correlates of family planning knowledge among people in fishing communities of Lake Victoria in Uganda

“…This poses challenges for safe motherhood and child survival as well as other development programmes aimed at improving the quality of life of the population at large. Family planning use is one of the public health interventions that needs to be promoted in Uganda because it helps families to achieve a desired number of children and is instrumental in child spacing [6]. By preventing pregnancy, family planning reduces pregnancy-related health risks in women [7], infant mortality and prevents teenage pregnancies [8].…”