Fertility Preferences and Contraceptive Change in Low‐ and Middle‐Income Countries

Abstract

The past four decades have witnessed an enormous increase in modern contraception in most low‐ and middle‐income countries. We examine the extent to which this change can be attributed to changes in fertility preferences versus fuller implementation of fertility preferences, a distinction at the heart of intense debates about the returns to investments in family planning services. We analyze national survey data from five major survey programs: World Fertility Surveys, Demographic Health Surveys, Reproductive Health Surveys, Pan‐Arab Project for Child Development or Family Health, and Multiple Indicator Cluster Surveys. We perform regression decomposition of change between successive surveys in 59 countries (330 decompositions in total). Change in preferences accounts for little of the change: less than 10 percent in a basic decomposition and about 15 percent under a more elaborate specification. This is a powerful empirical refutation of the view that contraceptive change has been driven principally by reductions in demand for children. We show that this outcome is not surprising given that the distribution of women according to fertility preferences is surprisingly stable over time.

Evaluating the Effectiveness of Educational Interventions in Family Planning for Men in Developing Countries: A Systematic Review

“…However, the study by Schuler et al may have been limited to rural areas, where contraceptive use is low and family planning needs are unmet compared with urban areas. Indeed, approaching groups with unmet contraceptive needs enhances the promotion of contraceptive use (5) ; hence, we believe that approaching groups with high needs is more effective in terms of intervention. A study of fishing communities in Uganda, where family planning needs are considered high, found an increase in knowledge among men and women, which suggests that community education for high-need groups has the potential to improve knowledge; however, in-depth studies are warranted.…”

“…Specific measures to combat unintended pregnancy have been attempted through material means, including the provision of contraceptives and contraceptive pills and expansion of contraceptive services (1) . While contraceptive use is increasing worldwide (4) , (5) , progress may vary between countries. According to Kantorová et al, contraceptive needs are not being met in developing regions, which have an estimated 214 million people of reproductive age (4) .…”

“…Therefore, providing access to contraceptives in populations with unmet needs can prevent unintended pregnancies. However, rather than the lack of access to contraception, barriers, including the lack of knowledge, concerns regarding side effects, social stigma, and opposition from partners and others, are the major obstacles to contraceptive use in low- and middle-income countries (1) , (5) , (6) , (7) . Therefore, contraceptive coverage alone is insufficient to reduce the rates of unintended pregnancy; educational interventions, such as promoting family planning and addressing underlying social norms, including gender dynamics, are also essential (5) .…”

Effective strategies for increasing the uptake of modern methods of family planning in South Asia: a systematic review and meta-analysis

“…Country disaggregated data from South Asia highlight significant disparities in modern contraceptive use and fertility rates both across and within countries [ 12 ]. The frequently reported barriers to modern contraceptive use among Asian women include cultural norms, lack of method knowledge, fear of side effects, and religious restrictions [ 13 , 14 ].…”

Effective Strategies for Increasing the Uptake of Modern Methods of Family Planning in South Asia: A Systematic Review and Meta-analysis

“…Country disaggregated data from South Asia highlight signi cant disparities in modern contraceptive use and fertility rates both across and within countries (12). The frequently reported barriers to modern contraceptive use among Asian women include cultural norms, lack of method knowledge, fear of side effects, and religious restrictions (13,14).…”