Longitudinal examination of changing fertility intentions and behaviors over a four-year period in urban Senegal

Abstract

Background: Fertility intentions and contraceptive use are often used to demonstrate gaps in programs and policies to meet the contraceptive needs of women and couples. Prior work demonstrated that fertility intentions are fluid and change over a woman's (or couple's) life course with changing marital status, childbearing, and education/employment opportunities. This study uses longitudinal data to better examine the fluidity of women's fertility intentions and disentangle the complex interrelationships between fertility and contraceptive use. Methods: Using survey data from three time points and three urban sites in Senegal, this study examines how women's fertility intentions and contraceptive use in an earlier period affect pregnancy experience and the intentionality of experienced pregnancies among a sample of 1050 women who were in union at all three time points. We apply correlated random effect longitudinal regression methods to predict a subsequent birth by fertility intentions and modern contraceptive use at an earlier period addressing endogeneity concerns of earlier analyses that only include two time periods. Results: Descriptive results demonstrate some change in fertility desires over time such that 6-8% of women who reported their pregnancy as intended (i.e., wanted to get pregnant at time of pregnancy) reported earlier that they did not want any(more) children. Multivariate analyses demonstrate that women who want to delay or avoid a pregnancy and are using modern contraception are the least likely to get pregnant. Among women who became pregnant, the only factor differentiating whether the pregnancy is reported as intended or unintended (mistimed or unwanted) was prior fertility intention. Women who wanted to delay a pregnancy previously were more likely to report the pregnancy as unintended compared to women who wanted to get pregnant soon. Conclusions: These results suggest some post-hoc rationalization among women who are getting pregnant. Women who say they do not want to get pregnant may be choosing not to use a contraceptive method in this urban Senegal context of high fertility. Programs seeking to reach these women need to consider their complex situations including their fertility intentions, family planning use, and the community norms within which they are reporting these intentions and behaviors.

Language and Measurement of Contraceptive Need and Making These Indicators More Meaningful for Measuring Fertility Intentions of Women and Girls

“…18 Further, many women have ambivalent fertility desires (i.e., are undecided about future childbearing or the timing of future childbearing). 19 Such women may be misclassified as having an unmet need when indeed they have no desire or intention to use a method in the future and may welcome an "unexpected" pregnancy, [20][21][22] although the majority of women with unintended pregnancies obtain abortions. 23 As noted previously, problems with language that is currently used to describe need-related indicators are further illustrated through the label of "demand satisfied" for contraception and especially "demand satisfied for modern methods."…”

Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women’s Health Cohort

“…Diversity is a major strength in the cohort with about equal representation among Black and non-Black women. Self-reported reproductive plans are linked to future reproduction, albeit imperfectly [ 58 , 59 ]. To create the adolescent pregnancy variable, we used self-reported age at first pregnancy, because self-reported maternal age has been established as reliable as medical records [ 60 ].…”

How do changes in motivation to prevent pregnancy influence contraceptive continuation? Results from a longitudinal study with women who receive family planning services from Community Pharmacists and Patent and Proprietary Medicine Vendors in Nigeria

“…These factors include experiencing an unintended pregnancy, having partner’s support, being older in age, achieving a desired number of children, higher number of living children, higher number of male children, being in school or working, and discussing FP with a friend [ 6 , 7 , 9 , 11 – 13 ]. Fertility intentions (the desire for a certain number of children and the intended timing of a first birth and subsequent spacing between births [ 14 ]) have also been shown to be associated with contraceptive use [ 15 ] and continuation [ 12 , 13 ]. Yet women’s fertility intentions can and often change, even within a short period of time [ 15 – 17 ].…”

“…Fertility intentions (the desire for a certain number of children and the intended timing of a first birth and subsequent spacing between births [ 14 ]) have also been shown to be associated with contraceptive use [ 15 ] and continuation [ 12 , 13 ]. Yet women’s fertility intentions can and often change, even within a short period of time [ 15 – 17 ]. For example, one study in the US has found that while 39% of women who were interviewed three times within a year reported being uncertain if they wanted more children, only 9% consistently reported uncertainty [ 16 ].…”