Planning a family in Nairobi’s informal settlements: results of a qualitative study

Abstract

Childbearing intentions among women in high-fertility contexts are usually classified into those wanting to have a baby, those wanting to ‘space’ a birth and those wanting to ‘limit’ their family size. However, evidence from Africa increasingly suggests that women’s intentions are more complex than this classification suggests, and that there is fluidity in these intentions. This research explores women’s accounts of their childbearing intentions and decisions in order to examine how this fluidity plays out in a low-fertility context in urban Africa. Six focus group discussions were conducted in April and May 2012 with women of reproductive age in Nairobi, Kenya. Participants were recruited using random and purposive sampling techniques. The focus group discussions had an average of seven participants each. Data were coded thematically and analysed using Nvivo software. The analysis explored the factors that women consider to be influential for childbearing and found that the health of the mother and child, costs of raising a child and relationships were commonly reported to be important. Evidence of intentions to space births and limit family size was found. However, the data also showed that there is fluidity in women’s family planning intentions, driven by changes in relationships or household finances, which often result in a desire to avoid pregnancy in the present moment. The fluidity observed in women’s childbearing intentions cannot be accounted for by the concepts of either ‘spacing’ or ‘limitation’ but is best explained by the concept of ‘postponement’. The research reveals the need for family planning clinics to provide a full method mix, as well as high-quality counselling, to enable women to choose a method that best suits their needs.

Pathways to Low Fertility: 50 Years of Limitation, Curtailment, and Postponement of Childbearing

“…The concepts of the curtailment and postponement of childbearing also align with recent literature emphasizing the uncertain, ambivalent, contingent, flexible, and fluid nature of the fertility intentions of women in both contemporary countries and historical Europe (Agadjanian 2005;Fisher 2000;Johnson-Hanks 2004Ní Bhrolcháin and Beaujouan 2019;Towriss et al 2019;Trinitapoli and Yeatman 2018;Yeatman et al 2013). Limiters who have reached their desired family size might revisit their decision to stop childbearing in the (now rather uncommon) circumstance that one of their children dies.…”

“…Nevertheless, the large and differential decreases in fertility over time documented in this article can result only from differential increases in volitional birth control rooted in varied changes in women's fertility preferences and intentions. 8 Our argument that women in many countries delay or stop childbearing for reasons other than family size limitation or spacing accords with evidence from both quantitative and qualitative research in several parts of Africa that has focused directly on women's fertility preferences and intentions (Agadjanian 2005;Garver 2018;Agadjanian 2017, 2019;Johnson-Hanks 2004;Towriss et al 2019). Equally, the results presented here add heft to the work of anthropological demographers such as Johnson-Hanks, Bledsoe, and others who have argued that what women do in reality may be far removed from the oversimplified typifications adopted by many demographers and policy analysts (Bledsoe 2002;Johnson-Hanks 2005, 2007Ware 1976).…”

“…In most of the countries, however, fertility has declined too slowly for this account to be plausible. Instead, an increasing proportion of women may be using birth control, in effect, to retire from childbearing as they become older, more senior, and perhaps more concerned about their health; because their partner has deserted the family or they think that he might; or simply because they feel that they already have enough children to care for and educate (Agadjanian 2005;Bledsoe 2002;Garver 2018;Towriss et al 2019).…”

Women’s and girls’ experiences of reproductive coercion and opportunities for intervention in family planning clinics in Nairobi, Kenya: a qualitative study

“…Consistent with research from other LMIC contexts [13,23], descriptions of RC from this study highlight the roles of both male partners and in-laws in perpetrating RC. This research uniquely builds upon the current body of qualitative research in Kenya around female decision-making by highlighting RC as a factor inhibiting FP use [24].…”

“…… I was picked up by my husband and taken to the hospital for the removal of the implant that I had." -FP Client FGD (ages [15][16][17][18][19][20][21][22][23][24] This participant described a partner who disregarded her need to heal after giving birth before becoming pregnant again and created barriers for her to access contraception in the future.…”