The illusion of stable fertility preferences

Are Contraceptive Method Preferences Stable? Measuring Change in the Preferred Method among Kenyan Women

Contraceptive preferences are important for reproductive outcomes, such as contraceptive continuation and pregnancy. Current approaches to measuring reproductive preferences in population surveys are limited to exploring only fertility preferences and implicitly assume that contracepting people are using a method they want. We know that people change their fertility preferences over the life course as a response to life events, but there is no information about changes in contraceptive preferences, given the limited evidence about the measurement and distribution of contraceptive preferences. In this study, we examined the extent of change in women's contraceptive preferences over one year and identified characteristics associated with this change in Kenya using three rounds of nationally representative longitudinal data. Over one year, 18 percent of contraceptive users and 46 percent of contraceptive nonusers reported changes in their preferred contraceptive. Experiencing a pregnancy or birth and changes in marital status were associated with changes in contraceptive preferences for users and nonusers. We found that contraceptive preferences are dynamic, suggesting that family planning programs should ensure people's access to various methods to respond to women's changing circumstances and preferences.

How genuine are sub-replacement ideal family sizes in urban China?

Ideal family sizes remain at or above two in most low-fertility settings, but sub-replacement fertility ideals have been reported for urban China. The presence of restrictive family planning policies has led to a debate as to whether such ideals are genuine. This study exploits the ending of the one-child policy and the beginning of a universal two-child policy in October 2015 to investigate whether relaxing the restrictions led to an increase in ideal family size. We apply difference-in-differences and individual-level fixed-effect models to longitudinal data from a near-nationwide survey. For married individuals aged 20-39, relaxing the restrictions from one to two children increased the mean ideal family size by around 0.2 and the proportion who desired two or more children by around 19 percentage points. Findings suggest that although reported ideal family sizes have been reduced by policy restrictions, sub-replacement ideal family sizes in urban China appear to be genuine.

Fertility Intentions During the Covid-19 Pandemic: An Analysis of Individual- and Municipality-Level Determinants

Recognizing the prolonged, uneven, and evolving nature of the Covid-19 pandemic, this study provides one of the first dynamic, multilevel perspectives of women's fertility intentions in response to the pandemic and its multifaceted impacts. We examine how evolving individual- and community-level Covid-19 risk mechanisms and socioeconomic and life-course conditions are associated with continuity and change in women's fertility intentions. We combine individual-level panel data from a population-based sample of women aged 18-34 in Pernambuco, Brazil in 2020 and 2021 with corresponding administrative data from 94 municipalities. We use multinomial logit regressions to model continuity and change in fertility intentions across waves. We then estimate fixed effect models to highlight the time-varying determinants of changing fertility intentions while accounting for unobserved, time-invariant individual factors. We find that high and/or increasing individual and community-level Covid-19 exposure is associated with a greater likelihood of abandoning initial childbearing plans and a greater likelihood to maintain intentions to forego versus to intend having additional children. We advance the literature by highlighting how individual-level Covid-19 infection risk perceptions matter for fertility intentions, net of community-level exposure, and the necessity of dynamic perspectives for understanding how fertility intentions have changed (or not) in response to the pandemic.

Explaining uncertainty in women's fertility preferences

People's fertility preferences are often considered an important determinant of fertility. What is often neglected in studies of preferred fertility, is the uncertainty that people may have about their preferences. In this study, using data on Dutch women through the Longitudinal Internet studies for the Social Sciences (collected early 2018), we examined women's fertility preferences and asked detailed questions about the certainty of these preferences. We also examined whether women agreed with their partner on preferred family size, and to what extent partner (dis)agreement shaped uncertainty. We show that Dutch women expressed much uncertainty about their fertility preferences, with only one-third feeling strongly about their preferences. Uncertainty strongly increased when women preferred higher numbers of children, whereas already having children reduced it. Women who wanted no children were most certain about their preference. Higher preferred family sizes also led to more disagreement with the partner about these preferences, and greater partner disagreement, in turn, led to more uncertainty. These findings imply that people are more likely to downgrade their fertility preferences than to increase them, as women are more certain about their preferences for lower numbers of children and are more open to family sizes below than above their preferred choice. Partner disagreement is often resolved by not having (more) children, lowering realised fertility. Hence, these findings provide another explanation for why many people have fewer children than desired.

Cameroon's slow fertility transition: A gender perspective

We interrogate the proposition that men's attitudes have constrained the fertility transition in Cameroon, where fertility remains high and contraceptive use low despite much socio-economic progress. We use five Demographic and Health Surveys to compare trends in desired family size among young women and men and analyse matched monogamous couple data from the two most recent surveys to examine wives' and husbands' desires to stop childbearing and their relative influence on current contraceptive use. In 2018, average desired family size was 5.6 and 5.1, for young men and women respectively, and this difference (half a child) has not changed since 1998. Among matched couples, the proportions wanting to stop childbearing were similar in wives and their husbands, but wives perceived husbands to be much more pronatalist than themselves. Surprisingly, men's own reported preferences were more closely associated with contraceptive use than wives' perceptions of husbands' preferences. We discerned little evidence that men's attitudes have impeded reproductive change.

Reproductive autonomy and the experience of later-than-desired pregnancy: results from a cross-sectional survey of reproductive-aged women in Uganda

BACKGROUND

The focus of reproductive autonomy research has historically been on the experience of unintended pregnancy and use of contraceptive methods. However, this has led to the neglect of a different group of women who suffer from constraints on their reproductive autonomy-women who experience pregnancies later than they desire or who are unable to become pregnant. This study examines the extent of later-than-desired pregnancy among women and evaluates the sociodemographic and reproductive factors associated with this experience in Uganda.

METHODS

We use data from the Performance Monitoring for Action Uganda 2022 female survey. We restricted the nationally representative sample of reproductive-aged women to those who were currently pregnant or who had ever given birth (n = 3311). We compared the characteristics of women across fertility intention categories (wanted pregnancy earlier, then, later, or not at all) of their current or most recent birth and used multivariable logistic regression to examine factors independently associated with having a pregnancy later than desired compared to at a desired time.

RESULTS

Overall, 28.3% of women had a later-than-desired pregnancy. Nearly all sociodemographic and reproductive characteristics were associated with the desired pregnancy timing of women's current or most recent pregnancy. Having higher education [adjusted odds ratio (aOR) 2.41, 95% confidence interval (CI) 1.13-5.13], having sought care for difficulties getting pregnant (aOR 2.12, 95% CI 1.30-3.46), and having less than very good self-rated health (good health aOR 1.74, 95% CI 1.12-2.71; moderate health aOR 1.77, 95% CI 1.09-2.86; very bad health aOR 4.32, 95% CI 1.15-16.26) were all independently significantly associated with increased odds of having a later-than-desired pregnancy. Being nulliparous (aOR 1.98, 95% CI 0.99-3.95) was also borderline significantly associated with having a later-than-desired pregnancy.

CONCLUSIONS

Identifying those who have later-than-desired pregnancies is essential if we seek to make progress towards supporting women and couples in achieving their reproductive goals, not just preventing pregnancies. Research on desired pregnancy timing in sub-Saharan Africa should be expanded to capture later-than-desired pregnancies, a population which is invisible in existing data. This work has public health implications due to commonalities in the factors associated with mistimed and unintended pregnancies and their link to poorer health and potentially poorer pregnancy outcomes.

Unmet need and intention to use as predictors of adoption of contraception in 10 Performance Monitoring for Action geographies

The determinants of fertility typically feature demand as the key motivation driver for contraceptive use. Yet relatively little is known about the extent to which demand for contraception predicts future contraceptive use, primarily due to the lack of longitudinal data that captures these measures at different time points. Two ways in which demand is often measured are unmet need and intention to use. Despite its intended use as a population measure, unmet need is commonly used in individual-level analyses and as a marker for individual-level demand for contraception. Few studies have assessed the extent to which unmet need predicts or reflects women's true latent demand as demonstrated by their future contraceptive use; the same is true for intention to use contraception in the future. We expand on previous research to assess whether and the degree to which unmet need and intention to use contraception predict adoption of contraception within a year, among nonusers in ten representative geographies using Performance Monitoring for Action (PMA) data. Findings show that in nine of ten sites, intention to use within a year was significantly associated with subsequent adoption, while in eight of ten sites, unmet need for spacing or limiting was not associated with adoption. Our results are important for programs as they try to identify true dynamic demand for contraception.

Is the mortality-fertility nexus gendered? A research note on sex differences in the impact of sibling mortality on fertility preferences

Research guided by demographic transition theory has shown that exposure to mortality influences women's fertility preferences and behaviours. Despite the myriad contexts, methodological approaches, and linkages featured in past studies, they have shared a focus on women, leaving questions on the gendered salience of mortality exposures for adults' fertility-related outcomes unanswered. In this research note, we analyse data from three African countries with distinct fertility profiles (Nigeria, Zambia, and Zimbabwe) to examine associations between sibling mortality exposure and ideal family size among women, men, and couples. We also investigate the stability of these associations over time. The associations between adults' sibling mortality exposure and their own and their spouses' ideal family sizes vary across countries. However, the gendered nature of the results in every country and evidence of cross-spousal effects uniformly demonstrate the need to incorporate sex differences into the study of the mortality-fertility link.

Measuring Fertility Intentions During Times of Crisis: An Example Using Survey Data Amid the Covid-19 Pandemic

Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.

Measurement of Unmet Need for Contraception: A Counterfactual Approach

Unmet need plays a critical role in reproductive health research, evaluation, and advocacy. Although conceptually straightforward, its estimation suffers from a number of methodological limitations, most notably its reliance on biased measures of women's stated fertility preferences. We propose a counterfactual-based approach to measuring unmet need at the population level. Using data from 56 countries, we calculate unmet need in a population as the difference between: (1) the observed contraceptive prevalence in the population; and (2) the calculated contraceptive prevalence in a subsample of women who are identified to be from "ideal" family planning environments. Women from "ideal" environments are selected on characteristics that signal their contraceptive autonomy and decision-making over family planning. We find significant differences between our approach and existing methods to calculating unmet need, and we observe variation across countries when comparing indicators. We argue that our indicator of unmet need is preferable to existing population-level indicators due to its independence from biases that are generated from the use of reported preference measures, the simplicity with which it can be derived, and its relevance for cross-country comparisons as well as context-specific analyses.