Childbearing desires and behaviour: a prospective assessment in Nairobi slums

Abstract

Background Advancing an understanding of childbearing desires is an important precursor to achievement of the policy goal of reducing unintended pregnancies. It has been long debated that concepts of fertility desires and planning may be particularly problematic in sub-Saharan Africa. However, examination of the utility of fertility preference measures and their link to reproductive behaviour is still rare in the region. The aim of this study is to assess the predictive validity of future childbearing desires on subsequent reproduction among women living in the highly unpredictable circumstances of Nairobi slums. Methods We used data from a longitudinal study (2007–2010) nested in the Nairobi Urban Health Demographic Surveillance System that is located in two slums in Nairobi, Kenya. We analysed baseline fertility desires among 4577 postpartum women. Cox proportional hazard model was employed to examine the effect of fertility desires on subsequent reproduction. Results One-third of the women wanted no more children and 37% wanted to wait for at least five years at baseline. While two-thirds of the women who wanted to have a child soon became pregnant within three years, less than one-third of those wanting no more children became pregnant. The multivariable analysis shows that the probability of becoming pregnant among women who expressed desires to stop or delay childbearing at least for five years was 50% less than among women who wanted to have a child in two to four years. In addition to prospective fertility desires, level of woman’s education, residence and ethnicity exerted important influences on implementation of baseline preferences. Conclusions Our study finds a strong link between baseline fertility desires and subsequent reproduction. A large difference in pregnancy risk was observed between those who wanted no more children and those who wanted another child. The link between a woman’s stated desire to stop childbearing and subsequent childbearing is just as strong in the Nairobi slums as elsewhere. In addition, the findings revealed a pronounced gradient in pregnancy risk according to preferred spacing length, which support other evidence on the important contribution of long-term spacing or postponement to fertility decline in sub-Saharan Africa.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

“…Important exceptions include the longitudinal research emerging from the few cities that host health and demographic surveillance systems. This work demonstrates the importance of the neighborhood context in shaping reproductive ideas and behaviors (50,84). Recent studies analyzing health inequalities in Accra (Ghana) by linking satellite imagery with survey and administrative data have also taken a specific interest in assessing neighborhood effects (8,(137)(138)(139).…”

“…For women living in slum areas of Nairobi, for example, age, parity and marital status each had a significant net effect on the likelihood of unplanned conception, while marital status and ethnicity were more significant determinants for those residing in less deprived areas of the city ( 49 ). One longitudinal study showed that women in one slum neighborhood of Nairobi were almost twice as likely to realize baseline fertility preferences than those living in a different slum area ( 50 ).…”

“…Generally, sub-Saharan African populations show high rates of contraceptive discontinuation and low probabilities of switching between methods, indicating high risks of unintended conception ( 97 ). Ambivalent, variable, or low motivations surrounding childbearing may be associated with discontinuation among urban African women, particularly if they experience method-related dissatisfaction ( 50 , 51 , 98 ).…”

The Enduring Case for Fertility Desires

“…The critiques of fertility desires are particularly acute in research on sub-Saharan Africa, where both over-and underachieved fertility are high at the end of women's reproductive lives (Casterline and Han 2017;Channon and Harper 2019;Günther and Harttgen 2016;Machiyama et al 2019). Indeed, some researchers have returned to old lines of inquiry, asking whether women in the region are able to realize their fertility desires and questioning whether desire is a useful construct for understanding behavior (Evens et al 2015;Günther and Harttgen 2016;Van der Sijpt 2014).…”

Son Preference and the Reproductive Behavior of Rural-Urban Migrant Women of Childbearing Age in China: Empirical Evidence from a Cross-Sectional Data

“…Studies on women's reproductive behavior in the existing literature focus on family reproductive intention, family planning, number of sons and contraceptive usage [8,12,14,32,33]. For example, prospective analysis is performed by directly asking questions such as "How many children do you expect to have?…”