Infertility, Perceived Certainty of Pregnancy, and Contraceptive Use in Malawi

Abstract

Infertility and unintended pregnancy are dual burdens in Malawi, where % of pregnancies are unintended and approximately % of people report infertility. Although preventing unintended pregnancy has been a focus in public health, infertility has rarely been explored as a factor that may be associated with contraceptive use. Using cross-sectional survey data (-; N = ), we report on the prevalence of and sociodemographic characteristics associated with infertility and certainty of becoming pregnant among women in Malawi. We conducted multivariable logistic regressions examining the relationship between infertility, certainty of becoming pregnant, and contraceptive use. Approximately % of women experienced infertility, and three-quarters (%) were certain they could become pregnant within one year. Women who experienced infertility had lower odds of contraceptive use than women who did not (Adjusted Odds Ratio [AOR]: .; % Conficence Interval [CI]: .-.). Women who said there was "no chance" or they were "unlikely" to become pregnant also had lower odds of contraceptive use compared to women who were certain they would become pregnant (AOR: .; % CI: .-.). Our findings indicate that experiences and perceptions surrounding fertility are associated with contraceptive use, underscoring their importance in understanding how people manage their fertility to reach their reproductive goals.

Measuring Nuance in Individual Contraceptive Need: A Case Study from a Cohort in Malawi

“…Perceived fecundity has been demonstrated to influence contraceptive use across settings, including in Malawi, such that lower perceived fecundity is associated with contraceptive nonuse (Bell and Gemmill 2021; Bornstein et al. 2021; Polis et al. 2020).…”

“…Perceived fecundity represents a person's own assessment of their likelihood of becoming pregnant if they do not use a method of contraception. Perceived fecundity has been demonstrated to influence contraceptive use across settings, including in Malawi, such that lower perceived fecundity is associated with contraceptive nonuse (Bell and Gemmill 2021;Bornstein et al 2021;Polis et al 2020).…”

“…Such factors include exposure to the possibility of pregnancy (e.g., sexual activity or frequency) and one's perception of their biological risk of pregnancy (e.g., perceived fecundity) (Bell and Gemmill 2021; Bornstein et al. 2021; Gemmill and Cowan 2021; Moreira et al. 2019; Polis et al.…”

“…Of note, additional factors, beyond pregnancy desires and intentions, have a demonstrated influence on people's contraceptive use and nonuse among those who do not wish to become pregnant (Moreira et al 2019). Such factors include exposure to the possibility of pregnancy (e.g., sexual activity or frequency) and one's perception of their biological risk of pregnancy (e.g., perceived fecundity) (Bell and Gemmill 2021;Bornstein et al 2021;Gemmill and Cowan 2021;Moreira et al 2019;Polis et al 2020). People may choose not to use a modern method of contraception, regardless of a counseling protocol that indicates their need, and this is a choice that must be respected (Senderowicz 2019).…”

“I know my body and I just can't get pregnant that easily” – Women's use and non-use of the injection to manage fertility

“…Data for this study come from the Umoyo Wa Thanzi (UTHA; Health for Life) research program, a mixed-methods cohort study focused on sexual and reproductive health decision making among women aged 15–49 years and their male partners in Central Malawi (2014–2019). Detailed descriptions of the cohort have been published elsewhere ( Bornstein, Huber-Krum, Norris, & Gipson, 2021 ; Huber et al, 2017 ; Huber-Krum et al, 2021 ; Huber-Krum & Norris, 2020 ; Rao et al, 2017 ).…”