Family Planning & Reproductive Health

Caryl Feldacker

MEASURE Evaluation conducted three studies that demonstrate the need to address fertility desires in programmatic approaches to reduce unintended pregnancies and HIV risk in sub-Saharan Africa. 

The objective of these studies were to examine fertility motivations in varying contexts and within varying sub-populations to inform strategies to prevent pregnancies that are mistimed or unwanted (unintended pregnancies) and reduce HIV risk in sub-Saharan Africa.

Secondary data from large, nationally representative surveys in sub-Saharan Africa were analyzed to examine intensity of fertility motivations in Kenya, Burkina Faso, and Ghana; coverage of program outreach and rural and urban differentials in fertility and family planning in Zambia; and female youth fertility desires and condom use in Mozambique. Descriptive and multivariate methods were used in each study. 

In Kenya, Burkina Faso, and Ghana, one quarter of women who want to delay or stop childbearing report that it would be ‘no problem’ or a ‘small problem’ if they became pregnant in the next few weeks. This was found among users and non-users of family planning. These women are ambivalent about future childbearing. In rural Zambia where high fertility prevails, the desire to postpone or stop childbearing has a larger effect on family planning use than does program outreach, measured as whether a health worker visited the household in the last year. In Mozambique, female youth who want to get pregnant in the near future are the most likely to be having unprotected sex with a non-marital partner. These women are acting on their desire for a pregnancy rather than intentionally engaging in HIV risk-taking. Policy makers and program managers need to consider the role of fertility desires that lead to unprotected sex in programmatic approaches to reduce unintended pregnancies and HV risk in sub-Saharan Africa.