Abstract
Introduction
Standard survey measures of fertility preferences, such as the desire for and preferred timing of future births, do not capture the complexity of individuals’ preferences. New research focuses on additional dimensions of emotions and expectations surrounding childbearing. Few quantitative studies, however, consider the influence of all three dimensions of fertility preferences concurrently.
Methods
Using longitudinal survey data from the Tsogolo la Thanzi project (2009–2012) in Malawi, this study employed logistic regression analysis to investigate the influence of young women’s emotions, expectations, and a standard measure of fertility preferences on pregnancy and modern contraceptive use.
Results
Young women experienced high unmet need; across survey waves, over three-quarters of women who desired a child in more than 2 years were not currently using modern contraceptives and over three-quarters of women who thought a pregnancy in the next month would be bad news (garnered from a measure of emotions surrounding pregnancy) were not currently using modern contraceptives. In regression models including all three measures of fertility preferences, each was significantly associated with the likelihood of a future pregnancy. The standard measure and emotions measure were significantly associated with modern contraceptive use.
Discussion
Emotions and expectations surrounding pregnancy and childbirth appear to be distinct and salient aspects of fertility preferences in addition to the standard measure. A better understanding of the multidimensional nature of fertility preferences will help individuals define and achieve their reproductive goals and obtain appropriate services. Furthermore, future research should incorporate new measures of fertility preferences into surveys internationally.
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Notes
The Malawi Demographic and Health Survey (DHS) also records use of traditional contraceptive methods including the rhythm method, withdrawal, and any other traditional methods reported by respondents (NSO and ICF Macro 2017).
Respondents indicated whether or not their households owned items including a bed with a mattress, television, radio, landline/mobile phone, refrigerator, and vehicle (coded owned the item = 1, did not own = 0); their main source of water (safer sources coded higher); and main material used for the floor of the house (more expensive materials coded higher). To create the index, a factor score was generated through principal components analysis utilizing the full sample of women across waves. The resulting asset scores were then standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. We utilized an approach similar to the DHS (NSO and ICF Macro 2017; Rutstein and Johnson 2004).
The variables included here had varying degrees of missing data. Two variables had no missing values (birth in the last 2 years and survey wave). Other variables had less than 6% of values missing (standard measure of fertility preferences, emotions, expectations, age, education, marital status, number of children, and economic status). Information on pregnancy in the subsequent 4 months was missing in 27% of person-waves, as numerous women were not located and interviewed 4 months later and a pregnancy test was thus not completed. All missing data were imputed to avoid list-wise deletion (Rubin 2004). Imputation of new data sets (estimating new values each time) can be limitless; however, 20 iterations is an acceptable threshold (Johnson and Young 2011). We performed 25 iterations to ensure confidence in our results.
Each woman was interviewed up to eight times in the survey across 3 years. Approximately half of the women in our sample became pregnant across the 3 years, however they were recorded as becoming pregnant (positive pregnancy test) in as few as one of the waves. Therefore, the percentage of women becoming pregnant is much higher than the percentage of survey waves (person-waves) where they were coded as becoming pregnant.
See Aiken et al. (2016) for a conceptual framework aiming to inform women-centered approaches to helping them achieve their reproductive goals. The framework is not theoretically based but nevertheless considers the multidimensional nature of fertility preferences and reproductive behaviors.
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Acknowledgements
This study uses data from Tsogolo la Thanzi, a research project designed by Jenny Trinitapoli and Sara Yeatman, and funded by Grants R01-HD058366 and R01-HD077873 from the National Institute of Child Health and Human Development (NICHD). The first author was supported by NICHD funding to the Population Research Institute at the Pennsylvania State University for Population Research Infrastructure (P2C HD041025) and Family Demography Training (T32 HD007514).
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Gibby, A.L., Luke, N. Exploring Multiple Dimensions of Young Women’s Fertility Preferences in Malawi. Matern Child Health J 23, 1508–1515 (2019). https://doi.org/10.1007/s10995-019-02778-5
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DOI: https://doi.org/10.1007/s10995-019-02778-5