Skip to main content

The Enduring Case for Fertility Desires

Demography volume 57, pages 2047–2056 (2020)Cite this article

Abstract

Persistently high levels of unintended fertility, combined with evidence that over- and underachieved fertility are typical and not exceptional, have prompted researchers to question the utility of fertility desires writ large. In this study, we elaborate this paradox: widespread unintendedness and meaningful, highly predictive fertility desires can and do coexist. Using data from Malawi, we demonstrate the predictive validity of numeric fertility timing desires over both four-month and one-year periods. We find that fertility timing desires are highly predictive of pregnancy and that they follow a gradient wherein the likelihood of pregnancy decreases in correspondence with desired time to next birth. This finding holds despite the simultaneous observation of high levels of unintended pregnancy in our sample. Discordance between desires and behaviors reflects constraints to achieving one’s fertility and the fluidity of desires but not their irrelevance. Fertility desires remain an essential—if sometimes blunt—tool in the demographers’ toolkit.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

Data Availability

Tsogolo la Thanzi data are available through Data Sharing for Demographic Research within ICPSR at the University of Michigan (https://www.icpsr.umich.edu/web/DSDR/series/767).

Notes

  1. We refer to desires throughout the text despite frequently citing literature that uses the language of “intentions.” Although some surveys actually measure intentions, it is far more common for surveys (e.g., NSFG, DHS, PRAMS) to measure desires (e.g., “Did you yourself want to have a(nother) baby?”; “How long would you like to wait before the birth of a(nother) child?”). Responding to calls from fertility researchers, we endeavor to align our terminology with our measurement (Kost and Zolna 2019; Kost et al. 2018; Miller et al. 2004).

  2. Aspects of this debate parallel broader conversations about the “attitudinal fallacy” taking place across the social sciences, specifically those questioning the predictive power of attitudinal survey items (Jerolmack and Khan 2014; Vaisey 2014).

  3. Researchers have pointed out that questions on timing desires may be easier to answer for women who seek to space their births or who have yet to start childbearing than for women who seek to postpone their next birth indefinitely (Cleland et al. 2019; Hayford and Agadjanian 2019; Timaeus and Moultrie 2008). These women may introduce some noise into our measurement, although the exceedingly rare responses of “don’t know” or “no preference” and our focus on the short-term suggest the impact will be limited.

  4. Importantly, this allows us to examine the predictors of pregnancy, not just births, in a context where the health risks of abortion, largely illegal and unsafe, can be severe (Polis et al. 2017). Even with the close spacing of surveys within TLT, however, some early miscarriages and abortions may be missed, and thus the total number of pregnancies will still be underestimated. These missed pregnancies may introduce some bias (in both directions) to our results. As a sensitivity analysis, we include self-reported miscarriages and abortions during the intersurvey period; the findings do not change.

  5. Women who tested not pregnant or refused a test are considered not to be pregnant. As a sensitivity analysis, we rerun all analyses classifying refusers by their self-reported pregnancy status as well as dropping these women from analyses. The cumulative incidence of pregnancy increases with these approaches, but the key relationships do not change.

  6. In another sensitivity analysis, we include women who participated in any wave; the results do not change.

  7. Of the small set of prospective studies of unintended births, it is most common for researchers to allow a one-year grace period before labeling a birth as unintended (see, e.g., Koenig et al. 2006; Singh et al. 2013; Yeatman and Sennott 2015).

  8. Here, we revert to the terminology of intended and unintended pregnancy as widely used in the literature, with the acknowledgment that what we—and most researchers—actually measure is desires rather than intentions.

  9. Thus, for the four-month period, women who reported a desire for pregnancy as soon as possible are compared with women who reported a desire for any delay. For the one-year time frame, women who reported a desired birth within two years are compared with women who expressed a desire to delay a birth beyond two years.

  10. The TLT study focuses on a specific age range in a particular context. However, the gradient that we identify is similar to that found recently among postpartum women in urban Kenya slums (Machiyama et al. 2019).

References

  • Aiken, A. R., Borrero, S., Callegari, L. S., & Dehlendorf, C. (2016). Rethinking the pregnancy planning paradigm: Unintended conceptions or unrepresentative concepts? Perspectives on Sexual and Reproductive Health, 48, 147–151. https://doi.org/10.1363/48e10316

    Article  Google Scholar 

  • Bearak, J., Popinchalk, A., Alkema, L., & Sedgh, G. (2018). Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: Estimates from a Bayesian hierarchical model. Lancet Global Health, 6, e380–e389. https://doi.org/10.1016/S2214-109X(18)30029-9

    Article  Google Scholar 

  • Bongaarts, J. (1992). Do reproductive intentions matter? International Family Planning Perspectives, 18, 102–108.

    Article  Google Scholar 

  • Bongaarts, J. (2001). Fertility and reproductive preferences in post-transitional societies. Population and Development Review, 27, 260–281.

    Article  Google Scholar 

  • Casterline, J., & Han, S. (2017). Unrealized fertility: Fertility desires at the end of the reproductive career. Demographic Research, 36, 427–454. https://doi.org/10.4054/DemRes.2017.36.14

    Article  Google Scholar 

  • Channon, M. D., & Harper, S. (2019). Educational differentials in the realisation of fertility intentions: Is sub-Saharan Africa different? PLoS One, 14, e0219736. https://doi.org/10.1371/journal.pone.0219736

  • Clark, S., Koski, A., & Smith-Greenaway, E. (2017). Recent trends in premarital fertility across sub-Saharan Africa. Studies in Family Planning, 48, 3–22.

    Article  Google Scholar 

  • Cleland, J., Machiyama, K., & Casterline, J. B. (2019). Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations. Population Studies, 74, 1–21.

    Article  Google Scholar 

  • Evens, E., Tolley, E., Headley, J., McCarraher, D. R., Hartmann, M., Mtimkulu, V. T., & FEM-PrEP SBC Preparedness Research Groups in South Africa and Malawi. (2015). Identifying factors that influence pregnancy intentions: Evidence from South Africa and Malawi. Culture, Health & Sexuality, 17, 374–389.

    Article  Google Scholar 

  • Gibby, A. L., & Luke, N. (2019). Exploring multiple dimensions of young women’s fertility preferences in Malawi. Maternal and Child Health Journal, 23, 1508–1515.

    Article  Google Scholar 

  • Günther, I., & Harttgen, K. (2016). Desired fertility and number of children born across time and space. Demography, 53, 55–83.

    Article  Google Scholar 

  • Harknett, K., & Hartnett, C. S. (2014). The gap between births intended and births achieved in 22 European countries, 2004–07. Population Studies, 68, 265–282.

    Article  Google Scholar 

  • Hayford, S. R., & Agadjanian, V. (2012). From desires to behavior: Moderating factors in a fertility transition. Demographic Research, 26, 511–542. https://doi.org/10.4054/DemRes.2012.26.20

    Article  Google Scholar 

  • Hayford, S. R., & Agadjanian, V. (2019). Spacing, stopping, or postponing? Fertility desires in a sub-Saharan setting. Demography, 56, 573–594.

    Article  Google Scholar 

  • Jerolmack, C., & Khan, S. (2014). Talk is cheap: Ethnography and the attitudinal fallacy. Sociological Methods & Research, 43, 178–209.

    Article  Google Scholar 

  • Kodzi, I. A., Johnson, D. R., & Casterline, J. B. (2010). Examining the predictive value of fertility preferences among Ghanaian women. Demographic Research, 22, 965–984. https://doi.org/10.4054/DemRes.2010.22.30

    Article  Google Scholar 

  • Koenig, M. A., Acharya, R., Singh, S., & Roy, T. K. (2006). Do current measurement approaches underestimate levels of unwanted childbearing? Evidence from rural India. Population Studies, 60, 243–256.

    Article  Google Scholar 

  • Kost, K., Maddow-Zimet, I., & Kochhar, S. (2018). Pregnancy desires and pregnancies at the state level: Estimates for 2014. New York, NY: Guttmacher Institute. Retrieved from https://doi.org/10.1363/2018.30238

  • Kost, K., & Zolna, M. (2019). Challenging unintended pregnancy as an indicator of reproductive autonomy: A response. Contraception, 100, 5–9.

    Article  Google Scholar 

  • Kuang, B., & Brodsky, I. (2016). Global trends in family planning programs, 1999–2014. International Perspectives on Sexual and Reproductive Health, 42, 33–44.

    Article  Google Scholar 

  • Lee, R. D. (1980). Aiming at a moving target: Period fertility and changing reproductive goals. Population Studies, 34, 205–226.

    Article  Google Scholar 

  • Levandowski, B. A., Kalilani-Phiri, L., Kachale, F., Awah, P., Kangaude, G., & Mhango, C. (2012). Investigating social consequences of unwanted pregnancy and unsafe abortion in Malawi: The role of stigma. International Journal of Gynecology & Obstetrics, 118(Suppl. 2), S167–S171.

  • Liefbroer, A. C. (2009). Changes in family size intentions across young adulthood: A life-course perspective. European Journal of Population/Revue Européenne de Démographie, 25, 363–386.

  • Machiyama, K., Baschieri, A., Dube, A., Crampin, A. C., Glynn, J. R., French, N., & Cleland, J. (2015). An assessment of childbearing preferences in northern Malawi. Studies in Family Planning, 46, 161–176.

    Article  Google Scholar 

  • Machiyama, K., Casterline, J. B., Mumah, J. N., Huda, F. A., Obare, F., Odwe, G., . . . Cleland, J. (2017). Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: Protocol for a multi-site cohort study. Reproductive Health, 14, 23. https://doi.org/10.1186/s12978-016-0268-z

  • Machiyama, K., Mumah, J. N., Mutua, M., & Cleland, J. (2019). Childbearing desires and behaviour: A prospective assessment in Nairobi slums. BMC Pregnancy and Childbirth, 19, 100. https://doi.org/10.1186/s12884-019-2245-3

    Article  Google Scholar 

  • Miller, W. B., Severy, L. J., & Pasta, D. J. (2004). A framework for modelling fertility motivation in couples. Population Studies, 58, 193–205.

    Article  Google Scholar 

  • Morgan, S. P. (2001). Should fertility intentions inform fertility forecasts? Paper presented at the U.S. Census Bureau Conference on the Direction of Fertility in the United States, Alexandria, VA. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.232.747&rep=rep1&type=pdf#page=165

  • Morgan, S. P., & Bachrach, C. A. (2011). Is the theory of planned behaviour an appropriate model for human fertility? Vienna Yearbook of Population Research, 9, 11–18.

    Article  Google Scholar 

  • Morgan, S. P., & Rackin, H. (2010). The correspondence between fertility intentions and behavior in the United States. Population and Development Review, 36, 91–118.

    Article  Google Scholar 

  • Mueller, M. W., Hicks, J. H., Johnson-Hanks, J., & Miguel, E. (2019). The illusion of stable preferences over major life decisions (NBER Working Paper No. 25844). Cambridge, MA: National Bureau of Economic Research.

  • Ní Bhrolcháin, M., & Beaujouan, É. (2019). Do people have reproductive goals? Constructive preferences and the discovery of desired family size. In R. Schoen (Ed.), Analytical family demography (pp. 27–56). Dordrecht, the Netherlands: Springer.

    Chapter  Google Scholar 

  • Polis, C. B., Mhango, C., Philbin, J., Chimwaza, W., Chipeta, E., & Msusa, A. (2017). Incidence of induced abortion in Malawi, 2015. PLoS One, 12, e0173639. https://doi.org/10.1371/journal.pone.0173639

  • Régnier-Loilier, A., Vignoli, D., & Dutreuilh, C. (2011). Fertility intentions and obstacles to their realization in France and Italy. Population, 66, 361–389.

    Article  Google Scholar 

  • Rocca, C. H., Ralph, L. J., Wilson, M., Gould, H., & Foster, D. G. (2019). Psychometric evaluation of an instrument to measure prospective pregnancy preferences: The desire to avoid pregnancy scale. Medical Care, 57, 152–158.

  • Sable, M. R. (1999). Pregnancy intentions may not be a useful measure for research on maternal and child health outcomes. Perspectives on Sexual and Reproductive Health, 31, 248–253.

  • Schoen, R., Astone, N. M., Kim, Y. J., Nathanson, C. A., & Fields, J. M. (1999). Do fertility intentions affect fertility behavior? Journal of Marriage and the Family, 61, 790–799.

    Article  Google Scholar 

  • Schoen, R., Astone, N. M., Nathanson, C. A., Kim, Y. J., & Murray, N. (2000). The impact of fertility intentions on behavior: The case of sterilization. Social Biology, 47, 61–76.

    Google Scholar 

  • Sennott, C., & Yeatman, S. (2012). Stability and change in fertility preferences among young women in Malawi. International Perspectives on Sexual and Reproductive Health, 38, 34–39.

    Article  Google Scholar 

  • Singh, A., Singh, A., & Mahapatra, B. (2013). The consequences of unintended pregnancy for maternal and child health in rural India: Evidence from prospective data. Maternal and Child Health Journal, 17, 493–500.

    Article  Google Scholar 

  • Speizer, I. S., & Lance, P. (2015). Fertility desires, family planning use and pregnancy experience: Longitudinal examination of urban areas in three African countries. BMC Pregnancy and Childbirth, 15, 294. https://doi.org/10.1186/s12884-015-0729-3

    Article  Google Scholar 

  • Timaeus, I. M., & Moultrie, T. A. (2008). On postponement and birth intervals. Population and Development Review, 34, 483–510.

    Article  Google Scholar 

  • Toulemon, L., & Testa, M. R. (2005). Fertility intentions and actual fertility: A complex relationship. Population & Societies, 415(4), 1–4.

  • Trinitapoli, J., & Yeatman, S. (2018). The flexibility of fertility preferences in a context of uncertainty. Population and Development Review, 44, 87–116.

    Article  Google Scholar 

  • Vaisey, S. (2014). The “attitudinal fallacy” is a fallacy: Why we need many methods to study culture. Sociological Methods & Research, 43, 227–231.

    Article  Google Scholar 

  • Van der Sijpt, E. (2014). Complexities and contingencies conceptualised: Towards a model of reproductive navigation. Sociology of Health & Illness, 36, 278–290.

    Article  Google Scholar 

  • Yeatman, S., Chilungo, A., Lungu, S., Namadingo, H., & Trinitapoli, J. (2019). Tsogolo la Thanzi: A longitudinal study of young adults living in Malawi’s HIV epidemic. Studies in Family Planning, 50, 71–84.

    Article  Google Scholar 

  • Yeatman, S., & Sennott, C. (2015). The sensitivity of measures of unwanted and unintended pregnancy using retrospective and prospective reporting: Evidence from Malawi. Maternal and Child Health Journal, 19, 1593–1600.

    Article  Google Scholar 

  • Yeatman, S., Sennott, C., & Culpepper, S. (2013). Young women’s dynamic family size preferences in the context of transitioning fertility. Demography, 50, 1715–1737.

    Article  Google Scholar 

Download references

Acknowledgments

This research uses data from Tsogolo la Thanzi, a research project designed by Jenny Trinitapoli and Sara Yeatman and funded by Grants R01-HD058366, R01-HD077873, and R03-HD095690 from the National Institute of Child Health and Human Development. This research was also supported by the population centers at the University of Colorado (CUPC; P2C-HD066613) and the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Health and Behavioral Sciences, University of Colorado Denver, Campus Box 188, PO Box 173364, Denver, CO, 80217, USA

    Sara Yeatman

  2. University of Colorado Population Center, Boulder, CO, USA

    Sara Yeatman

  3. Sociology Department, University of Chicago, Chicago, IL, USA

    Jenny Trinitapoli & Sarah Garver

Authors
  1. Sara Yeatman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jenny Trinitapoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah Garver
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Sara Yeatman developed the idea for the study and conducted the analyses with the assistance of Sarah Garver. Jenny Trinitapoli contributed heavily to the framing of the study, and the first draft of the manuscript was written by Sara Yeatman. All authors commented on previous versions of the manuscript and approved the final version.

Corresponding author

Correspondence to Sara Yeatman.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethics and Consent

Ethical approval for the Tsogolo la Thanzi study was obtained in Malawi from the National Health Sciences Research Committee (NHSRC) and in the United States from the Office for Research Protections at The Pennsylvania State University and the Social and Behavioral Sciences Institutional Review Board at the University of Chicago. Respondents gave consent at the time they were recruited for the study, before each interview, and before biomarker collection. Unmarried women aged 15–17 in the core sample enrolled in the study only after the study team obtained informed consent from a parent or guardian and assent from the minors themselves.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yeatman, S., Trinitapoli, J. & Garver, S. The Enduring Case for Fertility Desires. Demography 57, 2047–2056 (2020). https://doi.org/10.1007/s13524-020-00921-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13524-020-00921-4

Keywords

  • Fertility
  • Fertility desires
  • Malawi