Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St, Chapel Hill, NC, 27516, USA.
Reprod Health. 2020 Mar 17;17(1):38. doi: 10.1186/s12978-020-0893-4.
Fertility intentions and contraceptive use are often used to demonstrate gaps in programs and policies to meet the contraceptive needs of women and couples. Prior work demonstrated that fertility intentions are fluid and change over a woman's (or couple's) life course with changing marital status, childbearing, and education/employment opportunities. This study uses longitudinal data to better examine the fluidity of women's fertility intentions and disentangle the complex interrelationships between fertility and contraceptive use.
Using survey data from three time points and three urban sites in Senegal, this study examines how women's fertility intentions and contraceptive use in an earlier period affect pregnancy experience and the intentionality of experienced pregnancies among a sample of 1050 women who were in union at all three time points. We apply correlated random effect longitudinal regression methods to predict a subsequent birth by fertility intentions and modern contraceptive use at an earlier period addressing endogeneity concerns of earlier analyses that only include two time periods.
Descriptive results demonstrate some change in fertility desires over time such that 6-8% of women who reported their pregnancy as intended (i.e., wanted to get pregnant at time of pregnancy) reported earlier that they did not want any(more) children. Multivariate analyses demonstrate that women who want to delay or avoid a pregnancy and are using modern contraception are the least likely to get pregnant. Among women who became pregnant, the only factor differentiating whether the pregnancy is reported as intended or unintended (mistimed or unwanted) was prior fertility intention. Women who wanted to delay a pregnancy previously were more likely to report the pregnancy as unintended compared to women who wanted to get pregnant soon.
These results suggest some post-hoc rationalization among women who are getting pregnant. Women who say they do not want to get pregnant may be choosing not to use a contraceptive method in this urban Senegal context of high fertility. Programs seeking to reach these women need to consider their complex situations including their fertility intentions, family planning use, and the community norms within which they are reporting these intentions and behaviors.
生育意愿和避孕措施的使用常被用于展示项目和政策在满足女性和夫妇避孕需求方面的差距。先前的研究表明，生育意愿是流动的，随着婚姻状况、生育和教育/就业机会的变化，女性（或夫妇）的生活轨迹也会发生变化。本研究使用纵向数据更好地考察了女性生育意愿的流动性，并理清了生育与避孕使用之间复杂的相互关系。
本研究使用塞内加尔三个城市的三个时间点的调查数据，考察了女性在较早时期的生育意愿和避孕措施如何影响怀孕经历，以及在所有三个时间点都处于婚姻状态的 1050 名女性中，有经验的怀孕的意图性。我们应用相关随机效应纵向回归方法，通过较早时期的生育意愿和现代避孕措施预测随后的生育，解决了先前分析中仅包含两个时间点的内生性问题。
描述性结果表明，随着时间的推移，生育愿望发生了一些变化，大约有 6-8%的报告怀孕是有意的（即怀孕时想要怀孕）的女性报告说她们之前不想再有孩子了。多变量分析表明，想要延迟或避免怀孕且正在使用现代避孕措施的女性怀孕的可能性最小。在怀孕的女性中，唯一能区分怀孕是计划内还是计划外（时机不当或不想要）的因素是之前的生育意愿。之前想要延迟怀孕的女性更有可能报告怀孕是意外的，而不是想要尽快怀孕的女性。
这些结果表明，一些怀孕的女性事后会进行一些合理化解释。在塞内加尔这个高生育率的城市环境中，说自己不想怀孕的女性可能会选择不使用避孕方法。寻求接触这些女性的项目需要考虑到她们的复杂情况，包括生育意愿、计划生育使用情况以及她们在报告这些意愿和行为时所处的社区规范。
