P–476 Women’s attitudes to having children: A mixed-methods study using an online questionnaire of women aged 25–45 years old

Study question What are women’s attitudes to having children including their ideal age to have children, factors affecting their decision and their understanding of female fertility? Summary answer The average age women wanted to have children was age 30, with most still developing their career. They showed a good knowledge of fertility awareness. What is known already Women globally are delaying the birth of their first child, with the average age of first birth approaching age 32 in some countries. The fertility rate stands at 1.3 in several European Union countries. Some people are not having the desired family size or are childless by circumstance. We need to ensure we provide fertility education from school-age onwards. Study design, size, duration We conducted an anonymous, online survey of multiple choice and open-ended questions using Qualtrics software. The survey was live for 32 days from May 15th, 2020 to June 16th, 2020 and was promoted using social media. A mixed-method approach was used to analyse quantitative and qualitative data. Participants/materials, setting, methods A total of 922 women from 44 countries participated in the survey. After filtering out women who did not consent and those who did not want to have children, a total of 834 responses remained. Elimination of blank surveys or insufficient data resulted in a final number of 667 responses. Main results and the role of chance The mean age of the respondents was 31.3 (±4.76). The majority were white British (347/667, 52%) and heterosexual (614/667, 92.0%). A high proportion had a university education (195/667, 29%) or postgraduate education (392/667, 59%). The majority were married/in a civil partnership (223/667, 33%) or cohabitating (215/667, 32%). 135/667 (20%) were single and never married. When asked ‘In an ideal world, at what age approximately would you like to have had or have children? a normal distribution was observed with a mean age of 30.2 (±3.2). When asked ‘What factors have led you to decide on that particular age?’ the most frequent choice was “I am developing my career”, followed by “I am not financially ready.” Women were asked how informed they felt about fertility. The majority of women said they felt moderately informed (60%, 400/667), very informed (28%, 190/667), or they were not informed at all (12%, 77 /667). Most women thought female fertility decline starts at age 35 (32.8%, 219/667). To the question “What is the oldest age at which women can get pregnant?” almost 70% of women (465/667) believed the oldest age to be between 40–49 and 24%, (160/667) said over 50. Limitations, reasons for caution All surveys have a selection bias. The survey was only promoted on social media. As the survey was in English, the women who answered the survey were mainly UK residents who were highly educated. Wider implications of the findings: In a group of highly educated women, age 30 was the most common age for wanting a child but career development and finances are the main reasons affecting their decision. These women had some understanding of female fertility. Global fertility education is essential to ensure people make informed reproductive choices. Trial registration number NA

Unintended pregnancy resolution among parous women in twelve low- and middle-income countries

Around 40% of pregnancies worldwide are unintended and a half of those are terminated. Yet, few international comparisons of unintended pregnancy resolution (choosing birth or abortion) exist. This study analysed how parous women’s pregnancy intentions and abortion decisions are associated with their reproductive histories and country contexts using twelve Demographic and Health Surveys representing four context groups: post-Soviet/communist and Asian countries with liberal abortion legislation, and Asian and Latin American countries with restrictive abortion legislation. Similarities were found across contexts: preference to have children of both sexes, space births, stop childbearing after reaching desired family size and an increased likelihood of unintended pregnancy when using less-effective contraceptive methods versus none. Contextual factors most clearly associated with reports of unintended pregnancy resolution were type of abortion legislation and living in post-Soviet/communist contexts. Women’s propensity to report abortions and unintended pregnancy varied by context and the decision-making processes for pregnancy versus fertility management were different.

Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

BackgroundWith a fertility rate of 5.4 children per woman, Burundi has been ranked as seventh highest country with the highest fertility rate in the world. Family planning is known to allow couples to achieve the desired family size, appropriate space birth and the limitation of pregnancies. Also, family planning can contribute to mitigating some health issues such as unintended pregnancies and abortions all of which, are often associated with multi-parity. In conservative community in rural Burundi, knowledge on family planning is high and such services are free yet utilisation is low. Employing a mixed methods, this study first quantifies contraceptive prevalence and second, explore the contextual multilevel factors associated with low family planning utilisation among married women.Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n=132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in Bururi and Rumonge provinces in Burundi. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.ResultsThe overall contraceptive prevalence was 22.6%. From logistic modelling analysis, it was found that women aged 25 to 29, those completed secondary school and having four or less children was significantly associated with use of family planning. Among factors why family planning was unused included experience with side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. ConclusionGiven that use of family planning is rooted in negative beliefs emanating mainly from religious and cultural practices, engaging local religious leaders and community actors may trigger positive behaviours change needed to increase its use.

Family Planning Providers and Contraceptive users in Rwanda Employ Strategies to Prevent Discontinuation

Background: Contraceptive discontinuation is a common event. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users is imperative for long-term family planning program success.Methods: This qualitative study in Rwanda in 2018 included eight focus group discussions with 88 family planning providers and 32 in-depth interviews with contraceptive users. The data were collected in the two districts with the highest and lowest rates of contraceptive use, Musanze and Nyamasheke, respectively. The aim of this study is to better understand how providers and contraceptive users in Rwanda navigate one of the greatest challenges to family planning programs: contraceptive discontinuation.Results: Family planning providers and current users in Rwanda do not consider method discontinuation an option. Providers give support and medicine for side effects for continuers and counseling for those opting to switch. Current users are willing to try many methods until they find the right one for them – and once they find the right method, they plan to, or use the method, for long durations.Conclusions: The Rwandan family planning program is primed to meet the needs of users in their sustained use of contraceptives through empathetic and responsive counseling. Concurrently, family planning users are determined to use family planning to meet their desired family size goals. The matching goals of both providers and clients indicates that contraceptive use will likely continue to increase in Rwanda. Due to long periods of pregnancy prevention desired by users the increased use of long acting methods should be encouraged.

Preferences, Partners, and Parenthood: Linking Early Fertility Desires, Marriage Timing, and Achieved Fertility

In the United States, underachieving fertility desires is more common among women with higher levels of education and those who delay first marriage beyond their mid-20s. However, the relationship between these patterns, and particularly the degree to which marriage postponement explains lower fertility among the highly educated, is not well understood. We use data from the National Longitudinal Survey of Youth 1979 cohort to analyze differences in parenthood and achieved parity for men and women, focusing on the role of marriage timing in achieving fertility goals over the life course. We expand on previous research by distinguishing between entry into parenthood and average parity among parents as pathways to underachieving, by considering variation in the impact of marriage timing by education and by stage of the life course, and by comparing results for men and women. We find that women with a bachelor’s degree who desired three or more children are less likely to become mothers relative to women with the same desired family size who did not attend college. Conditional on becoming mothers, however, women with at least a bachelor’s degree do not have lower completed family size. No comparable fatherhood difference by desired family size is present. Postponing marriage beyond age 30 is associated with lower proportions of parenthood but not with lower parity among parents. Age patterns are similar for women and men, pointing at social rather than biological factors driving the underachievement of fertility goals.

Trends in fertility and fertility preferences in sub-Saharan Africa: the roles of education and family planning programs

A common explanation for the high fertility prevailing in sub-Saharan Africa (SSA) is a widespread desire for large families. This situation poses a challenge to population policy-makers in the continent. If the desired family size is high, then presumably family planning programs can only have a limited effect on fertility because these programs aim to assist women in achieving their reproductive goals. But this conclusion is based on the assumption that family planning programs do not affect the desired family size, which is questionable and is investigated here. This study examines the determinants of trends wanted and unwanted fertility in SSA using fixed-effects regressions of country-level data. The dependent variables include the total fertility rate, and its wanted and unwanted components. Explanatory variables include a family planning program score and four socioeconomic variables (women’s educational attainment, child mortality, GNI per capita, and percent urban). Data come from 103 DHS surveys in 25 countries in SSA with at least two DHS surveys between 1989 and 2019. Women’s education and family planning programs are found to be the dominant determinants of fertility decline and their effects operate by reducing both wanted and unwanted fertility. The effects of education are not surprising but the finding that family planning programs can reduce wanted fertility implies that their impact can be larger than conventional wisdom suggests. Indeed, in a few poor countries, the implementation of high-quality programs has been associated with substantial declines in wanted fertility (e.g., Ethiopia, Malawi, Rwanda). The mechanism through which this effect operates is unclear but likely involves media programs that diffuse knowledge about the benefits of smaller families.

Beyond knowledge acquisition: factors influencing family planning utilization among women in conservative communities in Rural Burundi.

Background With a fertility rate of 5.4 children per woman, Burundi has been ranked as seventh highest country with the highest fertility rate in the world. Family planning is known to allow couples to achieve the desired family size, appropriate space birth and the limitation of pregnancies. Also, family planning can contribute to mitigating some health issues such as unintended pregnancies and abortions all of which, are often associated with multi-parity. In conservative community in rural Burundi, knowledge on family planning is high and such services are free yet utilisation is low. Employing a mixed methods, this study first quantifies contraceptive prevalence and second, explore the contextual multilevel factors associated with low family planning utilisation among married women.Methods An explanatory sequential mixed study was conducted. Five hundred and thirty women in union were interviewed using structured and pre-tested questionnaire. Next, 11 focus group discussions were held with community members composed of married men and women, administrative and religious leaders (n=132). The study was conducted in eighteen collines of two health districts of Vyanda and Rumonge in provinces of Bururi and Rumonge respectively. Quantitative data was analysed with SPSS and qualitative data was coded and deductive thematic methods were applied to find themes and codes.Results The overall contraceptive prevalence was 22.6%. Injectables (40%), Implants (24.6%), Male condom (10.8%) and pills (6.2%) were the major contraceptive methods utilized by study participants. Factors inhibiting family planning use emanated from a range of issues which were identified during the qualitative phase. Notable among those was experiencing side effects and costs associated with its management in the health system. Religious conceptualisation and ancestral negative beliefs of family planning had also shaped how people perceived it. Furthermore, at the household level, gender imbalances between spouses had resulted in break in communication, also serving as a factor for non-use of family planning. Conclusion The study suggests that low uptake of family planning can be attributed to perceived or experienced side effects as well as deeply rooted negative beliefs which are reinforced by religious beliefs. Men and religious leaders’ involvement in family planning initiatives can positively impact behaviour change and increase family planning acceptance.