Fertility Preferences and Contraceptive Change in Low- and Middle-Income Countries

Area of Science:

• Demography
• Public Health
• Reproductive Health

Background:

• Modern contraception use has significantly increased in low- and middle-income countries over the past four decades.
• Debates persist regarding whether this increase stems from evolving fertility desires or better fulfillment of existing preferences.

Purpose of the Study:

• To empirically assess the relative contributions of changes in fertility preferences versus the implementation of these preferences to the rise in contraceptive use.
• To inform discussions on the impact and investment returns of family planning services.

Main Methods:

• Analysis of national survey data from five major global programs: World Fertility Surveys, Demographic Health Surveys, Reproductive Health Surveys, Pan-Arab Project for Child Development or Family Health, and Multiple Indicator Cluster Surveys.
• Regression decomposition of changes between successive surveys across 59 countries, totaling 330 decompositions.

Main Results:

• Changes in fertility preferences accounted for a small proportion of the increase in contraceptive use, less than 10% in basic models and approximately 15% in more complex specifications.
• The distribution of women's fertility preferences remained remarkably stable over time, suggesting limited shifts in desired family size.

Conclusions:

• The rise in modern contraceptive use is primarily driven by improved access and implementation, rather than a significant reduction in the demand for children.
• Findings empirically challenge the notion that contraceptive uptake is mainly propelled by evolving fertility desires.