Determinants of the desire to limit childbearing among married women in sub-Saharan African countries

Most sub-Saharan African countries have experienced high total fertility rates, leading to rapid population growth and policy concerns. This study examined the determinants of the desire to limit childbearing among married women in four high-fertility sub-Saharan African countries using the most recent demographic and health survey data: Gabon (2019), Mali (2018), Tanzania (2022), and Zambia (2018). The analysis included married women desiring to limit childbearing, with sample sizes of 3,664 (Gabon), 6,782 (Mali), 6,946 (Tanzania), and 6,674 (Zambia). Multivariate binary logistic regression was performed, and the results were reported with 95% confidence intervals (CIs). Zambia recorded the highest proportion of married women desiring to limit childbearing (47%), whereas Mali had the lowest (23.9%). Older women (35 – 49 years) were more likely to express this desire than younger women (15 – 19 years) in Gabon (adjusted odds ratio [aOR] = 3.02; CI: 1.60 – 5.70), Mali (aOR = 44.28; CI: 26.19 – 74.89), Tanzania (aOR = 8.85; CI: 5.81 – 13.49), and Zambia (aOR = 6.74; CI: 4.61 – 9.86). Increasing parity was also a significant predictor. Women with one to two children had lower odds of wanting to limit childbearing compared to those with five or more children: (aOR = 0.05; CI: 0.03 – 0.08) in Gabon, (aOR = 0.10, CI: 0.06 – 0.15) in Mali, (aOR = 0.03; CI: 0.02 – 0.04) in Tanzania, and (aOR = 0.04; CI: 0.03 – 0.06) in Zambia. Across all countries, the age of a woman, parity, and decision-making were significant determinants of the desire to limit childbearing among married women. The study highlights the need to intensify reproductive health education and family planning services, particularly for younger women. In addition, empowering marginalized women can help them make informed reproductive choices, thus increasing their desire to limit childbearing.
Adhikari, R. (2010). Demographic, socio-economic, and cultural factors affecting fertility differentials in Nepal. BMC Pregnancy and Childbirth, 10(1):19. https://doi.org/10.1186/1471-2393-10-19
Adilo, T.M., & Wordofa, H.M. (2017). Prevalence of fertility desire and its associated factors among 15- to 49-year-old people living with HIV/AIDS in Addis Ababa, Ethiopia: A cross-sectional study design. HIV/AIDS (Auckland, N.Z.), 9:167-176. https://doi.org/10.2147/HIV.S133766
African Union. (2006). Latest Documents. African Union. Available from: https://au.int/en/documents/20061230/ maputo-plan-action [Last accessed on 2025 Jan 23].
Ahinkorah, B.O., Seidu, A.A., Armah-Ansah, E.K., Ameyaw, E.K., Budu, E., & Yaya, S. (2021). Socio-economic and demographic factors associated with fertility preferences among women of reproductive age in Ghana: Evidence from the 2014 demographic and health survey. Reproductive Health, 18(1):2. https://doi.org/10.1186/s12978-020-01057-9
Ahinkorah, B.O., Seidu, A.A., Armah-Ansah, E.K., Budu, E., Ameyaw, E.K., Agbaglo, E., Yaya, S., et al. (2020). Drivers of desire for more children among childbearing women in sub-Saharan Africa: Implications for fertility control. BMC Pregnancy and Childbirth, 20(1):778. https://doi.org/10.1186/s12884-020-03470-1
Atake, E.H., & Gnakou Ali, P. (2019). Women’s empowerment and fertility preferences in high fertility countries in Sub- Saharan Africa. BMC Women’s Health, 19(1):54. https://doi.org/10.1186/s12905-019-0747-9
Babalola, S., Oyenubi, O., Speizer, I.S., Cobb, L., Akiode, A., & Odeku, M. (2017). Factors affecting the achievement of fertility intentions in urban Nigeria: Analysis of longitudinal data. BMC Public Health, 17(1):942. https://doi.org/10.1186/s12889-017-4934-z
Bolarinwa, O.A., Afaya, A., Ajayi, K.V., Ojo, A., & Alawode, O.A. (2022). Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in Sub-Saharan Africa. BMC Public Health, 22(1):2141. https://doi.org/10.1186/s12889-022-14575-x
Bongaarts, J. (1993). The supply-demand framework for the determinants of fertility: An alternative implementation. Population Studies, 47(3):437-456.
Bongaarts, J. (2009). Human population growth and the demographic transition. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1532):2985-2990. https://doi.org/10.1098/rstb.2009.0137
Bongaarts, J. (2016). Development: Slow down population growth. Nature, 530(7591):409-412. https://doi.org/10.1038/530409a
Bongaarts, J. (2020). Trends in fertility and fertility preferences in Sub-Saharan Africa: The roles of education and family planning programs. Genus, 76(1):32. https://doi.org/10.1186/s41118-020-00098-z
Bongaarts, J., & Casterline, J. (2013). Fertility transition: Is Sub‐ Saharan Africa Different? Population and Development Review, 38(s1):153-168. https://doi.org/10.1111/j.1728-4457.2013.00557.x
Bwalya, B.B., Kasonde, M.E., Mulenga, J.N., Mapoma, C.C., Wamunyima, N., Siamianze, B., et al. (2023). The association between contraceptive use and desired number of children among sexually active men in Zambia. BMC Public Health, 23(1):1833. https://doi.org/10.1186/s12889-023-16750-0
Casterline, J.B. (2017). Prospects for fertility decline in Africa. Population and Development Review, 43(S1):3-18. https://doi.org/10.1111/padr.12055
Casterline, J.B., & Agyei-Mensah, S. (2017). Fertility desires and the course of fertility decline in sub-Saharan Africa. Population and Development Review, 43(S1):84-111. https://doi.org/10.1111/padr.12030
Casterline, J.B., & El-Zeini, L.O. (2007). The estimation of unwanted fertility. Demography, 44(4):729-745. https://doi.org/10.1353/dem.2007.0043
Cheng, H., Luo, W., Si, S., Xin, X., Peng, Z., & Zhou, H. (2022). Global trends in total fertility rate and its relation to national wealth, life expectancy and female education. BMC Public Health, 22(1):1346. https://doi.org/10.1186/s12889-022-13656-1
Church, A.C., Ibitoye, M., Chettri, S., & Casterline, J.B. (2023). Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: A scoping review. Reprod Health, 20(1):86. https://doi.org/10.1186/s12978-023-01627-7
Cleland, J., Machiyama, K., & Casterline, J.B. (2020). Fertility preferences and subsequent childbearing in Africa and Asia: A synthesis of evidence from longitudinal studies in 28 populations. Population Studies, 74(1):1-21. https://doi.org/10.1080/00324728.2019.1672880
Croft, T.N., Alleen, CK., Zachary, B.W., et al. (2018). Guide to DHS Statistics. Rockville, Maryland, USA: ICF.https://www. dhsprogram.com [Last accessed 2025 Jan 23].
Demissie, G.D., Akalu, Y., Gelagay, A.A., Alemnew, W., & Yeshaw, Y. (2022). Factors associated with decision-making power of married women to use family planning in Sub- Saharan Africa: A multilevel analysis of demographic health surveys. BMC Public Health, 22(1):837. https://doi.org/10.1186/s12889-022-13251-4
DHS Program. (2021). The Demographic and Health Surveys Program, USAID. Available from: https://www.dhsprogram. com [Last accessed on 2025 Jan 23].
Easterlin, R.A. (1975). An economic framework for fertility analysis. Studies in Family Planning, 6(3):54. https://doi.org/10.2307/1964934
Emeh, A.N., Hermann, N., Tanue, E.A., & Dickson, N.S. (2023). Sexual and reproductive health of CDC plantation camp residents: A focus on unmet need for family planning among women in union. BMC Public Health, 23(1):193. https://doi.org/10.1186/s12889-023-15114-y
Ezeanolue, E.E., Iwelunmor, J., Asaolu, I., Obiefun, M.C., Ezeanolue, C.O., Osuji, A., et al. (2015). Impact of male partner’s awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria. BMC Public Health, 15(1):879. https://doi.org/10.1186/s12889-015-2216-1
Gilda, S., & Ashford, L.S. (2016). Unmet Need for Contraception in Developing Countries: Examining Women’s Reasons for Not Using a Method. New York: Guttmacher Institute.
Hoyweghen, K.V., Bemelmans, J., Feyaerts, H., Broeck, G.V.D., & Maertens, M. (2022). Small Family, Happy Family? Fertility Preferences and the Quantity-Quality Trade-off in Sub- Saharan Africa. Germany: Springer. https://doi.org/10.21203/rs.3.rs-2010000/v1
Kabagenyi, A., Ndugga, P., Wandera, S.O., & Kwagala, B. (2014). Modern contraceptive use among sexually active men in Uganda: Does discussion with a health worker matter? BMC Public Health, 14(1):286. https://doi.org/10.1186/1471-2458-14-286
Kidie, A.A., Aychiluhm, S.B., Ayal, B.G., Kodo, T.K., Fentie, E.A., Masresha, S.A, et al. (2024). Women’s desire to limit child-bearing and its associated factors in rural Ethiopia: A multilevel analysis. Heliyon, 10(3):e25372. https://doi.org/10.1016/j.heliyon.2024.e25372
Mardi, A., Ebadi, A., Shahbazi, S., Esmaelzade Saeieh, S., & Behboodi Moghadam, Z. (2018). Factors influencing the use of contraceptives through the lens of teenage women: A qualitative study in Iran. BMC Public Health, 18(1):202. https://doi.org/10.1186/s12889-018-5116-3
Matovu, J.K.B., Makumbi, F., Wanyenze, R.K., & Serwadda, D. (2017). Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: A cross-sectional study. Reproductive Health, 14(1):2. https://doi.org/10.1186/s12978-016-0272-3
Muhoza, D.N. (2019). The heterogeneous effects of socioeconomic and cultural factors on fertility preferences: Evidence from Rwanda and Kenya. Journal of Population Research, 36(4):347-363.
Muluneh, M.W., & Moyehodie, Y.A. (2021). Determinants of desire for more children among women in Ethiopia. BMC Women’s Health, 21(1):408. https://doi.org/10.1186/s12905-021-01563-3
Mwaisaka, J., Gonsalves, L., Thiongo, M., Waithaka, M., Sidha, H., Agwanda, A., et al. (2020). Exploring contraception myths and misconceptions among young men and women in Kwale County, Kenya. BMC Public Health, 20(1):1694. https://doi.org/10.1186/s12889-020-09849-1
Naghibi, S.A., Khazaee-Pool, M., & Moosazadeh, M. (2019). Psychometric properties of fertility desire scale (FDS) developed for Iranian parents. BMC Public Health, 19(1):1113. https://doi.org/10.1186/s12889-019-7413-x
Namukoko, H., Likwa, R.N., Hamoonga, T.E., & Phiri, M. (2022). Unmet need for family planning among married women in Zambia: Lessons from the 2018 Demographic and Health Survey. BMC Women’s Health, 22(1):137. https://doi.org/10.1186/s12905-022-01709-x
Nibaruta, J.C., Kamana, B., Chahboune, M., Chebabe, M., Elmadani, S., Turman, J.E. Jr., et al. (2023). Heterogeneous effects of socio-economic and cultural factors on fertility differentials in Burundi and Morocco during their fertility transition periods: A retrospective, cross-sectional and comparative study. The Pan African Medical Journal, 45:161. https://doi.org/10.11604/pamj.2023.45.161.36150
Ojakaa, D.I. (2022). Trends and patterns in fertility and its proximate determinants in Sub-Saharan Africa. In: The Routledge Handbook of African Demography. England, UK: Routledge.
Oronje, R.N., Crichton, J., Theobald, S., Lithur, N.O., & Ibisomi, L. (2011). Operationalising sexual and reproductive health and rights in Sub-Saharan Africa: Constraints, dilemmas and strategies. BMC International Health and Human Rights, 11(S3):S8. https://doi.org/10.1186/1472-698X-11-S3-S8
Phiri, M., Lemba, M., Shasha, L., Sikaluzwe, M., & Simona, S. (2023a). Perceived ideal number of children among adolescent girls in Sub-Saharan Africa: Does exposure to family planning messages matter? BMC Women’s Health, 23(1):479. https://doi.org/10.1186/s12905-023-02609-4
Phiri, M., Shasha, L., Musonda, E., Muhanga, M., & Lemba, M. (2023b). Choice of desired family size among young women in Zambia: What matters? Journal of Population Research, 40(3):18. https://doi.org/10.1007/s12546-023-09311-0
Qamar, A.H. (2022). Social value of the child in the global south: A multifaceted concept. Journal of Early Childhood Research, 20(4):610-623. https://doi.org/10.1177/1476718X221089581
Samuel, O., Zewotir, T., & North, D. (2021). Decomposing the urban-rural inequalities in the utilisation of maternal health care services: Evidence from 27 selected countries in Sub- Saharan Africa. Reproductive Health, 18(1):216. https://doi.org/10.1186/s12978-021-01268-8
Shiferaw, T., Kiros, G., Birhanu, Z., Gebreyesus, H., Berhe, T., & Teweldemedhin, M. (2019). Fertility desire and associated factors among women on the reproductive age group of antiretroviral treatment users in Jimma Town, South West Ethiopia. BMC Research Notes, 12(1):158. https://doi.org/10.1186/s13104-019-4190-7
Tesfa, D., Tiruneh, S.A., Gebremariam, A.D., Azanaw, M.M., Engidaw, M.T., Kefale, B., et al. (2023). The pooled estimate of the total fertility rate in sub-Saharan Africa using recent (2010-2018) Demographic and Health Survey data. Frontiers in Public Health, 10:1053302. https://doi.org/10.3389/fpubh.2022.1053302
Teshale, A.B., Worku, M.G., & Tesema, G.A. (2022). Fertility decision and its associated factors in Sub-Saharan Africa: A multilevel multinomial logistic regression analysis. BMC Women’s Health, 22(1):337. https://doi.org/10.1186/s12905-022-01920-w
Tufa, D., Wassihun, B., Misker, D., & Beyene, K. (2023). Fertility desire and associated factors among women of reproductive age living with HIV/AIDS attending antiretroviral therapy clinic in Arba Minch General Hospital, South Ethiopia, 2021. Frontiers in Global Women’s Health, 4:1001479. https://doi.org/10.3389/fgwh.2023.1001479
UNFPA. (2022). World Population Prospects 2022: Summary of Results - Population Division. Available from: https://www. un.org/development/desa/pd/content/world-population-prospects-2022 [Last accessed on 2025 Jan 23].
UNFPA. (2024). 8 Billion: A World of Infinite Possibilities. Available from: https://www.unfpa.org/8billion [Last accessed on 2025 Jan 23].
UNPD. (2019). World Population Prospects 2019 Highlights. United States: UNPD.
Van Lith, L.M., Yahner, M., & Bakamjian, L. (2013). Women’s growing desire to limit births in Sub-Saharan Africa: Meeting the challenge. Global Health: Science and Practice, 1(1):97-107. https://doi.org/10.9745/GHSP-D-12-00036
Warner, R.M. (2008). Applied Statistics: From Bivariate through Multivariate Techniques. 2nd ed. United States: Sage Publications.
Wildeman, J., Smits, J., & Schrijner, S. (2023). Ethnic variation in fertility preferences in Sub-Saharan Africa. Population Research and Policy Review, 42(4):58. https://doi.org/10.1007/s11113-023-09804-z