Fertility preferences remain high in rural Tanzania despite family planning access
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The researchers evaluated the results of a 15-month family planning program for rural households in Tanzania's Meatu district, conducted in partnership with the country's Ministry of Health and the Meatu District Hospital. Local women were trained to provide education on birth spacing, the safety of contraceptives, and free birth control options available from public dispensaries.
The study followed 515 households in 12 villages, randomly assigned to one of three groups: joint consultations for couples, individual consultations for wives only, and a control group. Before and after the program, each spouse was asked privately and separately by a person of their own gender how many additional children they wanted.
Participants were, on average, 37 years old for men and 30 for women, and already had five children. Before the intervention, 89% of women were not using contraception.
"The program triggered the opportunity for these men and women to learn about their spouse's fertility preferences. Most of them had never talked about it before - about two-thirds of couples had never discussed how many children they wanted," Herrera Almanza said.
The researchers found that men, on average, wanted 4 more children, while women would like 2.4. However, after participating in the couples consultations, both spouses' fertility preferences increased. After the joint counseling, husbands desired an additional 0.77 children, while there were no differences for men who did not receive counseling.
Women who participated in joint counseling increased their desired fertility by 1.6 children. In contrast, women in the individual group reported lower desired fertility after the program. Furthermore, women in the couples' group overestimated their husbands' desire for more children after the consultations, while this was not the case for the individual group.
The researchers found the results were driven by women in polygamous marriages, which was nearly a third of the sample.
"In polygamy, this can be strategic behavior where women want children because there is no old-age security, and land inheritance follows the sons. A wife with more children might be able to claim more resources," Herrera Almanza said.
The researchers speculated that power imbalances in the relationship might influence the result, causing women to say they want more children simply to appease their husbands.
"This increase in desired additional fertility might seem to be 'cheap talk' that may not be backed up by actual desire to increase your fertility. For example, women who are in a domestic violence situation may be fearful and therefore be willing to go along with what their husbands are saying. However, we didn't find any evidence of that being the case. If anything, women who are more empowered in their household were more likely to increase their fertility preferences," Herrera Almanza said.
This is aligned with the policy of Tanzania's Ministry of Health in Tanzania, which recommends spacing children two years apart to improve the health of both babies and mothers.
The study highlights the dichotomy between uptake in contraceptives and preference for large families.
"If the policy goal is to address the women's desired fertility and have healthier birth spacing, then it would make more sense to have joint family planning consultations, but to avoid asking couples about the number of children they want, and allow those discussions to happen more organically," McCarthy said.
While this study only measured fertility preferences, the researchers are in the process of conducting follow-up interviews with participants, and preliminary results suggest that women are having the children they indicated they would.
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