Multiple Perspectives on Recent Trends in Unwanted Fertility in Low- and Middle-Income Countries

The last four decades have witnessed large declines in fer til ity glob ally. This study uses data from 78 low-and mid dle-income countries to exam ine con cur rent trends in unwanted fer til ity. Three mea sures of unwanted fer til ity are contrasted: the con ventional unwanted total fer til ity rate, a pro posed con di tional unwanted fer til ity rate, and the per cent age of births unwanted. Incidence of unwanted births and prev a lence of expo sure to unwanted births are both derived from answers to ques tions on pro spec tive fer til ity pref er ence, rec og nized as the most valid and reli able sur vey mea sure of pref er ences. Country-level trends are mod eled both his tor i cally and with the decline in total fer tility, with a focus on regional dif fer en tials. Results show that unwanted fer til ity rates- espe cially the con di tional unwanted fer til ity rate-have declined sub stan tially in recent decades. By con trast, the per cent age of births unwanted has declined less, remaining sta ble or even increas ing: from a birth cohort per spec tive, declines in unwanted fer til ity have been far more mod est than the increased paren tal suc cess in avoiding unwanted births. The regional pat terns sug gest that sub-Saharan Africa has sev eral sim i lar i ties with other major regions but also some pecu liar fea tures, includ ing a recent stall in the decline of unwanted fer til ity that per sists after con trol ling for the stage of fer til ity tran si tion.