Conceptualizing and Testing a New Measure of Fertility Intentions: A Mixed Methods Exploration of Factors that Affect the Achievement of Childbearing Plans

Understanding fertility intentions is crucial for reproductive health research and programs. While quantitative research has identified factors associated with fertility intentions and simple measures of intentions predict pregnancy moderately well, discrepancies between stated intentions and behavior are common and understanding of fertility decision making remains imperfect. Knowledge of factors that enable some women to achieve plans for pregnancy while others fail could advance understanding of unintended pregnancy, unmet need for family planning and contraceptive discontinuation. Two analyses were conducted to explore factors affecting the achievement of fertility intentions among Honduran women of reproductive age seeking health services in four Honduran cities. First, focus group discussions and individual in-depth interviews were conducted to examine reproductive decision making and factors thought to affect intentions. Locus of motivation for fertility decision making, the ability to pursue educational and occupational opportunities and the ability to care for family were found to be relevant to childbearing decision making. Individual and community-level factors affecting intentions were identified and results provide evidence that the formation and operationalization of intentions are distinct processes, influenced by different factors. Second, longitudinal data from 671 contraceptive users was used to explore aspects thought to influence the attainment of intentions. Using factor analysis, a multi-dimensional measure of motivation to avoid pregnancy was proposed and compared to the standard measure of fertility intentions using multivariate logistic regression to see which predicted contraceptive continuation and pregnancy better. Three dimensions of motivation were identified: Control Locus, Expectations and Feelings. Decreased expectations to use contraception were found to diminish the chances of continuing contraceptive use. Overall, the multidimensional measure performed similarly to the standard categories in the prediction of contraceptive use and pregnancy. Findings suggest factors likely to influence fertility intentions in other developing country settings. Future research should explore the role of motivation among a wider population in order to further assess the role of attitudinal factors in fertility and contraceptive decision making. Improved knowledge of fertility decision making will increase understanding of unmet need for family planning, contraceptive discontinuation and unintended pregnancy and, ultimately, help determine how best to address these issues