Using strength of fertility motivations to identify family planning program strategies.

CONTEXT Use of unmet need for family planning to identify prospective clients may misrepresent the actual family planning needs of a population, given that a large proportion of women have ambivalent fertility desires. METHODS Survey data for 1998 and 2003 from Burkina Faso, Ghana and Kenya were used to examine the fertility desires and motivations of women who said they wanted to delay or limit childbearing. A question on how much of a problem it would be if women found out they were pregnant in the next few weeks measured the strength of their fertility motivations. RESULTS In Burkina Faso and Ghana, about a quarter of women who said they wanted to delay or limit childbearing also reported that it would be no problem or a small problem if they became pregnant soon. This response pattern was equally common among contraceptive users and nonusers. In Kenya, more than four in 10 women gave such ambivalent responses. Among women with an unmet need for means of delaying or limiting childbearing, 16-31% of those in Burkina Faso and Ghana, and 30-56% of those in Kenya, said that getting pregnant in the next few weeks would be no problem or a small problem. CONCLUSIONS It is critical to consider the strength of fertility motivations when determining which women have family planning needs. Targeting women who are the most motivated to avoid childbearing will likely have the greatest impact on reducing unintended pregnancy in Sub-Saharan Africa.