DHS ANALYTICAL

STUDIES 9

MAY 2006

This publication was produced for review by the United States Agency for International Development. It was prepared by Charles F. Westoff 

of the Office of Population Research, Princeton University, and Anne R. Cross of ORC Macro.
MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Funded by the U.S. Agency for International Development 

(USAID), MEASURE DHS is implemented by ORC Macro in Calverton, Maryland. The opinions 

expressed herein are those of the authors and do not necessarily reflect the views of USAID. 

The main objectives of the MEASURE DHS project are to: 

1) provide decisionmakers in survey countries with information useful for informed policy choices 

2) expand the international population and health database 

3) advance survey methodology, and 

4) develop in participating countries the skills and resources necessary to conduct high-quality demographic and health surveys. 

 

Information about the MEASURE DHS project or the status of MEASURE DHS surveys is available 

on the internet at http://www.measuredhs.com or from: 

ORC Macro 

11785 Beltsville Drive, 

Suite 300 

Calverton, MD 20705 USA 

Telephone: 301-572-0200 

Fax: 301-572-0999 

E-mail: reports@orcmacro.com 

DHS Analytical Studies No. 9 

The Stall in the Fertility 

Transition in Kenya 

 

 

 

 

Charles F. Westoff 

 Office of Population Research 

Princeton University 

Anne R. Cross 

ORC Macro 

ORC Macro 

Calverton, Maryland, USA 

May 2006
Editor: Sidney Moore 

Document Production: Kaye Mitchell 

This publication was made possible through support provided by the U.S. Agency for International 

Development under the terms of Contract No. HRN-C-00-97-00019-00. The opinions expressed 

herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for 

International Development. 

Recommended citation: 

Westoff, Charles F., and Anne R. Cross. 2006. The Stall in the Fertility Transition in Kenya. DHS 

Analytical Studies No. 9. Calverton, Maryland: ORC Macro. 
Contents iii

Contents 

Tables and Figures v 

Executive Summary ix 

Preface xi 

Acknowledgments xiii 

1 Introduction 1 

2 Fertility in Kenya 3 

3 Contraceptive Use in Kenya 7 

 3.1 Trends in Contraceptive Prevalence 7 

 3.2 Trends in the Contraceptive Mix 10 

 3.3 Trends in Contraceptive Prevalence by Background 

 Characteristics 11 

 3.4 Trends in Contraceptive Failure Rates and Discontinuation 15 

 3.5 Trends in Sources of Methods 16 

 3.6 Trends in Attitudes Toward Family Planning 17 

 3.7 Trends in Unmet Need for Family Planning 18 

 3.8 HIV/AIDS and Contraceptive Use 18 

4 Reproductive Preferences 21 

 4.1 Perspective of a Quarter of a Century 21 

 4.2 Trends by Residence 23 

 4.3 Trends by Education 24 

 4.4 The “Wanted and Unwanted” Explanation 27 

 4.5 Trends by Ethnicity, Religion, and Wealth 28 

 4.6 Trends in Male Preferences 31 

 4.7 The AIDS Hypothesis 32 

 4.8 Child Mortality Trends and Reproductive Preferences 33 

 4.9 Multivariate Analysis 34 

5 Summary and Conclusions 37 

References 41 

Tables and Figures v

Tables and Figures 

Figure 2.1 Trends in the total fertility rate, Kenya 1977-78 to 2003 3 

Figure 2.2 Trends in age-specific fertility rates, Kenya 1975-78 to 2000-03 4 

Table 2.1 Percentage of women age 15-19 who are mothers or pregnant 

with their first child, by background characteristics, Kenya 

1993- 2003 4 

Table 2.2 Trends in the total fertility rate, by background characteristics, 

 Kenya 1993-2003 5 

Table 2.3 Trends in percentage of women who had a birth in the five 

years preceding the survey, by number of children ever born 

at the beginning of the five-year period, Kenya 1993-2003 5 

Figure 3.1 Trends in percentage currently using contraception, Kenya 

 1993-2003 7 

Figure 3.2 Annual estimates of the percentage of all women using a 

 modern method of contraception during the ten years 

 preceding the 2003 DHS survey in Kenya 8 

Figure 3.3 Trends in the use of any contraceptive method among all 

 women and among women who had sex in the past four 

 weeks, Kenya 1993-2003 9 

Figure 3.4 Trends in the use of modern methods of contraception and 

traditional methods of contraception among women who had 

 sex in the past four weeks, Kenya 1993-2003 9 

Figure 3.5 Change in the method mix for modern contraceptive methods: 

percentage of woman-months of use of modern methods 

 Kenya 1993-2003 11 

Figure 3.6 Trends in current use of contraception among currently 

 married women by age, Kenya 1993-2003 12 

Figure 3.7 Trends in current use of contraception among currently 

 married women by number of living children, Kenya 

 1993-2003 12 

Figure 3.8 Trends in current use of contraception for spacing and for 

 limiting births among currently married women, Kenya 

1993-2003 13 
vi Tables and Figures

Figure 3.9 Trends in current use of contraception among currently 

 married women by province 13 

Figure 3.10 Trends in current use of contraception among currently 

 married women by education, Kenya 1993-2003 14 

Figure 3.11 Annual estimates of married woman–years of use of 

 modern contraceptive methods during the ten years 

 preceding the 2003 DHS survey in Kenya, by level of 

 education 15 

Figure 3.12 Trends in annual contraceptive failure rates during the ten 

 years preceding the 2003 DHS survey in Kenya 16 

Table 3.1 Trends in percentage of contraceptive users who 

 discontinued use after the first year of use for reasons 

 other than “to become pregnant,” Kenya 1998 and 2003 16 

Figure 3.13 Trends in the use of public sources of modern method of 

 contraception by current users (most recent source), 

 Kenya 1993-2003 17 

Table 3.2 Trends in percentage of currently married women and 

 men who approve of family planning, by level of education, 

 Kenya 1998 and 2003 17 

Table 3.3 Trends in unmet need for family planning among currently 

 married women, by background characteristics, Kenya 

 1993-2003 18 

Table 3.4 Trends in use of contraception by perceived risk of 

 getting AIDS, Kenya 1993 and 1998 19 

Figure 4.1 Trends in percentage of currently married, fecund women 

 who want no more children, Kenya 1977-78 to 2003 22 

Table 4.1 Trends in percentage of currently married, fecund women 

 who want no more children by number of living children, 

 Kenya 1977-78 to 2003 22 

Table 4.2 Trends in percentage of currently married, fecund women 

 who want no more children by age, Kenya 1977-78 to 2003 22 

Figure 4.2 Trends in percentage of currently married women who 

 want no more children (including those sterilized) by 

 residence, Kenya 1989-2003 23 
Tables and Figures vii

Figure 4.3 Trends in percentage of currently married women who want 

 no more children (including those sterilized) by province, 

 Kenya 1989-2003) 24 

Figure 4.4 Trends in percentage of currently married women who want 

 no more children (including those sterilized) by education, 

 Kenya 1989-2003 25 

Table 4.3 Trends in the percentage of currently married women with 

 two to four children who want no more children (including 

 those sterilized) by level of education, Kenya 1993-2003 25 

Figure 4.5 Trends in wanted, unwanted, and total fertility rates by 

 education, Kenya 1993-2003 26 

Table 4.4 Trends in planning status of births in the three years 

 preceding the survey (including current pregnancy), 

 Kenya 1993-2003 27 

Figure 4.6 Trends in percentage of currently married women who want 

 no more children (including those sterilized) by ethnic group, 

 Kenya 1993-2003 29 

Figure 4.7 Trends in the percentage of currently married women who 

 want no more children (including those sterilized) by religion, 

 Kenya 1993-2003 30 

Figure 4.8 Trends in wanted, unwanted, and total fertility rates by wealth 

quintile, Kenya 1993 and 2003 31 

Table 4.5 Trends in percentage of currently married men who want no more 

 children, by background characteristics, Kenya 1993, 1998, 

 and 2003 31 

Table 4.6 Percentage of currently married women and men who want no 

 more children by the perceived chance of contracting AIDS and 

whether they know anyone with the disease or who has died 

 from it, Kenya 2003 32 

Table 4.7 Percentage of married women who want no more children by 

whether they experienced the death of a child under five years 

 of age in the five years preceding the survey, by number of living 

children, Kenya 2003 34 

Table 4.8 Percentage of currently married men (with two, three, or four 

living children) who want no more children by whether they ever 

experienced the death of a child, Kenya 1998 and 2003 34 

Table 4.9 Odds ratios of wanting no more children for currently married 

women in 1998 and 2003 35

Executive Summary ix

Executive Summary 

A stall occurred in the decline of fertility in Kenya between 1998 and 2003. The 

fertility rate had been declining and contraceptive prevalence had been increasing for 

a quarter of a century. This unexpected interruption of an established trend is the 

focus of this inquiry. 

The stall or reversal of the fertility decline is seen throughout the country but is 

particularly evident among the least educated women while those with a secondary or 

higher education still show a modest decline in childbearing. The stall in contraceptive prevalence is seen mainly among younger women and among those with less 

education. The use of oral contraceptives, the IUD, and sterilization declined over 

the preceding decade while the use of injectables increased. 

A finding of particular interest is that while use of contraception among all women 

remained constant between 1998 and 2003, the expected increase did occur among 

sexually active women, regardless of marital status. There was a decline in the proportion of women who had sex in the four weeks preceding the survey. This trend 

has also been seen in other countries in southern and eastern Africa (but not in West 

Africa) and may be related to the higher prevalence of HIV/AIDS in that region. 

Another factor underlying the stall in the increase in contraceptive prevalence and 

the decrease in fertility is the observed decline in the proportion of women who want 

no more children, a marked departure from the steady increase in this variable since 

1977. This recent change is seen in urban and rural areas, in all provinces and ethnic 

groups, and among women with less than a secondary education. A similar change is 

seen among men. 

HIV/AIDS may have a role in the reversal of reproductive preferences in Kenya 

because it has contributed to the increase in child mortality. Women who have experienced the death of a young child are more likely than other women to want 

another child. 

Although the analysis has identified the demographic dynamics of the stall in the 

fertility transition in Kenya, a full explanation is lacking. Shortages of contraceptive 

supplies have probably played some role but this does not explain the increase in the 

proportion of women who want more children. 

Preface xi

Preface 

One of the most significant contributions of the MEASURE DHS program is the 

creation of an internationally comparable body of data on the demographic and 

health characteristics of populations in developing countries. The DHS Analytical 

Studies series and the DHS Comparative Reports series examine these data, focusing 

on specific topics. The principal objectives of both series are: to provide information 

for policy formulation at the international level, and to examine individual country 

results in an international context. Whereas Comparative Reports are primarily descriptive, Analytical Studies take a more analytical approach. 

The Analytical Studies series comprises in-depth, focused studies on a variety of 

substantive topics. The studies are based on a variable number of data sets, depending 

on the topic under study. A range of methodologies is used, including multivariate 

statistical techniques. The topics covered are selected by MEASURE DHS staff in 

conjunction with the MEASURE DHS Scientific Advisory Committee and USAID. 

It is anticipated that the Analytical Studies will enhance the understanding of significant issues in the fields of international population and health for analysts and 

policymakers. 

Martin Vaessen 

Project Director 

Acknowledgments xiii

Acknowledgments 

We would like to thank Judie Miller at Princeton for the preparation and continuous 

revision of the many tables and figures in this report and Bert Themme at DHS for 

his help in part of the data processing, particularly the calendar data. 


Introduction 1

 1

Introduction 

or the past 25 years, Kenya has been a prominent example of the fertility 

transition in sub-Saharan Africa. From one of the world’s highest fertility 

rates, 8.1 births per woman in 1975-78, fertility dropped dramatically to 

4.7 by 1995-98. At the same time, contraceptive use increased rapidly as 

women began wanting fewer children. These trends came to an abrupt halt in 

the first few years of this century according to the findings of the 2003 Kenya 

Demographic and Health Survey (Central Bureau of Statistics, 2004). The 

following analytical study examines this recent development, describing the 

details of the stall in the fertility transition and attempting to explain its 

dynamics (McDevitt and Johnson, 2005). The 2003 Kenya Demographic and 

Health Survey (KDHS) data used throughout this analysis exclude the 

Northeast province and several other districts not represented in the earlier 

surveys. 

The analysis begins with a description of the changes that have occurred in 

fertility in Kenya, followed by trends in contraceptive prevalence, and 

concludes with a discussion of the changes in reproductive preferences. 

F 
Fertility 3

 2

Fertility in Kenya 

he long-term decline in the total fertility rate (TFR) is depicted in Figure 

2.1. The plateau between 1995-98 and 2000-03, at about 4.8 births per 

woman, has come as quite a surprise to observers. The trends by age 

group (Figure 2.2) indicate that the decline has been interrupted at almost every 

age. 

&

&

&

&

&

&

8.1

7.7

6.7

5.4

4.7 4.8

1977-78 1984 1989 1993 1998 2003

4

5

6

7

8

9

Births per woman

Figure 2.1 Trends in the total fertility rate, Kenya

1977-78 to 2003

Note: Rates are based on the three-year period preceding each survey 

except for the 1984 estimate, which is based on a one-year period.

T 
4 Fertility 

)

) ) )

)

(

(

(

( (

&

&

&

& &

$

$

$

$

$

#

#

#

# #

"

"

"

" "

!

!

!

!

!

1975-78 1984-89 1990-93 1995-98 1999

0

100

200

300

400

Bir ht s per 1,000 Figure 2.2 Trends in age-specific fertility rates, Kenya 

1975-78 to 2000-03

2000-03

25-29

20-24

30-34

35-39

15-19

40-44

45-49

314

197

255

293

227 218

257 248

241

342

303

241

154

183

239

193 188

109

357

110

152

168

119 111

114

51 55

99 70

145

50 16 15 35

59

Special interest attaches to 

teenage childbearing trends. 

In Table 2.1, the percentages 

of teenagers who are either 

already mothers or who are 

pregnant with their first child 

are shown for each of the last 

three surveys. Overall, there 

is little change. In rural areas 

the percentage is also little 

changed, but in cities there is 

an increase in the last five 

years from 18 to 22 percent. 

Some of this results from the 

dramatic rise in teenage 

childbearing in Nairobi, from 

10 to 20 percent in the most 

recent period, a return to its 

level of ten years earlier. 

There is little change in the other provinces, with the possible exception of 

Nyanza, where the earlier decline reversed from 23 to 26 percent. By 

education, there has been little recent change except among those teenagers 

with no schooling, among whom the percentage of teenage childbearing has 

increased substantially over the decade, from 30 percent in 1993 to 41 percent 

in 1998 to 55 percent by 2003. 

To identify more precisely the recent changes in fertility in Kenya, trends are 

examined by residence and education (Table 2.2). Urban or rural residence 

does not alter the trend; the most recent TFRs show a slight increase in both 

populations. The greatest changes have occurred in Nyanza and in the Rift 

Table 2.1 Percentage of women age 15-19 who are 

mothers or pregnant with their first child, by background characteristics, Kenya 1993-2003

–––––––––––––––––––––––––––––––––––––––––––––

Background KDHS KDHS KDHS 

characteristic 1990-93 1995-98 2000-03

–––––––––––––––––––––––––––––––––––––––––––––

Residence 

 Urban 17 18 22 

 Rural 21 22 23 

 

Province 

 Nairobi 19 10 20 

 Central 16 15 14 

 Coast 17 28 29 

 Eastern 20 16 14 

 Nyanza 28 23 26 

 Rift Valley 20 28 30 

 Western 22 22 21 

 

Education 

 No education 30 41 55 

 Incomplete primary 20 22 23 

 Complete primary 24 30 29 

 Secondary+ 12 9 21 

All teenagers 21 21 22 
Fertility

5

Valley, where fertility over the 

five-year interval actually increased by about 10 percent. 

Elsewhere, the picture is largely 

one of a stall in the decline, 

with the exception of Central 

province, where the TFR has 

dropped from 3.7 to 3.4. In 

Western province, there is no 

evidence of any change over a 

decade. 

The trends in fertility by educational attainment are revealing. 

There have been sharp increases in fertility (by about 16 

percent) in the two leasteducated strata while in the 

primary complete category, the 

TFR shows no change at all. Only among the most educated women do fertility 

rates continue a pattern of decline, moving from 3.5 in 1998 to 3.2 in 2003. 

All these patterns of change in 

the TFR are also evident in the 

proportions of women who are 

currently pregnant, the most 

recent indicator of fertility (not 

shown). 

In Table 2.3, the analysis shifts 

to the fertility of women over 

the next five years according to 

their parity at the beginning of 

the five-year period. For example, 64 percent of women with 

four children ever born by 1989 

had another birth (one or more) 

in the ensuing years to 1993, 

while between 1993 and 1998 

only 49 percent had another birth. In the most recent five-year period, this 

direction was reversed and climbed to 54 percent. In general, between 1993 

and 1998, fertility declined at most parities, while between 1998 and 2003 

there was little or no change at the low parities and then an increase in most 

higher parities, beginning at parity four. Most of these increases at higher 

parities appear to be the result of increases in unwanted fertility (data not 

shown). 

Table 2.3 Trends in percentage of women who 

had a birth in the five years preceding the survey, 

by number of children ever born at the beginning 

of the five-year period, Kenya 1993-2003 

––––––––––––––––––––––––––––––––––––––––

Number of children Percentage with a birth in 

ever born at past five years 

beginning of ——————————— 

five-year period 1993 1998 2003 

––––––––––––––––––––––––––––––––––––––––

0 37 39 39 

1 76 72 71 

2 71 64 64 

3 72 59 57 

4 64 49 54 

5 61 52 51 

6 57 43 49 

7 58 48 51 

8 58 37 46 

9 46 46 49 

10+ 37 29 36 

Total 52 48 49

Table 2.2 Trends in the total fertility rate, by background characteristics, Kenya 1993-2003 

––––––––––––––––––––––––––––––––––––––––––

Background KDHS KDHS KDHS 

characteristic 1990-93 1995-98 2000-03

––––––––––––––––––––––––––––––––––––––––––

Residence 

 Urban 3.4 3.1 3.3 

 Rural 5.8 5.2 5.4 

Province 

 Nairobi 3.4 2.6 2.7 

 Central 3.9 3.7 3.4 

 Coast 5.3 5.1 4.9 

 Eastern 5.9 4.7 4.8 

 Nyanza 5.8 5.0 5.6 

 Rift Valley 5.8 5.3 5.8 

 Western 5.7 5.6 5.8 

Education 

 No education 6.0 5.8 6.7 

 Primary incomplete 6.2 5.2 6.1 

 Primary complete 5.0 4.8 4.8 

 Secondary+ 4.0 3.5 3.2 
Contraceptive Use 7

 3

Contraceptive Use in Kenya 

here has been a plateauing of contraceptive use in Kenya according to 

DHS data on all women interviewed in the 1998 and 2003 surveys. 

3.1 Trends in Contraceptive Prevalence 

The percentage of women using any method of contraception increased from 

26 percent in 1993 to 30 percent in 1998, but remained unchanged at 30 

percent in 2003 (Figure 3.1). The prevalence of modern methods also remained 

the same, at 24 percent. Among currently married women, prevalence 

increased by only 2 percent for all methods and 1 percent for modern methods, 

following major increases between 1993 and 1998. The only trend that might 

have been anticipated is the continued increase in contraceptive use among 

unmarried, sexually active women. In this group, overall method use in the 

preceding five years increased from 47 to 54 percent, while modern method use 

increased from 36 to 44 percent. This increase is not sufficient to affect the 

prevalence among all women because the proportion of sexually active 

unmarried women is comparatively small—3-6 percent of women. Young, 

never-married women who think that abstaining from sex is the best way to 

avoid AIDS are more likely never to have had sexual intercourse (69 percent) 

than those who cite other means of HIV/AIDS prevention (49 percent). 

Figure 3.1 Trends in percentage currently using 

contraception, Kenya 1993-2003

26

21

6

30

24

6

30

24

5

Any method

Modern method

Traditional method

0 5 10 15 20 25 30 35

1993 1998 2003

Percent

T 
8 Contraceptive Use 

Both the 1998 and the 2003 KDHS included monthly retrospective calendars 

covering five to six years preceding the survey. Recent births and pregnancies 

and months of gestation were first entered in the appropriate calendar months 

going back in time from the most recent events. Questions were then asked 

about contraceptive practice before and after these events, about reasons for 

any discontinuation of use, and about whether each month was in or out of 

marriage. These monthly data can be used to reconstruct more detailed trends 

over the past ten years in contraceptive prevalence, in the mix of methods used, 

and in contraceptive failure rates. In addition such trend data can be produced 

for various subsets of the population, for example for all women or for married 

months of experience, for the different regions of the country, by parity, by 

education, and so forth. The calendar tabulation is organized to represent 

women age 15-44 in each year. 

The annual series for prevalence of the use of modern methods shows a fairly 

flat trajectory over the 10 years preceding the 2003 survey (Figure 3.2). Use of 

modern methods increased slowly to 23 percent, declined to 21 percent in 

1998, and then gradually rose again to 23 percent.1

 Whether the sudden decline 

in 1998 was real or the result of a problem with the data is not known. What is 

clear, however, is that contraceptive prevalence has not changed much over the 

decade. A similar picture can be seen for married women and for the lesser use 

of traditional methods. 

& & & &&& & & & & 21 22 23 23 23

21 21 22 22 23

10 9 9 7 6 5 4 3 2 1

Years preceding 2003 survey

0

5

10

15

20

25

30

35

40

Percent of all women Figure 3.2 Annual estimates of the percentage of all 

women using a modern method of contraception 

during the ten years preceding the 2003 DHS survey

in Kenya

 

1

 The level of 23 percent for woman-years is slightly lower than the 24 percent for all 

women. 
Contraceptive Use 9

However, although the increase in contraceptive prevalence among all women 

has stalled between 1998 and 2003, contraceptive use among women currently 

sexually active (had sex in the past four weeks) has continued to increase 

(Figure 3.3). In fact, there is no evidence of any plateau in this relevant 

subpopulation. Moreover, the increase is evident for all marital statuses (Figure 

3.4). 

Figure 3.3 Trends in the use of any contraceptive method 

among all women and among women who had sex in the 

past four weeks, Kenya 1993-2003

26

37

30

44

30

49

0 10 20 30 40 50 60

1993

1998

2003

1993

1998

2003

Percent using any method

All women

Women who had sex

in past 4 weeks

Figure 3.4 Trends in the use of modern methods of 

contraception and traditional methods of contraception 

among women who had sex in the past four weeks,

Kenya 1993-2003

31

37

39

31

37

39

39

43

46

24

33

44

6

7

10

6

7

9

5

4

6

11

13

13

All sexually

active women

1993

1998

2003

Currently married,

sexually active 1993

1998

2003

Formerly married,

sexually active 1993

1998

2003

Never married,

sexually active 1993

1998

2003

0 10 20 30 40 50 60

Percent

Modern method Traditional method

37

44

49

37

44

48

44

47

52

35

46

57
10 Contraceptive Use 

This distinction between all women and sexually active women (comprising 

about half of all women) is important because it affects the nature of the 

apparent stall. Rather than attributing the stall to shortages of contraceptive 

supplies, which also have occurred, it focuses attention on the trend in sexual 

activity. In Kenya, the proportion of women who had sex in the past four 

weeks declined from 52 percent in 1998 to 48 percent in 2003. The decline was 

greatest among never-married women but even among currently married 

women there was a slight drop, and there has been a decline across every age. 

None of the standard background variables (including changes in the 

proportion of husbands away from home, which has actually decreased over 

time) accounts for this change. Concern about HIV/AIDS seems like a 

plausible explanation but there is no hard evidence for this in the extensive 

DHS coverage of that subject. Over time, the order of the questions on sex in 

the DHS questionnaires has changed somewhat; this might have had some 

effect on the estimated proportions that never had sex, but the declines in 

sexual activity seem too pervasive to attribute to measurement differences. 

Moreover, similar declines in recent sex are evident also among women who 

ever had sex. And recent declines in sexual activity are also apparent in other 

countries, for example Namibia, Uganda, and Zambia. 

One might reasonably ask why, if sexual activity has diminished, the fertility 

rate has not declined. The problem is that there is no close, unambiguous link 

between the recency of sex (for women who ever had sex) and recent fertility. 

On the other hand, the proportion of women who never had sex has increased 

and this change does affect nonmarital fertility: 10.3 percent of never-married 

women in 2003 had a birth in the past three years, down from 13.1 percent in 

1998. But aside from this direct and obvious effect of an increase in premarital 

abstinence, one would not expect a clear connection of the recency of sex and 

fertility among currently married women. An analysis is also obscured by the 

fact that recency of sex is a current status measure while fertility is measured 

over the preceding three years, or at least one year. A recent birth or current 

pregnancy also has an effect on sexual activity, further obscuring the 

connection. The fact that there has been an increase in the proportion of women 

who want more children (see Section 4) may be another reason why a decline 

in recent sexual activity does not translate into a decline in fertility. 

3.2 Trends in the Contraceptive Mix 

The main change in the method mix has been the rise in the use of injectables 

and the decline in reliance on the pill. This increase in injectables began more 

than five years ago: “Injectables have recorded the most dramatic and 

consistent increase over the years .............” (Magadi et al., 2001). Our 

evidence from the calendar data (Figure 3.5) shows a strong continuation of the 

upward trend to the point in 2003 that injection use, along with implants at 4 

percent, amounts to 40 percent of all method use. All other methods, except 

condoms, declined in the total mix, with use of the pill dropping from 27 to 20 

percent of use over the decade and sterilization declining from a high of 13 

percent in 1998 to 8 percent five years later. The IUD also declined in 

popularity over the past 10 years from 10 to 5 percent. 
Contraceptive Use 11

& &

&&& & & & & & &

#

#

# # # # # # # # #

'

'

' ' ' ' ' ' ' ' '

!

!

! ! ! ! !

! ! ! !

,

,

, , , , , , , , ,

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

0

10

20

30

40

50

Percent of total use

Figure 3.5 Change in the method mix for modern 

contraceptive methods: percentage of woman-months 

of use of modern methods, Kenya 1993-2003

Note: Injection includes implants, which in 2003 were 4 percent of all modern method use.

Pill

Injection

Sterilization

IUD

Condom

20

22 22

24 23

26 24 26

27 27 27

38 38

36

34

31

29 28

26 23 24

40

8 9

11

13 12 13 13 12 13

10 10

10

5 4

6

7 7 8 8 9 8 8 7

3 3 3 4 4 3 4

5 5

6

3.3 Trends in Contraceptive Prevalence by Background 

 Characteristics 

Trends in contraceptive prevalence by age and by parity among currently 

married women are shown in Figures 3.6 and 3.7 for the current status data for 

the three surveys. The stall is evident mainly among the younger women while 

increased use continues above age 35. Similarly, the clearest evidence of 

increased use is for women with three or more children. Nonetheless, the use of 

modern contraception has increased in the past five years among women with 

one child from 25 to 28 percent and among those with two from 35 to 38 

percent. In fact, all of the small increase in contraceptive use among married 

women is concentrated among those using it to space births. When current 

users are divided into those who want more children and those who want no 

more—spacers and limiters—there is a small continuing increase in use among 

spacers but a plateau among limiters (Figure 3.8). 
12 Contraceptive Use 

Figure 3.6 Trends in current use of contraception among 

currently married women by age, Kenya 1993-2003

6

10

13

18

25

23

32

32

34

33

36

38

32

40

41

32

37

43

25

26

28

4

8

4

6

6

6

4

8

9

7

10

9

4

7

11

5

7

8

5

5

12

15-19

1993

1998

2003

20-24

1993

1998

2003

25-29

1993

1998

2003

30-34

1993

1998

2003

35-39

1993

1998

2003

40-44

1993

1998

2003

45-49

1993

1998

2003

0 10 20 30 40 50 60

Modern method Any method

Percent

10

18

17

24

31

29

36

40

43

40

46

47

36

47

52

37

44

51

30

31

40

Figure 3.7 Trends in current use of contraception among 

currently married women by number of living children,

Kenya 1993-2003 

2

6

4

20

25

28

26

35

38

30

33

42

33

36

37

4

6

3

6

6

5

5

10

7

7

7

9

5

7

9

No children

1993

1998

2003

One child

1993

1998

2003

Two children

1993

1998

2003

Three children

1993

1998

2003

Four or more children

1993

1998

2003

0 10 20 30 40 50 60

Modern method Any method

Percent

6

12

7

26

31

33

31

45

45

37

40

51

38

43

46
Contraceptive Use 13

The trends by region are quite diverse (Figure 3.9). In Nairobi and Nyanza 

contraceptive prevalence both in the use of modern and all methods has 

declined between 1998 and 2003, after having increased over the preceding 

five years. In contrast, there have been increases in Central, Eastern, and 

Western provinces. Little change is apparent in Coast and in Rift Valley. 

Figure 3.8 Trends in current use of contraception 

for spacing and for limiting births among currently 

married women, Kenya 1993-2003

10

13

15

23

26 26

1993 1998 2003

0

5

10

15

20

25

30

Percent of current yl marr ei d women

Spacing Limiting

Figure 3.9 Trends in current use of contraception among 

currently married women by province

38

47

44

50

55

58

17

20

19

31

36

39

22

25

21

21

26

26

22

22

27

7

9

7

6

6

8

3

2

5

7

10

13

2

3

4

7

12

10

3

8

7

Nairobi

1993

1998

2003

Central

1993

1998

2003

Coast

1993

1998

2003

Eastern

1993

1998

2003

Nyanza

1993

1998

2003

Rift Valley

1993

1998

2003

Western

1993

1998

2003

0 10 20 30 40 50 60 70

Percent

Modern method Any method

45

56

51

56

61

66

20

22

24

38

46

52

24

28

25

28

38

36

25

30

34
14 Contraceptive Use 

The picture by education (Figure 3.10) shows a significant decline in 

contraceptive use among those women with no education (who are a decreasing 

proportion of the population); it plateaus at the primary levels and shows a 

continued increase among women with secondary or more schooling. These 

trends are shown in annual estimates from the calendar data in Figure 3.11. The 

abrupt change in use among those with no schooling is curious; it seems 

unlikely that this can be explained by the small decline in the proportion of 

married women with no schooling (from 12.1 to 10.5 percent over the five 

years). 

We have also looked at the reasons women offer for not using any method of 

contraception, to see whether there have been any changes between 1998 and 

2003. But the same reasons prevail throughout that period. The main ones are 

menopause and infecundity, concerns over health and side effects, and 

opposition to use; and these reasons show no change over the five years. 

Figure 3.10 Trends in current use of contraception among 

currently married women by education, Kenya 1993-2003

15

16

11

23

22

23

29

37

36

45

46

52

5

7

5

5

6

7

6

7

8

7

11

10

No education

1993

1998

2003

Incomplete primary

1993

1998

2003

Complete primary

1993

1998

2003

Secondary or more

1993

1998

2003

0 10 20 30 40 50 60 70

Percent

Modern method Traditional method

20

23

16

28

28

30

35

44

44

52

57

62
Contraceptive Use 15

&

&

& & & &

& & & &

15

17 16 16 17

10 9 10 11 11

, , , , , , , ,,, 20 21 21 22 21

18

20 20 20 21

' ' ' ' ' ' ' ' ' ' 33 34 35 34 34 33 32 32 33 34

!

!

! ! ! ! ! !!!

41 42

44

42 43

45

47 47 47

50

10 9 8 7 6 5 4 3 2 1

0

10

20

30

40

50

60

Percent of use of modern me ht ods Figure 3.11 Annual estimates of married woman-years 

of use of modern contraceptive methods during the ten 

years preceding the 2003 DHS survey in Kenya, by 

level of education

Secondary+

Complete primary

Incomplete primary

No education

Years preceding 2003 survey

3.4 Trends in Contraceptive Failure Rates and Discontinuation 

Given the increasing use of injectables, the overall effectiveness of 

contraception could be expected to improve. Annual estimates from the 

calendar data (Figure 3.12), however, show little evidence of any overall 

change, with estimates ranging in a narrow band around the 0.04 and 0.05 

levels (these are annualized monthly ratios of pregnancies from contraceptive 

failure to months of exposure to such risk). Failure rates for modern methods 

are mostly at the 0.02 level. There is some suggestion of an increase in failure 

rates for traditional method users, although the pattern is irregular, with a range 

between 0.13 and 0.19. There has been an increase in the use of periodic 

abstinence among married women (from 6.1 to 6.6 percent in the last five 

years) and that may explain some of the increase in the average failure rate in 

1993-1998 of 0.15 to 0.18 between 1998-2003. 
16 Contraceptive Use 

& & & & & & & & & &

, , , , , , , , , ,

'

'

'

' '

'

' ' '

'

10 9 8 7 6 5 4 3 2 1

0.000

0.050

0.100

0.150

0.200

0.250

Contracept vi e af i ul re rates

Figure 3.12 Trends in annual contraceptive failure rates

during the ten years preceding the 2003 DHS survey in 

Kenya

Years preceding 2003 survey

Traditional methods

All methods

Modern methods

.134

.167

.130

.140

.161

.170

.184 .176

.157

.193

.045 .043 .052 .053 .044 .048 .051 .055 .052

.019 .014 .019 .019 .018 .022 .021 .021 .029 .017

.051

.250

.200

.150

.100

.050

.000

First-year contraceptive discontinuation 

rates (excluding the reason “to become 

pregnant”) increased over the five years 

from 1998 to 2003 (Table 3.1). In 1998 

the first-year discontinuation rate was 

28 percent, which climbed to 33 

percent by 2003. Most of this increase 

was not because of method failure. Side 

effects are the primary explanation for 

the overall increase in discontinuation. 

There have been higher discontinuation 

rates for the pill and injectables in the 

later survey. 

3.5 Trends in Sources of Methods 

It seems clear that there is a trend toward reduced use of public sources for 

contraceptive supplies (Figure 3.13). In 1993 the public sector was responsible 

for 68 percent of modern methods; this proportion dropped to 58 percent by 

1998 and is now at 53 percent, with private sources becoming more common. 

Of the observed decline in use of public sources to obtain contraceptive 

methods, the largest proportion is among those who formerly went to 

government hospitals to obtain their methods. This trend is affecting all of the 

main modern methods and may have some implications for the costs of 

contraception, although cost is not a reason frequently cited by women for not 

using a method. 

Table 3.1 Trends in percentage of 

contraceptive users that discontinued 

use after the first year of use for reasons 

other than “to become pregnant,” Kenya 

1998 and 2003 

–––––––––––––––––––––––––––––––– 

 KDHS KDHS

Method 1998 2003 

–––––––––––––––––––––––––––––––– 

Pill 32 42 

Injectables 18 28 

Condom 54 53 

Periodic abstinence 27 27 

All methods 28 33 
Contraceptive Use 17

Figure 3.13 Trends in the use of public sources of modern 

methods of contraception by currrent users (most recent 

source), Kenya 1993-2003

68

58

53

64

64

54

73

53

49

69

67

49

71

63

61

All modern

methods

1993

1998

2003

Female

sterilization

1993

1998

2003

Pill

1993

1998

2003

IUD

1993

1998

2003

Injectables,

implants

1993

1998

2003

0 20 40 60 80 100

Percent

1

1 Includes condoms

3.6 Trends in Attitudes Toward Family Planning 

There has been a slight decline in the last five years in the proportion of both 

women and men who say they approve of family planning (Table 3.2), from 89 

to 86 percent among women and from 89 to 87 percent among men. Although 

this difference is not great, the trend by educational attainment shows that the 

decline in approval is concentrated among less educated persons. What 

accounts for this decline is not clear although, as noted above, the less 

educated, particularly those with no education, are becoming a smaller 

proportion of the population and perhaps more selective in their choices. What 

is clear is that the trend in attitudes toward contraceptive use is consistent with 

the plateau in contraceptive prevalence. 

Table 3.2 Trends in percentage of currently married women and men who 

approve of family planning, by level of education, Kenya 1998 and 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

 Women Men

Level of ––––––––––––––– –––––––––––––––

education 1998 2003 1998 2003

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

No education 74 64 61 58 

Incomplete primary 89 85 89 83 

Complete primary 89 89 89 90 

Secondary+ 94 94 93 93 

Total 89 86 89 87 
18 Contraceptive Use 

3.7 Trends in Unmet Need for Family Planning 

Unmet need for family planning among married women, which had declined 

by one-third between 1993 and 1998, remained unchanged, at 25 percent, by 

2003. The stall in unmet need in the last five years has been pervasive—both 

for spacing and for limiting births—in urban and rural areas, in all but one of 

the provinces, and at different educational levels (Table 3.3). Coast province is 

the sole exception, with unmet need continuing its decline. In Nyanza there has 

been a significant rise in unmet need, from 26 to 35 percent in the last five 

years. 

3.8 HIV/AIDS and Contraceptive Use 

When considering the link between AIDS and contraception, the most attention 

has, understandably, gone to condom use. The question is whether the plateau 

in general contraceptive practice is related to the increase in AIDS in Kenya. 

There is concern about competition for resources, with those formerly targeted 

for family planning now going to HIV prevention activities. There has also 

been a decline in international donor funding for contraceptive supplies. 

Table 3.3 Trends in unmet need for family planning among 

currently married women, by background characteristics, Kenya 

1993-2003 

––––––––––––––––––––––––––––––––––––––––––––––––––– 

Background KDHS KDHS KDHS 

characteristic 1993 1998 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––– 

Total unmet need 36 24 25 

 For spacing 22 14 15 

 For limiting 15 10 10 

Residence 

 Urban 26 17 17 

 Rural 38 26 27 

Region 

 Nairobi 27 13 16 

 Central 25 11 11 

 Coast 33 30 25 

 Eastern 41 22 22 

 Nyanza 39 26 35 

 Rift Valley 37 27 28 

 Western 43 32 32 

Education 

 No education 37 25 24 

 Primary incomplete 42 31 35 

 Primary complete 38 23 25 

 Secondary+ 27 15 13 
Contraceptive Use 19

Women who are currently infected (and who may or may not know about their 

condition) show the same proportions using contraception as other women. 

There is also no difference in contraceptive use by men between those infected 

and uninfected. A better measure of the possible effects of AIDS is the 

perception of risk and the effect this has on contraceptive use. The association 

both for men and women (Table 3.4) shows the lowest use among those who 

perceive no risk, both in 2003 and in 1998. It is therefore possible that the lack 

of increase in contraceptive prevalence may be connected with the decline in 

the perception of risk between 1998 and 2003. 

One might infer, however, that such a connection would involve mainly 

condom use and yet there has been little change in the use of this method, 

except among the sexually active unmarried population. 

Table 3.4 Trends in use of contraception by perceived risk of 

getting AIDS, Kenya 1993 and 1998 

––––––––––––––––––––––––––––––––––––––——————–

 Percentage currently using 

 a contraceptive method 

 ———————————————— 

 Women Men 

Perceived ——————— ——————— 

risk of AIDS 1998 2003 1998 2003a

––––––––––––––––––––––––––––––––––––––——————–

None 25 22 43 39 

Small 31 32 50 50 

Moderate 34 39 58 59 

Great 33 32 56 54 

––––––––––––––––––––––––––––––––––––––——————–

a

 Method most recently used 
Reprodutive Preferences 21

 4

Reproductive Preferences 

he reversal of the decline in the number of children desired is perhaps the 

most unexpected change in Kenya. The importance of evaluating changes 

in these preferences for understanding changes in contraceptive behavior 

and fertility is clear (Westoff and Bankole, 2002). The decline in the number of 

children wanted that had been continuous from the early World Fertility Survey 

in 1977-78 (Central Bureau of Statistics, 1980) and the 1984 Contraceptive 

Prevalence Survey (Central Bureau of Statistics, 1984), has reversed itself and, 

in some segments of the population, shows major change. This analysis 

emphasizes trends based on data mainly from the 1993, 1998, and 2003 KDHS 

surveys, with initial reference to earlier survey estimates as well. The main 

focus is on trends in various strata and geographic divisions of the Kenyan 

population, in an effort to locate the sources of these changes in reproductive 

preferences and thereby sharpen the explanation of the reversal. 

4.1 Perspective of a Quarter of a Century 

The trend in the proportion of married (fecund)2 women who want no more 

children is shown in Figure 4.1 at intervals of approximately five years for the 

past 25 years, from 1977-78 to 2003. The proportion increased sharply over the 

first ten years from 17 to 49 percent by 1989 and gradually to 52 and 53 

percent in 1993 and 1998; it then dropped back down to 49 percent in 2003, the 

level that had been reached ten years earlier. The statistic for “want no more 

children” is obviously related to the number of living children and this 

distribution has changed over the 25 years with the decline of fertility. 

Nonetheless, the plateau or reversal between 1998 and 2003 has occurred at 

almost every parity (see Table 4.1). 

The same observation applies to the trend by age group (Table 4.2). The recent 

reversal of the long-term increase in the proportion of women who want no 

more children is concentrated between ages 25-39. 

______________________________ 

2 The definition of “fecund” differs somewhat between the early and late surveys. The 

restriction to fecund women in this section is necessary because in the early surveys 

infecund women were not asked about their reproductive intentions. In the rest of this 

section, the only restriction is to currently married women. 

T 
22 Reproductive Preferences 

&

&

&

&

& &

17

32

49

52 53

49

1977-78 1984 1989 1993 1998 2003

0

10

20

30

40

50

60

Percent who want no more chi dl ren Figure 4.1 Trends in percentge of currently married, 

fecund women who want no more children, 

Kenya 1977-78 to 2003

Table 4.1 Trends in percentage of currently married, fecund 

women who want no more children by number of living children, 

Kenya 1977-78 to 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––– 

 Number of living children 

 ––––––––––––––––––––––––– 

Survey 2 3 4 5+ Total 

––––––––––––––––––––––––––––––––––––––––––––––––––– 

1977-78 4 7 16 32 17 

1984 10 17 30 59 32 

1989 24 35 50 78 49 

1993 27 45 65 81 52 

1998 34 53 73 87 53 

2003 34 50 71 83 49 

Table 4.2 Trends in percentage of currently married, fecund women who want 

no more children by age, Kenya 1977-78 to 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

 Age 

 –––––––––––––––––––––––––––––––––––––––––––––

Survey 20-24 25-29 30-34 35-39 40-44 45-49

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

1977-78 4 12 19 25 40 42 

1984 11 23 45 54 67 76 

1989 18 42 60 72 85 89 

1993 22 47 65 80 89 88 

1998 23 45 64 84 91 95 

2003 23 37 60 77 90 97 
Reprodutive Preferences 23

4.2 Trends by Residence 

In Figure 4.2 the trend in the proportion of women who want no more children 

indicates that the decline between 1998 and 2003 is evident in both urban and 

rural areas. These estimates are based exclusively on the KDHS surveys and 

the denominator is expanded to all currently married women rather than only to 

fecund women. 

Figure 4.2 Trends in percentage of currently married women 

who want no more children (including those sterilized) by 

residence, Kenya 1989-2003

40

48 48

46

51

53 54

52

1989 1993 1998 2003

0

10

20

30

40

50

60

Percent who want no more chi dl ren

Urban Rural
24 Reproductive Preferences 

The trend in each of the provinces (Figure 4.3) also uniformly indicates the 

recent reversal. Although the earlier trend toward increasing proportions who 

want no more children is not completely consistent, the 2003 estimates for each 

province are all below the 1998 values. The recent decline in Nairobi has been 

the most pronounced, from 50 to 42 percent.

4.3 Trends by Education 

The trend in reproductive preferences by education is the most interesting and 

revealing. Among women with no education—a segment of the female 

population that has declined from 25 percent in 1989 to 10 percent by 2003— 

the earlier increasing proportion who wanted no more children abruptly 

reversed in 2003, dropping to 46 percent from the 59 percent five years earlier 

(Figure 4.4). More moderate declines are also evident in the two primary 

school categories, but among women with more than a primary school 

education (now over 30 percent) the upward trend may be continuing. Since the 

proportion of women who want no more children is influenced by the number 

they already have, these tabulations were repeated with a parity control 

(women with 2-4 children), but the same pattern prevails (Table 4.3). The one 

exception is a continued increase in the proportion who want no more children 

that is evident for women with at least a completed primary education. 

Figure 4.3 Trends in percentage of currently married women who want no more 

children (including those sterilized), by province, Kenya 1989-2003)

49

52

53

50

1989

1993

1998

2003

20 30 40 50 60 70

44

45

50

42

1989

1993

1998

2003

20 30 40 50 60 70

Kenya Nairobi

67

64

64

61

1989

1993

1998

2003

20 30 40 50 60 70

Central

28

30

37

33

1989

1993

1998

2003

20 30 40 50 60 70

60

62

61

59

1989

1993

1998

2003

20 30 40 50 60 70

42

47

51

47

1989

1993

1998

2003

20 30 40 50 60 70

Coast Eastern Nyznza

50

49

53

49

1989

1993

1998

2003

20 30 40 50 60 70

43

54

53

52

1989

1993

1998

2003

20 30 40 50 60 70

Rift Valley Western
Reprodutive Preferences 25

Another measure of reproductive preferences focuses on comparison of wanted 

and unwanted fertility, which are the two components of the total fertility rate 

(Figure 4.5). As discussed in Section 2, the sum of these two components—the 

TFR—shows a nationwide decline from 5.4 births per woman in the 1993 

survey to 4.7 births per woman in the 1998 survey, and then plateaus at 4.8 

births per woman in the 2003 survey. During this decade, the wanted 

component of total fertility remained constant at 3.5 births per woman while 

the unwanted component dropped from 2.0 to 1.2 births per woman and then 

stalled. Since 1998, no further decline in unwanted fertility has been observed. 

The picture by education is quite different, especially at the extremes of the 

distribution. Among the women with no education, there has been a sharp 

increase in the wanted component, from 4.2 in 1993 to 5.5 in 2003 and a 

decrease in unwanted fertility, from 1.8 to 1.2. The net result was an increase in 

the overall TFR among those with no education, from 5.8 in 1998 to 6.7 in 

2003 (calculated over the three years preceding each survey), all of which is 

concentrated in the wanted component. 

Figure 4.4 Trends in percentage of currently married women 

who want no more children (including those sterilized) by 

education, Kenya 1989-2003

54 56 59

46

1989 1993 1998 2003

53 52 51 47

1989 1993 1998 2003

46 49

55 52

1989 1993 1998 2003

37

50 53 54

1989 1993 1998 2003

No education Some primary

Primary complete Secondary+

Table 4.3 Trends in the percentage of currently married 

women with two to four children who want no more children 

(including those sterilized), by level of education, Kenya 

1993-2003 

–––––––––––––––––––––––––––––––––––––––––––––––––– 

Level of KDHS KDHS KDHS 

education 1993 1998 2003

–––––––––––––––––––––––––––––––––––––––––––––––––– 

No education 32 48 30 

Primary incomplete 42 41 38 

Primary complete 50 51 54 

Secondary+ 54 60 63 

Total 45 51 50
26 Reproductive Preferences 

At the opposite end of the educational scale—women with more than primary 

school education—the expected pattern emerges. The TFR for these women 

declined from 4.0 to 3.5 to 3.2 over the ten-year period (1991-93 to 2001-03). 

The primary change was in the wanted component, which declined from 2.8 to 

2.3 in the last five years. 

In the incomplete primary category (a third of the women in 2003), the wanted 

component increased in the recent five-year period as it did among those with 

no education, but not by as much (from 3.7 to 4.2). In contrast to those with no 

education, for those with incomplete primary education, unwanted fertility also 

increased from 1.5 to 1.9, after having declined from the 1993 level of 2.5. 

Among women with completed primary education (26 percent in 2003), both 

components of the fertility rate were unchanged between 1998 and 2003, 

following a decrease in the unwanted fertility from 2.0 in 1993 to 1.3 in each of 

the later surveys. 

These figures show that most of the changes in fertility have occurred among 

the least educated segment of the population, largely in the wanted component. 

 

Another measure of preferences, the ideal number of children, shows a similar 

pattern; it is not shown here because it is similar to the wanted and unwanted 

indicators that capture the difference between the ideal and actual fertility. 

Figure 4.5 Trends in wanted, unwanted, and total fertility rates

by education, Kenya 1993-2003

3.4

3.5

3.5

4.2

4.4

5.5

3.7

3.7

4.2

3.0

3.5

3.5

2.8

2.8

2.3

2.0

1.2

1.3

1.8

1.4

1.2

2.5

1.5

1.9

2.0

1.3

1.3

1.2

0.7

0.9

All women

1993

1998

2003

No education

1993

1998

2003

Incomplete

primary

1993

1998

2003

Complete

primary

1993

1998

2003

Secondary+

1993

1998

2003

2.0 3.0 4.0 5.0 6.0 7.0

Births per woman

Wanted births Unwanted births

5.4

4.7

4.8

6.0

5.8

6.7

6.2

5.2

6.1

5.0

4.8

4.8

4.0

3.5 3.2
Reprodutive Preferences 27

4.4 The “Wanted and Unwanted” Explanation 

Overall, the evidence presented so far indicates that an important explanation 

for the lack of any further decline in fertility in Kenya between 1998 and 2003 

lies in women’s fertility preferences, as evidenced by the decline of the 

proportion of women who want no more children and the plateauing of the 

wanted total fertility rate (WTFR). The WTFR is unchanged, while the 

unwanted component increased slightly from the three years before the 1998 to 

before the 2003 surveys (top panel of Figure 4.5). This accounts for the slight 

rise in the overall TFR from 4.7 to 4.8. These rates measure the recent past 

while the decline in the proportion of women who want no more children 

suggests that the WTFR might increase in the near future. 

A more direct measure of the contribution of the unwanted dimension to the 

reversal phenomenon is the trend in the planning status of recent births. Each 

survey included a question about whether recent births had been wanted at that 

time (“then”), wanted later, or not wanted at all. The distribution of the 

planning status of births in the three years preceding each survey is shown in 

Table 4.4. Two statistics are noteworthy: the lack of any change reported in 

1998 and 2003 in the proportion of births wanted “then” and a near doubling of 

the proportion of unwanted births over this same period, following a significant 

decline between 1993 and 1998. This unwanted percentage declined from 18 

percent in the three years prior to the 1993 survey to 11 percent five years later 

but then increased to 21 percent in the three years before the 2003 survey. 

Since contraceptive failure has not increased, this is probably related to the stall 

of contraceptive prevalence. Other analyses, not presented here, show that this 

increase in unwanted births occurred at every age at birth and at every birth 

order, as well as in every province. The only exception is that it has remained 

unchanged at 22 percent for women with no education while increasing at all 

higher levels. Figure 4.5 indicates that the primary change among least 

educated women has been in the wanted fertility component. 

Table 4.4 Trends in planning status of births in the three 

years preceding the survey (including current pregnancy), 

Kenya 1993-2003 

––––––––––––––––––––––––––––––––––––––––––––––––– 

 Wanted Wanted Wanted 

Survey then later no more Total

––––––––––––––––––––––––––––––––––––––––––––––––– 

1993 45 37 18 100 

1998 51 37 11 100 

2003 51 29 21 100 

––––––––––––––––––––––––––––––––––––––––––––––––– 

Note: Total includes a small number of cases with missing 

information. 
28 Reproductive Preferences 

The most current measure of wantedness is the report of currently pregnant 

women (included in the analyses above). The proportion of pregnant married 

women who reported that pregnancy as unwanted dropped from 20 percent in 

1993 to 9 percent in 1998 but then increased to 16 percent by 2003. 

The large increase in unwanted pregnancies—a doubling over the recent fiveyear period—prompts some concern about the reliability of the data. The fact 

that the current pregnancy information shows the same magnitude of change as 

that for the last birth provides some assurance, since the questions are asked at 

different stages of the interview. Moreover, the phrasing of the answer 

categories to the question on current pregnancy was identical across surveys 

whereas there had been a slight change in wording relating to the last birth. 

Another analysis has been undertaken to assess the consistency of the report on 

the planning status of the last birth with reproductive intentions. Women who 

say they did not want their last birth could be presumed more likely to say they 

want no more children in the future, although one can imagine circumstances 

when this might not be the case. This kind of “inconsistency” (the percent of 

women who reported their last birth as unwanted but say they want more 

children) has in fact increased to nearly 20 percent in 2003 from half that 

proportion in both earlier surveys. Analysis of the characteristics of these 

women reveals that they are much younger (by nine years) and have only half 

the number of children as those who want no more and who also reported their 

last birth as unwanted. This suggests that the “inconsistency” is probably real 

and that there is more conflict among these younger, low parity women in 2003 

about their future reproductive preferences. 

The conclusion about the reversal is that there has been both an increase in 

unwanted births and a decline in the proportion of women who currently want 

no more children. 

4.5 Trends by Ethnicity, Religion, and Wealth 

The reversal or plateauing of the decline in fertility preferences is evident in all 

the major ethnic groups in Kenya (Figure 4.6). 
Reprodutive Preferences 29

Figure 4.6 Trends in percentage of currently married women who want no 

more children (including those sterilized), by ethnic group, 

Kenya 1993-2003

46

52

48

1993

1998

2003

20 30 40 50 60 70

60

55

55

1993

1998

2003

20 30 40 50 60 70

63

60

57

1993

1998

2003

20 30 40 50 60 70

53

58

54

1993

1998

2003

20 30 40 50 60 70

Kamba

Kikuyu Kisii

Kalenjin

53

53

53

1993

1998

2003

20 30 40 50 60 70

43

44

44

1993

1998

2003

20 30 40 50 60 70

Luhya Luo

38

34

1993

1998

2003

20 30 40 50 60 70

62

66

58

1993

1998

2003

20 30 40 50 60 70

26

31

29

1993

1998

2003

20 30 40 50 60 70

45

51

50

1993

1998

2003

20 30 40 50 60 70

Meru

Mijikenda Taita/Taveta

Masai

46

56

46

1993

1998

2003

20 30 40 50 60 70

Other
30 Reproductive Preferences 

There is a slight decline in the proportion of women who want no more 

children among Roman Catholics and Protestants. Among the minority Muslim 

population (6 percent of the total population), the decline is more pronounced, 

dropping from 41 to 28 percent between 1998 and 2003 (Figure 4.7). 

The main feature of the recent trend in reproductive preferences in terms of 

wealth is the increase in both wanted and unwanted fertility in the lowest 

quintile of the wealth distribution (Figure 4.8). Overall, the TFR in this 

category increased from 6.5 to 7.8 births per woman. The increase in the 

unwanted component from 1.8 to 2.6 births in the five-year interval is 

especially important. Only in this lowest wealth quintile has the unwanted 

birthrate shown such a change. The only other large difference is in the middle 

quintile where the wanted component increased from 3.4 to 3.9 births. 

Figure 4.7 Trends in the percentage of currently married women who want no 

more children (including those sterilized) by religion, Kenya 1993-2003

53

54

52

1993

1998

2003

20 30 40 50 60 70

43

41

29

1993

1998

2003

20 30 40 50 60 70

54

56

53

1993

1998

2003

20 30 40 50 60 70

Catholics

Protestants

Muslims
Reprodutive Preferences 31

Figure 4.8 Trends in wanted, unwanted, and total fertility 

rates by wealth quintile, Kenya 1998 and 2003

4.7

5.2

4.1

4.0

3.4

3.9

3.1

2.9

2.5

2.5

1.8

2.6

1.5

1.7

1.3

1.1

1.1

1.1

0.5

0.6

Lowest quintile

1998

2003

Second quintile

1998

2003

Middle quintile

1998

2003

Fourth quintile

1998

2003

Highest quintile

1998

2003

2.0 3.0 4.0 5.0 6.0 7.0 8.0

Births per woman

Wanted births Unwanted births

6.5

7.8

5.6

5.7

4.7

5.0

4.2

4.0

3.0

3.1

4.6 Trends in Male Preferences 

Samples of men have been included in the last three surveys in Kenya. As in 

the trends observed among women, there has been a reversal in the preference 

for fewer children among married men (Table 4.5). The proportion who say 

they want no more children has dropped from 46 to 40 percent between 1998 

and 2003. This decline is concentrated among men with four or more children. 

It is evident in both urban and rural areas, but particularly among men in cities. 

Table 4.5 Trends in percentage of currently married men who 

want no more children, by background characteristics, Kenya 

1993, 1998, and 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––

Background KDHS KDHS KDHS 

characteristic 1993 1998 2003

––––––––––––––––––––––––––––––––––––––––––––––––––

Number of living children 

 2 22 24 29 

 3 38 41 44 

 4 50 63 59 

 5 61 72 57 

 6+ 66 69 66 

Residence 

 Urban 41 48 37 

 Rural 45 45 42 

Education 

 No education 36 36 27 

 Some primary 49 42 35 

 Primary complete 46 49 42 

 Secondary or more 40 46 45 

Total 44 46 40 
32 Reproductive Preferences 

The trend by education shows the largest reversal among the less educated 

men. 

Among those with some secondary education or more, the proportion of men 

who want no more children in 2003 has remained at essentially the same level 

as in 1998. 

4.7 The AIDS Hypothesis 

One speculation about the reversal of reproductive intentions in Kenya is that 

increasing concern about AIDS might induce parents to want more children—

as a way of insuring that they have some surviving children. In fact, the highest 

levels of the disease are among women age 25-39 (Central Bureau of Statistics, 

2004), the same age group in which the reversal of reproductive preferences is 

seen. However, concern about AIDS appears to have diminished somewhat in 

Kenya. An increasing proportion of women now say that their chances of 

contracting the infection are small or nonexistent (rising from 66 to 75 percent 

between 1998 and 2003). Among men there has been almost no change in their 

perception of risk. 

Nonetheless, we examined the association between the perception of 

risk and reproductive intentions and 

found that in fact the relationship is 

the reverse from that hypothesized: 

the proportion of women who want 

no more children increases as the 

perceived risk increases (Table 4.6). 

For men there is little relationship. 

Another measure—whether the respondent knows someone who has 

AIDS or who has died from the 

disease (known by three-fourths of 

Kenyan men and women)—also 

shows the same association with reproductive intentions: for both men 

and women there is a slight increase 

in the proportion who want no more children among those who know someone 

with the disease. Imposing an age control on these tabulations does not alter 

the picture. The general results are consistent with other research in Zimbabwe 

(Grieser et al., 2001). 

Another (limited) test of this hypothesis is to examine the association among 

persons who actually have the disease, based on the HIV testing in the 2003 

DHS. This is a limited test because an unknown fraction of those who tested 

positive are aware of their HIV status (only 21 percent of these women and 

men reported having had a previous blood test, which may or may not be 

currently relevant for those who then tested negative). The HIV-positive 

women in the survey show a lower proportion (40 percent) who want no more 

children compared with women with negative blood test results (51 percent). 

This could imply higher future fertility with the increasing prevalence of 

AIDS, although men do not follow the same pattern. Among men the 

corresponding estimates are 42 and 36 percent. 

Table 4.6 Percentage of currently married 

women and men who want no more children 

by the perceived chance of contracting AIDS 

and by whether they know anyone with the 

disease or who has died from it, Kenya 2003 

––––––––––––––––––––––––––––––––––––

Perceived risk of AIDS/ Percent who want 

knows someone who no more children 

has AIDS or who ––––––––––––––– 

 has died of AIDS Women Men

––––––––––––––––––––––––––––––––––––

Perceived risk of AIDS 

None at all 46 40 

Small 50 42 

Moderate 56 35 

Great 55 37 

Knows someone who 

has AIDS or who has 

died of AIDS 

No 44 34 

Yes 52 42
Reprodutive Preferences 33

The conclusion from these tabulations is that HIV prevalence and related 

concerns in Kenya do not directly explain the reversal of the trend toward a 

smaller desired number of children. The possible effect of the increase in AIDS 

on reproductive preferences may, however, operate through child mortality. 

4.8 Child Mortality Trends and Reproductive Preferences 

The mortality rate of children under five increased between the five-year 

period before 1998 and the five years before 2003 by an estimated 15 percent, 

after being relatively unchanged from the 1993 estimate.3

 The rate increased in 

every province compared with the 1998 estimates and is now even higher in 

every province than the estimates for the ten years before the 1993 survey.4

The increase is probably the result of a general deterioration of health services 

related to children, such as immunization coverage and prenatal care, as well as 

to AIDS (Hill, Bicego, and Mahy 2003; Newell 2004). Of women who tested 

positive for the virus, 14 percent reported the death of a child under five over 

the preceding five years compared with 7 percent for those who tested negative). An increase in child mortality could plausibly lead to the interruption of 

the decline in the proportion of women who want no more children. What is 

the evidence? 

In Table 4.7 the proportions of women who want no more children are shown 

for women who did or did not have a child who died in the past five years. 

Overall the difference is in the hypothesized direction, with a lower proportion 

who want no more found in the category with a child who had died in the last 

five years. To state it more directly, the evidence (as hypothesized) suggests 

that women who have recently experienced the death of a young child are more 

likely to want another child than those who have not. The same picture appears 

when the comparison is confined to women who had a birth in the preceding 

five years. The “effect” of a child death is strongest for women with two or 

three living children; it diminishes as parity increases and women grow older 

because most women at this stage want no more children regardless of a recent 

child death. (Conversely, at the lower parities, virtually all women want 

another child).5

 The same pattern can be seen in the 1993 and 1998 data, so 

with an increase in child mortality it seems reasonable to expect a decline in 

the proportion of women who want no more children. 

______________________________ 

3

 This is based on a recalculation of the rate from the 1998 data, standardizing the 

estimate using the 2003 distribution of the weighted sample by province. Comparison 

of the province distributions for 1993, 1998, and 2003 suggests strongly that Central 

province is significantly under-represented and Nyanza over-represented in 1998. 

Since Central province has the lowest mortality rate (54) and Nyanza the highest rate 

(206), adjusting on the basis of the 2003 distribution lowers the 1998 national rate from 

112 to 99. The result is that there is then little change from the 1993 estimate of 96 and 

a much greater increase between 1998 and 2003 (from 99 to 115). 4

 The province mortality rates are calculated for ten-year periods because of sampling 

error concerns. 

5 The differences for all women and for women at parities 2, 3, and 4 are statistically 

significant at the .001 level. 
34 Reproductive Preferences 

A similar association is evident for men, 

as indicated in Table 4.8. Because of 

smaller samples and less available information, the comparison is limited to those 

with or without any experience of a child 

who had died at any age (among men who 

currently have two, three, or four 

children). The evidence is consistent with 

that for women and shows a lower proportion of men who want no more children 

among those with a child death in their 

history. The same association exists in the 

1998 sample of men. 

In general, the evidence about the connections of AIDS, child mortality, and 

reproductive intentions presented here for Kenya are consistent with the 

conclusions of a study in Tanzania (Ainsworth et al., 1998) that an increase in 

child mortality can be expected to increase fertility (Gyimah and Rajulton, 

2004) while an increase in adult mortality or concern about AIDS would 

reduce fertility. 

4.9 Multivariate Analysis 

The question arises whether the covariates of reproductive preferences have 

changed at all in the last five years and if so, whether related changes in the 

composition of the population might explain the reversal. In Table 4.9, the 

odds ratios from two logit regressions are shown for identical covariates for 

2003 and 1998, in which the dichotomy of want more-want no more children is 

the dependent variable. The odds ratio for a particular variable estimates the 

predictive power of that variable with all other covariates controlled. For 

example, the odds ratios for number of children in both surveys indicate that 

with each additional child the odds of wanting no more children approximately 

double, an effect that is independent of all of the other variables in the 

regression. Or, residents in Nairobi in 2003 are only 39 percent as likely as 

those in Central province (the reference category) to want no more children. 

The main impression from a comparison of these odds ratios is how similar 

they are at the two times. The odds of wanting no more children at both times 

are significantly and similarly associated in both surveys with age, number of 

children, urban residence, exposure to mass media, wealth, and province. At 

both times, educational achievement (contrasted with no education) is related 

Table 4.7 Percentage of married women who want no more children by 

whether they experienced the death of a child under five years of age in the five 

years preceding the survey, by number of living children, Kenya 2003 

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

 Number of living children 

Occurrence ––––––––––––––––––––––––––––––––––––––––––– 

of child death 1 2 3 4 >4 Total 

––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 

No 15 36 57 71 83 51 

Yes 16 22 32 65 86 45 

Table 4.8 Percentage of currently 

married men (with two, three, or four 

living children) who want no more 

children by whether they ever 

experienced the death of a child, 

Kenya 1998 and 2003 

–––––––––––––––––––––––––––––– 

 Percentage 

 who want 

 no more children 

Occurrence of ––––––––––––––– 

child death 1998 2003

–––––––––––––––––––––––––––––– 

No 42 43 

Yes 33 37 
Reprodutive Preferences 35

to wanting no more children and the effect increases with increasing schooling. 

The impact of education on preferences seems stronger in 2003 than in 1998 

but this is probably because of the characteristics of the women with no 

schooling who are the reference category. In 2003, these women are younger 

than in 1998 and are more likely 

to be in the poorest quintile. 

One difference in the values is in 

the religion covariate: in 1998 it 

is not significantly associated 

with reproductive preferences but 

in 2003 being Muslim implies a 

lower proportion wanting to 

cease childbearing. If the trend in 

the proportion who want no more 

children is confined to nonMuslim women as well as to 

women with some education, the 

difference across the five years in 

the proportion who want no more 

children shrinks from 3 to 1 percent, but it is not enough to 

change the direction of the trend. 

Table 4.9 Odds ratios of wanting no more 

children for currently married women in 1998 

and 2003 

–––––––––––––––––––––––––––––––––––––– 

 Want no 

 more children 

 ––––––––––––– 

Covariate 1998 2003

–––––––––––––––––––––––––––––––––––––– 

Age (in single years) 1.05 1.06 

Number of living children 2.04 1.98 

Rural residence 0.59 0.78 

Province 

Central 1.00 1.00 

Nairobi 0.46 0.39 

Coast 0.22 0.34 

Eastern ns ns 

Nyanza 0.45 0.57 

Rift Valley 0.38 0.57 

Western 0.41 0.67 

Education 

No education 1.00 1.00 

Primary incomplete 1.57 2.08 

Primary complete 1.73 2.74 

Secondary incomplete 1.96 2.53 

Secondary complete 1.97 2.95 

Higher 2.29 2.93 

Religion 

Protestant 1.00 1.00 

Catholic ns ns 

Muslim ns 0.60 

Mass media 1.13 1.14 

Wealth (in quintiles) 1.08 1.22 

R squared .323 .317 

Number of women 4,745 4,446 

Chi squared 2,114 1,954 

–––––––––––––––––––––––––––––––––––––– 

ns = Not statistically significant at the .05 level 
Summary and Conclusions 37

 5

Summary and Conclusions 

his report addresses the recent unexpected plateau of the fertility decline 

in Kenya. The overall fertility rate, estimated from successive Kenyan 

Demographic and Health Surveys, has remained unchanged in the past 

five years after three preceding decades of decline. The stall is also evident for 

teenage pregnancy and childbearing rates. With the exception of Central 

province, where the TFR has continued its decline, the lack of decline is 

evident in all of the provinces except Nyanza and the Rift Valley, where 

fertility actually increased by about 10 percent over these five years. A similar 

increase in fertility has occurred among the least educated women, while a 

continuing decline is evident for women with at least some secondary 

education. No change in fertility appears for women with fewer than four 

children, while increases are evident at higher parities. 

Contraceptive prevalence among all women has not changed. However, when 

the analysis is confined to sexually active women (those who reported sex in 

the past four weeks), contraceptive prevalence has increased, as had been 

expected. This alters the possible explanation and focuses it on what appears to 

be a pervasive decline in recent sexual activity—at all ages and marital statuses 

(especially among the unmarried)—a trend that also appears in several other 

African countries in the region. Concerns about HIV/AIDS would seem 

relevant in the abstract but are difficult to connect unambiguously. 

The overall plateau in contraceptive prevalence has occurred mainly among 

younger women, while those over 35 years of age continue to show an increase 

in use. As in trends in fertility, the least educated women show a significant 

decline in prevalence while the most educated continue to show an increase in 

use. Contraceptive failure rates have not changed for the most part, but there 

has been some increase in discontinuation rates for reasons other than failure or 

seeking pregnancy. Changes in the mix of methods have continued, with an 

increase in the use of injectables and a decline in the use of the pill, 

sterilization, and the IUD. 

There has been a continuing increase in reliance on the private sector for 

contraceptive supplies. Approval of family planning has declined slightly, 

especially among the least educated women. At the same time, the level of 

unmet need for family planning has remained unchanged throughout the 

country. There seems to be little connection between overall changes in 

contraceptive use and current HIV infection or perceived risk of getting AIDS. 

However, shortages of contraceptive supplies have been linked in the Kenya 

press to increases in support for HIV prevention programs as well as to the 

reduction of international donor funding for contraception. 

T 
38 Summary and Conclusions

Perhaps the most intriguing and more basic change has been in the historically 

steady increase in the proportion of Kenyan women who want no more 

children, which has reversed direction since 1998. This change is pervasive; it 

affects all parities and ages. It has occurred in both urban and rural areas and in 

every one of the seven provinces, although it is most extreme in Nairobi. With 

few exceptions, a plateauing or reversal of reproductive intentions has occurred 

at every age group, in every province. 

The reversal is especially dramatic among women with no education; it is 

moderate for those who reached or completed primary grades; among women 

with secondary or more education, the long-term trend toward preferences for 

smaller families continues. This educational contrast is particularly evident 

with the wanted fertility rate, where the average number of children desired by 

women with at least some secondary education dropped from 2.8 to 2.3 over 

this recent period in contrast to the increase from 4.4 to 5.5 births wanted 

among women with no education. 

Examination of these trends by ethnicity shows no exception in the 11 groups 

identified; in each ethnic group, the increase in the desire to stop childbearing 

stalled or reversed. The same is true for Protestants and Catholics and is 

especially dramatic for the Muslim minority. 

We have searched for other indicators in the 2003 KDHS data that might 

elucidate the reasons for the stall or reversal in reproductive preferences, with 

mixed success. For example, there does not seem to be any connection with 

concern about AIDS, although some additional work is needed here. A more 

promising lead lies in the increase in child mortality between 1998 and 2003. 

There is a clear association between wanting more children and having 

experienced the loss of a child under five in the past five years. It seems 

reasonable to conclude that the increase in child mortality, partly because of 

AIDS, has played a role in the changes in reproductive intentions. 

We also know that there has been a significant increase in unwanted births 

between 1998 and 2003. Thus, changes in reproductive intentions are not the 

only explanation. 

In conclusion, we return to the original questions. The decline of fertility has 

stalled because of the plateau in contraceptive prevalence and, perhaps more 

fundamentally, a shift toward wanting more children. We have been able to 

identify the segments of the population where stalls or reversals have occurred 

and some of the mechanisms. These changes in reproductive preferences have 

been pervasive; women with no education and Muslim women show dramatic 

reversals while women with at least some secondary education have continued 

to want and have fewer births. Women without any education and Muslim 

women in Kenya are not very large segments of the population and cannot 

account for the overall pattern of change. Even the child mortality increase 

associated with wanting additional children is not enough to explain the 

reversal of reproductive preferences. Also, the multivariate examination of the 

covariates of these preferences shows values in 2003 very similar to those for 

1998. In conclusion, it would appear that more general social or economic 

changes have recently occurred in Kenya beyond the individual characteristics 
Summary and Conclusions 39

measured in these surveys. For example, the role of the government and 

international donor support for family planning may very well have contributed 

to the stall in contraceptive prevalence. The increase in the proportion of 

women who want more children is more puzzling. 

 

References 41

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