Ideation and intention to use contraceptives in Kenya and Nigeria

1. IntroductionContraceptive use is a key factor in preventing unwanted pregnancies, reducing maternal and child mortality, and improving the lives of women and their families (Cleland et al. 2012; Kavanaugh and Anderson 2013; Sonfield et al. 2013; Tsui, McDonald-Mosley, and Burke 2010). A recent study estimated that contraceptive use could avert more than two-fifths of maternal deaths (Ahmed et al. 2012). Increased access to contraceptive services has been established as a cost-effective strategy for countries to reduce maternal and child mortality (Moreland and Talbird 2006). The benefits of contraceptive use go beyond the health sector. Providing unrestricted access to contraceptives will help ensure a reduction in unwanted pregnancies and thereby contribute to increased female education, women's empowerment, poverty reduction, and even environmental sustainability (Moreland and Talbird 2006; Smith et al. 2009; Sonfield et al. 2013).Regrettably, levels of contraceptive use remain low in many African countries: unintended pregnancies are common, and unmet need is high. In Nigeria, for example, the results of the 2013 Demographic and Health Survey indicate that only 15.1% of married women were using any contraceptive method, while only 9.8% were using a modern method (NPC/ICF 2014). These numbers have not changed meaningfully since 2003 (NPC/ICF 2009). Partly as a result of low contraceptive use, in 2013 fertility remained high in Nigeria at 5.5 children per women, on average. Underlying the low contraceptive use and high fertility rate in Nigeria are fertility preferences that favor a large family size. Only 19% of currently married women desired no more children while 33% desired another child within the next two years (NPC/ICF 2014). Furthermore, the mean ideal family size was 7.1 children per women while unmet need stood at 16% among currently married women.Kenya's reproductive health context is different from the situation in Nigeria. The total fertility rate was 4.6 children per woman in 2008 (KNBS/ICF 2010). In 2008, 39% of married Kenyan women were using modern contraceptive methods, a noticeable increase from 32% in 2003 (KNBS/ICF 2010). In addition, in 2008, 49% of married women in Kenya desired no more children while 27% would want to wait at least two years for another child (KNBS/ICF 2010). The mean ideal number of children among married women in Kenya, 4.0 children per woman, was lower than the actual fertility rate, while 26% had an unmet need for family planning.Clearly, the two countries are different, not only in terms of fertility but also in terms of unmet need and fertility desires. Comparing the context of high fertility and low contraceptive use in Nigeria to Kenya, which has lower fertility (but still higher than replacement level at 2.1) and higher contraceptive use, is useful when examining the role of social influences on family planning norms and practices, which is the focus of this paper.In this paper we examine differences and commonalities in the determinants of contraceptive use intentions in these two contexts with a special focus on ideational variables. Ideation can be defined as "views and ideas that people hold individually" (van de Kaa 1996: 423). These views and ideas reflect individuals' ways of thinking; the media and social interactions contribute to shaping these views and ideas (Kincaid 2000a).The suggestion that ideational change or changes in the way people think is a key factor in fertility decline is not new: more than a century ago, Leroy-Beaulieu attributed fertility decline to changing moral values (Leroy-Beaulieu 1896). Nonetheless, it was not until the 1980s that ideational change gained prominence in demographic literature as an explanation for fertility decline and to add nuance to the classical demographic transition theory (Bongaarts and Watkins 1996; Cleland 1985; Cleland and Wilson 1987; Lesthaeghe 1983; Lesthaeghe and Surkyn 1988; van de Kaa 1996). …