Reproductive Behavior: Intentions & Outcomes in Bali, Indonesia

BACKGROUND: Women's childbearing intentions are commonly used to predict demand for contraception. A strong correlation between reproductive intention and behavior has been reported in studies worldwide. In Indonesia, completed family size often exceeds the ideal size, possible due to a high unmet need for family planning. This study's objective was to determine what predicts consistency between fertility intentions and outcomes.

METHODS: This longitudinal study was conducted in an isolated community in East Bali with high fertility rates and low contraceptive use. At baseline, women reported their future fertility intentions, which were compared to their actual fertility five years later. Logistic regression was used to determine the predictors of matching fertility intentions with outcomes among 745 women who wanted no more children or who were unsure about fertility intentions.

RESULTS: Based on the literature, ten dependent variables hypothesized to influence fertility decisions were tested, including women's demographic characteristics, distance from health center, contraceptive use, history of child loss, etc. Two variables, both related to the number of living sons, remained significant. Contraceptive use and completed family size are highly dependent on the number of sons. The odds of consistency were much greater for women who had living sons compared to those with none.

RECOMMENDATIONS: Son preference may help explain inconsistent fertility behavior. Sons are highly valued because of their responsibility for caring for elderly parents and for important family rituals. Improving women's education and job opportunities may help raise the value of future generations of daughters in Southeast Asia.