Improving the Understanding and Predictive Ability of Fertility Intentions: Evidence from Honduras

Understanding fertility intentions is crucial for family planning and reproductive health research and programs. While simple measures of intentions predict pregnancy moderately well, discrepancies between women's stated intentions and their behavior are common and tools to predict fertility remain imperfect. Knowledge of factors that enable some women to successfully achieve plans for pregnancy while others fail to do so could advance understanding of unintended pregnancy and contraceptive discontinuation. Using longitudinal data from 671 Honduran contraceptive users, aspects thought to influence the attainment of intentions were explored using factor analysis and a multidimensional measure of motivation to avoid pregnancy was proposed. This measure was 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; other dimensions of motivation were not found to be significant. Overall, the multidimensional measure of intentions performed similarly to the standard intention categories in the prediction of contraceptive use and pregnancy. Future research should explore the role of motivation in order to further assess the role of attitudinal factors in fertility and contraceptive decision making. Additionally, the interaction between motivation to avoid pregnancy and individual experience with contraceptive side effects should be explored. Improved knowledge of contraceptive and fertility decision making will increase understanding of contraceptive discontinuation and unintended pregnancy and, ultimately, help determine how best to address these issues.