Dynamics of contraceptive use in rural Mozambique: fertility intentions, life course changes, and institutional context

Sarah R. Hayford, Arizona State University
Victor Agadjanian, Arizona State University

Analyses of unmet need typically focus the characteristics that predict non-use of contraception – that is, they examine variation across women in the use of contraception. However, the association between the desire to stop childbearing and the use of modern methods to carry out that desire may also vary within women: women’s desires, resources, and social and family context vary over time, which may alter how childbearing goals are translated into contraceptive use. In this paper, we leverage longitudinal data collected over a five-year period in rural Mozambique to examine change over time in women’s use of modern contraception. We focus on how the association between fertility intentions and contraceptive use evolves over this period. Results show that women’s contraceptive use increases over time, but that this increase is largely accounted for by changes in life course factors and fertility intentions. The association between the desire to stop childbearing and contraceptive use declines non-linearly with time. We propose that changes in the institutional context, namely changes in the health care system as local maternal and child health clinics adapted to the HIV epidemic, can explain the weakened association between fertility intentions and contraceptive use.