Volume 38 - Article 64 | Pages 2027–2052  

Contraceptive use and lengthening birth intervals in rural and urban Eastern Africa

By Catriona Towriss, Ian Timæus


Background: The transition towards low fertility has been slow in sub-Saharan Africa. Although increasing numbers of women are now using contraception, levels of unmet need for contraception remain high. And yet the dynamics of fertility are changing: national estimates have documented significant lengthening of birth intervals across the region.

Objective: The aim of this paper is to explore trends in birth interval length by residence in Ethiopia, Kenya, Tanzania, and Zimbabwe, and the role of contraception in these changes.

Methods: We conducted a birth interval analysis of fertility using up to six Demographic and Health Surveys from each country. We modelled age-order duration-specific period fertility using Poisson regression and calculated median birth interval lengths from the fitted rates using life-table techniques.

Results: Birth intervals have lengthened in all four countries, most notably Zimbabwe. Urban populations now have median intervals that exceed 35 months in all four countries. The lengthening of birth intervals is associated with, although not limited to, the use of contraception. In urban areas the median birth interval among ever-users of contraception ranges between 52 and 86 months.

Conclusions: The increase in the length of birth intervals in Eastern Africa has been concentrated in urban areas. The trend is most pronounced among contraceptive users, but also results from unreported forms of birth control. It might become even more pronounced if access to contraception were improved.

Contribution: We show that lengthening of birth intervals in Eastern Africa has resulted largely from dramatic increases among urban women and women who have ever used contraception.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

The Own-Children Method of fertility estimation: The devil is in the detail
Volume 45 - Article 25

Unconventional approaches to mortality estimation
Volume 13 - Article 12

Most recent similar articles in Demographic Research

Predictive utility of key family planning indicators on dynamic contraceptive outcomes: Results from longitudinal surveys in Burkina Faso, Kenya, Uganda, and Côte d'Ivoire
Volume 50 - Article 45    | Keywords: contraception, contraceptive adoption, contraceptive discontinuation, contraceptive use, family planning, longitudinal data, methods, panel data, Performance and Monitoring for Action (PMA) surveys, sub-Saharan Africa

A new look at contraceptive prevalence plateaus in sub-Saharan Africa: A probabilistic approach
Volume 50 - Article 31    | Keywords: contraceptive prevalence plateaus, demand for family planning, family planning, modern contraceptive prevalence, probabilistic model

Religion and contraceptive use in Kazakhstan: A study of mediating mechanisms
Volume 50 - Article 21    | Keywords: contraceptive use, Generations and Gender Programme (GGP), Kazakhstan, mediation, religion, religiosity

The big decline: Lowest-low fertility in Uruguay (2016–2021)
Volume 50 - Article 16    | Keywords: adolescent fertility, birth order, fertility, Latin America, ultra-low fertility, Uruguay

Cohort fertility of immigrants to Israel from the former Soviet Union
Volume 50 - Article 13    | Keywords: age at first birth, assimilation, cohort analysis, fertility, immigration, parity, religiosity