Birth Intervals and Reproductive Intentions in Eastern Africa: Insights from Urban Fertility Transitions

Towriss, CA; (2014) Birth Intervals and Reproductive Intentions in Eastern Africa: Insights from Urban Fertility Transitions. PhD thesis, London School of Hygiene & Tropical Medicine. DOI:

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This thesis examines the dynamics of fertility in Eastern Africa with a particular focus on urban women. Urbanisation has long been closely associated with demographic transition and the reproductive behaviour of urban women is thought to provide insights about the future fertility transition at the national level. A mixed methods approach is used to explore birth intervals, family building strategies and women‟s fertility intentions. The quantitative analysis uses Demographic and Health Survey data from Ethiopia, Kenya, Tanzania and Zimbabwe, while the qualitative analysis uses data from focus group discussions that I conducted in two informal settlements of Nairobi, Kenya. The analysis of birth intervals uses survival analysis to calculate interval-duration-specific fertility rates, median birth intervals and parity progression ratios. These are used to make inferences about fertility decision-making at the population level. Birth intervals are long and lengthening in all four countries, particularly among women who have used contraception and women with higher levels of education. Large differences exist in birth interval lengths between rural and urban women, even when the results are disaggregated by contraceptive use and educational status. Generally, lengthening birth intervals are being driven by increasing birth postponement and birth spacing, with postponement dominating among women with very long birth intervals. In Ethiopia, there is some evidence of parity-specific family size limitation. The focus group discussions were analysed using a thematic approach. Urban living, particularly in the informal settlements, is characterised by high levels of social uncertainty, especially among new immigrants from rural areas. This is an important influence on women‟s relationships, which are found to be highly unstable. Fertility intentions are found to be fluid and contingent upon a variety of different factors in women‟s lives. As a result, women‟s decisions about birth spacing and family size are less distinct than demographic theory often assumes. In sum, this thesis contributes to the body of research suggesting that long birth intervals and postponement are both important features of the fertility transition in Sub-Saharan Africa. These phenomenon are related to each other: social uncertainty leads to fluid fertility intentions, which, in turn cause the widespread postponement of births and lengthening birth intervals.

Item Type: Thesis
Thesis Type: Doctoral
Thesis Name: PhD
Contributors: Timaeus, I (Thesis advisor);
Additional Information:
Faculty and Department: Faculty of Epidemiology and Population Health
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Funders: Economic & Social Research Council (ESRC)


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