Traditional supports and contemporary disrupters of high fertility desires in sub-Saharan Africa: a scoping review.

Rationale: The desired number of children is markedly higher in Sub-Saharan Africa (SSA) than in other major regions. Efforts to understand how and why these desires are generated and maintained have yielded a broad research literature. Yet there is no full picture of the range of contextual, cultural, and economic factors that support and disrupt high fertility desires. Objective: This scoping review synthesizes thirty years of research on the determinants of fertility desires in SSA to better understand what factors underlie men and women's stated fertility desires and how they weigh the costs and benefits of having (more) children. Method: We identified and screened 9863 studies published from 1990 to 2021 from 18 social science, demographic, and health databases. We appraised determinants of fertility desires from 258 studies that met inclusion criteria according to their roles as traditional supports or contemporary disrupters of high fertility desires. Results: We identified 31 determinants of high fertility desires, which we organized into six overarching themes: economy and costs; marriage; the influence of others; education and status; health and mortality; and demographic predictors. For each theme, we summarize ways in which the determinants both support and disrupt high fertility desires. We find that high fertility remains desirable in many regions of sub-Saharan Africa but contemporary disrupters, such as the economic situations and increases to family planning and education, cause individuals to decrease their desired fertility with such decreases often viewed as a temporary adjustment to temporary conditions. Most included studies were quantitative, cross-sectional, and based on survey data. Conclusion: This review demonstrates how traditionally supportive and contemporary disruptive forces simultaneously influence fertility desires in sub-Saharan Africa. Future studies analyzing fertility desires in sub-Saharan Africa should be informed by the lived experiences of men and women in this region, with qualitative and longitudinal studies prioritized. Plain language summary: In sub-Saharan Africa, both men and women continue to desire large numbers of children in contrast to most regions of the world where the desired number of children is near or below replacement level (around 2.0 children per couple). We conducted a comprehensive review of the existing research on the sources and drivers of the persistently high desired fertility in sub-Saharan Africa. Based on the review, 258 studies were included in this analysis. Several factors that influence fertility desires among men and women in this population were identified. We categorized them as either traditional supports (factors that have historically supported and promoted high fertility desires) or contemporary disrupters (factors that have more recently inhibited or discouraged high fertility desires). Although fertility desires are shaped by a wide range of factors that vary based on specific country and population, several overarching conclusions were clear. Contemporary changes in the economy and family have caused individuals to shift their fertility desires downward, and this shift is often viewed as a temporary adjustment to temporary conditions. Increased autonomy and formal schooling of women and availability of family planning can help position women to implement lower fertility desires. There is a need for more longitudinal research in this region to better understand how fertility desires may change over a person's life, and for more qualitative studies that allow people to describe and explain their lives and fertility desires more directly in ways that allow for uncertainty and ambiguity. [ABSTRACT FROM AUTHOR]

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