From fertility intentions to contraceptive behaviour: evidence among women with children in Malawi

Abstract

Background Although fertility has declined in Malawi, a substantial gap persists between women's fertility-limiting intentions and contraceptive behaviour. Previous studies often include childless women, potentially obscuring patterns among women who have already entered parenthood. This study examines fertility preferences and contraceptive behaviour among in-union women with at least one living child in Malawi. Methods We analysed cross-sectional data from the 2015–16 Malawi Demographic and Health Survey. The fertility intention analysis included 15,866 married or in-union women aged 15–49 years with at least one living child. Multinomial logistic regression models were used to estimate adjusted average marginal effects (AMEs) for wanting another child and being undecided (reference: wants no more children). A sub-sample of women with limiting demand ( n = 5,358) was analysed to examine modern and traditional contraceptive use using multinomial logistic regression. All analyses accounted for complex survey design. Results Overall, 49.8% of women reported wanting no more children, while 44.7% desired additional children. The likelihood of wanting another child declined markedly with age (AME = −0.308 among women aged 35–49 years) and parity (AME = −0.504 among women with four or more children). Muslim women were more likely to desire additional children (AME = 0.053). Among women with limiting demand, 72.4% used modern contraception, 25.4% used no method, and 2.2% relied on traditional methods. Modern method use was positively associated with higher parity, primary and secondary education, employment, urban residence, and residence in the Central and Southern regions, while older age and Muslim religion were negatively associated. Side effects (37.4%) were the leading reason for discontinuation of modern methods. Conclusions In Malawi, fertility preferences strongly reflect parity and age, yet a substantial proportion of women with limiting demand remain non-users of contraception. Reducing unmet need requires strengthening access, method continuation support, and regionally responsive family planning strategies.