Fertility preferences, intentions and outcomes: A mixed-methods study of fertility in a Balinese village

Introduction. Improving women's ability to meet their fertility goals is an important step in promoting women's reproductive rights worldwide. Fertility is a complex phenomenon involving both biological influences and individual decisions, which are influenced by socioeconomic conditions and cultural beliefs and practices. A more thorough appreciation of how these factors influence fertility will help fill the gaps in the current understanding of the relationship between fertility intentions and reproductive behavior. Methods. The objective of this mixed-method dissertation was to explore how fertility preferences and intentions affected fertility outcomes in one isolated community in Bali, Indonesia over a period of five years. Household surveys were conducted in 2002-3 and 2007. A total of 1,367 women were included in the follow-up, representing a response rate of 90%. Multi-variate logistic regression was used to examine the predictors of: (1) the desire for more children; (2) current contraceptive use and (3) consistency between fertility intentions and subsequent reproductive outcomes. In addition, semi-structured interviews with 39 women further explored four major theme: perceived control over fertility; major influences on fertility decisions; inconsistency between intentions and outcomes; and the impact of socio-economic development on fertility preferences and behavior. Results. Social and cultural factors were extremely important influences on fertility preferences. This study explains why ideal family sizes and actual completed sizes may be discordant. Fertility is highly unpredictable; this study helps explain the fallibility of demographic survey questions measuring intentionality. Reproductive decisions were influenced by numerous competing factors and intentions were highly subject to change. This study offers explanations for why a significant proportion of women's fertility outcomes were inconsistent with their reported intentions. Conclusions. Fertility decisions are based on the current context in which they were made and are adjusted according to life events, such as the birth of a son, financial considerations or new socio-economic opportunities. This study demonstrates that measuring fertility intentions in communities in the midst of significant change, in which fertility intentions are dependent on unforeseeable factors, may not be practical or reliable.