The study focused on examining the influence of exposure to family planning messages on desired family size among adolescents in SSA. Study also examined sub-regional variations in factors influencing desire for family size among adolescents. Our review of the literature reveals that there has been no known comprehensive study of this nature conducted before in sub-Saharan Africaand thus bolstering the importance of our findings. We focused on understanding adolescents’ideal number of children because future fertility of a country is highly likely to be influenced by present adolescents’ reproductive behavior. Sincefamily planning services are mostly offered during antenatal and under five clinics, adolescentsmay prefer getting family planning information via mass-media channels (36).Our study revealed that exposure to family planning messages wassignificantly associated with adolescents’ desire for family size in sub-Saharan Africa. Other variables found to be important included age, marital status, household wealth status, education level, contraceptive use and visiting health facility in the last 12 months prior to data collection.
Study findings revealed that adolescentswho had exposure to family planning messages were 17% less likely to desire a large family size comparable to those who had no exposure. This is can be attributed to the appreciation of benefits of family planning education gainedby adolescentsthrough via mass-media, visit to health facility and community visits by community health workers. Family planning messages are usually targeted at influencing individuals’ reproductive behavior towards contraception, limiting of births, spacing of children and choice of small family. This findingimplied a significant contribution of family planning education interventions to social and reproductive behavior change among adolescents in SSA. Similar results were reported in a study conducted in Rwanda in 2016 (37) where reduction in fertility desire among women of reproductive age was attributed to massive family planning education through mass-media and community-led sensitization programmes.
The study found that adolescents who were married or living with a partner were twice as likely to prefer a large family size compared to the never married. In most African culture, women may be expected to start having children soon after marrying, causing partnered women to stop using contraception(38). Such practices could explain why teenage pregnancy and early motherhood are high in sub-Saharan Africa. There may also be sub-regional disparities in the norms surround timing of having a child after marriage. This result implies the urgent need for community led family planning education programmes aimed at influencing reproductive behavior change of married adolescents, especially those coming from rural settings.
Earlier studies have shown that education and wealth status are strongly associated with fertility desire(9,39,40) such that individuals with higher level of education and those from higher wealth groups have a tendency to desire low family size. This is because this demographic has adequate information about benefits that accrue with smaller family sizes. Our study confirms the findings presented by earlier studies. We established that adolescents with secondary and higher-level education were 70% and 7% less likely to desire a large family size, respectively. These findings are consistent with similar studies conducted in Zambia, Rwanda, Burkina Faso, Niger, Mali and Egypt that reported education and wealth status as significant predictors of ideal number of children (23,27,39,41). This implies that education is an important component for reducing fertility in SSA. Therefore, education policies should propagate the implementation of strategies that improve education access to girls and young women, especially those in marginalized communities.
Another notable finding from this study was the effect of contraceptive use on desired family size. Contraception in adolescence was associated with a low chance of desiring large family sizes. Twenty-nine percent of adolescents who used any form of contraception preferred a small family size. This finding signifies the importance of family planning programmes in sub-Saharan Africa’s agenda to reduce population growth rate through fertility reduction. Many studies conducted in SSA (17,39,40,42) have found that contraception enables women in the reproductive age to make an informed decision about planning their births and decide their desirable number of children. Such decisions have far-important health benefits for couples and their households at large.
Access to family planning communication is another issue that needs to be addressed in most countries in SSA. Places such as schools, community youth friendly corners, private pharmacies/drug stores and traditional ceremonies can also serve as distribution points for family planning information to adolescents. The merits of disseminating family planning information in schools through introduction of comprehensive sexually education need to be explored further. Improving the demand for family planning information among adolescents should be stressed in the country’s population policies as key priority strategy to reduce fertility further. Increasing access to family planning information is essential and has been shown to have a significant impact on decision making to use contraception, postponing of marriage and limiting the number of children, thus reducing fertility(43,44). Health education on limiting family size through family planning programming will surely assist in changing reproductive behavior of adolescents, but it will only be effective if adolescents will embrace the advantages of having smaller families.
Although the study has provided useful findings to inform strengthening of family planning education programmes targeting at changing adolescents reproductive behaviour. There are a few limitations that could make the conclusions from thestudy to be interpreted with caution. First, because our data is cross-sectional, we cannot conduct causality analyses, which limits our ability to understand the complexities of adolescents' experiences regarding their desire for children through their life cycle. As a result, our findings highlight the need for additional research, particularly qualitative and longitudinal research, to further our understanding of the complex interplay between the various individual and community factors that shape adolescents' reproductive behavior and desire for children, as well as how these factors change over the course of their lives. Finally, because of the lack of other country level data on the DHS program website, the study did not contain data for all countries in SSA. As a result, the conclusions should not be extrapolated beyond the sub-sample of nations included in our analysis.