All over the world over the years, trends of fertility preferences have changed tremendously even though these changes differ as compared to most countries in West Africa largely due to the fact that transitions to replacement of fertility have not yet started in many parts of West Africa. The purpose of this study was to evaluate factors that influence fertility preferences and contraceptive use among rural and urban communities. The study employed an analytical cross sectional design, using females aged 18 or more years. A multi stage cluster sampling method was used to select the 603 respondents who were administered with structured questionnaire and an interview guide. About 33.8% had more than three children, with about 72.4% having the intention of having more children. Finance was seen as a possible barrier to having more children. A majority, 57.3% preferred any sex. About 88.5% believed fertility preference was important in their communities. Almost 90% of respondents who had never given birth before intended to give birth, with 44.8% desiring to give more than 3 children. Giving children proper training was the main reason for desired number of children (89.7%). The fertility preference of women was influenced by their age, religion and ethnic groups (p=0.006). Mean age of first birth, number of children to have also influenced fertility preference. Majority of the women in the Asunafo North district studied intended to have more than three children. Fertility preference in the studied district varied significantly with respect to age, ethnicity, religion, age at first birth and desired children. Improving education on the importance of small family norms, male involvement and the need to diffuse the dominance of one partner in the choice of a particular gender could be helpful.