Recent fertility surveys in Africa reveal that a striking majority of women in all countries want more children, even those who use
modern contraception. Given these high individual fertility desires, the very low prevalence of contraceptive use, and the strong demand for children embedded in African societies, African fertility is low compared with potential fertility because of counteracting and powerful regulation of fertility through customary restrictions. Fertility regulation in sub-Saharan Africa is achieved through two means: avoidance of next pregnancy following a birth, through breastfeeding and abstinence, and rearrangement of the timing and tempo of raising children through fostering. Contraception, abortion and sterilization are all used to lesser extents among groups of women with well defined characteristics; for populations as a whole all three have very little fertility-limiting effect. For example, contraceptive prevalence is still low among the women reportedly most motivated to ave.;t pregnancy.
The prospects for modern contraception to be used for limitation of fertility would depend on two things: acceptability of substituting contraception for traditional regulation, and increased desire to limit fertility because of declining demand for children.
The author suggests that uncertainties attached to successful childraising due to the real risks of infertility, failure to thrive, disablement, and divorce have strongly favored, and still favor, the traditional forms of regulation that have arisen in accomodation. Furthermore, there appears little equivalence between traditional regulation and modern contraception in purpose or practice, even where substitution has been offered, since the abandonment of customary restrictions has nowhere been followed by an equivalent uptake of contraception through family planning services. A "take-off" in contraceptive prevalence will probably not occur until there is an underlying shift in the demand for children, and there is little indication in the region of change in the conditions hypothesized to bring that about, as in food production, income, education, and the chances of healthy survival.
Against the foregoing, particular groups can be identified who have an interest in controlling fertility at specific points in their
life-cycle. On this basis a range of focussed family planning activities are proposed.