The present study seeks to compare, over time, changes (if any) in the proximate determinants of fertility with a view to understanding whether transition to lower fertility has begun in Malawi where a woman’s average number of children (TFR) has dropped by one birth between 1992 to 2010 (from 6.7 to 5.7) At the same time, there has been a notable improvement in use of modern contraception among married women (CPR). CPR increased from 7.4 % (1992) to 42.2 % (2010). Through the integration of quantitative and qualitative approaches, a mixed-method approach is used in the study in order to explore the reasons for the little change in fertility level. Using birth histories data from the 2000 to 2010 Malawi Demographic and Health Surveys, cohort fertility techniques is applied to women aged 15–49 years, and for each survey, to better understand the trends in Malawian fertility over time. Although there is a slow fertility decline, the findings show that fertility decline started in urban areas in 1980s, while rural areas lagged behind by five years. Significant fertility declines were associated with increased women’s education and urban residence. The slow fertility decline is due to the lack of change in median age at marriage, with half of women still being married by the age of 18 years. The rapid increase in modern contraceptive use is largely because the proportion of young women (aged 15–24) using modern contraceptives doubled between 2000 and 2010. However, the predominant method is the three-month injection, which is used for spacing and not for limiting. The key feature of the use of sterilisation in Malawi is that it is paritydependent. While fieldwork findings show that men encourage their wives to use contraceptives, the women who start using them have already had a high number of children—typically five—implying that the desire for a large family is strong. Although the study findings show that there was no apparent sex preference in either patrilineal or matrilineal study sites, some women deliberately stop using contraceptives to secure the sex distribution of children—a practice likely to adjust the reproductive behaviour of the couple.