Abstract
Introduction: Male fertility preferences significantly influence reproductive outcomes and family
wellbeing in sub-Saharan Africa, yet their implications for child and adolescent mental health remain
underexplored. This study examines the determinants of male fertility preferences and their
potential developmental impacts in Nigeria, Uganda, and South Africa.
Methods: We analyzed harmonized data from the IPUMS-DHS men’s files, including 20,825 male
respondents across the three countries. The outcome variable (ideal number of children) was categorized
as 1–3, 4–5, and 6 or more children. Multinomial logistic regression was used to assess
associations with predictors at p<.0.05.
Results: Fertility preferences were highest in Nigeria (mean = 7.5), followed by Uganda (5.5) and
South Africa (3.2). Men without formal education were nearly three times more likely to prefer six
or more children than those with higher education (OR = 2.87; 95% CI: 2.32–3.54). Those in the
poorest wealth quintile had over four times higher odds of desiring large families (OR = 4.55; 95%
CI: 3.80–5.45). Justifying wife beating, rural residence, and low family planning media exposure
were also significantly linked to higher fertility preferences.
Conclusions: High fertility aspirations among men, shaped by socioeconomic disadvantage and
patriarchal norms, strain family resources and adversely affect child and adolescent mental health.
Male-inclusive, gender-transformative reproductive health interventions are urgently needed to inform
national policies and support the achievement of Sustainable Development Goals (SDGs) 3,
4, and 5.