Afr J Reprod Health. 2026 Apr 28;30(8):53-65. doi: 10.29063/ajrh2026/v30i8.6.
ABSTRACT
Using a qualitative interpretive descriptive-analytical approach, this study analysed harmonised secondary data from the World Bank World Development Indicators covering six countries between 2000 and 2024. Longitudinal trend assessment and crosscountry comparisons were employed to examine urban population, modern contraceptive prevalence, and total fertility rates. The findings indicate sustained urban expansion across all countries, accompanied by gradual increases in contraceptive uptake and fertility decline. However, these patterns remain uneven across national contexts. Ghana and Sierra Leone combine relatively high urbanisation with stronger improvements in contraceptive prevalence and faster fertility decline. In contrast, Nigeria and Guinea maintain comparatively high fertility levels despite substantial urban growth and weaker contraceptive uptake. The Gambia and Liberia display intermediate trajectories characterised by moderate urbanisation, rising contraceptive use, and gradual fertility reduction. The results indicate that urbanisation alone does not generate uniform reproductive outcomes; rather, fertility transitions are mediated by contraceptive access and the effectiveness of urban health service. The study recommends integrating family planning into urban development strategies and strengthening reproductive health service delivery in rapidly expanding urban and peri-urban settlements to reduce persistent reproductive health inequalities.
PMID:42047119 | DOI:10.29063/ajrh2026/v30i8.6
