Demographic and Socio-economic Characteristics
The study included a total of 4,775and 10,807 women with reproductive age in 2008 and 2014 census periods respectively. In the study area, substantial proportion of women were rural residents (75.8 % in 2008 and 62 % in 2014), though showing a declining trend. The proportion of women of reproductive age who desired to bear an additional child has shown a significant reduction from about 63% to 30 % in the period 2008 to 2014. Women who got married before reaching 18 years of age was still high accounted 86% in 2014. Moreover, the proportion of women who had at least a primary level of education increased from 20.5% to 51.3% where as women with no formal education decreased from 79.5% to 48.7% in 2008 and 2014 respectively. With regard to marital status, the percentage of single and dissolved (divorced and widowed) women increased from 2.8% and 11% in 2008 to 30% and 15% respectively, whereas currently married women decreased from 86% in 2008 to 55% in 2014. The proportion of women who used any contraceptive method showed no change in both census with 19% (Table 1).
A decline in the average number of children ever born was observed during the study period. The mean children ever born to women in the reproductive age group decreased from3.3 to 2.4 children in the years 2008 and 2014 respectively whereas the average number of children at the end of their reproductive years (45-49 years) was higher and has showed a slight increase from 6.0 to 6.2 children respectively, but showed a decreasing trend among young age groups. Average number of children ever born was high among women who had the desire to bear additional child, illiterate, rural residents, currently married, married early and currently used contraceptive methods during both censuses. In addition, during the study period, the mean number of children ever born has showed a declining trend in all wealth quantiles except women in rich families that showed a slight increase. The last census result also indicated that average number of children to women of reproductive age increased with an improvement of their wealth status (Table 1).
Table 1: Distribution of Women and Number of Children Ever Born by Demographic and Socioeconomic Characteristics of Women in age 15-49 in Dabat HDSSS, 2008 - 2014,
Variables and categories
|
Census year
|
2008
|
2014
|
Women (4,775)
|
CEB
|
ACEB per Women
|
Women (10,807)
|
CEB
|
ACEB per Women
|
No.(%)
|
No.(%)
|
Current Age
|
15-19
|
542(11.35)
|
485
|
0.9
|
2977 (27.55)
|
432
|
0.2
|
20-24
|
1036 (21.70)
|
1852
|
1.8
|
1857 (17.18)
|
1817
|
1.1
|
25-29
|
1235 (25.86)
|
3858
|
3.1
|
1729 (16.00)
|
3898
|
2.4
|
30-34
|
873 (18.28)
|
3588
|
4.1
|
1264 (11.70)
|
4496
|
3.8
|
35-39
|
570 (11.94)
|
2837
|
4.9
|
1344 (12.44)
|
6264
|
4.9
|
40-44
|
363 (7.60)
|
1926
|
5.3
|
977 (9.04)
|
5316
|
5.7
|
45-49
|
156 (3.27)
|
931
|
6.0
|
659 (6.10)
|
3561
|
6.2
|
Early Marriage
|
Yes
|
3622 (75.85)
|
12536
|
3.5
|
8547 (86.60)
|
23336
|
2.7
|
No
|
1153 (24.15)
|
2941
|
2.6
|
1322 (13.40)
|
2448
|
1.9
|
Reproductive Intention
|
Yes
|
3005 (62.93)
|
9342
|
3.1
|
3202 (29.63)
|
10394
|
3.3
|
No
|
1770 (37.07)
|
6135
|
3.5
|
7605 (70.37)
|
15390
|
2.3
|
Educational Status
|
No Education
|
3796 (79.50)
|
13553
|
3.6
|
5264 (48.71)
|
21137
|
4.4
|
Primary
|
450 (9.42)
|
1084
|
2.4
|
2012 (18.62)
|
2505
|
1.4
|
Secondary+
|
529 (11.08)
|
840
|
1.6
|
3531 (32.67)
|
2142
|
0.7
|
Residence
|
Urban
|
1157 (24.23)
|
2758
|
2.4
|
4093 (37.87)
|
5216
|
1.4
|
Rural
|
3618 (75.77)
|
12719
|
3.5
|
6714 (62.13)
|
20568
|
3.4
|
Marital Status
|
Single
|
134 (2.81)
|
154
|
1.1
|
3281 (30.36)
|
286
|
0.1
|
Married
|
4103 (85.93)
|
13607
|
3.3
|
5896 (54.56)
|
21623
|
3.9
|
Dissolved
|
538 (11.27)
|
1716
|
3.2
|
1629 (15.07)
|
3875
|
2.6
|
Migration Status
|
None-Migrant
|
1951 (40.86)
|
6669
|
3.4
|
3809 (35.25)
|
8659
|
2.5
|
In-migrant
|
2824 (59.14)
|
8808
|
3.1
|
6998 (64.75)
|
17125
|
2.7
|
Family Size
|
<=4
|
2314 (48.46)
|
4065
|
1.8
|
4927 (45.59)
|
6050
|
1.3
|
> 4
|
2461(51.54)
|
11412
|
4.6
|
5880 (54.41)
|
19734
|
3.7
|
Current Contraceptive Use
|
Yes
|
891(18.66)
|
2826
|
3.2
|
2079 (19.24)
|
6783
|
3.3
|
No
|
3884 (81.34)
|
12651
|
3.3
|
8728 (80.76)
|
19001
|
2.4
|
Wealth Quantile
|
Lowest
|
694 (14.53)
|
2546
|
3.7
|
1503 (14.48)
|
2386
|
1.8
|
Lower
|
1182 (24.75)
|
4498
|
3.8
|
1668 (16.07)
|
3641
|
2.3
|
Middle
|
859 (17.99)
|
2687
|
3.1
|
2203 (21.23)
|
4971
|
2.4
|
Higher
|
1084 (22.70)
|
3580
|
3.3
|
2245 (21.63)
|
6104
|
2.9
|
Highest
|
956 (20.02)
|
2166
|
2.3
|
2758 (26.58)
|
7649
|
3.0
|
Total
|
|
4,775 (100)
|
15,477
|
3.3
|
10,907 (100)
|
25,784
|
2.4
|
Source Calculated from Dabat DHSS Census and Re-census Data
Note: CEB = Children Ever Born, and ACEB = Average Number of Children Ever Born.
Factors Associated with Fertility Changes
The study showed that current age of women, age at first marriage, educational status, marital status and family size were significant predictors of fertility changes in both censuses. The result also revealed that residence was significantly associated with fertility changes only for 2014 census.
Current age of women had a strong effect on their fertility. Compared to women with age group 15-19, older women were more likely to have birth in both 2008 and 2014 censuses and the magnitude of the rate ratios increased from 2008 to 2014. Educational status is also significantly and negatively correlated with fertility of women with reproductive age. Women with secondary or higher education were 21% (95%CI: 0.72 - 0.86) and 33% (95%CI: 0.63 - 0.71) lower fertility in 2008 and 2014 respectively compared with women with no formal education (Table 2).
The result also indicated that age at first marriage influences fertility of women. Women whose age at first marriage was 18 or above were 16% lower fertility (95%CI: 0.81 -0.88) in 2008 whereas it was 24% lower (95%CI: 0.73-0.80) in 2014 compared with women whose age at first marriage was below eighteen years. Marital status of women had also an effect on fertility. Compared to never married women, currently married and women whose marriage was dissolved (divorced and widowed) had more births with an increasing effect from 2008 to 2014 censuses. With regard to family size, women with greater than four family size had 1.78(95% CI: 1.70-1.86) and 1.47 times (95% CI: 1.42-1.52) more births in 2008 and 2014 respectively compared to women with family size less than or equal to four (Table 2).
Results from the pooled data also showed that current age, age at first marriage, educational status, place of residence, marital status and family size were significantly associated with fertility among women with reproductive age in the decade. The census year variables also revealed that fertility was lower in 2014 compared with 2008 (AIRR= 0.95; 95%CI: 0.93 – 0.97) (Table 2).
Table 2: Trends in Poisson Regression of CEB to Woman in Age 15-49in Dabat HDSSS, 2008-2014
Variables and categories
|
Census year
|
2008
|
2014
|
Pooled (2008-2014)
|
AIRR
|
95% CI
|
AIRR
|
95% CI
|
AIRR
|
95% CI
|
Current Age
|
15-19
|
1.00
|
|
1.00
|
|
1.00
|
|
20-24
|
1.78***
|
1.61 - 1.97
|
3.04***
|
2.72 – 3.40
|
2.50***
|
2.32 – 2.70
|
25-29
|
2.42***
|
2.18 – 2.67
|
4.65***
|
4.13 – 5.18
|
3.68***
|
3.42 – 3.96
|
30-34
|
2.98***
|
2.68 – 3.30
|
6.02***
|
5.40 – 6.71
|
4.66***
|
4.33 – 5.03
|
35-39
|
3.58***
|
3.23 – 3.98
|
7.40***
|
6.65 – 8.24
|
5.71***
|
5.29 – 6.14
|
40-44
|
4.07***
|
3.65 – 4.53
|
8.62***
|
7.74 – 9.60
|
6.60***
|
6.12 – 7.11
|
45-49
|
4.56***
|
4.05 – 5.13
|
9.39***
|
8.41 – 10.48
|
7.24***
|
6.71 – 7.82
|
Early Marriage
|
Yes
|
1.00
|
|
1.00
|
|
1.00
|
|
No
|
0.84***
|
0.81 – 0.88
|
0.76***
|
0.73 – 0.80
|
0.82***
|
0.78 – 0.83
|
Reproductive Intention
|
Yes
|
1.00
|
|
1.00
|
|
1.00
|
|
No
|
1.01
|
0.97 – 1.04
|
0.99
|
0.96 – 1.02
|
0.99
|
0.97 – 1.01
|
Educational Status
|
No Education
|
1.00
|
|
1.00
|
|
1.00
|
|
Primary
|
0.96
|
0.90 – 1.03
|
0.92**
|
0.88 – 0.97
|
0.92***
|
0.89 – 0.96
|
Secondary+
|
0.79***
|
0.72 – 0.86
|
0.67***
|
0.63 – 0.71
|
0.68***
|
0.65 – 0.71
|
Residence
|
Urban
|
1.00
|
|
1.00
|
|
1.00
|
|
Rural
|
1.05
|
0.96 – 1.15
|
1.14***
|
1.10 – 1.19
|
1.14***
|
1.10 – 1.18
|
Marital Status
|
Single
|
1.00
|
|
1.00
|
|
1.00
|
|
Married
|
1.39**
|
1.18 – 1.64
|
9.59***
|
8.42 – 10.92
|
7.28***
|
6.57 – 7.07
|
Dissolved
|
1.46***
|
1.24 – 1.74
|
8.49***
|
7.44 – 9.69
|
6.65***
|
5.98 – 7.89
|
Migration Status
|
None-Migrant
|
1.00
|
|
1.00
|
|
1.00
|
|
In-migrant
|
1.01
|
0.98 – 1.04
|
0.99
|
0.96 – 1.02
|
1.00
|
0.98 – 1.02
|
Family Size
|
<=4
|
1.00
|
|
1.00
|
|
1.00
|
|
> 4
|
1.78***
|
1.70 – 1.86
|
1.47***
|
1.42 – 1.52
|
1.55***
|
1.51 – 1.59
|
Current Contraceptive Use
|
Yes
|
1.00
|
|
1.00
|
|
1.00
|
|
No
|
0.99
|
0.94 – 1.03
|
0.98
|
0.95 – 1.01
|
0.98
|
0.95 – 1.00
|
Wealth Quantile
|
Lowest
|
1.00
|
|
1.00
|
|
1.00
|
|
Lower
|
0.99
|
0.94 – 1.03
|
1.01
|
0.95 – 1.06
|
0.99
|
0.95 – 1.03
|
Middle
|
0.96
|
0.91 – 1.02
|
0.99
|
0.94 - 1.04
|
0.98
|
0.94 – 1.01
|
Higher
|
0.97
|
0.91 – 1.01
|
1.02
|
0.97 – 1.08
|
1.00
|
0.97 – 1.04
|
Highest
|
0.90
|
0.81 – 1.01
|
1.06*
|
1.01 – 1.11
|
1.05**
|
1.02 – 1.09
|
Year
|
2008
|
|
|
|
|
1.00
|
|
2014
|
|
|
|
|
0.95***
|
0.93 – 0.97
|
Total Number
|
|
|
|
|
|
|
|
Significance level: *** p<0.001, ** p<0.01, * p<0.05; AIRR = Adjusted Incidence Risk Ratio
Source: Calculated from Dabat DHSS Census and Re-census Data
Decomposition of Fertility Decline
The findings indicated that there was a reduction of an average 640.95 births per 1,000 women of the reproductive age during the year 2014 compared to the year 2008 in the surveillance site (P-value <0.001; 95% CI: -669.5 to -582.4). This overall change in fertility between 2008 and 2014 was attributed to both changing characteristics of women and reproductive behavior. The result showed that 78% (499.99 births per 1,000 women) of the births were attributable to differences in characteristics of women (endowment) (P-value < 0.001; 95%CI: -537.65, -462.32), whereas the remaining 22% (140.96 births per 1,000 women) were explained by the changes in the reproductive behavior of women (coefficient) during the study period, between 2008 and 2014 (P-value <0.001; 95% CI: -214.56 to -67.368).
Under the endowment component, the larger proportion of the discrepancy, 34.5% (221.06 births per1000 women) was due to the postponing of women’s first marriage to later age over the years (P-value <0.001, 95%CI: -237.13 to -204.99). The decline in the proportion of currently married women observed in the comparison period also resulted to an average reduction of 148.89 births per 1,000 women (21.7%) with P-value <0.001; 95% CI: -149.71 to -128.08. Postponing of women’s birth to later age has also contributed to 20.4% (130.75 births per 1,000 women) (P-value <0.001; 95% CI: -141.62 to -119.88). A decrease in the proportion of women who had no formal education contributed a 27.208 births per 1000 women (4.2%) fertility decline (P-value <0.001; 95% CI: -32.875 to -21.541) and an increase in the proportion of women whose educational attainment was secondary and above contributed a 30.498 births per 1000 women (4.7%) fertility decline (P-value < 0.001; 95% CI: -36.14 to -24.856) (Table 3).
On the other hand, under the coefficient component; the change of women’s reproductive behavior in the study period was mainly attributed to the postponing of births to the later age among young women (9.9% or a 63.384 births per 1000 women decline), postponing of first marriage (5.1% or a 32.947 births per 1000 women decline), and the change in the experience of giving birth among women with large family size (7.4% or a 47.131 births per 1000 women decline).
Table 3: Decomposition of the Decline in Children Ever Born in Dabat HDSSS, 2008-2014, Northwest Ethiopia
Variables
|
Endowment (E)
|
Coefficient (C)
|
Coef.
|
P-value
|
95% CI
|
%
|
Coef.
|
P-value
|
95% CI
|
%
|
Residence
|
|
|
|
|
|
|
|
|
|
|
Urban
|
-6.050
|
0.000
|
-7.806
|
-4.296
|
0.9
|
-10.023
|
0.103
|
-22.087
|
2.041
|
1.6
|
Rural
|
-6.050
|
0.000
|
-7.806
|
-4.296
|
0.9
|
31.543
|
0.077
|
-6.382
|
95.068
|
-4.9
|
Age Group
|
|
|
|
|
|
|
|
|
|
|
15-19
|
-130.75
|
0.000
|
-141.62
|
-119.88
|
20.4
|
-63.384
|
0.000
|
-89.11
|
-37.658
|
9.9
|
20-24
|
10.255-
|
0.000
|
8.987
|
11.522
|
-1.6
|
-9.986
|
0.161
|
-23.945
|
3.973
|
1.6
|
25-29
|
0.652
|
0.474
|
-1.135
|
2.440
|
-0.1
|
16.998
|
0.010
|
4.114
|
29.882
|
-2.6
|
30-34
|
-8.642
|
0.000
|
-10.163
|
-7.523
|
1.3
|
20.814
|
0.000
|
9.926
|
31.701
|
-3.2
|
35-39
|
1.886
|
0.000
|
1.723
|
2.049
|
-0.3
|
16.036
|
0.000
|
8.016
|
24.056
|
-2.5
|
40-44
|
5.900
|
0.000
|
5.438
|
6.363
|
-0.9
|
12.105
|
0.000
|
6.196
|
18.014
|
-1.9
|
45-49
|
10.097
|
0.000
|
9.322
|
10.871
|
-1.5
|
4.289
|
0.002
|
1.605
|
6.975
|
-0.7
|
Education
|
|
|
|
|
|
|
|
|
|
|
No Education
|
-27.208
|
0.000
|
-32.875
|
-21.541
|
4.2
|
51.125
|
0.014
|
10.226
|
92.023
|
-7.9
|
Primary
|
3.843
|
0.000
|
2.368
|
5.319
|
-0.6
|
2.209
|
0.319
|
-2.522
|
7.741
|
-0.4
|
Secondary+
|
-30.498
|
0.000
|
-36.14
|
-24.856
|
4.7
|
-10.192
|
0.012
|
-18.168
|
-2.215
|
1.6
|
Marital Status
|
|
|
|
|
|
|
|
|
|
|
Single
|
-221.06
|
0.000
|
-237.13
|
-204.99
|
34.5
|
-32.947
|
0.000
|
-45.893
|
-20.00
|
5.1
|
Married
|
-148.89
|
0.000
|
-149.71
|
-128.08
|
21.7
|
575.75
|
0.000
|
351.05
|
800.45
|
-89.8
|
Dissolved
|
16.264
|
0.000
|
14.991
|
17.537
|
-2.5
|
56.786
|
0.000
|
33.636
|
79.937
|
-8.8
|
Migration Status
|
|
|
|
|
|
|
|
|
|
|
None-Migrant
|
-0.092
|
0.705
|
-0.571
|
0.386
|
0.01
|
2.742
|
0.524
|
-5.683
|
11.167
|
-0.4
|
In-migrant
|
-0.092
|
0.705
|
-0.571
|
0.386
|
0.01
|
-3.969
|
0.524
|
-16.164
|
8.226
|
0.6
|
Family Size
|
|
|
|
|
|
|
|
|
|
|
<=4
|
1.982
|
0.000
|
1.740
|
2.223
|
-0.3
|
44.315
|
0.000
|
21.572
|
67.059
|
-6.9
|
> 4
|
1.982
|
0.000
|
1.740
|
2.223
|
-0.3
|
-47.131
|
0.000
|
-71.319
|
-22.942
|
7.4
|
Early Marriage
|
|
|
|
|
|
|
|
|
|
|
Yes
|
8.035
|
0.000
|
6.645
|
9.424
|
-1.3
|
36.820
|
0.011
|
-8.587
|
65.053
|
-5.7
|
No
|
4.035
|
0.000
|
6.645
|
9.424
|
-1.3
|
-11.721
|
0.011
|
-20.708
|
-2.733
|
1.8
|
Fertility Intention
|
|
|
|
|
|
|
|
|
|
|
Yes
|
-0.619
|
0.613
|
-3.019
|
1.780
|
0.09
|
5.173
|
0.453
|
-8.325
|
18.671
|
-0.8
|
No
|
-0.619
|
0.613
|
2.019
|
1.780
|
0.09
|
-3.047
|
0.453
|
-10.998
|
4.903
|
0.5
|
Current Contraceptive Use
|
|
|
|
|
|
|
|
|
|
Yes
|
0.109
|
0.301
|
-0.097
|
0.315
|
0.02
|
0.484
|
0.839
|
-4.181
|
5.149
|
-0.07
|
No
|
0.109
|
0.301
|
-0.097
|
0.315
|
0.02
|
-2.110
|
0.839
|
-22.449
|
18.228
|
0.3
|
Wealth Quintile
|
|
|
|
|
|
|
|
|
|
|
Lowest
|
0.035
|
0.291
|
-0.031
|
0.102
|
-0.01
|
-7.449
|
0.072
|
-15.571
|
0.673
|
1.2
|
Lower
|
0.496
|
0.480
|
-0.881
|
1.873
|
-0.07
|
-7.822
|
0.180
|
-19.254
|
3.609
|
1.2
|
Middle
|
-0.498
|
0.049
|
-0.996
|
0.001
|
0.07
|
-4.536
|
0.275
|
-12.688
|
3.615
|
0.7
|
Higher
|
-0.057
|
0.424
|
-0.195
|
0.082
|
0.01
|
1.781
|
0.684
|
-6.794
|
10.357
|
-0.3
|
Highest
|
1.666
|
0.000
|
0.862
|
2.469
|
-0.25
|
20.065
|
0.025
|
2.502
|
37.628
|
-3.1
|
Constant
|
NA
|
NA
|
NA
|
NA
|
NA
|
-825.88
|
0.000
|
-1159.7
|
-492.04
|
128.85
|
Component
|
-499.99
|
0.000
|
-537.65
|
-462.32
|
78.007
|
-140.96
|
0.000
|
-214.56
|
-67.368
|
21.993
|
Raw Difference -640.95
|
0.000
|
-699.5
|
-582.4
|
100
|
|
|
|
|
Number of observations
|
|
|
|
15,582
|
|
|
|
|
Source: Calculated from Dabat DHSS Census (2008) and Re-census (2014) Data
Notes: NA = Not Applicable, and CI = Confidence Interval