Fertility status and associated factors among the reproductive age group in Ethiopia: Mini Demographic and Health Survey 2019

doi:10.21203/rs.3.rs-2401527/v1

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Fertility status and associated factors among the reproductive age group in Ethiopia: Mini Demographic and Health Survey 2019

https://doi.org/10.21203/rs.3.rs-2401527/v1

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Background: Fertility status is the possibility to produce offspring through reproduction following the onset of reproductive age. There are a number of environmental and biological factors that influence a person's reproductive behavior when viewed from a demographic perspective, which serve to mediate the impact of culture, society, economic conditions, living standards, and other similar background factors. The aim of this study was to determine factors associated with fertility status among the reproductive age group.

Methods: The data for this study was extracted from Ethiopia mini demographic and health survey 2019. The study involved 8885 household with reproductive age group in a weighted sample. The analysis was performed using STATA version 16 software. Using sampling weights for descriptive statistics and complex sample designs for inferential statistics, backward stepwise elimination was manually applied. Finally, statistical significance declared at the level of p-value < 0.05.

Result: The prevalence of fertility status in Ethiopia was observed to be 44.7%. In multivariate analysis the household female (AOR = 0.465, 95% CI: 0.418-0.517) had lower odds of fertility status in comparison to household male. The odds of fertility status were higher among the catholic religion as compared to the orthodox religion, (AOR = 1.615, 95% CI: 1.408-1.853). The odds of fertility status were lower in the Addis Ababa region in comparison to the Tigray region (AOR = 0.636, 95% CI: 0.495-0.818).

Fertility status odds were lower among those who could read only parts of the sentence literacy in comparison to those who were unable to read at all (AOR = 0.736, 95% CI: 0.623-0.869). The odds of fertility status were lower among primary educational levels as compared to no educational levels (AOR = 0.721, 95% CI: 0.632-0.823).

Regarding the household wealth index, the richest-wealth index (AOR = 0.832, 95% CI: 0.689-1.004) had lower odds of fertility status when compared with children from the poorest-wealth index. There was a lower odds of fertility status for electricity users compared with wood charcoal users using electricity as a cooking fuel (AOR = 0.825, 95% CI: 0.681-0.999). The odds of fertility status were higher among those with no toilet facility than those with pit latrines (AOR = 1.145, 95% CI: 1.009-1.298).

Conclusion: The high fertility status and population growth observed in this study. It shows significantly associated with household sex, region, literacy, educational level, religion, wealth index, cooking fuel, and toilet facility had a statistically significant association with fertility status. There are many factors contributing to economic development, including access to education and media, as well as job opportunities in modern economic sectors. In addition to this, it is important to develop and maintain access of family planning services.

Fertility status

reproductive age group

Mini Demographic and Health Survey

Ethiopia

Fertility indicates the product or result of reproduction, rather than the capability of bearing children [1]. Fertility status is the possibility to produce offspring through reproduction following the onset of reproductive age [2]. There are a number of environmental and biological factors that influence a person's reproductive behavior when viewed from a demographic perspective, which serve to mediate the impact of culture, society, economic conditions, living standards, and other similar background factors [1]. The world population is growing by about 80 million people each year and linked with rapid population growth; The fertility rate is an important determinant of population size [3].

In many African countries, the recent decline in fertility is paving the way for economic development. It is important to note, however, that the rate of fertility decline on this continent is not the same as on other continents [4]. In 2017, the United Nations Population Division estimated the TFR of sub-Saharan Africa to be 4.76 due to the high demand for children in the region [5].

In Ethiopia, fertility rates declined from 5.4 in 2005 to 4.6 in 2016. This decline has been caused by a number of factors. Understanding the factors contributing to the fertility decline and their level of fertility-inhibiting effect has a paramount policy implication in any country [5, 6].

Thus, this study aimed to use the 2019 Ethiopian Mini Demographic Health Survey to determine factors associated with fertility status. In this way, may be able to evaluate the National strategy for family planning service in the Federal ministry of health in Ethiopia. The goal of this National strategy for family planning service was to improve maternal health and bringing about development [7].

Sampling, Data source and Data collection

The survey was conducted from March 21, 2019, to June 28, 2019, based on a nationally representative sample that provided national and regional estimates for urban and rural areas [8]. The survey interviewed 8,855 women of reproductive age (age 15–49) from a nationally representative sample of 8,663 households. Detailed information was collected on respondents’ background characteristics, fertility determinants, marriage, awareness, use of family planning methods, child feeding practices, nutritional status of children, childhood mortality, and height and weight of children aged 0–59 months [8]. This finding presents comprehensive outcomes of the survey at the national level and for Ethiopia’s nine regional states and two city administrations [8].

Variables

Outcome variable

Fertility status

The outcome variable for this study was the fertility status of households in the last five years. This information is obtained by asking the households how many births had in the past five years. The responses were recorded as either (no birth = 0) or (give birth = 1).

Independent variables

The independent variables were sex, region, type of place of resident, literacy, educational level, religion, wealth index, sources of drinking water, cooking fuel, toilet facility, main floor materials, main roof materials and main wall materials which were selected from the available similar studies on the subject matter [9, 10].

Socio-Demographic Characteristics of the households

As summarized in Table 1, the majority of the households (71.8%) were males, most of them in the Oromia region (11.8%), SNNPR (11.3%), and Amhara region (10.7%).

Fertility Status of reproductive age groups

In this study, the prevalence of fertility status in Ethiopia was observed to be 44.7% (Table 2) There was a regional difference in fertility status. It indicates the fertility status was found in Oromia 5.2%, SNNPR 5.0%, Amhara 4.5%, Benishangul 3.9%, Tigray 3.8%, Afar 3.8%, Gambela 3.6%, Harari 3.2%, Somali 3.1%, Dire Dawa 3.0%, and Addis Ababa 2.6% (Table 2).

Fertility status of reproductive age group by place of residence

Fertility status of the reproductive age group by place of residence was highest in rural (75%) and urban (25%) areas (Figure 1).

Factors associated with Fertility status in Ethiopia

The result reveals that, in bivariate analysis, sex, region, type of place of resident, literacy, educational level, religion, wealth index, sources of drinking water, cooking fuel, toilet facility, main floor materials, roof materials, and wall materials had p-value less than 0.2. However, in multivariate analysis sex, region, literacy, educational level, religion, wealth index, cooking fuel, and toilet facility had a statistically significant association with fertility status, while others failed to persist (Table 3).

In terms of the sex, household female (AOR = 0.465, 95% CI: 0.418-0.517) had lower odds of fertility status in comparison to household male. The odds of fertility status were higher among the catholic religion as compared to the orthodox religion, (AOR = 1.615, 95% CI: 1.408-1.853). The odds of fertility status were lower in the Addis Ababa region in comparison to the Tigray region (AOR = 0.636, 95% CI: 0.495-0.818) (Table 3).

This population-based study evaluated the factors associated with fertility status in reproductive age groups using data from the Ethiopian Mini Demographic and Health Survey.

Accordingly, sex, region, type of place of residence, literacy, educational level, religion, wealth index, sources of drinking water, cooking fuel, toilet facility, main floor materials, roof materials, and wall materials were independently and significantly associated with fertility status.

In this study, the household sex/gender was significantly associated with fertility status. The household female had less likely fertility status compared to the household male. The finding was supported by a study conducted in Iran and Malawi [11, 12]. This could explain by in sex/gender households, studies show that the need for caregiving and the burden of that need typically falls on families, especially women. So, they do not want to have more children [13, 14].

According to our study, place of residence was higher significantly associated with fertility status. Rural areas had higher odds of fertility status as compared to urban areas. The finding was supported by a study conducted in Ghana and another sub-Saharan Africa [15, 16]. This could explain by in place of residence, evidence suggests that limited access to family planning and reproductive health information in rural areas and services contributes to these outcomes and rural residents desiring additional children [17].

Literacy was again significantly associated with fertility status. Household literacy able to read only parts of the sentence are less likely to have fertility status when compared with literacy cannot read at all. The finding was supported by a study conducted in different regions of Ethiopia [18, 19]. This could explain by informal literacy constitutes a society-wide problem that cannot be isolated to one strand or tier but must be addressed by everyone. While the government has invested a great deal in resolving the issue, it remains a deep-rooted problem [20, 21].

In our study, educational level is also significantly associated with fertility status. Primarily education levels are less likely to have fertility status when compared with no education level. The finding was supported by a study conducted in Greece and Poland [22, 23]. This could explain by in educational level among primary education level couples, childbearing patterns are more uniform and more often lead to the birth of precisely two children. Infertility status for the primary education level is much lower than for the less or no education level [24, 25].

Religion is also significantly associated with fertility status. Catholic religion higher odds of fertility status as compared to orthodox religion. The finding was supported by a study in Brundi and national [26, 27]. This could explain by in Catholic religion can affect fertility status in several ways [28]. The Catholic church believes that contraception defeats the primary purpose of marriage to reproduce by preventing conception and can lead to an increase in fertility through its direct effect on contraceptive use [28].

Wealth index is also significantly associated with fertility status. The richest wealth index lower odds of fertility status as compared to the poorest wealth index. The finding was supported by a study in the country and Liberia [29, 30]. This could explain by in wealth index the richest households could delay childbirth with expensive, long-term contraceptives. In addition, wealthy women may have the means to reduce their fertility rates, whereas poorer women may not, owing to financial constraints [31].

In our findings, Cooking fuel is also significantly associated with fertility status. Compared to wood charcoal, electricity as a cooking fuel lowers the odds of fertility status. The finding was supported by a study in Ghana, India, and Bangladesh [32, 33]. This could explain by in the utilization of electricity is still limited by barriers such as the cost of technologies, financial issues, and scientific and technical limitations [32].

Toilet facility is also significantly associated with fertility status. The no toilet facility higher odds of fertility status when compared to the pit latrine toilet facility. The finding was supported by a similar study conducted in Malawi and India [34, 35]. This could explain by inadequate water and toilet facilities during fertility status and childbirth are likely to lead to poor household and offspring outcomes [36]. Thus, the regional health bureau, the ministry of health, and other stakeholders on family planning services should pay special attention to the above regions, facilities, and households to fill the gaps in fertility status. As a national survey, the Ethiopian Mini Demographic Health Survey 2019 provided us with valuable data for this study. There is a major drawback to the current study, which is recall bias. Furthermore, the study had limitations due to incomplete data, such as not accounting for Age of respondent at 1st birth, family size, and total children ever born that could affect practice.

Accordingly, the study found that fertility status differed differ from other factors significantly between rural and urban Ethiopians. It is important to modernize different factors to fill the gaps in fertility status. between rural and urban populations. There are many factors contributing to economic development, including access to education and media, as well as job opportunities in modern economic sectors. In addition to this, it is important to develop and maintain access of family planning services.

AOR

Adjusted odds ratio

TFR

Total fertility rate

CDC

Center for Disease Control

COR

Crude odds ratio

Confidence interval

DHS

Demographic and Health Survey

EMDHS

Ethiopia Mini Demographic and Health Survey

EPHC

Ethiopian Population and Housing Census

EPHI

Ethiopian Public Health Institute's

NRERC

National Research Ethics Review Committee

SNNP

Southern Nations Nationalities and Peoples

Ethics approval and consent to participate

We followed all ethical considerations as prescribed by the Helsinki Declaration. Secondary data analysis of the EMDHS was conducted, and permission was granted by MEASURE DHS/ICF International for this use. International and national ethical guidelines were followed in the collection of the original DHS data. ICF International's Institutional Review Board, the Ethiopian Public Health Institute's Review Board (EPHI), the National Research Ethics Review Committee (NRERC) at the Ministry of Science and Technology, and the Center for Disease Control and Prevention (CDC) provided ethical clearance for this study. During the EMDHS 2019, mothers/caregivers provided written informed consent, and data were collected anonymously.

Consent for publication

Not applicable.

Availability of data and materials

In this study, survey datasets were obtained from publicly available datasets freely available online without any participant identifying information from http://www. dhsprogram.com/data/available-datasets. cfm. In accordance with reasonable requests, the corresponding author will provide minimal data used in this study.

Competing interests

The authors declare that they have no conflict of interest.

Funding

Not applicable.

Authors’ contributions

Dereje Derbew and Semere Gebremariam designed the study, performed analysis and interpretation of data, and drafted the paper and revised the manuscript. Both authors read and approved the final manuscript.

Acknowledgments

We would like to express our deepest gratitude to the DHS project for providing us with the EDHS 2019 dataset when requested.

Author information

¹Department of Emergency and critical care Nursing, Menelik II Medical & Health Sciences College, Addis Ababa, Ethiopia.

¹Department of Public Health, Menelik II Medical & Health Sciences College, Addis Ababa, Ethiopia.

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Tables 1 to 3 are available in the Supplementary Files section.

No competing interests reported.

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Fertility status and associated factors among the reproductive age group in Ethiopia: Mini Demographic and Health Survey 2019

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Abstract

Figures

Background

Methods And Materials

Sampling, Data source and Data collection

Variables

Independent variables

Results

Discussion

Conclusions

Abbreviations

Declarations

References

Tables

Additional Declarations

Supplementary Files

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