TREND AND ASSOCIATED FACTORS OF HIGH FERTILITY RATE IN ETHIOPIA. USING DEMOGRAPHIC HEALTH SURVEY DATA FROM 2000-2019: MULTILEVEL ANALYSIS MODEL

Abstract

Background: High fertility rate remains one of the most important determinants playing a key role in changing the size and structure of the population of a given nation over time. Even if there were a declining trend in last few years, like many African countries, the fertility rate of Ethiopia is still high, make the nation as the second most populous nation in Africa, after Nigeria. Therefore, this study was aimed to analyze the magnitude, trend and determinants of high fertility (number of children ever born alive ≥ 5) among reproductive-age women in Ethiopia using the Demographic Health Surveys conducted from 2000 to 2019. Method: The trend with cross-sectional study design operated using data from the Ethiopian demographic health survey from 2000 to 2019. A total weighted sample of 44,596 women of reproductive ages were included in the analysis from the latest 2016 EDHS data to compute the magnitude and identify the determinants of high fertility. Multilevel logistic regression analysis assessed the relationship between high fertility and its determinants using STATA software (version 16; StataCorp, College Station, TX). Trend analysis of high fertility assessed using the extended Mantel- Haenszel Chi-square test for linear trend using the OpenEpi (V.3.01) response program and the adjusted odds ratio (AOR) with the 95% confidence interval was computed, and a significant association was declared at p value ≤ 0.05. Results: The magnitude of high fertility was 64.6 % (95 % CI, 64.10 - 65.01). The multilevel logistic regression model reviled that high fertility were significantly associated with residing in rural area [AOR = 3.90, 95% CI: 2.85-5.34], lack of formal education [AOR=2.21; 95%CI:1.93 2.53], never used any contraceptive [AOR=1.38; 95% CI:1.24-1.53], early marriage [AOR=2.42; xi 95% CI: 2.11-2.78], childbearing at early age [AOR=2.70; 95% CI: 2.44-3.00], polygamous marriage [AOR=1.47; 95% CI:1.30-1.65], short birth intervals of ≤36 months [AOR=2.36; 95% CI:2.17-2.56] and husband low education status [AOR=3.64; 95%CI:2.12-4.27]. But women with a met contraceptive need [AOR = 0:28, 95% CI: 0.08, 0.93] were less likely to have high fertility. Conclusions: The finding of this study implies that sixty-five out of hundred women in this survey reported having high fertility, and the magnitude and trend did also show significant change during the last two decades. Key determinants of high fertility were early marriage and childbearing at early ages, lack of formal education, low rate of family planning use, polygamous marriage status, short birth intervals of ≤36 months, and unmet needs for family planning that needs public health attention. It is recommended to stakeholders develop new approaches to deal with the primary causes of high fertility factors. Special attention should also be done on improving the Adolescents and Youth Sexual and Reproductive Health (AYSRH) services focused on rural settings