Spatial distribution and determinants of high-risk fertility behavior among reproductive-age women in Ethiopia

Fantu Mamo Aragaw; Dagmawi Chilot; Daniel Gashaneh Belay; Mehari Woldemariam Merid; Anteneh Ayelign Kibret; Adugnaw Zeleke Alem; Melaku Hunie Asratie

doi:10.1186/s41182-023-00506-y

Spatial distribution and determinants of high-risk fertility behavior among reproductive-age women in Ethiopia

Trop Med Health. 2023 Mar 6;51(1):14. doi: 10.1186/s41182-023-00506-y.

Authors

Fantu Mamo Aragaw¹, Dagmawi Chilot^{2

3}, Daniel Gashaneh Belay^{4

5}, Mehari Woldemariam Merid⁴, Anteneh Ayelign Kibret⁵, Adugnaw Zeleke Alem⁴, Melaku Hunie Asratie⁶

Affiliations

¹ Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. fantuma3@gmail.com.
² Department of Human Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
³ College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
⁴ Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁵ Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
⁶ Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.

Abstract

Background: In low-and-middle-income, including Ethiopia, high-risk fertility behavior is a major public health concern. High-risk fertility behavior has an adverse influence on maternal and child health, which hampered efforts to reduce maternal and child morbidity and mortality in Ethiopia. Therefore, this study aimed to assess the spatial distribution and associated factors of high-risk fertility behavior among reproductive-age women in Ethiopia using recent nationally representative data.

Methods: Secondary data analysis was done with a total weighted sample of 5865 reproductive-aged women using the latest mini EDHS 2019. The spatial distribution of high-risk fertility behavior in Ethiopia was determined using spatial analysis. Multilevel multivariable regression analysis was used to identify predictors of high-risk fertility behavior in Ethiopia.

Results: The prevalence of high-risk fertility behavior among reproductive-age women in Ethiopia was 73.50% (95% CI 72.36%, 74.62%). Women with primary education [AOR = 0.44; 95%CI; 0.37, 0.52], women with secondary and above education [AOR = 0.26; 95%CI; 0.20, 0.34], being Protestant religion followers [AOR = 1.47; 95%CI; 1.15, 1.89], being Muslim religion follower [AOR = 1.56; 95%CI; 1.20, 2.01], having television [AOR = 2.06; 95%CI; 1.54, 2.76], having ANC visit [AOR = 0.78; 95%CI; 0.61, 0.99], using contraception [AOR = 0.77; 95%CI; 0.65, 0.90], living in rural areas [AOR = 1.75; 95%CI; 1.22, 2.50] were significantly associated with high-risk fertility behavior. Significant hotspots of high-risk fertility behavior were detected in Somalia, SNNPR, Tigray region, and Afar regions of Ethiopia.

Conclusions: A significant proportion of women in Ethiopia engaged in high-risk fertility behavior. High-risk fertility behavior was distributed non-randomly across Ethiopian regions. Policymakers and stakeholders should design interventions that take into account the factors that predispose women to have high-risk fertility behaviors and women who reside in areas with a high proportion of high-risk fertility behaviors to reduce the consequences of high-risk fertility behaviors.

Keywords: EDHS; Ethiopia; High-risk fertility behavior; Multilevel analysis; Spatial analysis.