Abstract
SummaryBackgroundUnderstanding subnational variation in age-specific fertility rates (ASFRs) and total fertility rates (TFRs), and geographical clustering of high fertility and its determinants in low-income and middle-income countries, is increasingly needed for geographical targeting and prioritising of policy. We aimed to identify variation in fertility rates, to describe patterns of key selected fertility determinants in areas of high fertility.MethodsWe did a subnational analysis of ASFRs and TFRs from the most recent publicly available and nationally representative cross-sectional Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016 for 70 low-income, lower-middle-income, and upper-middle-income countries, across 932 administrative units. We assessed the degree of global spatial autocorrelation by using Moran's I statistic and did a spatial cluster analysis using the Getis-Ord Gi* local statistic to examine the geographical clustering of fertility and key selected fertility determinants. Descriptive analysis was used to investigate the distribution of ASFRs and of selected determinants in each cluster.FindingsTFR varied from below replacement (2·1 children per women) in 36 of the 932 subnational regions (mainly located in India, Myanmar, Colombia, and Armenia), to rates of 8 and higher in 14 subnational regions, located in sub-Saharan Africa and Afghanistan. Areas with high-fertility clusters were mostly associated with areas of low prevalence of women with secondary or higher education, low use of contraception, and high unmet needs for family planning, although exceptions existed.InterpretationSubstantial within-country variation in the distribution of fertility rates highlights the need for tailored programmes and strategies in high-fertility cluster areas to increase the use of contraception and access to secondary education, and to reduce unmet need for family planning.FundingWellcome Trust, the UK Foreign, Commonwealth and Development Office, and the Bill & Melinda Gates Foundation.
Highlights
An awareness of fertility rate is crucial for describing the demographic profile of a country, opportunities for development, change in population size, and for assessing challenges to women’s reproductive health.[1]
Added value of this study This study provides a comprehensive descriptive analysis of the geographical heterogeneities in fertility rates within countries, by assembling subnational age-specific fertility rates (ASFRs) and total fertility rates (TFRs) from nationally representative household surveys for a total of 932 administrative units in 70 low-income, lower-middleincome, and upper-middle-income countries
The analyses explore how fertility clusters relate to fertility determinants, such as the use of contraception, women’s secondary education or higher, and unmet needs for family planning
Summary
An awareness of fertility rate is crucial for describing the demographic profile of a country, opportunities for development, change in population size, and for assessing challenges to women’s reproductive health.[1]. Universal and equitable access to high quality sexual and reproductive health services is yet to be achieved, and there are still vulnerable populations that face major barriers to access, such as those who live in remote areas far away from health facilities, do not have access to transportation, Lancet Glob Health 2021; 9: e802–12
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