High Fertility Countries Research Articles

The Fertility Transition in Sub-Saharan Africa: The Role of Structural Change.

Despite recent economic growth and reductions in child mortality in many African countries, the region has experienced a slow fertility transition. In this study, we explore whether the slow structural economic change on the continent can explain this discrepancy. We construct a unique panel dataset combining Demographic and Health Surveys and nighttime light intensity data (an indicator of industrialization) from 57 countries at the subnational region level over three decades to analyze the drivers of fertility transitions across low- and middle-income countries. Our results confirm that household wealth, reduced child mortality, and female primary education are crucial for fertility declines. However, our analysis also highlights the importance of indicators of structural economic change, including the share of labor in nonagricultural occupations, industrialization, the share of women with higher education, and the formalization of the economy. Our simulations suggest that if high-fertility countries in sub-Saharan Africa underwent structural economic transformations comparable to those of other low- and middle-income countries with low fertility rates, their fertility levels could fall by 1 to 1.6 children.

BAYESIAN PROJECTIONS OF TOTAL FERTILITY RATE CONDITIONAL ON THE UNITED NATIONS SUSTAINABLE DEVELOPMENT GOALS.

Women's educational attainment and contraceptive prevalence are two mechanisms identified as having an accelerating effect on fertility decline and that can be directly impacted by policy. Quantifying the potential accelerating effect of education and family planning policies on fertility decline in a probabilistic way is of interest to policymakers, particularly in high-fertility countries. We propose a conditional Bayesian hierarchical model for projecting fertility given education and family planning policy interventions. To illustrate the effect policy changes could have on future fertility, we create probabilistic projections of fertility that condition on scenarios such as achieving the Sustainable Development Goals (SDGs) for universal secondary education and universal access to family planning by 2030.

Risk factors for infertility and barriers to treatment in Tanzania: a survey and medical records study.

The burden of infertility is serious for women in high-fertility countries. We sought to identify demographic, behavioral/environmental, and reproductive risk factors for various infertility factors (i.e., ovarian, tubal, uterine/cervical, male/other) among women seeking infertility treatment in central Tanzania; to determine the association between pelvic inflammatory disease (PID) and tubal factor infertility (TFI); and to identify barriers to infertility treatment by women's home regional zone. We conducted a cross-sectional survey of women seeking infertility treatment in Dodoma, Tanzania from January-March 2020. We surveyed 168 participants aged 18-49 years and reviewed their medical records to confirm infertility status and potential risk factors. We estimated prevalence ratios for factors associated with infertility using logistic regression. Treatment barriers were compared by women's regional zone to see if barriers varied geographically. The median age of participants was 32 years (range: 18-48). Infertility factors did not vary greatly by patient demographics, behavioral/environmental, or reproductive risk factors. Approximately 31.48% of women had PID diagnoses. Those with PID had 1.94 (95% CI: 1.30, 2.90) times the prevalence of TFI diagnosis as those with other infertility factors, after adjusting for age, pesticide use, alcohol use, age at sexual debut, prior obstetric events, and family history of infertility. Logistical barriers to treatment, such as time and cost, were more frequently reported than emotional, stigma, or other barriers, regardless of regional zone. PID was strongly associated with TFI after adjustment for confounders. Infertility treatment access due to cost remains a challenge in Tanzania.

Married women decision making autonomy on health care utilization in high fertility sub-Saharan African countries: A multilevel analysis of recent Demographic and Health Survey.

Women's decision-making autonomy has a potential impact on the scale-up of health care utilization. In high fertility countries, evidence regarding women's decision-making autonomy on their health care utilization and its associated factors is limited and inconclusive. Hence, it is important to investigate women decision-making autonomy on their health care utilization and associated factors in high fertility countries in sub-Saharan Africa. The data source for this study was obtained from recent Demographic and Health Surveys that were comprised of a weighted sample of 178875 reproductive age women. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios, along with the 95% confidence interval were generated to identify individual and community-level factors associated with women's autonomy in health care decision-making. A p-value less than 0.05 was declared as statistical significance. In this study, 42% (95% CI: 41.7, 42.3) of women were able to exercise their reproductive autonomy. The highest (74.8%) and the lowest (19.74%) magnitude of women autonomy was found in Angola and Mali, respectively. In multilevel analysis; age of women 25-34 years, 35 and above (AOR = 1.34, 95% CI: 1.29, 1.39), and (AOR = 1.78, 95% CI: 1.75, 1.90), women's primary and secondary educational level (AOR = 1.25, 95% CI: 1.20, 1.31), and (AOR = 1.44, 95% CI: 1.32, 1.54), husband primary and secondary educational level (AOR = 1.24, 95% CI: 1.18, 1.29), and (AOR = 1.21, 95% CI: 1.15, 1.27), women who had work (AOR = 1.67, 95% CI: 1.59, 1.74) female household heads (AOR = 1.44, 95% CI: 1.37, 1.51), media exposure (AOR = 1.04, 95% CI: 1.09, 1.18), health insurance coverage (AOR = 1.26, 95% CI: 1.17, 1.36), urban residence (AOR = 1.14, 95% CI: 1.09, 1.19), community education (AOR = 2.43, 95% CI: 2.07, 2.85) and low community poverty level (AOR = 1.27, 95% CI: 1.08, 1.49) were predictor variables. Although every woman has the right to make her own health care decisions, this study showed that almost 58% of them had no role in making decisions about their health care utilization. Thus, each country Government should support women's decision making autonomy regarding their healthcare utilization through mass media and extensive behavioral education.

Prevalence and factors associated with the utilisation of modern contraceptive methods among married women of childbearing age in Yemen: a secondary analysis of national survey data

ObjectiveImproving reproductive health requires access to effective contraception and reducing the unmet need for family planning in high-fertility countries, such as Yemen. This study investigated the utilisation of modern contraception...

Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys

BackgroundIn developing countries, short birth interval is one of the major public health issues. It is one of the leading cause’s adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries.MethodsData for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15– 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.ResultsOverall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0 .91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0 .93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54).ConclusionThe prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries.

Prevalence of teenage pregnancy and its associated factors in high fertility sub-Saharan Africa countries: a multilevel analysis

BackgroundTeenage pregnancies are persistently high among adolescent women in high fertility countries in sub-Saharan Africa. It has been attributed to the high unmet need for family planning in this population. The aim of this study was to determine the prevalence and factors associated with teenage pregnancy in high fertility countries in sub-Saharan Africa.MethodsData for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 33,391 adolescent girls who had ever had sexual contact were included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors for teenage pregnancy. Finally, the Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to declare as statistically significant.ResultsThe overall teenage pregnancy in sub-Saharan Africa high frtility countries was 24.88% (95% CI, 24.42, 25.35). Educational status; no formal education (AOR = 1.39, 95% CI, 1.23, 1.56) and primary education (AOR = 1.45, 95% CI, 1.30, 1.62), not working (AOR = 1.32, 95% CI, 1.21, 1.45), being married (AOR = 67.88, 95% CI, 61.33, 75.12), poor (AOR = 1.47, 95% CI, 1.32, 1.65) and middle wealth quantile (AOR = 1.21, 95% CI, 1.07, 1.35), knowledge about contracptives (AOR = 2.45, 95% CI, 2.19, 2.74), unmet need for family planning (AOR = 2.42, 95% CI, 2.14, 2.74), Angola (AOR = 9.59, 95% CI, 7.82, 11.77), Chad (AOR = 3.05, 95% CI, 2.49, 3.74), DR.Congo (AOR = 3.77, 95% CI, 3.06, 4.65), and Mali (AOR = 1.84, 95% CI, 1.47, 2.28) were factors significantly associated with teenage pregnancy.ConclusionsThis study found that teenage pregnancy remains a common public health problem in the study areas. Level of education, marital status, occupation, wealth index, unmet need for family planning, knowledge about contraceptives, and country were significantly associated with teenage pregnancy. Hence, for sustainable development goal 3 to be realized by 2030, there must be investment in policy implementation and evaluation, as well as engagement with stakeholders in adolescents’ sexual and reproductive health.

Determinants of early marriage among married women in nine high fertility sub-Saharan African countries: a multilevel analysis of recent demographic and health surveys

BackgroundEarly marriage is global issue that seriously harms women’s personal development and rights. Regarding this, information about married women’s early marriage is inadequate in the world, including sub-Saharan Africa; therefore, this study aimed to assess the early marriage of women in the top nine highly fertile SSA countries.MethodsData for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 121,077 married reproductive-age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of early marriage. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.ResultsOverall prevalence of early marriage was 55.11% (95% CI: 54.8, 55.4) and ranged from 28.11% in Burundi to 80.77% in Niger. The factors significantly associated with early marriage were women’s educational status; primary education (AOR = 0.39; 95% CI: 0.38, 0.41), secondary and higher (AOR = 0.1; 95% CI: 0.09, 0.11), employed (AOR = 0.73; 95% CI: 0.71, 0 .75), classified as rich wealth index level (AOR = 0.87; 95% CI: 0.85, 0.91), a number of family size ≥ 7 (AOR = 1.28; 95% CI: 1.23, 1.33), community-level poverty, (AOR = 1.28; 95% CI: 1.23, 1.33) and rural residency (AOR = 1.16;95% CI: 1.12, 1.21).ConclusionMarriage before the age of 18 is moderately high in high-fertility countries. Therefore, the respective countries government should give due attention to access to education, and encourage the participation of women in making marriage-related decisions, especially those residing in rural areas.

Predictors of modern contraceptive use among reproductive age women in high fertility countries in sub-Saharan Africa: evidence from demographic and health surveys

BackgroundThe world’s population has increased faster than expected due to high fertility rates, with sub-Saharan Africa accounting for most of the increase. Modern contraceptive use is the best option to reduce the high fertility rate. There is limited information on the prevalence of modern contraception and its predictors in sub-Saharan Africa’s high-fertility countries. Therefore, this study aimed to assess the prevalence and predictors of modern contraception among reproductive-age women in high fertility countries in sub-Saharan Africa.MethodsWe used Demographic and Health Survey data sets from the top 10 high fertility countries in sub-Saharan Africa. Stata version 16.0 software was used to analyze the data, and all statistical analyses were completed after the data had been weighted. Multilevel binary logistic regression was performed to identify factors associated with modern contraceptive use. Adjusted odds ratio with a 95% confidence interval, and a p value < 0.05 was used to declare statistical significance.ResultsThe prevalence of modern contraceptive use in all the countries considered in this study was 10.72% (95% CI 10.57, 10.87). In terms of the predictor variables, young aged women, those who had attended a primary or secondary level of formal education, women who received antenatal care follow up, women who reported distance to the health facility as not a big problem, and women from rich families were more likely to use modern contraceptives.ConclusionOnly one in 10 women of reproductive age used modern contraceptive methods in high fertility countries in sub-Saharan Africa. To improve the use of modern contraceptives, governments and non-governmental organizations studied in the countries should intensify programs that focus on those women who are economically poor, those with no formal education, no media exposure, and those with no antenatal care follow up.

Prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in sub-Saharan Africa

BackgroundSub-Saharan Africa, characterised by high fertility and low contraceptive use prevalence, remains one of the settings with the poorest maternal and child health indices globally. Studies have established that grand-multiparous women are at increased risk of these adverse maternal health outcomes, and contraceptive use is important to averting these adverse outcomes. Thus, this study examines the prevalence and determinants of intention to use modern contraceptives among grand-multiparous women in 10 sub-Saharan African countries with high fertility rates.Materials and methodsThe study utilized data from the last installments of the Demographic and Health Survey from the 10 leading countries with the highest total fertility rates in sub-Saharan Africa. These countries include: Angola, Benin, Burundi, Chad, Cote d’Ivoire, the Republic of the Congo, Democratic Republic of Congo, Mali, Niger, and Nigeria. Data analysis of 23,500 grand-multiparous women was done at three univariate levels involving a frequency table and bar chart. We employed bivariate logit and multivariate logit regression at the bivariate and multivariate levels to achieve the study objectives. A significant level was determined at p < 0.05.ResultsOur study found that less than 40% of grand-multiparous women in these high fertility countries in sub-Saharan Africa, have the intention to use modern contraceptives (39%), but country variations exist with as low as 32.8% in Angola to as high as 71.2% in the Republic of the Congo. The study found that modern contraceptives use intention among grand-multiparous women in these high fertility countries was predicted by a history of contraceptive use and pregnancy termination, exposure to family planning messages on social media, and knowledge of family planning methods. Others were women’s fertility planning status, ideal family size, number of marriages (remarriage), couple’s fertility desire, current age, and level of education.ConclusionIn the high fertility context of sub-Saharan Africa, characterized by low contraceptive use, improving contraceptive use intention among grand-multiparous women is vital for preventing adverse maternal and child health outcomes, including mortality, resulting from a high-risk pregnancy. Hence, interventions should be more innovative in targeting this group of women to increase the contraceptive prevalence rate in line with Family Planning 2030 goals, and ultimately reduce high fertility rates in the region.

Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa

BackgroundThe proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA.MethodsSecondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05.ResultsThe prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03–1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41–1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure.ConclusionThe study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA.

Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa

BackgroundGiven the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa.Materials and methodsWe pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs).ResultsAt the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs.ConclusionOur findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5.

Time to first birth and its predictors among reproductive age women in high fertility countries in Sub-Saharan Africa: Inverse Weibull gamma shared frailty model

BackgroundEarly initiation of childbearing leads to an increase in total fertility rate and population growth. It has been linked with both maternal and child morbidity and mortality. However, there is limited information on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve fertility rate, maternal and child survival.MethodsThe survey used recent (2010 – 2018) Demographic and Health data; a stratified, two-stage cluster sampling technique was used to select the sample. Inverse Weibull gamma shared frailty model was used to model the data at 95% confidence interval. Adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Statistical significance was declared at p value < 0.05.ResultsThe overall median age at first birth was found to be 19 years (IQR: 16, 21 years). Rural residency (AHR = 1.02, 95%, CI 1.00,1.04), agricultural employee (AHR = 1.14, 95%, CI 1.13, 1.17), and nonagricultural employee (AHR = 1.06, 95%, CI 1.05, 1.08), marriage below 15 years (AHR = 5.47, 95%, CI 5.37, 5.57) and 15–17 years (AHR = 3.27, 95%, CI 3.22, 3.32), had sex below 15 years (AHR = = 1.57, 95%, CI 1.54, 1.61) and 15–17 years (AHR = 1.38, 95%, CI 1.38, 1.43), women who had unmet need for contraceptive (AHR = 1.39, 95%, CI 1.37, 1.42), and met need (AHR = 1.32, 95%, CI 1.30, 1.35), high spousal age gap (AHR = 1.17, 95%, CI 1.15, 1.19), not heard family planning message (AHR = 1.02, 95%, CI 1.01,1.04) were the higher hazard of early childbirth.ConclusionThe median age at first birth was found to be 19 years. This is lower than the optimal age for giving first birth, which is between late 20 s and early 30 s years. Rural residences, occupation, hearing family planning massage in the media, early sexual intercourse, early age at first marriage, high spousal gap, and unmet need for family planning were predictors of first birth at an early age. Thus, governments and non-governmental organizations should strive to implement programs that aim to reduce early age at first birth by considering these factors.

A two-sex renewal model and its population projection

Population projections rely on one-sex renewal models. Consequently, changing the projection of male mortality does not affect the projection of birth, contradicting commonsense. A two-sex renewal model is presented in this paper to provide a better description of reproduction and more reasonable population projections. This model is nonlinear and includes the one-sex renewal models as special cases. In this model, age-specific birth rates are defined for two sexes jointly; total fertility, net reproduction rate, and intrinsic growth rate are also derived for two sexes jointly; and age-specific populations approach or converge to stable status. Applying the two-sex renewal model to Australia, it indicates that one-sex models underestimated the intrinsic growth rate by 14 percent. Compared to the results of one-sex models, the two-sex model would provide higher growth rate for low-fertility countries, and lower growth rate for high-fertility countries. In other words, the one-sex models are commonly biased. If the two-sex model is applied to all the countries, it would project smaller populations for the world in the future.

Fertility differentials in Bangladesh and Pakistan: evidence from demographic and health surveys

ABSTRACT Following the launch of family planning programs in the 1960s and 1970s, there has been a divergence in fertility transition across Muslim countries. Bangladesh and Pakistan provide an interesting contrast in the pace of fertility transition. Typical of the Muslim world, both countries had a high fertility level of around 6.6 children per woman in the middle of the twentieth century. While the fertility level in Bangladesh had declined to replacement level by 2016, Pakistan’s fertility rate remained well above that level, at 3.5 children per woman. Drawing on data from multiple waves of the Demographic and Health Surveys to run bivariate analyses and negative binomial regression, the paper examines the determinants of fertility differentials within and across the two countries. Pakistani women had more children than Bangladeshi women across all socio-economic variables. Differences in socio-economic conditions, cultural practices such as childbearing norms, and access to family planning between the two countries are plausible reasons for the fertility variations. The paper concludes with implications of fertility differentials in developing countries, and some recommendations on strategies to enhance planned parenthood in high fertility countries.

Social contexts of fertility desire among non-childbearing young men and women aged 15\u201324\xa0years in Nigeria

BackgroundReduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria.MethodsData source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages.ResultsDLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68–5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29–0.75) or richest wealth index (OR = 0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52–0.89), child mortality experience (OR = 1.29, CI 1.11–1.51) and negative attitude to family planning (OR = 1.36, CI 1.13–1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women.ConclusionActive communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria.

Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa

BackgroundMost of the unintended pregnancies that occur among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) end up in pregnancy termination. In this study, the socio-demographic determinants of pregnancy termination among AGYW (aged 15–24) in selected countries with high fertility rates in SSA were examined.MethodsThis was a cross-sectional analysis of data from the most recent Demographic and Health Surveys of nine countries in SSA. The countries included are Angola, Burkina Faso, Burundi, Chad, Gambia, Mali, Niger, Nigeria, and Uganda. A total of 62,747 AGYW constituted the sample size for the study. Fixed and random effects models were used to examine the determinants of pregnancy termination with statistical significance at p < 0.05.Results Higher odds of pregnancy termination were found among AGYW aged 20–24, those who were cohabiting and married, those who listened to radio and watched television at least once a week and those who lived in communities with high literacy level. Conversely, the odds of pregnancy termination were lower among AGYW with three or more births and those with secondary/higher education.ConclusionThe socio-demographic determinants of pregnancy termination among AGYW in this study were age, level of education, marital status, exposure to radio and television, parity, and community literacy level. The findings provide the needed information for designing health interventions to reduce unwanted pregnancies and unsafe abortions in countries with high fertility rates in SSA. It is recommended that governments and non-governmental organisations in these countries should enhance sexuality education and regular sensitization of adolescent sexual and reproductive health programmes targeted at AGYW who are at risk of pregnancy termination.

SCENARIO OF EDUCATION LEVEL AND FERTILITY INDICATOR IN RAJASTHAN, INDIA

Background: High fertility countries provided the example that increment in female education can decrease the fertility up to 25 %. (1) Whereas a contradiction also appeared, when maternal education was highlighted with a negative association with maternal fertility in Africa.(2-6) Methodology: Search engine Pub Med and Google were searched to nd the valuable work previously done. Study studied and contemplated the data taken from MoHA, India. The data has its concern with education level and fertility indicators. Results and conclusions were made consequently. Results: Results were described under the three legends, as study considered rural as well as urban disparities, age specic fertility (ASFR)as a whole while concerning with education level, ASFR belonging to rural area while concerning with education level and ASFR belonging to urban area while concerning with education level. Discussion: The uctuations in the fertility indicators with education level were described

Comparing infertility-related stress in high fertility and low fertility countries

We surveyed 169 women seeking infertility treatment in Central Tanzania using an abbreviated version of the Fertility Problem Inventory (FPI) to measure infertility-related stress. We compared our FPI results to similar studies in another high fertility country (Ghana) and in three low fertility countries (the US, Canada, and Italy).Tanzanian women reported higher infertility-related stress than women in low-fertility countries but lower stress than Ghanaian women. Infertility-related stress is a serious concern for women in high-fertility countries, who experience greater pressure to have children. These findings underscore the need for increased access to infertility treatment and addressing community infertility norms.

The right to move and the right to exclude: Ilya Somin and ‘foot voting’

The right to move and the right to exclude: Ilya Somin and ‘foot voting’