High-risk Fertility Behavior Research Articles

Maternal High-Risk Fertility Behavior and Its Associated Factors in Hadiya Zone, Southern Ethiopia: A Facility-Based Cross-Sectional Study

BACKGROUND: The fertility behavior of women is characterized by maternal age, birth spacing and order, and it impacts the health of women and children. Evidence on the factors associated with maternal high-risk fertility behavior is scant in Ethiopia. Thus, the aim of this study was to identify the factors associated with maternal high-risk fertility behavior in Hadiya Zone, Southern Ethiopia. METHODS: A facility-based cross-sectional study was conducted. Three hundred women of reproductive age admissions to public hospitals in the Hadiya Zone who gave birth in the five years preceding this study were selected using systematic random sampling. Face-to-face interviews were held to gather data using interviewer-administered questionnaires. Descriptive statistics and binary logistic regression models were used to analyze data. Statistical significance was assessed using odds ratios and 95% confidence intervals and declared at a p-value of less than 0.05. RESULTS: The overall proportion of maternal high-risk fertility behavior was 60.3%. Mother, who lived in rural areas (AOR = 4.85; 95%CI: 2.56, 9.19), had early marriage (AOR = 3.39; 95%CI: 1.87, 6.14) and had unplanned last pregnancy (AOR = 2.62; 95%CI: 1.28, 5.39) were more likely engaged in high-risk fertility patterns. CONCLUSIONS: In the study area, there was a high overall proportion of married women engaging in high-risk fertility behavior. Mothers with early marriages, unplanned pregnancies, and rural residence were more likely engaged in high-risk fertility behaviors. Plans for interventions aimed at preventing maternal high-risk fertility behavior should center on expanding access to family planning services and ending the practice of early marriage by giving rural women extra care and attention.

Determinants of high-risk fertility behavior among women of reproductive age in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BackgroundWomen’s high-risk fertility behavior (HRFB), which is characterized by narrow birth intervals, high birth order, and younger maternal age at birth, have been scientifically reported to have detrimental effects on the mother and child’s health. To date, there has been limited research into the underlying factors contributing to high-risk fertility behavior in Kenya. Thus, the aim of this study is to identify the factors associated with high-risk fertility behavior among women of reproductive age in Kenya.MethodThe 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 15,483 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.ResultsThe overall prevalence of HRFB among Kenyan women were 70.86% (95%CI = 69.96, 71.40). Women with primary, secondary, and higher educational levels, Protestant and Muslim religion followers, women whose husbands/partners had secondary and higher educational levels, a high household wealth index, ever had a terminated pregnancy, and rural residence, all of these factors were found to be strongly associated with high-risk fertility behavior.ConclusionAs per the findings of our study, in Kenya a significant proportion of women has experienced HRFB. This is a matter of concern as it poses a significant challenge to the healthcare system. The high prevalence of HRFB indicates that there is an urgent need to take appropriate measures in order to mitigate its impact. The situation calls for a comprehensive and coordinated approach involving all stakeholders to address this issue effectively. It would benefit policymakers to create programs that consider factors like education, wealth, and residence that make women more susceptible to HRFB. Targeting women living in high HRFB-prevalence areas could help address the root causes of the issue. This approach can alleviate negative impacts and ensure effective and sustainable solutions.

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

BackgroundIn 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.MethodsSecondary 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.ResultsThe 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.ConclusionsA 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.

Women's education, contraception use, and high-risk fertility behavior: A cross-sectional analysis of the demographic and health survey in Ethiopia.

High-risk fertility behavior (HRFB) among women is the main factor in a wide range of detrimental effects on both the mother's and the child's health, which has an impact on both the mother's and the child's survival. Early childbearing is associated with a higher number of live births and may result in poorer maternal, baby, and child health outcomes. Infant and child mortality are also linked to short birth intervals and higher birth order. Thus, this study aims to examine the link between women's education, contraception use, and high-risk fertility behavior in Ethiopia. Data was drawn from the 2019 Ethiopian Interim Demographic and Health Survey. The analysis covered a total of 5,846 women. The effect of predictor variables on HRFB was quantified using multivariable logistic regression analysis. At a 95% CI of the odds ratio excluding one, a significant association between the HRFB and predictor variables was observed. About 72.8% (95% CI 71.6%-73.9%) of women experience high-risk fertility behaviors. Of these, 32% experience single high-risk fertility behavior, and 40.8% experience multiple high-risk fertility behaviors. Of those who experience high-risk fertility behaviors, 58.7% have birth orders of more than three, 22.4% have short birth intervals (less than 24 months); 35.1% are old (over 34 years old); and 1.6% are young (less than 18 years old). Women with no education (AOR = 4.31; 95% CI: 2.09, 8.89) and primary education only (2.71; AOR = 2.71; 95% CI: 1.63, 4.50) are more likely to engage in high-risk fertility behaviors than women with a higher level of education. Every additional year of schooling reduces the odds of high-risk fertility behavior by 6% (AOR = 0.94; 95% CI: 0.89, 0.98). The use of modern contraception (AOR = 0.74; 95% CI: 0.622, 0.879) and knowledge of modern contraception methods (AOR = 0.80; 95% CI: 0.66, 0.96) reduce the risk of HRFB. Primary education and a lack of education significantly raise the risk of HRFB. However, in Ethiopia, the risk of experiencing HRFB is reduced through modern contraceptive methods, awareness of modern contraceptive methods, and years of education. All initiatives to decrease maternal and newborn mortalities by reducing the risk of HRFB should educate women and encourage them to use modern contraception.

Association of maternal high-risk fertility behavior and under-five mortality in Ethiopia: Community-based survey.

BackgroundHigh-risk fertility behavior is a major public health concern in low and middle-income countries including Ethiopia. Some studies show that the relationship between high-risk fertility behavior and child mortality has analyzed each fertility behavior individually. Yet, there are limited studies that have analyzed outcomes associated with the joint impact of high-risk fertility behaviors. Therefore, the objective of this study was to examine the individual and combined influence of high-risk fertility behavior on under-five mortalities in Ethiopia.MethodsData from the 2016 Ethiopian Demographic and Health Survey were used analyzed. A total of 10,773 mothers who gave live births were included in the final analysis. Both descriptive and bivariate and multivariate logistic regression analyses were performed using STATA V.14.ResultsOverall, 62.1%, 24.0%, and 2.3% of women experienced at least one, two, and three high-risk fertility behaviors, respectively. In the multivariable analysis, under-five mortality was significantly associated with a combination of two or more maternal high-risk fertility behaviors. The odds of under-five mortality among children of women who were engaged in a combination of two high-risk fertility behaviors (AOR = 2.17, 95%CI: 1.52–3.08) and three high-risk fertility behaviors (AOR = 3.69, 95%CI:1.80, 7.55) was higher compared to children of women who have not engaged any high-risk fertility behaviors.ConclusionThis study revealed that a single high-risk fertility behavior was not associated with under-five mortality, yet the presence of two or more maternal high-risk fertility behaviors was an important factor that increased the likelihood of under-five child death. Thus, special emphasis should be given to children of women who engage in a combination of high-risk fertility behaviors. Furthermore, more emphasis should be placed on increasing access to family planning services and raising awareness about high-risk reproductive behaviors among Ethiopian women.

Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: A pooled analysis of nine East African countries.

In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia. This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia. According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women's residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia. This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.

Determinants of high-risk fertility behavior among reproductive-age women in Ethiopia using the recent Ethiopian Demographic Health Survey: a multilevel analysis

BackgroundHigh-risk fertility behavior is associated with numerous unfavorable child and maternal health outcomes such as chronic undernutrition, anemia, and child mortality. As far as our knowledge goes, there is not much study on determinants of high-risk fertility behavior in Ethiopia. Therefore, this study aimed to assess determinants of high-risk fertility behavior among reproductive-age women in Ethiopia.MethodThe study was based on secondary data analysis from the 2016 Ethiopia Demography and Health Survey. A total of 11,022 women who gave birth 5 years preceding the survey were included in this study. Kid’s Record (KR) dataset was used. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) was calculated for those variables included in the multilevel logistic regression model. P value ≤ 0.05 was employed to declare the statistically significant variables.ResultsMore than three-fourths (76.9%) of (95% CI 76.11 to 77.69) reproductive-age women had at least one high-risk fertility behavior. Attended primary and secondary education adjusted odds ratio (AOR) (AOR = 0.71; 95% CI 0.63, 0.80 and AOR = 0.73; 95% CI 0.60, 0.89, respectively), never used contraceptive (AOR = 1.25, 95% CI 1.12, 1.40), unwanted pregnancies (AOR = 1.40, 95% CI 1.23, 1.59), had no ANC visit (AOR = 1.19, 95% CI 1.05, 1.35), rural-dwelling (AOR = 1.26, 95% CI 1.04, 1.51), regions of Ethiopia [Somalia (AOR = 1.70; 95% CI 1.24, 2.32) and Amhara (AOR = 0.72; 95% CI 0.53, 0.96)] were determinants of high-risk fertility behavior.ConclusionEducation, rural residence, unwanted pregnancies, no antenatal care follow-up, and never used contraceptives were determinants of high-risk fertility behavior. Therefore, increased maternal health services, special intervention for hotspot areas, and giving special attention to rural dweller women were highly recommended.

Geographical variation in determinants of high-risk fertility behavior among reproductive age women in Ethiopia using the 2016 demographic and health survey: a geographically weighted regression analysis

BackgroundMaternal and child mortalities are the main public health problems worldwide and both are the major health concern in developing countries such as Africa and Asia. The fertility behavior of women characterized by maternal age, birth spacing, and order, impacts the health of women and children. The aim of this study was to assess the geographically variation in risk factors of high-risk fertility behavior (HRFB) among reproductive-age women in Ethiopia using the 2016 Demographic and Health Survey.MethodsA total of 11,022 reproductive-age women were included in this study. The data were cleaned and weighted by STATA 14.1 software. Bernoulli based spatial scan statistics was used to identify the presence of pure high-risk fertility behavior spatial clusters using Kulldorff’s SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial distribution of high-risk fertility behavior. Geographically weighted regression analysis was employed by multiscale geographical using Multiscale geographical weighted regression version 2.0 software. A p-value of less than 0.05 was used to declare statistically significant predictors (at a local level).ResultsOverall, 76% with 95% confidence interval of 75.60 to 77.20 of reproductive age women were faced with high-risk fertility problems in Ethiopia. High-risk fertility behavior was highly clustered in the Somali and Afar regions of Ethiopia. SaTScan identified 385 primary spatial clusters (RR = 1.13, P < 0.001) located at Somali, Afar, and some parts of Oromia Regional Stateregional state of Ethiopia. Women who are living in primary clusters were 13% more likely venerable to high-risk fertility behavior than outside the cluster. In geographically weighted regression, not using contraceptives and home delivery were statistically significant vary risk factors affecting high- risk fertility behavior spatially. No contraceptive use and home delivery were statistically significant predictors (at the local level) in different regions of Ethiopia.ConclusionIn Ethiopia, HRFB varies across regions. Statistically, a significant-high hot spot high-risk fertility behavior was identified at Somali and Afar. No contraceptive use and home delivery were statistically significant predictors (at a local level) in different regions of Ethiopia. Therefore, policymakers and health planners better to design an effective intervention program at Somali, and Afar to reduce high-risk fertility behavior and Special attention needs about health education on the advantage of contraceptive utilization and health facility delivery to reduce high-risk fertility behavior.

Association between Maternal High-Risk Fertility Behavior and Childhood Morbidity in Bangladesh: A Nationally Representative Cross-Sectional Survey.

In this cross-sectional study, we evaluated data from the 2014 Bangladesh Demographic and Health Survey (BDHS), which consisted of 7,707 married women aged 15-49 years who lived with at least one child younger than 5 years. This study's primary aim was to examine the relationship between maternal high-risk fertility behavior and child morbidity. To define high-risk fertility behaviors, we considered three variables: maternal age at the time of delivery, birth order, and birth interval. The main outcome measures were mortality-related disease in the past 2 weeks (acute respiratory infection [ARI], diarrhea, and fever) and low birth weight (LBW). We used modified Poisson regression with generalized estimating equations to assess the relationships between the variables of interest. Results indicate that a substantial portion of women (34%) exhibited high-risk fertility patterns; 28.7% engaged in a single high-risk behavior and 5.4% engaged in multiple high-risk behaviors. After adjusting for relevant covariates, high-risk fertility behaviors were significantly associated with an increased likelihood of ARI (adjusted relative risk [ARR]: 1.22, 95% CI: 1.05-1.50), diarrhea (ARR: 1.18, 95% CI: 1.03-1.35), fever (ARR: 1.29, 95% CI: 1.11-1.58), and LBW (ARR: 1.27, 95% CI: 1.10-1.52). In addition, engaging in multiple high-risk fertility behaviors appeared to have far-reaching consequences on the outcomes measured. Maternal high-risk fertility behaviors are important predictors of morbidity in children younger than 5 years. Preventing high-risk fertility behavior may reduce childhood morbidity and mortality in Bangladesh.