https://orcid.org/0000-0002-9206-9528
Abstract
Background
Fertility decline in Ethiopia has been documented since the 1990s. Amhara National Regional State has recorded the most noticeable fertility decline. However, the specific factors that explain the incipient course of fertility decline in the study area and their relative contributions were not well investigated. Hence, the purpose of this study was to determine contributing factors of fertility decline and to assess variations in fertility that can be attributed to both changes in characteristics and reproductive behaviors of women aged 15–49 years between 2008 and 2014 in Dabat Demographic and Health Surveillance Site, Northwest Ethiopia.
Methods
Cross-sectional censuses were carried out in a Dabat Health and Demographic Surveillance System site in 2008 and 2014. Data for 4,775 and 10,807 women of reproductive age in 2008 and 2014 were used for the analysis. A Poisson regression model was employed to assess the trends of determinants of fertility, and multivariate decomposition analysis was applied to evaluate observed changes in fertility using data from two consecutive cross-sectional censuses of Dabat HDSS.
Results
Findings indicated that there was a reduction of an average 640.69 births per 1,000 women of reproductive age during 2014 compared to 2008 in the surveillance site (95% CI=−669.5 to −582.4). This overall change in fertility was attributed to both the changing characteristics of women (76%) (95% CI=−524.74 to −453.13) and their reproductive behavior (24%) (95% CI=−224.36 to −79.14). Drivers of the recent fertility decline were increased age at first marriage, a decreased proportion of currently married women, shift in women’s birth to later age, and a higher women’s educational status.
Conclusion
This study indicated that the overall reduction in fertility was attributed to both changing characteristics of women and their reproductive behavior. Major contributors to the changes in fertility were postponing women’s first marriage to a later age and changes in the proportion of currently married women over the study period. Encouraging women to complete at least secondary education is important to increase the age at first marriage and birth, which will in turn accelerate the current fertility transition.
Abbreviations
HDSS, Health and Demographic Surveillance Site; TFR, total fertility rate; EDHS, Ethiopia’s Demographic and Health Survey; ANRS, Amhara National Regional State; CEB, children ever born.
Data Sharing Statement
Data are available at Dabat Research Center with the permission of the Institute of Public Health at the University of Gondar.
Ethical Considerations
Dabat HDSS has obtained ethical clearance from the Health Research Ethics Review Committee (HRERC) of the University of Gondar. A formal letter was written to the local district administrative and health offices. Informed consent was also obtained from eligible women. The right of the respondent to withdraw from the interview or not to participate at all was informed and respected. All data was anonymized, and identifiers were excluded to ensure confidentiality of the participants. The authors have also obtained an ethical clearance from the Health Research Ethics Review Committee (HRERC) of the University of Gondar for further analysis of the 2008 and 2014 census data conducted in Dabat HDSS site.
Acknowledgments
The authors express their gratitude to Dabat Research Center for providing the data. We also gratefully acknowledge and appreciate Mr. Tariku Dejenie from Addis Ababa University for his technical support in STATA and for giving comments on the first version of this article.
Disclosure
The authors declare that they have no competing interests.