Determinants of fertility desire among reproductive-aged married/cohabiting women in Ethiopia: an analysis of PMA-ET 2021 data

Abstract

Abstract Background: In Ethiopia, although many activities have been performed to control rapid population growth and reduce the average number of births per woman, in the last ten years, it has not been feasible to achieve the desired level of change, as was planned and intended in the National Health Sector Transformation Plan (HSTP) and reproductive health (RH) strategies. The annual growth of the population and fertility rates continue to increase at 2.7 and 4.6, respectively. Fertility is one of the fundamental aspects affecting population dynamics, while the fertility desire of women to have children is one of the key elements of fertility and can be a precursor to actual fertility performance, a useful tool for understanding aggregate fertility trends, and important for understanding future reproductive behavior. Women's fertility desire is the number of children they want to have in the next few years, based on their assessment of the costs and benefits of childbearing. Methods: This analysis used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2021. A total of 4138 married or cohabiting individual women between the ages of 15 and 49 who were not pregnant were included in this analysis. Sampling weighting factors and design were applied in this analysis, and chi-square test statistics were computed to determine the overall association and used to assess the adequacy of the cell sample size. Multilevel binary logistic regression was used to identify important predictors of women’s fertility desire. The results are presented as percentages and odds ratios with 95% confidence intervals (CIs). Statistical significance was declared at a significance level of 0.05. Results: Approximately three-quarters (74.1%, 95% CI; 71.5% - 76.6%) of reproductive-aged married/cohabiting women in Ethiopia desired to have a child. Women who reported having a forced pregnancy by their spouse, being of the Muslim religion, being aged 19 and above at first sex, and having attained secondary or higher education were found to be positively and significantly associated with the likelihood of fertility desire to have a child. However, women who reported 40 years of age or older, partner’s age 45 years of or older, who had three or more live births, who had a family size of five or more members, and who had ever used FPs were found to have lower odds of having a fertile desire to have a child. Conclusion: The prevalent high-fertility desire to have a child in Ethiopia hinders the quick reduction of fertility rates and calls for the implementation of multifaceted strategies that preserve this high-fertility desire. Accordingly, sociocultural and demographic variables were determined to influence the desire for children. Understanding these determinants is vital to developing successful fertility programs and policies specifically designed for different populations, prioritizing and adopting interventions that increase everyone's access to and use of family planning options, and messaging that speaks to a range of religious and cultural groups.