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Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16: a subnational analysis of cross-sectional surveys

Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16: a subnational analysis of cross-sectional surveys
Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16: a subnational analysis of cross-sectional surveys

Background: Understanding 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. Methods: We 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. Findings: TFR 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. Interpretation: Substantial 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. Funding: Wellcome Trust, the UK Foreign, Commonwealth and Development Office, and the Bill & Melinda Gates Foundation.

2214-109X
E802-E812
Pezzulo, Carla
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Nilsen, Kristine
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Carioli, Alessandra
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Tejedor Garavito, Natalia
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Hanspal, Sophie E
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Hilber, Theodor
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James, William HM
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Ruktanonchai, Corrine Warren
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Alegana, V.A.
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Sorichetta, Alessandro
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Wigley, Adelle
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Hornby, Graeme
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Matthews, Zoe
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Tatem, Andrew
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Pezzulo, Carla
876a5393-ffbd-479a-9edf-f72a59ca2cb5
Nilsen, Kristine
306e0bd5-8139-47db-be97-47fe15f0c03b
Carioli, Alessandra
6c08c2a8-db01-49c5-811e-64a41d02845f
Tejedor Garavito, Natalia
26fd242c-c882-4210-a74d-af2bb6753ee3
Hanspal, Sophie E
3fbe6342-6629-4b8d-ac8b-bad338fa5650
Hilber, Theodor
05a5c536-6fec-4fc8-bc3f-d20619f29563
James, William HM
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Ruktanonchai, Corrine Warren
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Alegana, V.A.
42ca5362-7e95-4d8e-8add-08bef6d57636
Sorichetta, Alessandro
c80d941b-a3f5-4a6d-9a19-e3eeba84443c
Wigley, Adelle
21b38ae2-ffd3-4d45-bf29-843e6d62807f
Hornby, Graeme
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Matthews, Zoe
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Tatem, Andrew
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Pezzulo, Carla, Nilsen, Kristine, Carioli, Alessandra, Tejedor Garavito, Natalia, Hanspal, Sophie E, Hilber, Theodor, James, William HM, Ruktanonchai, Corrine Warren, Alegana, V.A., Sorichetta, Alessandro, Wigley, Adelle, Hornby, Graeme, Matthews, Zoe and Tatem, Andrew (2021) Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16: a subnational analysis of cross-sectional surveys. The Lancet Global Health, 9 (6), E802-E812. (doi:10.1016/S2214-109X(21)00082-6).

Record type: Article

Abstract

Background: Understanding 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. Methods: We 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. Findings: TFR 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. Interpretation: Substantial 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. Funding: Wellcome Trust, the UK Foreign, Commonwealth and Development Office, and the Bill & Melinda Gates Foundation.

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Accepted/In Press date: 11 February 2021
e-pub ahead of print date: 25 May 2021
Published date: 1 June 2021

Identifiers

Local EPrints ID: 449336
URI: http://eprints.soton.ac.uk/id/eprint/449336
ISSN: 2214-109X
PURE UUID: a186cfba-ee40-409b-8e92-8cd1dbd8f30a
ORCID for Carla Pezzulo: ORCID iD orcid.org/0000-0003-4775-1787
ORCID for Kristine Nilsen: ORCID iD orcid.org/0000-0003-2009-4019
ORCID for Natalia Tejedor Garavito: ORCID iD orcid.org/0000-0002-1140-6263
ORCID for Alessandro Sorichetta: ORCID iD orcid.org/0000-0002-3576-5826
ORCID for Graeme Hornby: ORCID iD orcid.org/0000-0002-2833-8711
ORCID for Zoe Matthews: ORCID iD orcid.org/0000-0003-1533-6618
ORCID for Andrew Tatem: ORCID iD orcid.org/0000-0002-7270-941X

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Date deposited: 25 May 2021 16:32
Last modified: 06 Jun 2024 01:54

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Contributors

Author: Carla Pezzulo ORCID iD
Author: Kristine Nilsen ORCID iD
Author: Alessandra Carioli
Author: Sophie E Hanspal
Author: Theodor Hilber
Author: William HM James
Author: Corrine Warren Ruktanonchai
Author: V.A. Alegana
Author: Adelle Wigley
Author: Graeme Hornby ORCID iD
Author: Zoe Matthews ORCID iD
Author: Andrew Tatem ORCID iD

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