Fertility in Ethiopia: factors associated with the number of live births —a survey—adjusted poisson regression analysis of the 2019 ethiopian mini demographic and health survey

Abstract

Fertility is a key demographic and public health phenomenon reflecting actual childbearing within a population. It can be characterized using several measures, including total fertility rate, age-specific fertility rates, children ever born, and the number of births occurring within a defined reference period. These measures capture different dimensions of reproductive experience and are associated with a complex interplay of socioeconomic, demographic, cultural, biological, and policy-related factors. By dividing the nine regions into urban and rural categories, twenty-one sampling strata were created. The survey employed a two-stage stratified cluster sampling design. In the first stage, 305 enumeration areas (EAs) were selected from the national sampling frame using probability proportional to size. A total of 8,885 women were included in the descriptive analysis, while the primary multivariable analysis was restricted to 6,585 ever-married/partnered women. A survey-adjusted Poisson regression model was used to examine associations between explanatory variables and the number of live births during the five years preceding the survey. Statistical significance was assessed using a two-sided p -value of <0.05. The mean age of the participants was 27.6 years. More than four-fifths of women had either no formal education (40.4%) or primary education (41.7%). Compared with women aged 15–19 years, the expected number of recent live births was higher among women aged 20–24 years (aIRR = 2.129, 95% CI: 1.759–2.577). Women residing in Amhara had a lower expected number of recent live births than women residing in Tigray (aIRR = 0.765, 95% CI: 0.658–0.890). Lower expected counts were also observed in Addis Ababa (aIRR = 0.818, 95% CI: 0.684–0.979) and Dire Dawa (aIRR = 0.792, 95% CI: 0.659–0.952). An inverse association was observed between household wealth and recent live-birth counts. These findings highlight the multifactorial nature of recent live births in Ethiopia and suggest that fertility patterns are associated with a combination of individual, household, and contextual factors. These insights may help inform evidence-based reproductive health and family planning policies tailored to the Ethiopian context.