TY - JOUR
T1 - Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16
T2 - a subnational analysis of cross-sectional surveys
AU - Pezzulo, Carla
AU - Nilsen, Kristine
AU - Carioli, Alessandra
AU - Tejedor-Garavito, Natalia
AU - Hanspal, Sophie E.
AU - Hilber, Theodor
AU - James, William H.M.
AU - Ruktanonchai, Corrine W.
AU - Alegana, Victor
AU - Sorichetta, Alessandro
AU - Wigley, Adelle S.
AU - Hornby, Graeme M.
AU - Matthews, Zoe
AU - Tatem, Andrew J.
N1 - Funding Information:
This work was funded by the Wellcome Trust (grant number: 204613/Z/16/Z), the UK Foreign, Commonwealth and Development Office, and, in part, by the Bill and Melinda Gates Foundation (grant number INV-007594). VA is funded through a Wellcome Trust Training Fellowship (211208). We thank the editor, assistant editor, and reviewers for their thoughtful comments and efforts towards improving our manuscript, and the DHS Program staff, in particular Tom Pullum, for their inputs on the construction of the fertility rates.
Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2021/6
Y1 - 2021/6
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85106330982&partnerID=8YFLogxK
U2 - 10.1016/S2214-109X(21)00082-6
DO - 10.1016/S2214-109X(21)00082-6
M3 - Article
C2 - 34019836
AN - SCOPUS:85106330982
SN - 2214-109X
VL - 9
SP - e802-e812
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 6
ER -