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

Carla Pezzulo*, Kristine Nilsen, Alessandra Carioli, Natalia Tejedor-Garavito, Sophie E. Hanspal, Theodor Hilber, William H.M. James, Corrine W. Ruktanonchai, Victor Alegana, Alessandro Sorichetta, Adelle S. Wigley, Graeme M. Hornby, Zoe Matthews, Andrew J. Tatem

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Downloads (Pure)

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.

Original languageEnglish
Pages (from-to)e802-e812
JournalThe Lancet Global Health
Volume9
Issue number6
Early online date18 May 2021
DOIs
Publication statusPublished - Jun 2021

Fingerprint

Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this