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Background: Intimate partner violence has adverse outcomes on the sexual and reproductive health of women. In this study, we examined the association between sexual violence and multiple high-risk fertility behaviours (MHRFB) among women in sub-Saharan Africa (SSA). Methods: We conducted a cross-sectional analysis of data pooled from the most recent Demographic and Health Surveys of 20 countries in SSA. We included countries with most recent datasets conducted from 2015 to 2021 and had data on all variables included in the study. A weighted sample of 88,011 was included in the study. We used a multilevel binary logistic regression to examine the association between sexual violence and MHRFB, controlling for other covariates. The regression results were presented using adjusted odds ratio (aOR) with 95% confidence interval (CI). Statistical significance was set at p < 0.05. Results: The overall prevalence of MHRFB was 22.53% (95% CI: 22.26–22.81), which ranged from 9.94% in South Africa to 30.38% in Chad. For sexual violence, the pooled prevalence was 7.02% (95% CI: 6.86–7.19). Burundi (20.58%) and the Gambia (2.88%) reported the highest and lowest proportions, respectively. Women who experienced sexual violence were more likely to engage in MHRFB compared to those who did not experience sexual violence [aOR = 1.11, 95% CI: 1.02, 1.21]. Conclusion: There is a positive association between sexual violence and the risk of MHRFB. Our findings underscore a need for sub-Saharan African countries to strengthen their efforts to reduce the occurrence of sexual violence in intimate partner relationships. To augment efforts and accelerate social change, sub-Saharan African countries can introduce pro-poor policies and interventions to improve the wealth status of women. Also, empowering women through the encouragement of attaining higher education would be a useful step in lowering the risk of MHRFB in SSA. [ABSTRACT FROM AUTHOR]

Purpose: Gender inequity and adverse health outcomes continue to be of concern among women in sub-Saharan Africa. We determined prevalence of intimate partner violence and excess fertility (having more children than desired) in reproductive age women in Malawi. We also explored factors associated with these outcomes and with spousal fertility intentions. Patients and methods: In a cross-sectional study, a total of 360 women and 410 men were recruited using multi-stage sampling from communities in a peri-urban setting in Blantyre District, Southern Malawi in 2021. Women and men were separately interviewed by trained study workers using a structured questionnaire. In addition to descriptive analyses, we used univariate and multivariate logistic regression models to assess associations of risk factors with the outcomes of intimate partner violence and excess fertility. Results: Among women, lifetime prevalence of intimate partner violence was 23.1%, and excess fertility was experienced by 25.6%. Intimate partner violence was associated with male partners alcohol consumption (adjusted odds ratio 2.13; P = 0.019). Women were more likely to report excess fertility if they were older (adjusted odds ratio 2.0, P<0.001, for a 5-year increase). Alcohol consumption by the male partner (adjusted odds ratio 2.14; P = 0.025) and women being able to refuse sex with their male partner (adjusted odds ratio 0.50; P = 0.036) were associated with discordant fertility preferences. Conclusions: Intimate partner violence, excess fertility, and social and health inequities continue to be prevalent in Malawi. These data suggest the underlying proximal and distal factors associated with these adverse outcomes such as alcohol consumption may be addressed through education, couple interactive communication, and community dialogue. To ensure sustainability and effectiveness, strong leadership involvement, both governmental and non-governmental, is needed. [ABSTRACT FROM AUTHOR]

Background: Women's levels of education and fertility are commonly associated. In Sub-Saharan Africa, the pace of decreasing fertility rates varies greatly, and this is linked to women's levels of education. However, this association may be influenced by unusual females who have uncommon measurements on both variables. Despite this, most studies that researched this association have only analysed the data descriptively, without taking into account the effect of potential outliers. This study aimed to examine the presence and impact of outlier women on the relationship between female education and fertility in Malawi, using regression methods. Methods: To analyse the correlation between women's schooling and fertility and evaluate the effect of outliers on this relationship, a bivariate Poisson model was applied to three recent demographic and health surveys in Malawi. The R software version 4.3.0 was used for model fitting, outlier computations, and correlation analysis. The STATA version 12.0 was used for data cleaning. Results: The findings revealed a correlation of -0.68 to -0.61 between schooling and fertility over 15 years in Malawi. A few outlier women were identified, most of whom had either attended 0 or at least 9 years of schooling and had born either 0 or at least 5 children. The majority of the outliers were non-users of modern contraceptive methods and worked as domestic workers or were unemployed. Removing the outliers from the analysis led to marked changes in the fixed effects sizes and slight shifts in correlation, but not in the direction and significance of the estimates. The woman's marital status, occupation, household wealth, age at first sex, and usage of modern contraceptives exhibited significant effects on education and fertility outcomes. Conclusion: There is a high negative correlation between female schooling and fertility in Malawi. Some outlier women were identified, they had either attended zero or at least nine years of schooling and had either born zero or at least five children. Most of them were non-users of modern contraceptives and domestic workers. Their impact on regression estimates was substantial, but minimal on correlation. Their identification highlights the need for policymakers to reconsider implementation strategies for modern contraceptive methods to make them more effective. [ABSTRACT FROM AUTHOR]

Background: High-risk fertility behaviour remains a major public health in the Democratic Republic of the Congo, like other sub-Saharan Africa countries, especially because Total Fertility Rate (TFR) is very high in the country, estimated at 6.6 children. Despite the commendable progress in reducing maternal deaths in the region, sub-Saharan Africa is still lagging very behind compared with other regions. Yet, high-risk fertility behaviours are pivotal to improve maternal and child health. This study aims to assess geographical variations of, and to identify risk factors associated with high-risk fertility behaviours among married women in the Democratic Republic of the Congo using the 2013–14 Demographic and Health Survey. Methods: Overall, 11,497 married women were selected from a nationally representative using a two-stage sampling design. Standard logistic regressions were performed to identify individual- and household/community-level factors associated with high-risk fertility behaviours. Additionally, interactions between women's age and education, and urban residence were tested. Bernoulli based spatial scan statistics were used to identify the presence of high-risk fertility behaviours spatial clusters using Kulldorff's SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial variations of high-risk fertility behaviours. Geographically weighted regression (GWR) analysis was employed using Multiscale GWR version 2.0 software. Results: Findings indicated that more than two-third of married women exhibited high-risk fertility behaviours in the Democratic Republic of the Congo. Multivariate logistic regression showed that education was negatively and significantly associated with the odds of high-risk fertility behaviours. In contrast, women's age significantly increased the odds of high-risk fertility behaviours. Interactions between urban residence and women's education and age confirmed the urban advantage identified from previous studies. Finally, high-risk fertility behaviours were highly clustered in the Northeastern provinces of the country. Conclusion: The study showed that there were significant geographical variations of high-risk fertility behaviours across provinces in the Democratic Republic of the Congo. The paper also identified significant-high hot spots of high-risk fertility behaviours in the Northeastern provinces of the country. To reduce high-risk fertility behaviours, and ultimately improve maternal and child outcomes in the country, policymakers and health planners need to strategically address these inequalities. Finally, this paper highlighted the persistent needs of country-specific studies due to differences across sub-Saharan African countries in terms of social development and cultures. [ABSTRACT FROM AUTHOR]

Background: In developing countries, short birth interval is one of the major public health issues. It is one of the leading cause's adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries. Methods: Data for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15– 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance. Results: Overall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0.91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0.93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54). Conclusion: The prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries. [ABSTRACT FROM AUTHOR]

Background: The proportion of women with family planning needs increased from 74 to 76% between 2000 and 2019, and this improvement has not transcended to a fertility rate stall or decrease in sub-Saharan Africa (SSA). In the face of a continuous increase in the fertility rate in SSA, population experts agreed that the efficient use of reliable family planning methods such as long-acting reversible and permanent contraceptive methods (LARC/PMs) could help reduce the high fertility rate and associated adverse reproductive health outcomes in the region. However, despite the effectiveness of LARC/PMs, its use remains elusive in SSA. Thus, this study examines the prevalence and factors associated with the use of LARC/PMs among women who desire no more children in high-fertility countries in SSA.Methods: Secondary datasets from the demographic health surveys conducted in 20 countries in SSA between 2010 and 2019 were included in the study. A total sample size of 46,290 sexually active women of reproductive age who desire no more children and who met the study inclusion criteria was pooled and analysed. Prevalence of LARC/PMs use was displayed using a graph whilst binary logistic regression was used to determine the associated factors, and results were presented as unadjusted odds ratio and adjusted odds ratio with a statistical significance of p < 0.05.Results: The prevalence of LARC/PMs use among women who desire no more children was 7.5%. Ranging from 20.9% in Senegal and as low as 0.4% in Congo. Women within the richest wealth index [aOR = 1.18, 95% CI = 1.03-1.36] and those exposed to mass media [aOR = 1.54, 95% CI = 1.41-1.68] had higher odds of LARC/PMs use among sexually active women of reproductive age who desire no more children compared to those within poorest wealth index and women with no mass media exposure.Conclusion: The study concluded that LARC/PMs use among sexually active women who desire no more children was very low, and women within the richest wealth index and those with mass media exposure were likely to use LARC/PMs. Interventions that will encourage using LARC/PMs should be prioritised to reduce fertility rates in SSA. [ABSTRACT FROM AUTHOR]

Background: Early initiation of childbearing leads to an increase in total fertility rate and population growth. It has been linked with both maternal and child morbidity and mortality. However, there is limited information on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve fertility rate, maternal and child survival.Methods: The survey used recent (2010 - 2018) Demographic and Health data; a stratified, two-stage cluster sampling technique was used to select the sample. Inverse Weibull gamma shared frailty model was used to model the data at 95% confidence interval. Adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Statistical significance was declared at p value < 0.05.Results: The overall median age at first birth was found to be 19 years (IQR: 16, 21 years). Rural residency (AHR = 1.02, 95%, CI 1.00,1.04), agricultural employee (AHR = 1.14, 95%, CI 1.13, 1.17), and nonagricultural employee (AHR = 1.06, 95%, CI 1.05, 1.08), marriage below 15 years (AHR = 5.47, 95%, CI 5.37, 5.57) and 15-17 years (AHR = 3.27, 95%, CI 3.22, 3.32), had sex below 15 years (AHR =  = 1.57, 95%, CI 1.54, 1.61) and 15-17 years (AHR = 1.38, 95%, CI 1.38, 1.43), women who had unmet need for contraceptive (AHR = 1.39, 95%, CI 1.37, 1.42), and met need (AHR = 1.32, 95%, CI 1.30, 1.35), high spousal age gap (AHR = 1.17, 95%, CI 1.15, 1.19), not heard family planning message (AHR = 1.02, 95%, CI 1.01,1.04) were the higher hazard of early childbirth.Conclusion: The median age at first birth was found to be 19 years. This is lower than the optimal age for giving first birth, which is between late 20 s and early 30 s years. Rural residences, occupation, hearing family planning massage in the media, early sexual intercourse, early age at first marriage, high spousal gap, and unmet need for family planning were predictors of first birth at an early age. Thus, governments and non-governmental organizations should strive to implement programs that aim to reduce early age at first birth by considering these factors. [ABSTRACT FROM AUTHOR]

Background: Globally, millions of people of reproductive age experience infertility. With that notwithstanding, most infertile patients undergoing pharmacotherapy withdraw from treatment before achieving the desired outcome. The reasons for their withdrawal, particularly in sub-Saharan Africa, have not been well examined, hence the need for this study. Objectives: The aim of the study was to examine why infertile patients discontinue pharmacotherapy prior to achieving conception. Methods: The study employed an exploratory qualitative design. Purposive sampling technique was used to recruit subjects into the study. Twenty infertile patients (fourteen females and six males) who discontinued their treatment, and eight attending health professionals who provided direct care to these patients were interviewed. Telephone and face-to-face interviews were conducted using a semi-structured interview guide. The data collected were transcribed, coded, and generated into themes using thematic content analysis. Results: The major reasons for discontinuation of infertility treatment included lack of support from male partners, seeking alternative treatment, unmet outcome, poor medical services, distance, stigmatization, and relocation. Conclusions: Patients and healthcare personnel shared both similar and diverse views on reasons for discontinuation of infertility treatment that reflect situations in a typical African setting, most of which are not reported in existing studies. The outcome of this study will provide insight for fertility therapists and policy makers in designing appropriate measures to facilitate maximum compliance and improvement in treatment outcome. [ABSTRACT FROM AUTHOR]

The interplay between remarriage and fertility is among the most poorly documented subjects in sub-Saharan Africa (SSA), despite remarriage being one of the fundamental aspects of marriage dynamics in this region. We use Demographic and Health Survey data from 34 countries in SSA to document the association between remarriage and fertility during the reproductive years and over the fertility transition. The findings show that in 29 countries, remarried women end up having fewer children than women in intact unions, despite attaining similar or higher levels of fertility at early reproductive ages. However, remarriage is found to have a positive effect on fertility in Sierra Leone. The effects of remarriage on fertility diminish as fertility declines, with smaller effects generally observed in countries that are relatively advanced in their fertility transition and larger effects found elsewhere. These findings shed light on the role that remarriage might play in country-level fertility declines. [ABSTRACT FROM AUTHOR]

BACKGROUND In most societies, childbearing is largely confined to women in formal marital unions, but in a subset of contemporary low-fertility Western societies, extramarital fertility has become common. However, extramarital fertility is often ignored in fertility research in contemporary low- and middle-income countries (LMICs). OBJECTIVE To document recent levels, trends, and differentials in extramarital fertility (both premarital and postmarital) in LMICs. METHODS We employ Schoumaker's (2013) Stata program tfr2 to calculate two fertility measures from Demographic and Health Surveys in 63 countries: (1) the standard total fertility rate (TFR), which is based on all births in the three years before the survey date, and (2) the marital total fertility rate (MTFR), which is based on all births within marital unions in the three years before the survey date. The percentage of fertility that is extramarital (PEM) is estimated as 100 x (TFR-MTFR)/TFR. RESULTS The unweighted average PEM for the most recent surveys in the 63 DHS countries equals 11.3%, with 7.9% premarital and 3.4% postmarital. By far the highest percentage premarital is found in southern Africa (43%) and the lowest in Asia/North Africa (0.9%). Postmarital fertility is most common in sub-Saharan Africa and Latin America. CONCLUSIONS Childbearing outside of marriage is an important feature of contemporary reproductive regimes in sub-Saharan Africa and Latin America. By contrast, less than 2% of births are extramarital in most Asian and North African societies. CONTRIBUTION Extramarital fertility has social and economic consequences - for women, for their households, and for their children. We estimate, for the first time, the levels, trends, and differentials in both categories (premarital and postmarital) of extramarital fertility in LMICs. [ABSTRACT FROM AUTHOR]

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Lowering desired family size is a necessary precondition for fertility declines in high-fertility settings. Although accumulated evidence links socio-economic developments to changing fertility desires, little research has disentangled the relative importance of key socio-economic determinants. Combining individual- and community-level data from Demographic and Health Surveys in 34 sub-Saharan African (SSA) countries, we compare the relative role of different socio-economic factors on fertility desires at the individual, community, and country levels. Results show that at the individual level, women's education has a stronger effect than household wealth and area of residence. The high levels of reported desired family size in rural parts of SSA are mainly a consequence of relatively lower levels of education. The relative impact of women's education is even stronger at the community level. Our findings are robust to alternative measures of fertility preferences and strengthen previous findings regarding the relationship between fertility and women's education. [ABSTRACT FROM AUTHOR]

With the onset of the demographic transition in sub-Saharan Africa, couples' desired number of children and the sex composition of offspring may become conflicted, with potential effects on future fertility. While intuitively expected, this effect has not been observed in studies in sub-Saharan Africa, where the level of fertility is higher than in other African regions. In this study, the hypothesis of a conflicted situation was examined by assessing the effect of sex composition of offspring on women's intentions regarding additional children and their use of modern contraceptives. A mixed-method analysis was performed using quantitative data regarding 2567 women aged 35–49 years drawn from a 2012 Demtrend retrospective longitudinal population survey, supplemented by qualitative data collected through 23 in-depth interviews of men and women in Ouagadougou. Results showed that the absence of one sex (boy or girl) in the existing offspring was associated with additional demand for children and lower contraceptive use. These results suggest that a desire for a combination of both girls and boys may be the driving factor contributing to larger family size; that is, continued fertility may not be determined by son preference, but rather by overall composition of offspring, when existing children are all girls or all boys. This could explain the stalling of the fertility decline observed in recent years in Ouagadougou. [ABSTRACT FROM AUTHOR]

BACKGROUND Continued rapid population growth in sub-Saharan Africa is driven predominantly by high fertility. Contraceptive use was a key determinant of past fertility transitions. An analysis of this relationship in sub-Saharan Africa can yield a better understanding of the region's prospects for fertility decline. METHODS Using global estimates and projections, we describe trends in contraceptive use and fertility and analyse the relationship between the two. Timing, pace, and level parameters derived from Bayesian hierarchical models of historic contraceptive and fertility transitions are used to investigate how the experience of sub-Saharan Africa may be distinctive. RESULTS Fertility in sub-Saharan Africa fell from 6.4 births per woman in 1990 to 4.6 in 2020, the highest among regions today. Contraceptive use among married/in-union women in sub- Saharan Africa increased from 13% to 33% over the same period, and remains the region with lowest use. At all levels of contraceptive use, countries of sub-Saharan Africa tend towards higher fertility compared to other regions. Transitions in contraceptive use and fertility have occurred later in sub-Saharan Africa, and have been slower in Middle and Western Africa (but not Eastern and Southern Africa), compared to the experience of Asia, Latin America, and the Caribbean. CONTRIBUTION Based on an analysis using Bayesian models, we demonstrate large differences across countries in the pace and timing of fertility and contraceptive use transitions, and we confirm that Middle and Western Africa are distinct. The findings from these separate and independent models are similar, lending additional support to the validity of these conclusions. [ABSTRACT FROM AUTHOR]

BACKGROUND While overall fertility across Sub-Saharan Africa (SSA) is still high, fertility rates have been declining among educated and wealthier women in many countries since the 1970s. It is not clear whether, five decades later, consistently lower fertility among better-off women represents a distinct fertility regime among this subpopulation. OBJECTIVE To determine whether advantaged women (the best educated or wealthiest) in contemporary SSA have fertility characteristic of late (total fertility rate [TFR] 2.0-2.9) or mid-to-late (TFR 3.0-3.9) fertility transition levels. METHODS We use data from the Demographic and Health Surveys (DHS) to calculate TFR for better-off women using six educational and wealth categories in 27 countries in SSA. RESULTS Women with completed secondary education (11% of the full sample) across SSA have late (2.0--2.9) or mid-to-late (3.0--3.9) TFR in 25 out of 27 sample countries (with an average TFR of 3.2). While better-educated women in higher-fertility countries (TFR>5) have somewhat higher fertility than their counterparts in lower-fertility settings (TFR<5), there is convergence towards similarly low fertility among highly educated women within countries with TFR <5. CONCLUSIONS Better-educated women across SSA today have fertility rates nearing late transition levels. Their fertility is only partly associated with the overall country fertility. CONTRIBUTIONS The finding that women in the upper social group in most countries in SSA are nearing the end of the fertility transition shows a more complex picture of fertility decline across the region than is commonly assumed. It shifts attention to understanding the intragroup differentials and diffusion processes that will impact the future path of fertility declines in the region. [ABSTRACT FROM AUTHOR]

The underrepresentation of women in STEM is of interest to development practitioners as it contributes to untapped intellect and creativity, and lower investment in human capital. Studies assessing lower participation of women in STEM mainly conceptualise and explain reasons for women's underrepresentation based on data and experiences from the global north. Many of these studies highlight women's family care roles as a key factor behind their low participation in STEM fields. The objective of this paper is to empirically examine the effect of fertility on participation of African women in STEM. We use panel data on 18 Sub- Saharan African countries for the period 2000 to 2017, using the percentage share of female graduates of STEM from tertiary education to measure women's participation in STEM, and fertility rate and birth rate to measure fertility. Results show that fertility has a negative correlation with women's participation in STEM. Thus, we conclude that increasing women's participation in STEM requires policy interventions to aim at making STEM occupations more accommodating to those with family care responsibilities. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa (SSA) has a disproportionate burden of both unintended fertility and HIV infection, but the relationship between these two reproductive health risks is not well understood. This paper investigates the association between HIV status and unintended (mistimed and unwanted) fertility and examines multilevel predictors and national variations of unintended fertility among HIV-positive women across countries in SSA. Multilevel multinomial logistic regression models are applied to Demographic and Health Surveys data collected during 2006–2014 from 25 countries of SSA. Overall findings reveal that across countries of SSA, pregnancies of HIV-positive women are, on average, less likely to be mistimed (RR = 0.90, p < 0.05) but more likely to be unwanted (RR = 1.18, p < 0.05), rather than wanted, compared to pregnancies among HIV-negative counterparts with similar characteristics. Besides, knowledge of HIV status is associated with lower unintended fertility among HIV-negative, but not HIV-positive women. At country level, higher HIV prevalence and testing coverage are associated with higher mistimed and unwanted, rather than wanted fertility. Interaction effects suggest different effect sizes between HIV-positive and HIV-negative women: pregnancies among HIV-positive women are more likely than those among HIV-negative women to be unwanted rather than wanted among those who know their HIV status, are of older age, are married, have higher parity or reside in rural areas. The results further reveal notable country effects on unintended fertility, depicting regional variations that mirror HIV prevalence—being highest in Southern Africa and lowest in Western/Central Africa. [ABSTRACT FROM AUTHOR]

Background: A woman's ability to achieve her preferred family size is critical in addressing issues of high fertility in sub-Saharan Africa. The socio-cultural context in sub-Saharan Africa presents some difficulty for the attainment of preferred fertility for many women. Few studies in sub-Saharan Africa have examined the extent to which women are unable to achieve their preferred family sizes. This study, therefore, examines the factors that are associated with the non-attainment of women's preferred fertility by the end of their reproductive years. Data and methods: The study analyzed pooled cross-sectional data with a sub-sample of 1,888 currently married women aged 45–49 years from five rounds of the Ghana Demographic and Health Survey, 1993 to 2014. Test of associations and multinomial logistic regression analysis were used to examine the predictors of underachieved and overachieved fertility relative to achieved fertility. Results: The results indicate that 44 per cent of the women recorded overachieved fertility while about 36 per cent underachieved their fertility. Partner wants more, experiencing child loss and married more than once were significantly associated with overachieved fertility. Nonetheless, increased years of a woman's education and delaying her at first birth were negatively associated with overachieved fertility. On the other hand, underachieved fertility was significantly associated with having a partner with fewer fertility preference, being of the Islamic faith and ever use of modern contraception. Conclusion: Partner's fertility preference, child loss experience, marrying more than once and ever use of modern contraception were important predictors of a woman's inability to achieve her fertility preference. Policies to regulate men's fertility behaviour, delaying age at first birth, use of modern contraception, encouraging longer years of education, and reducing infant and child mortality are important strategies to achieve fertility preference in Ghana. [ABSTRACT FROM AUTHOR]

In Malawi, Africa, the median age at first marriage is among the lowest on the continent and adolescent fertility rates are among the highest. Using high‐frequency panel data from the country designed to follow single women and men into marriage, we examine the extent to which premarital fertility is associated with the timing of marriage. Two notable findings emerge. First, premarital fertility typically leads to a more rapid transition into marriage, compared to not having had a premarital conception or birth, and this effect is as strong for men as it is for women. Second, among women with premarital fertility, those who are wealthier, and those who have two parents alive, have lower odds of not marrying. Among men with premarital fertility, however, no patterns predict their subsequent marital outcomes. This study contributes to the literature on fertility and marriage in sub‐Saharan Africa by including men in the analysis. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to offer a descriptive overview of the stability and quality of marriages formed by women following premarital fertility in contemporary sub‐Saharan Africa. Background: Premarital sex and fertility rates are high in many sub‐Saharan African countries, yet we know little about how premarital childbirth, or even premarital conception, corresponds with women's subsequent marital outcomes. For instance, it is unknown whether premarital fertility is associated with forming unions that are less stable, polygynous, or more violent. Method: We analyze Demographic and Health Survey data for 25 sub‐Saharan African countries to describe women's marital experiences following a premarital pregnancy or premarital birth (relative to marital pregnancy and birth). We estimate country‐specific, two‐stage Heckman probit models to understand whether, conditional on having married, premarital pregnancy or premarital birth is associated with union instability, and among women currently married, polygyny and intimate partner violence. Results: In most countries, unions following a premarital pregnancy or premarital birth were less stable relative to unions in which pregnancy occurred only after marriage. Premarital births were also associated with a higher likelihood of entering a polygynous union, especially in West and Central African countries, as well as a greater likelihood of being in a physically violent union, particularly in East and Southern African countries. Conclusion: The associations between premarital fertility and women's subsequent marital experiences raise questions about the broader health and life course implications for the women and children involved. [ABSTRACT FROM AUTHOR]

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Data Project (ACLED) with data on fertility goals and outcomes from the Demographic and Health Surveys (n = 368,765 women aged 15–49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents' preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women's vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the second-order effects of organized violence on vulnerable populations. [ABSTRACT FROM AUTHOR]

Between the early 1950s and the present, the global fertility transition has been nearly universal in the developing world. However, as of 2017, two countries out of the 190 countries for which the United Nations provides fertility estimates had not yet met the conventional criterion for establishing the onset of the fertility transition (a decline of at least 10 per cent from peak fertility), and another five countries did so only very recently. These are the laggards in the global fertility transition. The countries are all in sub-Saharan Africa: Chad, the Democratic Republic of the Congo, Equatorial Guinea, The Gambia, Mali, Niger, and Somalia. This paper first reviews the fertility history of these seven countries, and subsequently provides data on the timing and pace of the global fertility transition in the four major developing regions: Asia, Latin America and the Caribbean, Northern Africa, and sub-Saharan Africa. It then explores potential reasons for the slow emergence of fertility decline in each country. The paper concludes with a discussion of each country’s prospects for fertility decline, which generally are weaker than those in the projections of the United Nations. [ABSTRACT FROM AUTHOR]

This paper is based on a study that examined the influence of spousal and household characteristics on fertility of married women in sub-Saharan Africa (SSA). It utilized data from Demographic and Health Survey (DHS) from four countries between 2010 and 2015. Fertility was measured by the number of Children Ever Born (CEB). Descriptive and Poisson regression techniques were used for analysis. Results showed variation in the mean number of CEB across categories of spousal and household characteristics and across the countries. The Poisson regression analysis showed that while spousal age and age at marriage influenced fertility similarly across the countries, spousal educational attainment and household characteristics influenced fertility differently across the countries. The study concludes that, although some disparities exist in the way spousal and household characteristics influence fertility across sub-Saharan Africa, these characteristics cannot be overlooked in driving sustainable fertility transition in the region. [ABSTRACT FROM AUTHOR]

The article discusses the hypothesis on African transitions and fertility inequality: Topics include family views regarding childbearing, demographic decomposition that results into social change, and changes in population composition. Several charts on fertility decline and fertility inequality are presented.

The article talks about the use of contraceptive drugs in sub-Saharan Africa (SSA). It also discusses its impact on ethnic clustering, population diversity and growth. Topics include economic conditions of SSA, increase in the age of marriage for women, and the need to overcome strong cultural resistance to family planning.

The article discusses the fertility desires and course of fertility decline in sub-Saharan Africa. It states that the social science and demographic literature on family planning is not as progressed as the literature on birth spacing. It highlights the unmet need for contraceptive drugs and the low demand for contraception.

An introduction is presented in which discusses the prospects of fertility decline and fertility transition, focusing on the overview of the demography in sub-Saharan Africa.

An introduction is presented in which the author talks about the special issue which focuses on fertility in sub-Saharan Africa through population and demographic change.

The article discusses the contemporary use of traditional contraception in sub-Saharan Africa. It talks about the role of alternative means of birth control and periods of sexual abstinence or inactivity. Topics include socioeconomic development, fertility transition, and constraints imposed on sexual intercourse.

The article discusses the effect of fertility decline on economic growth in sub-Saharan Africa. It states that decline in promotes changes in behavior that can lead to higher income and higher labor force participation rates for women. Topics include improved health outcomes for children, change in the population age structure, and increase in contraceptive use and expansion in family planning programs.

The article discusses the challenges posed by the demographic change in sub-Saharan Africa. It talks about the economic growth and the trending annual real gross domestic product (GDP). Topics include falling fertility, declining dependency ratios, and population pressure on human capital formation.

Demographic research in sub-Saharan Africa (SSA) has long relied on a blunt urban/rural dichotomy that may obscure important inter-urban fertility and mortality differentials. This paper uses Demographic and Health Survey (DHS) geo-referenced data to look beyond the simple urban/rural division by spatially locating survey clusters along an urban continuum and producing estimates of fertility and child mortality by four city size categories in West Africa. Results show a gradient in urban characteristics and demographic outcomes: the largest cities are the most advantaged and smaller cities least advantaged with respect to access to urban amenities, lower fertility and under-5 survival rates. There is a difference in the patterns of fertility and under-5 survival across urban categories, with fertility more linearly associated with city size while the only significant distinction for under-5 survival in urban areas is broadly between the larger and smaller cities. Notably, the small urban 'satellite cities' that are adjacent to the largest cities have the most favourable outcomes of all categories. Although smaller urban areas have significantly lower fertility and child mortality than rural areas, in some cases this difference is nearly as large between the smallest and largest urban areas. These results are used to argue for the need to give greater consideration to employing an urban continuum in demographic research. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Summary Women’s employment is considered essential for gender equality and female empowerment, as well as for the living standard, dependency burden, and saving patterns of households in poor countries. To develop effective policies, it is important to know whether mothers with young children who are not gainfully employed prefer to be at home and care for their children, or are involuntarily out of the labor force, because they could not prevent getting those children. In this study having twins is used as the external shock due to which some women have obtained more children than they wanted. These women are compared with those who are similar in many respects (married and have at least one child) but did not experience this shock. We use a newly constructed database that contains information on almost 250,000 women living in Sub-Saharan Africa of whom 4,863 women, or about 2%, reported a twin birth of which both children survived. To our knowledge, the present study has the highest number of twins of any Instrumental Variables study that uses twins for estimating causal effects, so that the estimates are very precise. We find that the number of children below age six has a significantly negative effect on the woman’s ability to work in the non-farm sector; it reduces the odds of employment of African mothers by 6%. The effects of the number of young children on women’s non-farm work are more problematic for older women and for women with more years of education. These findings imply that investments in family planning are likely to enhance the opportunities for women to work for pay and that policies aimed at facilitating the combination of child rearing and paid labor are particularly important for educated and older women. [ABSTRACT FROM AUTHOR]

Objective: Understanding the fertility of HIV-positive women is critical to estimating HIV epidemic trends from surveillance data and to planning resource needs and coverage of prevention of mother-to-child transmission services in sub-Saharan Africa. In the light of the considerable scale-up in antiretroviral therapy (ART) coverage over the last decade, we conducted a systematic review of the impact of ART on the fertility outcomes of HIV-positive women.Methods: We searched Medline, Embase, Popline, PubMed and African Index Medicus. Studies were included if they were conducted in sub-Saharan Africa and provided estimates of fertility outcomes (live births or pregnancies) among women on ART relative to a comparison group.Results: Of 2070 unique references, 18 published papers met all eligibility criteria. Comparisons fell into four categories: fertility of HIV-positive women relative to HIV-negative women; fertility of HIV-positive women on ART compared to those not yet on ART; fertility differences by duration on ART; and temporal trends in fertility among HIV-positive women. Evidence indicates that fertility increases after approximately the first year on ART and that while the fertility deficit of HIV-positive women is shrinking, their fertility remains below that of HIV-negative women. These findings, however, were based on limited data mostly during the period 2005-2010 when ART scaled up.Conclusions: Existing data are insufficient to characterise how ART has affected the fertility of HIV-positive women in sub-Saharan Africa. Improving evidence about fertility among women on ART is an urgent priority for planning HIV resource needs and understanding HIV epidemic trends. Alternative data sources such as antenatal clinic data, general population cohorts and population-based surveys can be harnessed to understand the issue. [ABSTRACT FROM AUTHOR]

This paper proposes a new method to infer gender preferences from birth spacing. We apply it to Africa, where the least is known about gender preferences. We show that son preference is strong and increasing in North Africa. By contrast, most Sub-Saharan African countries display a preference for variety or no preference at all. Further analysis concludes that traditional family systems predict well the nature of gender preferences, while religion does not. Last, the magnitude of preferences is stronger for wealthier and more educated women. [ABSTRACT FROM AUTHOR]

Globally, the percentage of married fecund women with unmet need--who use no contraceptive method despite wishing to avoid childbearing for two years or more--fell from 22% in 1970 to 12% in 2010. Substantial health, economic and environmental, and demographic benefits have resulted from this change. Promotion of contraception is one of the great success stories of the past 50 years. However, unmet need remains high in sub-Saharan Africa, at 25%, because of insufficient knowledge of methods, social opposition, and fear of health effects. In addition to obvious factors such as political commitment and adequate funding, success in this region will require improvement in continuation of use and the range of available methods. [ABSTRACT FROM AUTHOR]

This article uses the Uganda Demographic and Health Survey (2006), which links an individual woman’s fertility outcomes to her education level. Thus, in this study, an attempt has been made to investigate the relationships between women’s education, contraceptive use, and fertility rates in Uganda. The findings indicate that women’s education and social–economic factors are important in explaining reproductive behavior. Fertility findings show that higher education levels are consistently associated with lower fertility rates and positively associated with contraceptive use. The major implication of these results is that raising women’s education improves their economic opportunities, and the behavioral responses in fertility will lead to the decline in population by reducing the willingness to engage in unprotected sex and subsequent fall in fertility. [ABSTRACT FROM AUTHOR]

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Child mortality rates have fallen substantially in developing countries since 1960. The expected fertility decline has followed only weakly in sub-Saharan Africa compared to other recent and historic demographic transitions. Disease and anthropometric data suggest that morbidity remains prevalent in Africa despite child survival improvements. The uniquely high infectious disease burden among children in Africa reduces population health and diminishes the returns to human capital investment, thwarting the quantity-quality tradeoff for children that typically accompanies the mortality transition. Individual-level data from the Demographic and Health Surveys are used to show that persistent morbidity has weakened the positive relationship between child mortality and total fertility rates throughout the region, slowing Africa's demographic transition. [ABSTRACT FROM AUTHOR]

Background High fertility and wide inequality in wealth distribution are phenomenal problems in sub- Saharan Africa. Modern Contraceptives (MC) are useful for limiting fertility, but are not always easily accessible in Malawi. This study examines the gap in MC use and fertility between women in the richest and poorest Wealth Quintile (WQ). Methods The study was cross-sectional in design and utilized Malawi DHS dataset, 2010. It focused on women of reproductive age. The dependent variables are ever and current use of MC. Chisquare and multinomial logistic regression were used for the analysis. Results Mean children ever born by women in the poorest and richest WQs were 3.94 ± 2.7 and 2.82 ± 2.3 respectively (p < 0.001). The adjusted total fertility rate (Adj.TFR) was higher among women in the poorest (Adj.TFR = 7.60) WQ than the richest (Adj.TFR = 4.45). The prevalence of ever use of MC was higher among women in the richest WQ (82.4%) than the poorest (66.8%) (p < 0.001). Similar pattern exists for current use of MC; 58.5% and 45.9% for women in the richest and poorest WQs respectively (p < 0.001). Women in the richest WQ were more likely to ever use (OR = 2.36; C.I = 2.07-2.69, p < 0.001) and currently using (OR = 1.66; C.I = 1.40-1.97, p < 0.001) MC than their counterparts in the poorest WQ. Slight reduction in odd-ratio of MC use among women in richest WQ resulted when sociodemographic variables were used as control. Conclusion Fertility was higher and the use of MC was lower among women in the poorest than their counterparts in the richest WQ. Ensuring availability of MC at little or no cost may bridge the gap in contraceptive use between women in the poorest and richest WQ in Malawi. [ABSTRACT FROM AUTHOR]

The contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15–19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan–Meier estimates and Cox regression models. About 15% of these adolescents have had a child. The findings show that marriage, being out of school and having negative models in peer, family and school contexts are associated with early childbearing among females aged 15–17 years. For adolescents aged 18–19 years, school attendance considerably delays entry into motherhood while marriage hastens its timing. Furthermore, older adolescents with high levels of social controls (parental monitoring or perceived peer orientation to or approval of prosocial behaviours) and individual controls (high religiosity and positive orientation to schooling) are likely to delay childbearing. Programmes aiming to reduce risky sexual behaviours that could lead to childbearing among adolescents should be introduced very early, and before the onset of sexual activity. Also, the findings underscore the need to identify and address the risky factors and reinforce the protective ones in order to improve sexual and reproductive health outcomes of adolescent girls in Nairobi slum settlements. [ABSTRACT FROM AUTHOR]

Marriage has traditionally been early and universal in sub-Saharan Africa and this has been blamed for high fertility and the failure to achieve most MDGs including the eradication of extreme poverty and hunger, achieving the goal of universal primary education, promotion of gender equality and empowerment of women, reduction of childhood mortality, improvement in quality of maternal health, and combating HIV and AIDS and other diseases. The paper used the 2006 Uganda Demographic and Health Survey and the 2003 South African Demographic and Health Survey data to investigate the hypothesis that ethnicity has a significant effect on age at first marriage even after controlling for the effects of other socio-demographic covariates. The Cox proportional hazard model was used to analyze the data. The study found that the Median Age at First Marriage (MAFM) was 19 years in Uganda and 29 years in South Africa, and that ethnicity had a significant effect on age at first marriage in both countries. Other factors with significant effects, through which ethnicity may have influenced age at first marriage were region, level of education and age at sexual debut. The paper concludes that marriage is early and universal in Uganda, while it is delayed in South Africa, suggesting that the two countries belong to different nuptuality regimes, this is arising from apparent differences in education and empowerment of women. [ABSTRACT FROM AUTHOR]

BACKGROUND The age at which childbearing begins influences the total number of children a woman bears throughout her reproductive period, in the absence of any active fertility control. For countries in sub-Saharan Africa where contraceptive prevalence rate is still low, younger ages at first birth tend to increase the number of children a woman will have thereby hindering the process of fertility decline. Research has also shown that early childbearing can endanger the health of the mother and her offspring, which can in turn lead to high child and maternal mortality. OBJECTIVES In this paper, an attempt was made to explore possible trends, geographical variation and determinants of timing of first birth in Nigeria, using the 1999 - 2008 Nigeria Demographic and Health Survey data sets. METHODS A structured additive survival model for continuous time data, an approach that simultaneously estimates the nonlinear effect of metrical covariates, fixed effects, spatial effects and smoothing parameters within a Bayesian context in one step is employed for all estimations. All analyses were carried out using BayesX -- a software package for Bayesian modelling techniques. RESULTS Results from this paper reveal that variation in age at first birth in Nigeria is determined more by individual household than by community, and that substantial geographical variations in timing of first birth also exist. COMMENTS These findings can guide policymakers in identifying states or districts that are associated with significant risk of early childbirth, which can in turn be used in designing effective strategies and in decision making. These findings can also point in the direction of effective utilisation of scarce resources: a major challenge to those effecting interventions in developing countries. [ABSTRACT FROM AUTHOR]

BACKGROUND There has been much concern about adverse individual and societal consequences of high fertility in sub-Saharan Africa. One concern is that children of high birth orders may have low birth weight. However, the evidence for such an effect is not strong. OBJECTIVE Our objective is to investigate whether a woman's high parity status might increase her risks of having a baby with low birth weight. METHODS Pooling 60 Demographic and Health Surveys data-sets from 32 sub-Saharan countries, we selected children of mothers who had at least two births of order two or higher within the five years preceding the surveys. We modeled the probability of having a child with low birth weight and controlled for all mother-specific, household, or community characteristics that are constant over the period of analysis, by including fixed-effects for the mother. We also controlled for salient factors including sex, maternal age, preceding birth interval, and whether prenatal care was received. RESULTS We found no adverse effect of increasing parity on the odds of having a child with low birth weight at normative ranges; such effects only manifest at extremely high parities - nine or more children. At moderately high parities, the chance of low birth weight is actually lower than at very low parities. CONCLUSIONS While high fertility may lead to various adverse outcomes for African families, low birth weight appears not to be among these outcomes. Other factors, such as adolescent childbearing, poverty, and inadequate prenatal care may be more important determinants of low birth weight in Africa. [ABSTRACT FROM AUTHOR]

BACKGROUND Earlier investigations have shown associations between a woman's chance of having a child, or various proximate determinants of her fertility, and the socioeconomic resources in the community in which she lives, net of her own resources. OBJECTIVES AND METHODS This study, which is based on DHS surveys from 28 countries in sub-Saharan Africa, adds to the knowledge about this issue. With a focus on first- and higher-order birth rates, four specific questions are addressed. RESULTS AND CONCLUSIONS One result is that the negative associations between a woman's birth rate and the average education in the census enumeration area in which she lives, net of her own education, have remained stable or become stronger over the last decade. Second, these associations are most pronounced among women who score high on indicators of socioeconomic development which suggests that they may become further strengthened. Third, associations even appear when a fixed-effects approach -- based on data from two DHS surveys with GPS coordinates in each country -- is employed to control for unobserved constant characteristics of units at a slightly higher level than the census enumeration area. Fourth, local processes seem to be particularly important: education among women in the province or nearest census enumeration areas is not inversely associated with fertility. [ABSTRACT FROM AUTHOR]

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