肯尼亚已婚女性 2003 年至 2014 年间终生生育率下降的趋势和相关因素：肯尼亚人口健康调查分析。

Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys.

机构信息

Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.

Department of Population Health, Aga Khan University, Nairobi, Kenya.

出版信息

BMC Public Health. 2023 Apr 20;23(1):718. doi: 10.1186/s12889-023-15620-z.

DOI:10.1186/s12889-023-15620-z

PMID:37081486

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10116796/

Abstract

BACKGROUND

Globally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014.

METHODS

The study used the Kenya Demographic and Health Survey (KDHS) datasets of 2003, 2008 and 2014. Analysis of variance (ANOVA) was used to calculate the mean number of children ever born and to assess the change in fertility across different factors. Poisson regression model with robust standard errors was used to study the relationship between number of children ever born (lifetime fertility) and independent variables. A Poisson-based multivariate decomposition for the nonlinear response model was performed to identify and quantify the contribution of demographic, socioeconomic and reproductive correlates, to the change in lifetime fertility between 2003 and 2014.

RESULTS

The study included 3,917, 4,002, and 7,332 weighted samples of women of reproductive age in 2003, 2008, and 2014, respectively. The mean number of children born declined from 3.8 (95% CI: 3.6-3.9) in 2003 to 3.5 (95% CI: 3.4--3.7) in 2008 and 3.4 (95% CI: 3.3-3.4) in 2014 (p = 0.001). The expected number of children reduced with the age at first sexual intercourse, the age at first marriage across the survey years, and household wealth index. Women who had lost one or more children in the past were likely to have increased number of children. The changes in the effects of women's characteristics between the surveys explained 96.4% of the decline. The main contributors to the change in lifetime fertility was the different in women level of education.

CONCLUSION

The lifetime fertility declined by one-tenth between 2003 and 2014; majorly as a result of the effects of characteristics of women in terms of level of education. These highlights a need to implement education policies that promotes women education focuses on gender equality and women empowerment. Continuous strengthening of the healthcare systems (access to quality antenatal care, skilled delivery, and postpartum care) to reduce child mortality is essential.

摘要

背景

在过去的三十年中，全球生育率有所下降。在撒哈拉以南非洲地区，包括肯尼亚在内，这种下降的开始时间较晚，而且速度比其他地区慢。尽管肯尼亚的生育率显著下降，但在不同地区之间仍存在差异。降低终生生育率对母婴健康都有好处，因此，提高与高生育率相关的妇女和儿童健康结果非常重要。因此，本研究评估了 2003 年至 2014 年间肯尼亚育龄已婚妇女终生生育率变化的相关因素。

方法

本研究使用了 2003 年、2008 年和 2014 年肯尼亚人口与健康调查（KDHS）数据集。方差分析（ANOVA）用于计算生育子女总数，并评估不同因素对生育率变化的影响。使用具有稳健标准误差的泊松回归模型来研究生育子女总数（终生生育率）与自变量之间的关系。采用基于泊松的非线性响应模型的多变量分解，以确定和量化人口、社会经济和生殖相关因素对 2003 年至 2014 年终生生育率变化的贡献。

结果

本研究纳入了 2003 年、2008 年和 2014 年分别有 3917、4002 和 7332 名育龄妇女的加权样本。2003 年生育子女的平均数量为 3.8（95%置信区间：3.6-3.9），到 2008 年下降到 3.5（95%置信区间：3.4-3.7），到 2014 年下降到 3.4（95%置信区间：3.3-3.4）（p=0.001）。首次性行为的年龄、首次婚姻的年龄和家庭财富指数都随着年龄的增长而降低。在过去失去过一个或多个孩子的妇女更有可能生育更多的孩子。调查期间妇女特征变化的影响变化解释了终生生育率下降的 96.4%。导致终生生育率变化的主要因素是妇女教育水平的差异。