Asresie Melash Belachew, Ekholuenetale Michael, Ahmed Kedir Y, Mistry Sabuj Kanti, Chandio Navira, Agho Kingsley, Fekadu Gedefaw Abeje, Arora Amit
Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Facility of Science and Health, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom.
PLoS One. 2024 Dec 31;19(12):e0313028. doi: 10.1371/journal.pone.0313028. eCollection 2024.
High-risk fertility behaviors (HRFB), including short birth intervals, early or late childbearing age, and high parity, are associated with adverse pregnancy outcomes. Understanding the importance of socioeconomic disparity in HRFB and the factors influencing this disparity is essential to improve maternal and child survival, Accordingly, this study investigated socioeconomic inequalities in HRFB over time and its contributing factors.
We included a total weighted sample of 11,163 and 5,527 women aged 15 to 49 years from the 2005 and 2019 Ethiopia Demographic and Health Surveys, respectively. Erreygers Concentration index (ECI) and curve, along with Erreygers normalized decomposition analysis, were used to examine socioeconomic-related inequalities in HFRB and identify contributing factors to these inequalities.
The study showed that the concentration curve for HFRB remained above the equality line over time, indicating a disproportionate concentration among socioeconomically disadvantaged individuals. In 2005, the pro-poor ECI was -0.0682; in 2019, it was -0.2634, indicating that pro-poor inequality has widened. Educational status (10% in 2005 and 28% in 2019), place of birth (7% in 2005 and 28% in 2019), religion (16% in 2005 and 4% in 2019), and region (9% in 2005 and 3% in 2019) contributed to the observed pro-poor inequality. In 2019, contraceptive use (12%) and wealth index (15%) emerged as additional factors explaining HRFB inequality.
Our findings revealed the disproportional concentration of HRFB among socioeconomically disadvantaged women in Ethiopia, with a widening disparity between 2005 and 2019. Future interventions to address the effect of socioeconomic disadvantage on HRFB should prioritize women with low or no formal education, those who give birth at home, and those who do not use contraceptives.
高风险生育行为（HRFB），包括生育间隔短、生育年龄过早或过晚以及多胎次，与不良妊娠结局相关。了解社会经济差异在高风险生育行为中的重要性以及影响这种差异的因素对于提高母婴存活率至关重要。因此，本研究调查了高风险生育行为随时间的社会经济不平等及其影响因素。
我们分别纳入了来自2005年和2019年埃塞俄比亚人口与健康调查的11163名和5527名年龄在15至49岁之间的女性加权样本。使用埃雷格斯集中度指数（ECI）和曲线以及埃雷格斯归一化分解分析来研究高风险生育行为中与社会经济相关的不平等，并确定这些不平等的影响因素。
研究表明，高风险生育行为的集中度曲线随时间一直高于平等线，这表明在社会经济弱势个体中存在不成比例的集中现象。2005年，有利于穷人的埃雷格斯集中度指数为-0.0682；2019年为-0.2634，表明有利于穷人的不平等现象有所加剧。教育状况（2005年为10%，2019年为28%）、出生地（2005年为7%，2019年为28%）、宗教信仰（2005年为16%，2019年为4%）和地区（2005年为9%，2019年为3%）导致了观察到的有利于穷人的不平等现象。2019年，避孕措施的使用（12%）和财富指数（15%）成为解释高风险生育行为不平等的额外因素。
我们的研究结果揭示了埃塞俄比亚社会经济弱势女性中高风险生育行为的不成比例集中现象，且2005年至2019年间差距不断扩大。未来旨在解决社会经济劣势对高风险生育行为影响的干预措施应优先考虑未接受过正规教育或接受正规教育程度低的女性、在家分娩的女性以及未使用避孕措施的女性。
