Bwalya Bwalya Bupe, Odimegwu Clifford
Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia.
Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of Witwatersrand, Johannesburg, South Africa.
PLOS Glob Public Health. 2025 Jan 8;5(1):e0004088. doi: 10.1371/journal.pgph.0004088. eCollection 2025.
Despite national efforts and a decrease in total fertility rate, Zambia's fertility remains high compared to global and regional averages. While previous research has examined the influence of bio-demographic and socio-economic factors, it has neglected the role of overlooked intermediate variables such as age at first marriage, contraception use, and abortion. This study investigated the influence of these variables, while controlling for bio-demographic and socio-economic factors, on women's fertility behaviour in Zambia. The study drew upon data from three cross-sectional Zambia Demographic Health Surveys (2007, 2013-14, 2018) to investigate fertility behaviour among 18,299 married women, measured by the number of children ever born (CEB). Descriptive and inferential statistical analyses, including Analysis of Variance and Negative Binomial regression, were conducted using Stata 14.2 to identify factors associated with women's fertility behaviour. The regression results are presented as adjusted incidence rate ratios with confidence intervals. Married Zambian women's fertility behaviours, as measured by CEB are concerning, and exhibit patterns influenced by intermediate factors like age at first marriage and abortion. Early marriage, specifically before the age of 18, is associated with higher likelihood of having more CEB than those who married at 18 years or above (AIRR = 1.10, 95% CI: 1.07-1.14 in 2007; AIRR = 1.10, 95% CI: 1.10-1.12 in 2013; and AIRR = 1.07, 95% CI: 1.05-1.10). Conversely, married women who reported having had an abortion were more likely to have fewer CEB. In 2018, women with a history of abortion had lower likelihood of higher CEB compared to those without (AIRR = 0.94, 95% CI: 0.91-0.97). Besides, demographic and socio-economic factors such as age, education level, geographic location, and decision-making autonomy were found to significantly impact women's fertility behaviour. This study shows that the two intermediate variables of age at first marriage and a history of prior abortion are more influential on women fertility behaviour than contraception among married women in Zambia. To effectively address stalled fertility and improve women's reproductive health, policies should address early marriage, enhance access to sexual reproductive healthcare, and empower women to enable them make informed reproductive decision-making.
尽管国家做出了努力，且总生育率有所下降，但与全球和地区平均水平相比，赞比亚的生育率仍然很高。虽然先前的研究考察了生物人口学和社会经济因素的影响，但却忽视了一些被忽视的中间变量的作用，如初婚年龄、避孕措施的使用和堕胎。本研究在控制生物人口学和社会经济因素的同时，调查了这些变量对赞比亚女性生育行为的影响。该研究利用了三次赞比亚人口与健康横断面调查（2007年、2013 - 2014年、2018年）的数据，以调查18299名已婚女性的生育行为，生育行为通过曾生育子女数（CEB）来衡量。使用Stata 14.2进行了描述性和推断性统计分析，包括方差分析和负二项回归，以确定与女性生育行为相关的因素。回归结果以调整后的发病率比值及置信区间呈现。以CEB衡量的赞比亚已婚女性的生育行为令人担忧，并且呈现出受初婚年龄和堕胎等中间因素影响的模式。早婚，特别是18岁之前结婚，与生育更多CEB的可能性较高相关，相比那些18岁及以上结婚的女性（2007年的发病率比值比 = 1.10，95%置信区间：1.07 - 1.14；2013年的发病率比值比 = 1.10，95%置信区间：1.10 - 1.12；2018年的发病率比值比 = 1.07，95%置信区间：1.05 - 1.10）。相反，报告有过堕胎经历的已婚女性生育CEB较少的可能性更大。在2018年，有堕胎史的女性生育较高CEB的可能性低于没有堕胎史的女性（发病率比值比 = 0.94，95%置信区间：0.91 - 0.97）。此外，年龄、教育水平、地理位置和决策自主权等人口学和社会经济因素被发现对女性的生育行为有显著影响。本研究表明，在赞比亚已婚女性中，初婚年龄和既往堕胎史这两个中间变量对女性生育行为的影响比避孕措施更大。为了有效解决生育率停滞问题并改善女性的生殖健康，政策应解决早婚问题，增加获得性生殖健康护理的机会，并赋予女性权力，使她们能够做出明智的生殖决策。
