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
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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.
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Since 2007 there have been decreases in the prevalence of P. falciparum and P. vivax, as well as global fertility rates, although absolute populations have grown at regional and global levels.
“Since 2007 there have been decreases in the prevalence of P. falciparum [12] and P. vivax [19], as well as global fertility rates [21, 22], although absolute populations have grown at regional and global levels.”
From Global estimates of pregnancies at risk of Plasmodium falciparum and Plasmodium vivax infection in 2020 and changes in risk patterns since 2000 (2022) · cites this paper as [21]
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Cites
Transforming Our World: The 2030 Agenda for Sustainable Development
Desa, U. (2018) · Springer Publishing Company eBooks · doi:10.1891/9780826190123.ap02 · Cited by 19,434 · see citing works
Local Spatial Autocorrelation Statistics: Distributional Issues and an Application
Ord, J., & Getis, A. (2010) · Geographical Analysis · doi:10.1111/j.1538-4632.1995.tb00912.x · Cited by 3,365 · see citing works
Family planning: the unfinished agenda
Cleland, J., Bernstein, S., Ezeh, A., Faúndes, A., Glasier, A. F., & Innis, J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69480-4 · Cited by 1,275 · see citing works
Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review.
Dahab, R., & Sakellariou, D. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17124292 · Cited by 335 · see citing works
Sedgh, G., Ashford, L. S., & Hussain, R. (2016) · Cited by 278 · see citing works
Demographic, socio-economic, and cultural factors affecting fertility differentials in Nepal.
Adhikari, R. (2010) · BMC Pregnancy and Childbirth · doi:10.1186/1471-2393-10-19 · Cited by 216 · see citing works
Bongaarts, J. (2020) · Genus · doi:10.1186/s41118-020-00098-z · Cited by 182 · see citing works
Population, poverty and economic development
Sinding, S. W. (2009) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2009.0145 · Cited by 165 · see citing works
Modeling the fertility impact of the proximate determinants: Time for a tune-up
Bongaarts, J. (2015) · Demographic Research · doi:10.4054/demres.2015.33.19 · Cited by 145 · see citing works
Can Family Planning Programs Reduce High Desired Family Size in Sub-Saharan Africa?
Bongaarts, J. (2011) · International Perspectives on Sexual and Reproductive Health · doi:10.1363/3720911 · Cited by 143 · see citing works
Alam, N., Hajizadeh, M., Dumont, A., & Fournier, P. F. (2015) · PLoS ONE · doi:10.1371/journal.pone.0120922 · Cited by 139 · see citing works
The causes of educational differences in fertility in Sub-Saharan Africa
Bongaarts, J. (2010) · Vienna Yearbook of Population Research · doi:10.1553/populationyearbook2010s31 · Cited by 132 · see citing works
Spatial Patterns of Fertility Transition in Indian Districts
Guilmoto, C. Z., & Rajan, S. I. (2001) · Population and Development Review · doi:10.1111/j.1728-4457.2001.00713.x · Cited by 128 · see citing works
AFRICA'S PROSPECTS FOR ENJOYING A DEMOGRAPHIC DIVIDEND
Bloom, D. E., Kuhn, M., & Prettner, K. (2017) · Journal of Demographic Economics · doi:10.1017/dem.2016.19 · Cited by 103 · see citing works
Spatial patterns and determinants of fertility levels among women of childbearing age in Nigeria
Alaba, O. O., Olubusoye, O. E., & Olaomi, J. (2017) · South African Family Practice · doi:10.1080/20786190.2017.1292693 · Cited by 62 · see citing works
Geographical variations in fertility and transition to second and third birth in Britain
Fiori, F., Graham, E., & Feng, Z. (2013) · Advances in Life Course Research · doi:10.1016/j.alcr.2013.11.004 · Cited by 54 · see citing works
Zika Virus: Implications for Public Health
Focosi, D., Maggi, F., & Pistello, M. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw210 · Cited by 47 · see citing works
Finlay, J. E., Mejía‐Guevara, I., & Akachi, Y. (2018) · PLoS ONE · doi:10.1371/journal.pone.0203344 · Cited by 45 · see citing works
Family Planning and Fertility Decline in Africa: From 1950 to 2010
Garenne, M. (2018) · InTech eBooks · doi:10.5772/intechopen.71029 · Cited by 32 · see citing works
Gridded birth and pregnancy datasets for Africa, Latin America and the Caribbean
James, W. H. M., Tejedor‐Garavito, N., Hanspal, S. E., Campbell-Sutton, A., Hornby, G., Pezzulo, C., Nilsen, K., Sorichetta, A., Ruktanonchai, C. W., Carioli, A., et al. (2018) · Scientific Data · doi:10.1038/sdata.2018.90 · Cited by 27 · see citing works
Self-citationAfrica’s Prospects for Enjoying a Demographic Dividend
Bloom, D. E., Kühn, M., & Klaus Prettner, A. (2016) · National Bureau of Economic Research · doi:10.3386/w22560 · Cited by 20 · see citing works
Spatial correlation and demography : explorating India's demographic patterns
Oliveau, S., & Guilmoto, C. Z. (2005) · Cited by 12 · see citing works
What Works in Family Planning Interventions in Sub-saharan Africa: A Scoping Review
Yarinbab, T. E., Getachew, S., Kassa, S., et al. (2019) · Journal of Women s Health Care · doi:10.35248/2167-0420.19.8.471 · Cited by 6 · see citing works
Long term Trajectories of fertility and contraceptive use
Pullum, T. W., & Assaf, S. (2016) · Cited by 3 · see citing works
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Gore-Langton, G. R., Cano, J., Simpson, H., Tatem, A., Tejedor-Garavito, N., Wigley, A., Carioli, A., Gething, P., Weiss, D. J., Chandramohan, D., et al. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001061 · Cited by 30 · see citing works
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- Authors
- Pezzulo, C., Nilsen, K., Carioli, A., Tejedor-Garavito, N., Hanspal, S. E., Hilber, T., James, W. H. M., Ruktanonchai, C. W., Alegana, V., Sorichetta, A., Wigley, A. S., Hornby, G. M., Matthews, Z., & Tatem, A. J.
- Affiliations
- University of Southampton (GB)
- Freie Universität Berlin (DE)
- University of Leeds (GB)
- John Radcliffe Hospital (GB)
- Corresponding author
- Pezzulo, Carla
- ORCID
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2021-06
- Volume
- 9
- Issue
- 6
- Pages
- e802-e812
- ISSN
- 2214-109X (ISSN-L)
- PMC
- PMC8149299
- OpenAlex
- W3163221912
- Cited by
- 57
- References
- 24
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 17 · 2023: 8 · 2022: 17 · 2021: 1
- FWCI
- 9.29
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VTechWorks (Virginia Tech) (submittedVersion, cc-by)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver (cc-by)
- Greater South Information System
- Funders
- Bill and Melinda Gates Foundation (211208, INV-007594)
- Wellcome Trust (204613/Z/16/Z)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Gender Studies › Demographic Trends and Gender Preferences
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- fertility rate, subnational variation, age-specific fertility, total fertility rate, spatial autocorrelation, spatial cluster analysis, contraceptive use, unmet need for family planning, women's secondary education, low-income countries, middle-income countries, fertility determinants
- MeSH terms
- Birth Rate, Cross-Sectional Studies, Developing Countries, Geography, Humans, Developed Countries
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