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Dadzie LK, Yengnone H, Frimpong JB, Agbaglo E, Seidu AA, Ahinkorah BO. Association between women's empowerment and fertility preferences in Ghana. Int Health 2024; 16:512-522. [PMID: 38850069 PMCID: PMC11375584 DOI: 10.1093/inthealth/ihae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/16/2023] [Accepted: 05/14/2024] [Indexed: 06/09/2024] Open
Abstract
As Ghana has embraced the concept of women's empowerment as a vital tool for sustainable development, it has become crucial to evaluate the role that women's empowerment plays in the fertility preferences of married and cohabiting women in the country. The study's objective was to examine the association between women's empowerment, the ideal number of children and women's ability to have their desired number of children. This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Both Poisson and binary logistic regression analyses were carried out. Women who had justification for wife-beating (incidence rate ratio [IRR] 0.98 [95% confidence interval {CI} 0.96 to 0.99]) and those who were autonomous (IRR 0.94 [95% CI 0.93 to 0.95]) had lower rates of having the ideal number of children. Moreover, women who had justification for wife-beating (adjusted odds ratio [aOR] 1.25 [95% CI 1.13 to 1.39]) and those who were involved in decision-making (aOR 1.31 [95% CI 1.19 to 1.44]) had higher odds of having the ability to have the desired number of children. However, autonomous women (aOR 0.78 [95% CI 0.71 to 0.86]) had lower odds of having the ability to have the desired number of children. Significant associations were found between women's empowerment (women's attitude towards justification for wife-beating, autonomy), an ideal number of children and the ability to have the desired number of children. These findings present target areas for policies and interventions aimed at determining Ghanaian women's fertility preferences and empowering them.
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Affiliation(s)
- Louis Kobina Dadzie
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Medical Social Welfare, Cape Coast Teaching Hospital, Cape Coast, Ghana
- School of Justice, Faculty of Creative Industries, Education and Social Justice, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hilda Yengnone
- Kumasi Centre for Research in Tropical Medicine, Kumasi, Ghana
| | - James Boadu Frimpong
- Department of Health, Physical Education and Recreation, University of Cape Coast, Cape Coast, Ghana
- Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, QLD 4811, Australia
| | - Bright Opoku Ahinkorah
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- REMS Consultancy Services, Sekondi Takoradi, Western Region, Ghana
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Osborne A, Bangura C, Aboagye RG, Wongnaah FG, Seidu AA, Ahinkorah BO. Spatial distribution and factors associated with high completed fertility among women aged 40-49 years in Ghana: evidence from the 2022 Ghana Demographic Health Survey. Reprod Health 2024; 21:104. [PMID: 38992674 PMCID: PMC11238405 DOI: 10.1186/s12978-024-01845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/07/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40-49 years in Ghana. METHODS Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS The national proportion of high completed fertility among married and cohabiting women aged 40-49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0-3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. CONCLUSION High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use.
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Affiliation(s)
- Augustus Osborne
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone.
| | - Camilla Bangura
- Department of Biological Sciences, School of Basic Sciences, Njala University, PMB, Freetown, Sierra Leone
| | - Richard Gyan Aboagye
- School of Population Health, University of New South Wales, Sydney, NSW, 2052, Australia
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health, and Allied Sciences, Hohoe, Ghana
| | | | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, 4811, Australia
- REMS Consultancy Services Limited, Western Region, Sekondi-Takoradi, Ghana
| | - Bright Opoku Ahinkorah
- REMS Consultancy Services Limited, Western Region, Sekondi-Takoradi, Ghana
- School of Clinical Medicine, University of New South Wales Sydney, Sydney, Australia
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Gbagbo FY, Ameyaw EK. Stakeholders' perceptions of the trends in contraceptive prevalence rate and total fertility rate in Ghana. PLoS One 2023; 18:e0288924. [PMID: 37486905 PMCID: PMC10365302 DOI: 10.1371/journal.pone.0288924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Studies in Ghana have reported discrepancies between trends in Total Fertility Rate (TFR) and Contraceptive Prevalence Rate (CPR). Yet, there is limited empirical literature on stakeholders' perceptions on the trends in CPR and TFR in Ghana. We, therefore, examined the perceptions of key stakeholders about the documented trends in CPR and TFR in Ghana. METHODS We adopted an exploratory (qualitative) research design with a qualitative approach of data collection from stakeholders in Ghana, focusing on the trends of the TFR and CPR. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist provided additional guidance for reporting the study results. We employed the Theory of Planned Behavior (TPB) as a theoretical framework/construct to explain and predict individual changes in health behaviors resulting in trends in CPR and TFR from stakeholders' perspectives and analyzed the data using framework analysis approach. RESULTS Two main themes emerged from the data: contraceptive prevalence and total fertility ratio, with five sub-themes identified: barriers to contraception, motivations for contraception uptake, unmet need for family planning, induced abortion, and effectiveness of planning programs. Specifically, participants indicated that there is a discrepancy between the trends of CPR and TFR based on the Ghana Demographic and Health Survey, conducted between 1988 and 2014. The high unmet needs for contraceptives were attributed to CRP trends, whilst abstinence, infertility, and high demands for induced abortions were identified to impact the TFR trends significantly. CONCLUSION The findings show that an extensive quantitative enquiry into the exact relationships between Ghana's CPR and TFR as well as the contributions of abstinence, infertility, and induced abortion are worth considering.
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Affiliation(s)
- Fred Yao Gbagbo
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Lingnan, Hong Kong
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Orwa J, Gatimu SM, Ariho P, Temmerman M, Luchters S. Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys. BMC Public Health 2023; 23:718. [PMID: 37081486 PMCID: PMC10116796 DOI: 10.1186/s12889-023-15620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
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.
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Affiliation(s)
- James Orwa
- 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.
- Department of Population Health Sciences, Aga Khan University, P.O. Box 30270 - 00100, Nairobi, Kenya.
| | - Samwel Maina Gatimu
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Diabetic Foot Foundation of Kenya, Nairobi, Kenya
| | - Paulino Ariho
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Marleen Temmerman
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Stanley Luchters
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Rafael Caro-Barrera J, García-Moreno García MDLB, Pérez-Priego M. Projecting Spanish fertility at regional level: A hierarchical Bayesian approach. PLoS One 2022; 17:e0275492. [PMID: 36256629 PMCID: PMC9578621 DOI: 10.1371/journal.pone.0275492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
The transition from a demographic regime of high mortality and high fertility to one with low mortality and low fertility is universal and comes along with the process of socio-economic modernization. The Spanish total fertility rate has decreased to below replacement levels in the last decades. The decline has persisted since the 1960s and is diverse across the country. Based on that diversity, the use of population forecasts, not only at national but at regional levels, for planning purposes (governments and private sector) with large horizons has become a must to provide essential services. Using a Bayesian hierarchical model we constructed probabilistic fertility forecasts for Spain at the regional level. Although this approach is already issued by the United Nations little research has been done focusing on the Spanish subnational level. Our objective is to disaggregate the national projections of the total fertility rate for Spain into regional forecasts. The results of this research will show the model fitting, first to the national level and then using a multifaceted and continuous evolution of fertility over time, at the regional level, to check its convergence.
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Affiliation(s)
| | | | - Manuel Pérez-Priego
- Department of Statistics and Econometrics, University of Córdoba, Córdoba, Spain
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