The qualitative evidences about fertility in Ethiopia
Ethiopia is often regarded as promising demographic role models since 1970 in reducing the high fertility rates of seven births per woman to below the current average rate for Sub-Saharan Africa, 4.9. But in 2011, Ethiopia reduce the number of births per woman to 4.8 which is lower than the stands of Sub-Saharan Africa (11).The Ethiopian Family and Fertility Survey conducted in 1990 by the Central Statistical Authority showed that only 8 percent of all Ethiopian reproductive age group women had ever used any method of contraception (12). The 2012 Inter-Censual Population Survey showed that the national average fertility rate has decreased from 6.2 percent in 2007 to 4.6 percent in 2012 (3). A research in 2009, in two Gondar zones reported the total fertility rate was 5.3 and the mean number of children ever born to older women (45-49 years) was computed as 6.5 (13). A study in 2015 reported that Addis Ababa had very low fertility but other regions mainly, Oromia, Somali, and SNNP had high total fertility rates. In addition, high fertility was observed in rural areas than urban areas. Religion also reported as having influence on the status of fertility that Muslim respondents had more children as compared to traditional religion, being in lower grade and being economically poor contribute for having more kids (14). Women without any education and women with secondary or higher education had on average 5.8 children, and 1.6 children respectively (11). The female literacy rate in each region was also documented as 80% in Addis Ababa, 76.5% in SNNP, in Harari 74.5%, 72.6% in Oromia, 71% in Tigray and Gambella, in Benishangul-Gumuz 66.3%, in Amhara 65.5%, in Dire dawa 64.6%, in Afar 53.2% and 47% in Somalia (15). In between 2000 and 2011, fertility rates in Somali, Afar, and Benishangul-Gumuz regions increased by 39%, 14%, and 4% respectively (16). Whereas in Amhara region and in Addis Ababa dropped by 24% and 17%, in SNNP and Tigray dropped by 13% respectively (17). The total fertility was increased from 1970s both in rural and urban areas. The TFR in the rural areas had increased from 4.3 in the 1970s to 8.1 in 1984 but it was constant till 1994 and revealed slight decline thereafter. The TFR in 1998 was 7.2 according to Nutrition and Health Survey data (18).
Improvement in the health status of women mainly the decrement in sexually transmitted diseases, decreasing in still births and a reduction in the duration of breastfeeding were the possible reasons for a fertility to rise in 1970s (19).
The other analysis reported as the TFR was 5.5 children per woman during the early 1970s and increased to 7.2 children per woman within 5-9 years, that was in 1984 (20). But in the latter year, the TFR decrease radically, and the decrement in fertility rates is largely due to the dissemination of contraceptives throughout the country. According to DHS of 2014, awareness of contraceptive methods between 2000 and 2014 has grown steadily among women and particularly among married women, 97% of whom report awareness (17). The government was the major provider of modern contraceptives. In which, 87% of users obtaining their family planning method from the state, health centers, and health extension workers (17).
The quantitative evidences about fertility in Ethiopia
The prevalence of modern contraceptive utilization in 2011 across the different regions were had a hug difference. The prevalence of utilization in Addis Ababa was 56.3%, 24.7% in SNNP, in Harari 31.5%, 24.9% in Oromia, 21.2% in Tigray and 33.2% in Gambella, in Benishangul-Gumuz 26.3%, in Amhara 33.0%, in Dire-Dawa 31.7%, in Afar 9.1% and 3.8% in Somalia (21). The fertility of Ethiopia decreases radically from 8.1 in 1965 to 4.0 in 2016. The mean fertility rate with standard variation for both urban and rural Ethiopia is (x + Sd) 6.03+ 1.3 for the last 51 years. According to EDHS report the maximum decline is recorded in Amhara region. In contrary Afar and Somalia had increased fertility rate in 2016 by 0.6 and 1.5 children per woman respectively (Table3)
Some of the previous large surveys like FFS, which was done before 2000 lack specificity to the area or region. In addition, earlier national survey like CSO, CSA and FFS had poor quality in design, or data collection. Therefore, for comparing the trends of fertility in Ethiopia across the regions and town administrators were not used. Because of methodological superior quality, only EDHS used to presnt figurative data. According to the 5 DHS data of Ethiopia, fertility is decreased by 1.5 from 2000 as a baseline and 2016 as current reference. Amhara, south nations and nationalities and Tigray took the first top three levels in decreasing the number of births in 2016 respectively. The mean and median fertility rate in both rural and urban was 6 and 5.9 respectively but the urban and rural median fertility rate was 5.7 and 7.5 with mean of 5.5 and 6.9 respectively. whereas the overall fertility rate in Ethiopia was X+sd (6+1.8) mean and standard deviation.
The minimum and maximum fertility rate was 4.1 and 7.7 respectively irrespective of residences. The fertility rate of Ethiopia across the 9 regions and two administrative cities is quite different according to all the previous EDHS absolute difference in 2000 and 2016. The rate of fertility in Ethiopia decrease from 2000 to 2014 consistently but there is a slight increment from 2014, 4.1 child per woman to 2016, 4.6 child per woman. The increment was also recorded in all regions and Addis Ababa except Amhara region and Dire-Dawa. The fertility rate was decreased by 0.1 and 0.3 children per woman in Amhara region and Dire-Dawa respectively (Fig 2, Fig 3, and Table 3)
Fig 2: The rate of Decrement in Fertility rate in 2016 using 2000 as Baseline data (2000-2016) in the 9 regions and 2 administrator cities of Ethiopia.
Fig 3: The total fertility rate of Ethiopia from 2000 to 2016 using 5 DHS data and the 2012’s EPHI survey