ArticleThe Lancet. Global health2021
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.
Article in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed.
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- Maternal mortality ratios in Southeast Asia (1990-2021): trends, disparities, and projections through 2050 based on the global burden of disease 2021, with reference to SDG 3.1.BMC pregnancy and childbirth · 2025Article
- Assessing coupling coordination between human-animal-environmental health for advancing uniform progress in One Health.One health (Amsterdam, Netherlands) · 2025Article
- Three-medical linkage in China: trend evolution and obstacle identification.BMC health services research · 2025Article
- Mapping mixed milk feeding practice and its spatial predictors among children aged 0-6 months in Ethiopia: a geographically weighted regression analysis.Scientific reports · 2025Article
- Worldwide patterns and trends in ovarian cancer incidence by histological subtype: a population-based analysis from 1988 to 2017.EClinicalMedicine · 2025Article
- Digital insights: Analyzing the reproductive intentions and influencing factors among urban women in China through online platforms.PloS one · 2025Article
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- Unmet Need for Family Planning in Spatial Analysis: A Systematic Review.Iranian journal of public health · 2024Review
- Trends and risk indicators for high fertility among Nigerian female youth aged 15-29 years: A pooled data analysis.Heliyon · 2024Article
- Net benefit of smaller human populations to environmental integrity and individual health and wellbeing.Frontiers in public health · 2024Review
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- Spatial-temporal analysis and spatial drivers of hepatitis-related deaths in 183 countries, 2000-2019.Scientific reports · 2023Article
- Small-area estimation and analysis of HIV/AIDS indicators for precise geographical targeting of health interventions in Nigeria. a spatial microsimulation approach.International journal of health geographics · 2023Article
- The Impact of Sociodemographic, Macroeconomic, and Health Status and Resources on Infant Mortality Rates in Oman: Evidence from 1980 to 2022.European journal of investigation in health, psychology and education · 2023Article
- Respiratory functions and health risk assessment in inhalational exposure to vinyl acetate in the process of carpet manufacturing using Monte Carlo simulations.Environmental science and pollution research international · 2023Article
- Fertility intention and its affecting factors in China: A national cross-sectional survey.Heliyon · 2023Article
- Prevalence and factors associated with the use of long-acting reversible and permanent contraceptive methods among women who desire no more children in high fertility countries in sub-saharan Africa.BMC public health · 2022Article
- A population-level data linkage study to explore the association between health facility level factors and unintended pregnancy in Bangladesh.Scientific reports · 2022Article
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Authors and funding
14 authors.
Funding
Abstract
backgroundUnderstanding 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.
methodsWe 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.
findingsTFR 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.
interpretationSubstantial 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.
fundingWellcome Trust, the UK Foreign, Commonwealth and Development Office, and the Bill & Melinda Gates Foundation.
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