ArticleFrontiers in reproductive health2026
Socioeconomic and demographic determinants of children ever born among ever-married women in Somalia: a multilevel negative binomial regression analysis.
Article in Frontiers in reproductive health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Somalia has one of the highest fertility rates in the world, occurring alongside widespread socioeconomic disadvantage, low female educational attainment, and limited access to reproductive health services and information. Objective: This study examines the socioeconomic, demographic, and information-access determinants of fertility among ever-married Somali women and identifies the count-regression model that best represents total children ever born. Methods: Data were drawn from the 2020 Somali Health and Demographic Survey (SDHS), restricted to 10,772 ever-married women aged 15-49 years with complete information on all study variables. Children ever born were modeled using Poisson, Negative Binomial (NB) and Multilevel Negative Binomial (MENB) regression. Model selection was based on log-likelihood, AIC, and BIC, with comparisons restricted to models with comparable likelihood frameworks. Results: The distribution of children ever born was right-skewed, with a mean of 4.11 children and evidence of over-dispersion. The MENB model provided the best fit, with the lowest AIC (45,392.37) and BIC (45,691.04), indicating the importance of accounting for both over-dispersion and clustering. Age was the strongest predictor of fertility; women aged 45-49 years had approximately 7.5 times the expected number of children compared with those aged 15-19 years (IRR = 7.52, 95% CI: 6.94-8.14, Conclusion: Fertility in Somalia remains high but is strongly shaped by age, education, wealth, marital status and region. Expanding female education, reducing poverty, and improving access to reproductive health services and information are essential to support improve maternal and child health outcomes across Somali populations.
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