Spatial Distributions and Determinants of High-risk Fertility Behavior among Women in Ethiopia: Further Analysis from 2016 Ethiopia Demographic Health Survey

Abstract Background: High-risk fertility behavior associated with numerous unfavorable child and maternal health outcomes such as chronic undernutrition, anemia, and child mortality. Although different studies have been conducted to assess the magnitude and effects of high-risk fertility behaviors, there are limited shreds of evidence about the geographical distributions and determinants in Ethiopia. Therefore, this study aimed to assess the spatial distributions and determinants of high-risk fertility behavior among reproductive-age women in Ethiopia. Method: This study was based on secondary data analysis from the 2016 Ethiopia Demography and Health Survey. Information about 11,022 women who gave birth five years preceding the survey were extracted from the kid’s record (KR) file. For the spatial analysis ArcGIS 10.6 and Sat ScanTM 9.6, were used and for multilevel analysis, STATA 14.1 was used. Mixed effect Multivariable multilevel logistic regression model was fitted to identify determinants of high-risk fertility behavior.Result: More than three fourth (76.5%) with 95%CI (75.1 to 77.1) women had high-risk fertility behavior. From the spatial analysis, high-risk fertility behavior in Ethiopia geographically varies, the eastern and northern parts of the country such as Somalia and Tigray had an increased risk of fertility behavior. Primary education (AOR=0.71, 95% CI: 0.63 to 0.80) and secondary (AOR=0.73; 95% CI: 0.60 to 0.89), not ever used contraceptive (AOR=1.25, 95%CI: 1.12 1.40), unwanted pregnancy (AOR=1.40, 95%CI: 1.23 1.59), no ANC visit (AOR=1.19, 95%CI: 1.05 1.35), rural-dwelling (AOR=1.26, 95%CI: 1.04 1.51), regions of Ethiopia [Somalia (AOR=1.70,95%CI:1.24 2.32) and Amhara (AOR=0.72,95%CI:0.53 0.96)] were determinants of high risk fertility behavior.Conclusion: High-risk fertility behavior was significantly higher and geographical variations also noticed and the eastern and northern parts of the country were the hot spot areas. Education, rural residence, unwanted pregnancies, No ANC visit, and contraceptive use were determinants of high-risk fertility behavior. This suggests that areas with high-risk fertilities need special interventions to avert related complications.