Levels and Determinants of Fertility among Refugees in Ethiopia
Creators: name: Haile, Gashawbeza
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2014

description: Background: Refugees are believed to be highly vulnerable, marginalized and underserved population groups and at high risks of different physical, psychosocial, sexual and mental health threats. The short and/or long term partner separation and other fertility inhibiting factors due to conflict and forced migration result in changing refugee fertility behavior. The refugees maternal and child health conditions are more affected by the forced migration and uncontrolled births. In the current study refugee population little is known about their fertility determinants. Objective: This study was an attempt to examine refugees' current and desired fertility levels and to assess the relative contribution of intermediate (proximate) fertility determinant variables and distal fertility determinant among refugee inhabiting in Ethiopia. Method: Refugee community based cross-sectional study design was employed. Using the standard and structured questionnaires 2041 sampled women refugee in the childbearing age and dwell in camps and urban settings interviewed mainly on their socio-demographic and reproductive characteristics. Bongaart's model was used to measure the relative contribution of the proximate determinants of fertility and negative binomial regression model was employed to identify distal fertility determinants. Data were entered in Epi info 7 and exported to SPSS version 20.0 and Stata 11 software for cleaning and analysis. Results: The observed total fertility rate and the total marital fertility rate were found to be 4.6 and 5.9 children per woman respectively. There was a big disparity of total fertility rate among urban vs. camp refugees with 3.0 and 5.8 children per woman respectively. The mean children ever born were 3.40 children per woman. The mean desired fertility rate was estimated at 8.72 children per woman and the mean children ever born to women in the age group 45-49 were 7.90 children per woman. However, 83% of the respondents attributed that only God/Allah will decide on the number of children refugees can have. On the other hand, non-marriage and postpartum amenorrhea contributed the highest (35% and 34%) fertility inhibition effect of its possible biological maximum respectively. Meanwhile, the inhibitory effect of contraception from its natural level was only 16% among refugees. Similarly, from the selected socio-demographic and reproductive variables, religion (fertility level among women refugee in the Muslim religious congregation were, 1.42: 95% CI (1.19, 1.70) times higher compared to Christianity followers). age at migration (fertility was 1.22: 95% CI (1.05,1.43), 1.66: 95% CI: (1.37,2.01) and 1.92: 95% CI (1.51,2.44) times higher among women refugee moved out from their usual place of abode 11-20, 21-30 and 31or more years ago respectively compared to those who migrated within the past 10 years). Similarly, age, monthly income, polygamous marital forms, history of abortion, age at first birth, partner's attitude on contraceptive use and marital duration were the significant predictors of refugee fertility. Conclusion: The refugees' current and desired fertility is among the highest, with significantly high disparities between current and desired fertility level. Women's religious belief has a greater effect on the desired fertility level. Non-marriage, postpartum amenorrhea and contraception significantly reduced fertility from its natural level. Refugee women's age, monthly income, marital forms, history of abortion, age at first birth, age at migration, religion, partner's attitude on contraceptive use and marital duration are the significant predictors of fertility. Hence, strengthening refugee women and girls' schooling help to empower women refugee and able claim and exercise their reproductive rights as appropriate. Religious leaders and male partners' involvement in the woman's fertility decision is highly recommended. The refugees' current and desired high fertility level entail the need for refugees based and friendly reproductive health program design with due emphasis on the identified predictor variables along with encouraging refugees' best practices of non-marriage, postpartum amenorrhea and contraceptives uses. Key words: Refugee women, desired and current fertility level, Proximate and distal determinants of fertility, Children ever born, socialization, disruptive, adaptation