High-risk fertility behaviours among women of reproductive ages in the Democratic Republic of the Congo: Prevalence, correlates, and spatial distribution

• Published in: PloS one Vol. 18; no. 3; p. e0283236
• Main Authors: Tsala Dimbuene, Zacharie, Tadesse Tessema, Zemenu, Wang Sonne, Soziac Elise
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.03.2023; Public Library of Science (PLoS)
• Subjects: Age; Analysis; Behavior; Birth control; Birth intervals; Birth order; Births; Child; Computer and Information Sciences; Confidence intervals; Democratic Republic of the Congo - epidemiology; Design standards; Earth Sciences; Education; Educational Status; Ethics; Family planning; Female; Fertility; Forecasts and trends; Geographical variations; Health aspects; Health risks; Health surveys; Households; Humans; Maternal behavior; Maternal mortality; Medicine and Health Sciences; People and places; Physical Sciences; Pregnancy; Prenatal care; Prevalence; Public health; Reproduction; Reproductive behavior; Reproductive health; Risk factors; Risk taking; Rural areas; Sampling designs; Social Sciences; Sociodemographics; Software; Spatial distribution; Spatial variations; Statistical analysis; Urban areas; Variables; Women; Democratic Republic of the Congo; Congo (Kinshasa); Central Africa; Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0283236

High-risk fertility behaviour remains a major public health in the Democratic Republic of the Congo, like other sub-Saharan Africa countries, especially because Total Fertility Rate (TFR) is very high in the country, estimated at 6.6 children. Despite the commendable progress in reducing maternal deaths in the region, sub-Saharan Africa is still lagging very behind compared with other regions. Yet, high-risk fertility behaviours are pivotal to improve maternal and child health. This study aims to assess geographical variations of, and to identify risk factors associated with high-risk fertility behaviours among married women in the Democratic Republic of the Congo using the 2013-14 Demographic and Health Survey. Overall, 11,497 married women were selected from a nationally representative using a two-stage sampling design. Standard logistic regressions were performed to identify individual- and household/community-level factors associated with high-risk fertility behaviours. Additionally, interactions between women's age and education, and urban residence were tested. Bernoulli based spatial scan statistics were used to identify the presence of high-risk fertility behaviours spatial clusters using Kulldorff's SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial variations of high-risk fertility behaviours. Geographically weighted regression (GWR) analysis was employed using Multiscale GWR version 2.0 software. Findings indicated that more than two-third of married women exhibited high-risk fertility behaviours in the Democratic Republic of the Congo. Multivariate logistic regression showed that education was negatively and significantly associated with the odds of high-risk fertility behaviours. In contrast, women's age significantly increased the odds of high-risk fertility behaviours. Interactions between urban residence and women's education and age confirmed the urban advantage identified from previous studies. Finally, high-risk fertility behaviours were highly clustered in the Northeastern provinces of the country. The study showed that there were significant geographical variations of high-risk fertility behaviours across provinces in the Democratic Republic of the Congo. The paper also identified significant-high hot spots of high-risk fertility behaviours in the Northeastern provinces of the country. To reduce high-risk fertility behaviours, and ultimately improve maternal and child outcomes in the country, policymakers and health planners need to strategically address these inequalities. Finally, this paper highlighted the persistent needs of country-specific studies due to differences across sub-Saharan African countries in terms of social development and cultures.