Determinants of high-risk fertility behavior among reproductive-age women in Ethiopia using the recent Ethiopian Demographic Health Survey: a multilevel analysis

BACKGROUND: High-risk fertility behavior is associated with numerous unfavorable child and maternal health outcomes such as chronic undernutrition, anemia, and child mortality. As far as our knowledge goes, there is not much study on determinants of high-risk fertility behavior in Ethiopia. Therefore, this study aimed to assess determinants of high-risk fertility behavior among reproductive-age women in Ethiopia. METHOD: The study was based on secondary data analysis from the 2016 Ethiopia Demography and Health Survey. A total of 11,022 women who gave birth 5 years preceding the survey were included in this study. Kid’s Record (KR) dataset was used. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) was calculated for those variables included in the multilevel logistic regression model. P value ≤ 0.05 was employed to declare the statistically significant variables. RESULTS: More than three-fourths (76.9%) of (95% CI 76.11 to 77.69) reproductive-age women had at least one high-risk fertility behavior. Attended primary and secondary education adjusted odds ratio (AOR) (AOR = 0.71; 95% CI 0.63, 0.80 and AOR = 0.73; 95% CI 0.60, 0.89, respectively), never used contraceptive (AOR = 1.25, 95% CI 1.12, 1.40), unwanted pregnancies (AOR = 1.40, 95% CI 1.23, 1.59), had 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: Education, rural residence, unwanted pregnancies, no antenatal care follow-up, and never used contraceptives were determinants of high-risk fertility behavior. Therefore, increased maternal health services, special intervention for hotspot areas, and giving special attention to rural dweller women were highly recommended.