Socio-cultural determinants of fertility in small town Tanzania: A baseline cross-sectional study

Introduction: Fertility in sub-Saharan Africa remains high. We determined the independent association of any previous child death, religion, ethnicity and women’s empowerment status with above-average fertility (AAF), defined as 4 live births or more, in the small town of Ifakara, Tanzania.

Methods:  Logistic regression was used to analyze 2012/2013 survey data from 3,029 mothers aged 20 – 49 years. Door to door in-person interviews were conducted by field workers who assessed reproductive history, demographic and social status using structured questionnaires adapted from previous surveys. 

Results: Adjusted for age and other demographic factors, women who had experienced child death were 4.2 times more likely to have AAF (95% CI: 3.3 – 5.2). Catholics and other Christians were 1.3 (95% CI: 1.05 – 1.6) and 1.5 (95% CI: 1.03 – 2.2) more likely to have AAF in comparison to Muslims. Lower women’s empowerment status was weakly correlated with AAF. Ethnicity showed little role in explaining AAF.

Policy implications:  Having experienced child death and religion were associated with AAF in Ifakara town. Whereas the temporal sequence of the child death and increased fertility could not be established in our study, adoption of a religion or religious denomination is presumed to precede the start of childbearing and religion can therefore be interpreted as a determinant of AAF. When designing interventions to increase uptake of family planning and reproductive health services, an ecological perspective is needed to understand social norms that shape fertility preferences and the structural barriers to services access.