The Role of Proximate Determinants and Distal Variables On Recent Fertility in Dabat Health and Demographic Surveillance System Site, Northwest Ethiopia: A Mediation Analysis

Abstract Background In Ethiopia, previous studies have explored the role of the proximate determinants for recent fertility decline at national and regional levels. However, none of these studies have examined the role of socioeconomic factors on the observed fertility decline through these proximate variables. This study aimed to estimate the effects of proximate determinants of fertility and the contribution of distal variables in recent fertility in Dabat Health and Demographic Surveillance Site, northwest Ethiopia. Methods A community based cross-sectional survey was carried out in 2020 among 1649 women of reproductive age group. Data were collected using structured and interviewer administered questionnaire. Generalized structural equation model was employed for the mediation analysis to estimate the relationships among distal and mediating variables with outcome variable, children ever born, simultaneously. A difference approach was used to test whether the effects of predictor variables were mediated. Results The Total Fertility Rate (TFR) for the three years preceding the survey was estimated at 3.4 children per woman. The Age Specific Fertility Rate (ASFR) in the study area reached its peak in the age group of 25–29 with 191 children per 1000 women. Among the proximate determinants, only marriage was a significant proximate determinant of recent fertility. The probability of having birth was more than fivefold higher among currently married women (IRR = 5.6 with a P-value = 0.000) than their unmarried counterparts. Age of women, occupation of women, household wealth status, ideal number of children, and experiencing child death had a significant total effect on recent fertility that were decomposed to direct and indirect or mediated effects of variables. Conclusion Marriage was the only proximate determinant that stood out as a significant mediated variable through which the distal variables affected fertility. Findings also clearly indicated that female participation in non-agricultural occupation affected the recent fertility. Hence, women's level of employment should be raised to increase their economic independence that will reduce the desirability of early marriage which in turn lower the number of children. In addition, the prevailing strategies on family planning programs should be improved to enhance the prevalence of contraceptive use among married women that will accelerate the current fertility transition.