Determinants of children ever born among women in Somalia: a national survey study

Fertility rates in Somalia are among the highest globally, posing significant challenges to maternal and child health and sustainable development. However, there is limited evidence regarding the specific drivers of high fertility. This study aimed to identify the factors associated with the number of children ever born among Somali women of reproductive age to inform reproductive health policies and programs.

A cross-sectional analysis of a nationally representative household survey was performed. We analyzed the weighted data of 27,352 women aged 15-49 years who participated in the 2020 Somali Health and Demographic Survey. The number of children born was defined as the total number of live births and was modeled as a count outcome. Owing to overdispersion, survey-adjusted negative binomial regression was used to estimate unadjusted and adjusted incidence rate ratios with 95% confidence intervals for demographic, socioeconomic, reproductive, and geographic factors.

The mean number of children born was 6.22. Higher education level showed the strongest inverse association (higher vs. none: incidence rate ratio = 0.154; 95% confidence interval: 0.049-0.487). A later age at first birth (> 20 vs. ≤20 years) and literacy were associated with fewer children ever born (incidence rate ratio = 0.913; 95% confidence interval: 0.902-0.923, and incidence rate ratio = 0.965; 95% confidence interval: 0.939-0.991, respectively). Compared with rural residents, urban women had more children ever born (incidence rate ratio = 1.019; 95% confidence interval: 1.003-1.035), whereas nomadic women had fewer (incidence rate ratio = 0.979; 95% confidence interval: 0.965-0.993). Women in the middle wealth quintile had more children ever born than the poorest women (incidence rate ratio = 1.033; 95% confidence interval: 1.021-1.046). Compared with current modern method users, non-users intending future use and non-users with no intention to use had more children ever born.

Fertility rates in Somalia remain high and are shaped by structural and behavioral factors. Expanding girls' education, delaying childbearing, improving literacy, and ensuring equitable access to contraception may help reduce fertility and improve population health.