The past few decades have witnessed a considerable decline in total fertility rates globally. However, in Ghana, there has been a slight increase in the fertility rate with little understanding of the reason for the increment.
To understand this change, it is important to first examine the trend over a considerable period of time while taking into consideration some important inequality dimensions. This informed the need for this present study as we examined the trends in total fertility rate in Ghana by different inequality dimensions from 1993 to 2014.
Understanding the reasons why people die helps with the understanding of how they lived, in order to improve health services and reduce preventable deaths in every country, responding effectively to changing circumstances.
"Life expectancy" refers to the number of years a person can expect to live from birth. The average number of years that a newborn could expect to live. This measurement takes into account years lived in less than full health due to disease and/or injury.
Population Distribution in Ghana
Population density increased steadily from 36 per square kilometer in 1970 to 52 per square kilometer in 1984. In 1990, the estimate for Ghana's overall population density was 63 persons per square kilometer. These averages did not reflect variations in population distribution.
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As was the case in the 1960 and 1970 figures, the greatest concentration of population in 1984 was to the south of the Kwahu Plateau. The highest concentration of habitation continued to be within the Accra-Kumasi-Takoradi triangle, largely because of the economic productivity of the region.
All of Ghana's mining centers, timber-producing deciduous forests, and cocoa-growing lands lie to the south of the Kwahu Plateau. A large part of the Volta Basin is sparsely populated. The far north is heavily populated. The population density of the Upper East Region is well above the national average.
Localities of 5,000 persons and above have been classified as urban since 1960. The 1960 urban population totalled 1,551,174 persons, or 23.1% of total population. By 1970, the urban percentage had increased to 28%.
Urban areas in Ghana have customarily been supplied with more amenities than rural locations. Consequently, Kumasi, Accra, and many settlements within the southern economic belt attracted more people than the savanna regions of the north; only Tamale in the north has been an exception.
Rural vs. Urban Population
Ghana has a hugely rural population that is dependent on subsistence agriculture. Ghana has continued to be a nation of rural communities. Rural residency was estimated to be 67% of the population in 1992. In the 1970s, 72% of Ghana's population lived in rural areas.
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The "Rural Manifesto," which assessed the causes of rural underdevelopment, was introduced in April 1984. Development strategies were evaluated, and some were implemented to make rural residency more attractive. The Bank of Ghana established more than 120 rural banks to support rural entrepreneurs, and the rural electrification program was intensified in the late 1980s.
Trends in Total Fertility Rate (TFR)
Data from the 1993-2014 Ghana Demographic and Health Surveys were used for the study, and we relied on the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software for the analysis. The analysis involved disaggregation of TFR by wealth index, education, place of residence and region.
This was followed by the estimation of inequality by Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. In the analysis, we set the statistical significance at a 95% confidence interval.
Key Findings:
- For all surveys, the total fertility rate was consistently highest among the poorest women (7.00, 6.28, 6.77, 6.61 and 6.29 in 1993, 1998, 2003, 2008 and 2014, respectively).
- The highest total fertility rate was recorded among women with no formal education in all the survey years. For instance, in the 2014 survey, the total fertility rate for women with no formal education was 5.98 and those with secondary/higher had a total fertility rate of 3.40.
- Women in rural areas had a higher total fertility rate compared to those in urban areas (4.90 vs. 3.40 in 2014).
Overall, TFR in Ghana decreased significantly from 5.50 to 4.14 between 1993 and 2008 but increased slightly to 4.15 in 2014. Throughout the surveys, there was a disparity in TFR across the four inequality dimensions. Specifically, TFR was consistently highest among the poorest women compared to the richest women.
Similarly, the highest TFR was recorded among women with no formal education in all the surveys, compared to those with secondary or higher education. The rural-urban disparity in TFR was also observed, with women in rural areas having a higher TFR, compared to those in urban areas. In terms of regions, the Northern region was the region where women consistently had the highest TFR over the surveys.
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We found an extensive absolute and relative wealth-related inequality in TFR from 1993 to 2014 both by simple (D, R) and complex (PAF, PAR) measures. A case in point is that in the 2014 survey, the PAF and Difference measure indicated a significant wealth-related inequality.
What is the Fertility Rate
In that same year, there was a significant education-related inequality, which was both absolute and relative. These findings indicate that both wealth and education favor women who are well-off in terms of economic and educational attainment, with respect to fertility. Similarly, we found absolute and relative urban-rural inequality in TFR from 1993 to 2014 both by simple and complex measures with a decreasing pattern.
We also found absolute and relative inequality in TFR across sub-national regions over the period studied. For instance, in the most recent survey, the PAR measure and the PAF measure indicated substantial absolute and relative regional inequality between the region with the highest TFR (Northern region) and the one with the lowest TFR (Greater Accra region).
Factors Influencing Fertility
Factors that are negatively associated with parity and high fertility include higher educational level, frequency of watching television, being insured and computer use. Residing in an urban location, being older, being in a higher wealth quintile (compared to the poorest) and the frequency of listening to the radio are all positively related to parity and being in a high-fertility zone.
The study found that educational level, media (television) exposure, insurance uptake and computer use are associated with a lower likelihood of having fewer children, while being in a union, residing in an urban location, being older, having higher wealth and exposure to radio are associated with parity and being in a high-fertility zone.
Many factors continue to influence fertility in Ghana. Nevertheless, in the same study, it was observed that achieved fertility increased from 23.8% in 2003 to 26.0% in 2014, while overachieved fertility decreased from 51.1% in 2003 to 38.2% in 2014, highlighting the fact that overachieved fertility (or high fertility) remains a significant problem in Ghana.
The slow decline in fertility rates in SSA, including Ghana, compared to global rates, remains to be fully understood.
The data for this study were obtained from the 2017 to 2018 Multiple Indicator Cluster Survey (MICS) conducted in Ghana.
The study employed three outcome variables: parity (measured as the number of children ever born), high fertility (if the number of children is above the average fertility rate of approximately 4 in Ghana) and the desire for another child, with a binary response of ‘yes’ or ‘no’.
The data were analysed using descriptive statistics, logistic regression and the generalised Poisson regression.
From the results, factors related to parity include educational level, location, age, wealth, frequency of listening to the radio and television, as well as computer use. We found that women who have attained formal education tend to give birth to fewer children compared to those with no formal education.
Similarly, compared to women who do not watch television at all, those who watch at least once a week and almost every day are less likely to have more children. The situation is the same for women covered by health insurance and those who have ever used a computer.
However, women in unions, those located in urban areas and older women are more likely to bear more children. Similarly, compared to those in the poorest wealth quintile, those in the second, middle and the richest quintiles are more likely to give birth to more children.
Regarding factors related to high fertility, women who attained primary, middle/JSS and secondary or higher levels are less likely to have more than four children compared to those without any formal education. Similarly, women in urban locations, covered by health insurance and those who ever used a computer, are less likely to give birth to more than the national average of four children.
In terms of the effect of listening to the radio, compared to those who do not listen at all, those who listen at least once a week and those who listen almost every day are less likely to give birth to more than four children. However, older women and women who are in a union or cohabiting with a male partner are more likely to have more than four children, compared to women who are not in a union.
When turning attention to the desire for another child, the results show that, compared to women who do not have any formal education, those who attained secondary level education or higher and those in a union are more likely to desire another child. Additionally, women who listen to the radio almost every day, compared to those who do not listen at all, and women covered by health insurance have a higher likelihood of desiring another child.
Our study contributes to the discourse on population dynamics in a changing world, re-examining the effects of socio-demographic factors on fertility and the desire for another child, specifically in the context of low- and middle-income countries.
We found that education, exposure to television, being located in an urban area, having health insurance, and computer use reduced the likelihood of having more children and being in a high-fertility zone. However, education and insurance increased the possibility of desiring another. Being in a union increased the chance of having more children, being in a high-fertility zone and desiring another child.
These findings reveal several insights. First, while attaining higher education reduces the likelihood of having more children, as has been established in previous studies, the desire for another child increases with education.
This observation of negative education effect on parity may be because women with advanced education typically possess enhanced access to family planning knowledge, prioritise professional advancement and financial security, and enter marriage at a later age. These factors facilitate educated reproductive choices, resulting in postponed childbirth and lower fertility rates. However, having attained higher education and increased their economic and social value, such women are probably finding it easier to care for another child.
Such a perceived increase in social status occasioned by educational attainment tends to encourage women to desire to have another child. In addition, education increases the social net worth and earnings of individuals, making it easier to care for another child. Our findings, which show that those on a higher wealth index tend to have more children, further validate this point.
Being in a union with a male partner has a significant influence on reproductive outcomes and the desire to have another child.
Our findings on the effect of location on fertility, albeit contradictory, are supported by the literature. The results show that women residing in urban locations were more likely to have more children but less likely to fall within the high-fertility zone, which means that these women did not have more than the national average of four children.
The age of a woman has a positive effect on fertility. As women age, their reproductive ability diminishes.
We found that frequently listening to the radio was associated with an increase in the number of children ever born. On the other hand, those who watch television more frequently are less likely to have more children. In the literature, media exposure is found to have a mixed effect on fertility.
| Year | Total Fertility Rate |
|---|---|
| 1993 | 5.50 |
| 2008 | 4.14 |
| 2014 | 4.15 |
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