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<p>High parity, commonly defined as having five or more children, remains a critical public health concern in sub-Saharan Africa, where women face elevated maternal and obstetric risks. In post-conflict settings such as Somaliland, fertility remains high due to persistent sociocultural and structural factors. However, multilevel evidence examining both individual and community determinants of high parity is limited in the literature. Addressing this gap is essential for informing context-specific fertility and maternal health interventions that align with global and regional development agendas.</p><p><b>Methods</b></p><p>The Somaliland Health and Demographic Survey (SLHDS) 2020 was used in this study to collect data. This study analyzed 4242 women of reproductive age from six Somaliland regions to estimate the number of ever-born children in Somaliland. This was grouped as less than five and greater than or equal to five. Stata version 16 was used for data analysis. Multilevel logistic regression analysis was used, and variables with P-values less than 0.05 were considered statistically significant. Adjusted odds ratio AOR) with a 95% confidence interval (CI) was used to show the strength and direction of the association.</p><p><b>Results</b></p><p>According to the Somaliland Health and Demographic Survey, the total fertility rate is 5.7. Women aged 35 years and above were more likely to have five or more children compared to those under 35 years of age (AOR = 10.44, 95% CI: 8.40–12.97). Women with primary education (AOR = 0.50, 95% CI: 0.34–0.74) and secondary education (AOR = 0.41, 95% CI: 0.20–0.87) were less likely to have five or more children than those with no formal education. Women in the highest wealth quintile were less likely to have five or more children compared to those in the lowest wealth quantile (AOR = 0.68, 95% CI: 0.47–0.99).</p><p><b>Conclusion</b></p><p>High parity remains prevalent among women in Somaliland, reflecting persistently elevated fertility levels. Both individual-level factors (age, education, literacy, wealth, fertility preferences, breastfeeding status, and reproductive knowledge) and community-level factors were significantly associated with high parity. The substantial cluster-level variation highlights the importance of contextual influences in fertility patterns. While the findings suggest that strengthening female education, reproductive health services, and access to fertility information may contribute to fertility reduction, causal inferences cannot be drawn due to the cross-sectional design. Context-specific, longitudinal research is recommended to better understand fertility dynamics in Somaliland.</p>

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High parity in Somaliland: individual and community-determinants from multilevel analysis of nationwide survey data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月13日

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  • Abdulkadir Mohamed Nuh,
  • Shukri Ali Mohamed,
  • Hamse Arab Ali,
  • Hamse Adam Abdi,
  • Abdisalam Hassan muse,
  • Osman Mohamed Osman

摘要

High parity, commonly defined as having five or more children, remains a critical public health concern in sub-Saharan Africa, where women face elevated maternal and obstetric risks. In post-conflict settings such as Somaliland, fertility remains high due to persistent sociocultural and structural factors. However, multilevel evidence examining both individual and community determinants of high parity is limited in the literature. Addressing this gap is essential for informing context-specific fertility and maternal health interventions that align with global and regional development agendas.

Methods

The Somaliland Health and Demographic Survey (SLHDS) 2020 was used in this study to collect data. This study analyzed 4242 women of reproductive age from six Somaliland regions to estimate the number of ever-born children in Somaliland. This was grouped as less than five and greater than or equal to five. Stata version 16 was used for data analysis. Multilevel logistic regression analysis was used, and variables with P-values less than 0.05 were considered statistically significant. Adjusted odds ratio AOR) with a 95% confidence interval (CI) was used to show the strength and direction of the association.

Results

According to the Somaliland Health and Demographic Survey, the total fertility rate is 5.7. Women aged 35 years and above were more likely to have five or more children compared to those under 35 years of age (AOR = 10.44, 95% CI: 8.40–12.97). Women with primary education (AOR = 0.50, 95% CI: 0.34–0.74) and secondary education (AOR = 0.41, 95% CI: 0.20–0.87) were less likely to have five or more children than those with no formal education. Women in the highest wealth quintile were less likely to have five or more children compared to those in the lowest wealth quantile (AOR = 0.68, 95% CI: 0.47–0.99).

Conclusion

High parity remains prevalent among women in Somaliland, reflecting persistently elevated fertility levels. Both individual-level factors (age, education, literacy, wealth, fertility preferences, breastfeeding status, and reproductive knowledge) and community-level factors were significantly associated with high parity. The substantial cluster-level variation highlights the importance of contextual influences in fertility patterns. While the findings suggest that strengthening female education, reproductive health services, and access to fertility information may contribute to fertility reduction, causal inferences cannot be drawn due to the cross-sectional design. Context-specific, longitudinal research is recommended to better understand fertility dynamics in Somaliland.