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https://doi.org/10.56556/gssr.v2i4.600 

                                                                  

 
 

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RESEARCH ARTICLE  

Examining the Effect of Urban Household Food Insecurity on Fertility in 

Lideta Sub-City, Addis Ababa, Ethiopia                    

Ephrem Tadesse Goda1*, Terefe Degefa Boshera1, Mengistu Ketema Aredo2   

1Center for Population Studies, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia 
2Ethiopian Economic Policy Research Institute: Ethiopian Economic Association, Addis Ababa, Ethiopia 

Corresponding author: Ephrem Tadesse Goda: ephr15@yahoo.com 

Received: 08 August, 2023, Accepted: 08 November, 2023, Published: 15 November, 2023 

 

Abstract  

Despite investment and support for family planning in developing countries, some people living in poverty are 

hesitant to use modern birth control methods, and usage rates are insufficient. Improved reproductive health is 

directly related to enhanced nutrition, while optimal nutrition fosters superior reproductive health outcomes. 

This study aims to examine the relationship between household food insecurity and fertility in Lideta Sub-City, 

Addis Ababa, Ethiopia. A study was conducted on 649 reproductive-age women in three randomly selected 

Woredas (districts) from a sub-city from February to March 2023. Data was collected through a validated 

survey by trained individuals, and household income and expenditure were used to measure food insecurity 

access. Poisson regressions were used to examine the link between household food insecurity and fertility, 

considering other covariates. The result of the study shows that food insecurity status was a significant predictor 

of the number of children ever born. The number of children ever born for women within food-secure 

households is 0.655 times lower compared to women with food insecurity. Similarly, the age of the mother, 

marital status, contraceptive use, women's income, and childhood mortality were significant in predicting the 

effect of the number of children ever born at P < 0.05. Household food insecurity exhibits a positive relationship 

with the number of children ever born. Thus, it is imperative to recognize food insecurity as a barrier that must 

be addressed when developing family planning services. 

Keywords: Fertility; Children ever born; Food insecurity; Lideta Sub-City; Addis Ababa; Ethiopia 

 

Introduction  

The world's population has experienced a remarkable increase, growing from 1 billion in 1800 to a staggering 8 

billion today. The less developed countries of Africa, Asia, and Latin America now account for 85 percent of 

the world's population but account for 99 percent of global population growth (United Nations, 2022). The 

highest fertility rates and higher childhood mortality rates are found in the poorest and most food-insecure 

countries (Boliko, 2019; FAO, 2020). Surprisingly, the world is still home to over 800 million undernourished 

people, over 97% of whom live in developing countries. The rate of undernourishment worldwide is on the rise, 

affecting 9.9% of people globally (FAO, 2021). 



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Sub-Saharan Africa, with a population of 1.3 billion (17% of the world population), has by far the fastest-

growing population of any major region in the world (United Nations, 2022). Despite significant advancements 

in reducing child mortality and enhancing life expectancy, reproductive health among women residing in 

developing nations, particularly in sub-Saharan Africa, remains insufficient, leading to persistently high birth 

rates. On average, women residing within the region have about 4.26 children (United Nations, 2022). The 

widespread adoption and utilization of family planning methods have become instrumental in mitigating the 

growth of the population as well as addressing the issues of hunger and malnutrition (Smith & Rhonda, 2015). 

Ethiopia remains one of the world's most impoverished and food-insecure nations, with 30.8% of its population 

living below the poverty line for sustenance (Odekon, 2022). The majority of urban households in Ethiopia, 

comprising approximately 80%, exhibit food insufficiency and rely heavily on market mechanisms to procure 

their food requirements (WFP/UNICEF, 2019). Following the Interim Report on Poverty Analysis Study in 

Ethiopia (FDRE, 2017), there was an estimated 14.8% proportion of the population in urban areas categorized 

as being below the food poverty line. In Addis Ababa, the estimated proportion of individuals experiencing food 

insecurity, defined as those unable to purchase consumption items that yield a minimum of 2,200 kilocalories, is 

19.1% (PDC, 2019). Similarly, the proportion of people suffering from food insecurity in the Lideta sub-city, 

which is considered to be one of the most deprived sub-cities in Addis Ababa, was estimated at around 29.3%. 

This means that about one-third of the population falls below the threshold of adequate food intake (MOFED, 

2018). The share of total household income spent on food is around 42.2% (CSA, 2016b). 

Urban food insecurity is mostly chronic, combined with higher urbanization rates, food price changes, and 

market instability (Boliko, 2019; Riley et al., 2019), and persists for long periods, if not lifetimes (FAO, 2020). 

It is closely associated with urban poverty. As the study conducted by Belachew et al. (2012) in Ethiopia 

showed, chronic food insecurity in households can result in persistent malnutrition as a consequence of the 

inability to secure adequate and sustained access to food. In situations where there is a surge in food prices, 

households that do not engage in food production, particularly those located in urban areas, are compelled to 

procure food through alternative means, predominantly through purchase. The purchasing power of households 

is contingent upon their income, so a rise in the prices of food can have adverse effects on their ability to access 

sufficient amounts of food (Boliko, 2019). 

Indisputably, households experiencing poverty typically encounter a plethora of challenges, such as unfulfilled 

family planning demands, families with sizes that exceed their preferences, and inadequate financial resources 

to afford the necessary quantity and quality of nourishing sustenance to meet the needs of their families. The 

condition of poverty precipitates inadequate access to family planning and, in turn, serves as a consequence 

thereof. Families with lower economic status experience limited availability of family planning services. They 

allocate a greater portion of their budget towards sustenance while expending a lesser amount of money per 

individual on food as opposed to affluent households (Smith & Rhonda, 2015; USAID, 2014). Though the total 

fertility rate in Addis Ababa is relatively better compared to other regions of Ethiopia and is estimated at 1.8 

children per woman, the fertility rate is still high at the national level, which is 4.6 children per woman (CSA, 

2016a). A crucial consideration towards maintaining sustainable population growth that does not burden the 

world's finite resources needs foremost attention to the interrelationship between food security and reproductive 

health (Khatun & Mallick, 2020). 

 

Literature review  

Economic, social, and religious factors like income, education, religion, work status, age at first birth, age at 

first marriage, contraceptive use, and childhood mortality affect fertility (Demeke et al., 2011; Dieu, 2016; 



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Masoud, 2009; Mekonnen & Worku, 2011c; Ojakaa, 2008; Rabbi et al., 2013; Tomkinson, 2019). Among the 

various theories of population and fertility, Neo-classical Microeconomic Theory (Becker & Lewis, 1973) and 

Demographic Transition Theory (Notestein, 1953) are considered the most useful in examining the 

interrelationship between food insecurity, fertility, and contraceptive use. These theories center on the principal 

determinants that are responsible for the elevated fertility rates observed in developing nations. This 

phenomenon is commonly attributed to a dearth of economic advancement. According to demographic 

transition theory, high infant and child mortality, poor agricultural productivity, insufficient utilization of 

contraceptives, and a relatively lower socioeconomic standing in terms of women's education, occupation, and 

social status contributed to the high fertility norm. 

Some empirical studies have also confirmed that food insecurity and fertility are related. The study conducted 

by Mekonnen and Worku (2011) in Butajira District, South Central Ethiopia, showed that food security is a 

significant predictor of the effect of having fewer children. The findings of the study indicate that women 

residing in food-insecure households exhibited a 6% increase in the number of children ever born relative to 

women inhabiting food-secure households. Another study conducted by DiClemente et al. (2021) in Tanzania 

also showed that food insecurity is positively related to the fertility experience of households when controlling 

education, place of residence, age of the mother, and number of living children. According to the finding, 

women who experience household hunger exhibit a higher likelihood of desiring additional children or 

expressing uncertainty about having more children in comparison to their counterparts who do not experience 

household hunger. This finding highlights the potential impact of food insecurity on reproductive decision-

making among women. The study undertaken by Abdu et al. (2018) in the Assayita District of the Afar 

Regional State in Ethiopia has demonstrated a significant correlation between household food insecurity and 

household fertility. The results of the study indicate that households characterized by a parity of five or more 

children were found to exhibit a significantly greater likelihood of experiencing food insecurity when compared 

to those who had not yet born  children (parity 0). According to this study, women who have two or more 

children under the age of five are at a statistically significant increased risk of being underweight due to 

malnutrition, with odds greater than nine times that of women without young children below five years of age. 

Although various studies have been conducted to show the effects of food insecurity on child health and 

development (Kimbro & Denney, 2015; Quyen et al., 2014), education performance, and intellectual 

development (Belachew et al., 2011), external and internal behaviors (Murphy et al., 1998), and stunting, 

wasting, and underweight (Abdu et al., 2018; Abdurahman et al., 2016; Berra, 2020; Betebo et al., 2017; 

DiClemente et al., 2021), insufficient emphasis has been placed on investigating the relationship  between urban 

household food insecurity and demographic outcomes within scholarly discourse. Undoubtedly, endeavors have 

been made to elucidate the correlation between women's reproductive health status, fertility, and the household's 

food security (Abdu et al., 2018; Feyisso et al., 2015); however, scant attention has been given to elucidating 

the reciprocal relationship between  food security, fertility, and family planning. This study aims to investigate 

the relationship between  urban household food insecurity and  fertility, providing policymakers and 

development stakeholders with valuable insights to guide well-informed decision-making and effective 

interventions. 

 

Methodology  

 

Study design and area 

A cross-sectional study design was used to collect data from February to March 2023 in Lideta sub-city, located 

in the central-western area of Addis Ababa. Borders are shared with Addis Ketema, Arada, Kirkos, Nifas Silk-



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Lafto, and Kolfe Keranio. The sub-city is divided into ten Woredas. The study randomly selected three Woredas 

and collected data at respondents' residences in the sub-city. Lideta Sub-City covers 9.18 sq km with a 

population of 284,208, including 134,372 males and 149,836 females. The study focuses on a highly populated 

and poor district in Addis Ababa with a population density of 30,960 people per square kilometer (CSA, 

2022b). 

 

Sampling design and procedure 

 

Sample size was determined by the single mean formula proposed by Bartlett et al. (2001) with the assumption 

that the single population proportion experiencing food insecurity is often estimated to be 50%, with a margin 

of error of 5% and a 95% CI (z1/2 = 1.96). A design effect of 1.5 for cluster sampling and some allowance were 

also added, considering the variability in the study population and controlling non-response rates and outliers, 

respectively. The sampling strategy of this study was operationally predicated on the pre-established 

enumeration areas of the sub-city, which had been delineated by the central statistical service of Ethiopia. 

Samples are drawn from a population using a multi-stage random sampling technique. In multistage random 

sampling, three Woredas are randomly selected at the first stage. Secondly, each Woreda comprises different 

Ketenas (villages), and from each of these three Woredas, two Ketenas are selected using the random sampling 

method. In the last step, a total of six Ketenas were there to select the final 649 respondents. The total sample, 

which was selected using a multi-stage random sampling technique, was divided among all those Woredas and 

then among Ketenas proportionally to their population. The households from the respective Woreda were 

selected by systematic random sampling based on a sampling frame of house numbers developed from Ketena 

records. Individual respondents of women within the age range of 15 to 49 years who would be either 

household heads or spouses and gave birth within the last 15 years preceding the survey were sampled. If the 

selected household was found to be closed, the household with the next number on the list was selected, and this 

continued until the required number of sampled women was acquired. 

 

Study variables 

 

The outcome variable of this study is fertility. It refers to the reproductive performance of an individual, a 

couple, a group, or a population, which could be measured by using the number of children ever born, the 

consecutive birth interval, or the total fertility rate. Here, fertility is measured by taking the number of children 

ever born (CEB) as a discrete outcome variable. Predictor variables and covariates include household food 

insecurity status and other demographic and socioeconomic variables such as the age of the mother, marital 

status, women's education, women's income, religion, work status, age at first birth, contraceptive use, the 

desired number of children, and childhood mortality. 

 

Analytical methods  

 

The relationship between urban food insecurity on fertility will be analyzed using the Poisson regression model 

taking children ever born as dependent variables and food insecurity as the main predictors. More formally, the 

Poisson regression model will be expressed as  

𝑙𝑜𝑔(𝜆𝑖) = 𝛽0  
+ 𝛽1 

𝑋𝑖1 
+  𝛽2 

𝑋𝑖 2 
+ . . . + 𝛽𝑛 

𝑋 𝑖𝑛 
+  𝑢𝑖 ) 



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λi is the number of children for women in the Lideta Sub-city, xi is a vector of k characteristics, 𝛽o is the 

intercept, 𝛽 is the vector of covariate parameters, and ui is the error term. The present study shows the outcomes 

of the model, which reveal the incidence rate ratio or Exp(ß) , elucidating the relative change in the number of 

children given a unit change in the explanatory variable, while keeping all other variables constant. The present 

study employed a Poisson regression model to evaluate the association between household food insecurity and 

the number of children ever born, along with several other independent variables. Descriptive statistics, on the 

other hand, will help to give bivariate analytical results for the study. 

The data was collected using KoboCollect 3.5 and entered into the SPSS 24 software with caution. The 

completeness and errors related to inconsistencies were verified using the data cleansing method. Bivariate 

analysis was employed to identify the variables that exhibited a statistically significant association with fertility. 

In this study, the variables that exhibited a p-value of less than 0.25 were subjected to a thorough examination 

for multicollinearity issues utilizing the variance inflation factor (VIF). Following this preliminary assessment, 

the identified variables were included in the Poisson  regression model to determine their effect on the outcome 

variable (children ever born). Incidence rate ratios with their corresponding 95% confidence intervals were 

computed. A significance level of 0.05 was deemed statistically significant in the present study. 

 

Measurement of household food insecurity 

 

The caloric value of foods that meet the threshold requirement of 2,200 kilocalories (kcal), as recommended by 

the Food and Agriculture Organization (FAO, 2004), for enabling healthy and moderately active adult living is 

determined by their corresponding national average prices to establish the food poverty line. Although the 2016 

Interim Poverty Analysis Report estimated the cost at 3,772 birr per year per adult person in Ethiopia (FDRE, 

2017; MOFED, 2018), this price is not feasible and had to be adjusted based on current food prices. However, 

the overall percentage of inflation has reached 122.2 % from June 2016 to January 2023; computing the amount 

of food inflation year by year brings the estimated cost to Birr 11,524.52 per year per adult (CSA, 2022a; NBE, 

2022). Accordingly, the cost of one kilocalorie is estimated to be Birr 0.0143. 

In this article, the national food poverty line was used to measure food insecurity status. The food poverty line 

determines whether a given household can have enough daily food expenditure (total household income spent 

on food) to meet its members' minimum daily calorie needs. Therefore, households that cannot afford the 

money or are unable to source consumer goods for these daily calorie needs are considered to be food insecure. 

However, individual access to food depends on household food distribution and gender parity, which in practice 

means that consumption patterns are not uniform (Battersby, 2011). Often, children, women, and older 

household members consume less food compared to those male adults (Claro et al., 2010). A per capita adult 

equivalent estimate is obtained by dividing the total daily income or calories by all household members, 

assuming a uniform food consumption pattern for families with different compositions. Therefore, if this adult 

person equivalent estimate were taken, Birr 31.46/2,200 kcal would be used as a standard threshold to identify 

food-insecure households from those that are not. But such an approach could make households food-insecure 

that were almost certainly not insecure since they fail to consider the presence of household members with 

distinct energy needs. Thus, in this article, an adult-equivalent estimate of the calorie availability scale that has 

an adult-equivalent conversion factor was used (Appendix). The application of an adult-equivalent scale 

effectively narrows the variance between estimated and actual food intake, thereby enabling the discernment of 

the relative contributions of distinct household members towards the overall dietary pattern of the household, 



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which is not feasible with the utilization of per capita metrics. Household income and expenditure survey is 

standard and widely applicable to measure household food insecurity and poverty at the household level 

(Abuelhaj, 2007; Bellú, L. G. & Liberati, 2005; Ruggeri Laderchi et al., 2003). The World Bank, USAID, the 

International Development Association (IDA), and the Ethiopian government have applied this monetary 

approach to measure household food insecurity/poverty related to the urban productive safety net program in 

urban Ethiopia (UPSNP, 2021). Moreover, the government of Ethiopia and other developing countries have also 

applied this monetary approach to food poverty and insecurity analysis, identifying the prevalence, gap 

(shortfall), and severity of household food insecurity (FDRE, 2017; PDC, 2019). 

 

Results and discussion  

 

Demographic and socio-economic characteristics of respondents 

 

As shown in Table 1, a total of 649 households participated in the study. Of these, nearly half, or 48.7%, are 

between 25 and 34 years old. Of all respondents, single, married, divorced, and widowed account for 114 

(17.5%), 432 (66.6%), 87 (13.4%), and 16 (2.5%), respectively. The majority of respondents (39.6%) attended 

secondary school, followed by primary school (33.7%). In addition, 8.0% had a diploma or higher and 11.9% 

had no educational qualifications. 

 

Table 1: Demographic and socio-economic characteristics of respondents  

 *P < 0.25 significant association          

           

Variables  Freq.   % Mean  Sig.  Variables Freq.   % Mean  Sig.  

Employment status Contraceptive use 

Unemployed  242 37.3% 1.69  

0.081* 

Yes  322 49.6% 1.31  

0.000* Employed  407 62.7% 1.52 No  327 50.4% 1.85 

Women income in Birr Marital status     

0-1500 204 31.4% 2.18  

0.000* 

Married  432 66.6% 1.87  

 

0.000* 

1500.01-3000 134 20.6% 1.54 Single 114 17.6% 0.79 

3000.01-4500 133 20.5% 1.36 Divorced 87 13.4% 1.18 

>4500 178 27.4% 1.09 Widowed  16 2.5% 1.75 

Age at first birth Age of Mother 

15-19 138 22.8% 1.88  

0.008* 

20-24 33 5.1% 1.03  

 

0.152 

20-24 240 39.6% 1.70 25-29 159 24.5% 1.48 

25-29 137 22.6% 1.67 30-34 156 24.1% 1.96 

30-34 66 10.9% 1.39 35-39 141 21.8% 2.00 

>35 25 4.1% 1.40 >40 159 24.5% 1.06 

History of Child mortality Household food security status 

No 534 87.8% 1.63 0.000* Food- secure  206 31.7% 1.14  

0.000* Yes  74 12.2% 2.11 Food-insecure 443 68.3% 1.79 

Desired number  of children Religion 

0-2 262 40.4% 1.50  

0.278 

Orthodox  418 67.5% 1.52  

0.035* 3-4 251 38.7% 1.65 Protestant  108 17.4% 1.45 

>5 136 21.0% 1.62 Muslim  93 15.0% 1.89 

Women level of education      

Uneducated  77 11.9% 1.48  

 

0.649 

     

Informal 44 6.8% 1.50      

Primary  219 33.7% 1.76      

Secondary  257 39.6% 1.51      

Above  Diploma 52 8.0% 1.42      



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Regarding their employment status, the majority (62.7%) of respondents are engaged in any income-generating 

activities, while 37.3%) of the respondents were not employed in any labor sector at the time of the survey. 

Significant proportions of the survey participants (67.5%) were Orthodox Christians, 15.0% were Muslims, and 

Protestants accounted for 17.4%. The majority of respondents (50.4%) are not using any modern contraceptive 

method and 12.2% of respondents have at least a history of childhood mortality. The majority of respondents, 

around 72.5%, earn a monthly income of 0–3000 Birr. Regarding age at first birth, the majority of respondents 

(39.6%) started childbearing at the age between 20 and 24. Moreover, measuring a household's food insecurity 

status also revealed that 68.3% of the sample households were food insecure and the remaining 32% were food 

secure.  

 

The relationship between food insecurity and fertility 

 

Table 1 presents the mean values of children ever born among women, categorized based on food insecurity and 

socio-demographic characteristics. The findings of the survey indicate that households experiencing food 

insecurity exhibit a higher mean number of children ever born at 1.79 compared to those who are food-secure, 

with a mean number of children ever born of 1.14. The mean number of children ever born exhibits variance 

across various religious groups. According to the findings of the survey, Muslims exhibited the highest mean 

number of children ever born, with a value of 1.89, followed by Orthodox Christians with 1.52 and Protestants 

with 1.45. Based on the findings of the survey, it was determined that women with monthly earnings ranging 

from 1,500 to 3,000 Birr and 3,000 to 4,500 Birr had a mean number of children ever born of 1.54 and 1.36, 

respectively. This result falls below the replacement level as it signifies that these women are not producing 

enough children to replace themselves. Comparably, the number of children that have ever been born to 

individuals belonging to the high-income category (earning over 4500 Birr per month) and low-income category 

(earning between 0 and 1500 Birr per month) was determined to be 1.09 and 2.18, respectively. According to 

the findings, the mean number of children ever born to married women (1.87) was compared to those of 

unmarried, divorced, and widowed women, whose mean numbers of children ever born were 0.79, 1.18, and 

1.75, respectively. These results suggest a significant association between marital status and the number of 

children ever born. In contrast, the findings indicate that females with no education and those holding degrees 

and above exhibit the greatest and least mean numbers of children ever born, standing at 1.48 and 1.42, 

respectively. Concerning the demographic category of females, there is a positive correlation between maternal 

age and the mean number of children ever born. The findings indicate that women in the age bracket of 35 to 39 

exhibits a significantly greater mean number of children ever born (2.00) in contrast to young women (1.03). 

 

Factors of household fertility in Lideta Sub-City, Addis Ababa, Ethiopia 

 

A bivariate analysis was conducted to ascertain potential variables for inclusion in the Poisson  regression. 

Utilizing specific criteria, the variables of maternal age, marital status, women's income and work status, age at 

first birth, food insecurity, and childhood mortality were deemed suitable for inclusion in the Poisson  

regression analysis. After adjusting for confounding factors, including maternal age, marital status, 

contraceptive use, and household food insecurity status, and childhood mortality, significant statistical 

associations were observed with fertility at p < 0.05 (Table 2). Efforts have been made to assess whether or not 

the necessary assumptions for the application of Poisson  regression are fulfilled. The present study compared 

the adequacy of two regression models, namely Poisson and negative binomial, in explaining a given set of data 

by utilizing two popular model selection criteria, namely Kaike's Information Criterion (AIC) and the Bayesian 



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Information Criterion (BIC). The results revealed that both AIC and BIC were lower for the Poisson distribution 

than for the negative binomial distribution. This finding suggests that the Poisson regression model represents a 

better fit for the data compared to the negative binomial regression model. Conversely, the evaluation of model 

fit using the goodness of fit test reveals a deviance below 1, signifying that under dispersion is present and the 

value approaches zero. This result is indicative of zero inflation, thereby suggesting that the Poisson regression 

model is best fitted. The utilization of an omnibus test in the Poisson regression model has resulted in a 

significant p-value of 0.001, indicating that all predictor variables incorporated in the model are meaningful full 

predictors of the effect of the number of children ever born. 

 

Table 2 : Coefficients and odds ratio of fertility in Lideta Sub-City, Addis Ababa 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Note: The reference group is listed in the parentheses.       

 

The result of the study shows that food security status was a significant predictor of the number of children ever 

born at p < 0.05. Holding the other variables constant, the number of children ever born for women within food-

secure households is 0.655 times lower compared to women with food insecurity. As we can see from Table 2 , 

women's monthly income was a significant predictor of the number of children ever born. Holding the other 

variables constant, the number of children ever born for women with monthly incomes of 0–1500, 1500–3000, 

and 3000–4500 Birr is 1.495, 1.287, and 1.236 times greater, respectively, compared to those women having an 

income of Birr higher than 4500. This means that the reduction in income levels from Birr 4500 and above to 

Birr 3000–4500, Birr 1500–3000, and Birr 0–1500 is associated with increases in the number of children ever 

born by 23.6%, 28.7%, and 49.5%, respectively. 

The results of the study show that marital status has a significant effect on the number of children ever born. 

The finding indicates that single women have 0.601 fewer children compared to their widowed counterparts. A 

woman's age is one of the most significant biological and demographic factors affecting fertility. The present 

investigation indicates that there is a significant disparity in the number of children born by older women as 

compared to their younger counterparts, meaning that a younger age at first birth is associated with a higher 

number of children ever born. When comparing the number of children ever born across different age groups, it 

Variables  B Sig.  Exp(b) 95% CI for Exp(b) 

Marital status 

Married (Widowed) -.139 .491 .870 .585 1.293 

Single(Widowed) -.509 .025* .601 .385 .938 

Divorced (Widowed) -.371 .089 .690 .450 1.058 

Women income (Birr) 

0-1500 (>4500) .402 .000* 1.495 1.233 1.812 

1500.01-3000 (>4500) .252 .019* 1.287 1.042 1.588 

3000.01-4500 (>4500) .212 .050* 1.236 1.000 1.529 

Contraceptive use 

Yes (No) -.183 .015 .833 .719 .965 

History of Child mortality 

Yes (No) -.327 .000 .721 .601 .865 

Household food security status 

Food- secure ( Food-insecure) -.423 .000* .655 .544 .789 

Age of  Women 

20-24  (>40) .306 .130 1.359 .914 2.020 

25-29  (>40) .318 .007* 1.375 1.092 1.731 

30-34  (>40) .520 .000* 1.682 1.359 2.084 

35-39 (>40) .498 .000* 1.646 1.334 2.031 



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is evident that there is a decreasing trend as age decreases. Specifically, the age group of 20–24 displays a low 

number of children ever born, whereas the age group of 35–39 exhibits a high number of children ever born. 

Women belonging to the age groups of 20–24, 25–29, 30-34, and 35–39 have 1.359, 1.375, 1.682, and 1.646 

fewer children, respectively, when compared with their counterparts in the 45–49 age brackets. 

The difference in the number of children ever born between contraceptive users and non-users was also found to 

be significant at P < 0.05. Other factors being equal, the number of children ever born for contraceptive users is 

0.833 times lower than for non-users. The history of child mortality and the need for children were also found to 

be significant predictors of the effect of the number of children ever born. Holding other factors constant, 

women with childhood mortality experiences have 0.721 more children than women without childhood 

mortality experiences. 

 

Discussion 

 

The present study endeavors to evaluate the association between food insecurity and fertility in Lideta Sub-City. 

According to the present investigation, the average number of children ever born to women of childbearing age 

in the study area is 1.58, which is below the replacement level. This finding was comparable with the study 

conducted in Addis Ababa, which was 1.9 births (Gurmu & Mace, 2008), but lower than what was reported in 

the Ethiopian Demographic and Health Survey  at the national level (2.84 births) (CSA, 2016a). The observed 

variability could potentially arise from differences in the demographic, socioeconomic, or cultural status of 

women or from other factors pertaining to health, such as disparities in counseling proficiency (Shiferaw et al., 

2019). 

The findings of the study also show that the number of children ever born from food-insecure households was 

higher compared to children from food-secure households. This finding was consistent with some studies 

(DiClemente et al., 2021; Feyisso et al., 2015; Mekonnen & Worku, 2011a). The plausible explanation for this 

phenomenon is that children residing in households experiencing food insecurity are perceived as contributing 

meaningfully to enhancing the socio-economic status of their family (Birhanu, 2013; Leibenstein, 1975; World 

Vision, 2022). Moreover, women who belong to households experiencing food insecurity are at a high risk of 

experiencing negative sexual and reproductive health consequences, including ineffective utilization of 

contraception and unintended pregnancies. These outcomes are predominantly attributed to limited decision-

making abilities and inadequate communication with their partners (Ahinkorah et al., 2021). The socio-

economic status of women is also a significant factor in contributing to their participation in fundamental 

approaches to regulating fertility and promoting the effective utilization of progressive healthcare services 

(Dixit et al., 2021). 

Considerable differences in the number of children ever born exist according to women's age, income, marital 

status, food security status, contraceptive use, and childhood mortality. The effect of marital status on the 

number of children ever born was found to be significant at p < 0.05. This finding was in line with the findings 

of previous studies and reports (CSA, 2016a; Shiferaw et al., 2019), but opposed by a study conducted in the 

Tigray region of Ethiopia (Atsbaha et al., 2016). Single women are susceptible to precarious sexual and 

reproductive health outcomes, such as inadequate utilization of contraception and undesired pregnancy, 

primarily attributable to insufficient decision-making and inadequate communication with their spouses 

compared to married women (Dixit et al., 2021). 

The age of the mother was also found to have a significant relationship with the expected number of children 

ever born at p < 0.05. This finding was consistent with a study conducted in Ethiopia (Abdu et al., 2018; 

Adhikari, 2010; Aragaw et al., 2023) but opposed the finding of a prior study (Azmoude et al., 2017). The 



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importance of these variables could be due to the fact that the likelihood of marrying and having more children 

increases as women get older, meaning that as women progress in age, there is a corresponding progression in 

their desire to achieve independence and establish an autonomous lifestyle. The cultural dimension also serves 

as a significant factor in the reinforcement of reproductive-age women to bear children before the cessation of 

their childbearing years (Atsbaha et al., 2016). 

In the majority of instances, there is an inverse correlation between education level and fertility. The present 

study indicates that the absence of primary education among women is associated with increased fertility rates 

in comparison to those who have attained secondary and higher education (CSA, 2016a, 2019). However, in this 

study, the level of education was not found to be statistically significant in predicting the effect of the number of 

children ever born. This finding was in line with prior studies (Adhikari, 2010; Azmoude et al., 2017) but in 

contrast with studies (Aragaw et al., 2023; Atsbaha et al., 2016; Mekonnen & Worku, 2011b; Muche & 

Gebremichael, 2020; Rutaremwa et al., 2015). Although educated women are usually more aware of family 

planning methods and the advantages and disadvantages of having children, they should have more autonomy 

and power in making reproductive decisions, so that they experience a lower fertility rate. 

This study has further revealed that employment status was not found to be a significant predictor in 

determining the effect of the number of children ever born. This finding corroborates studies (Adhikari, 2010; 

Azmoude et al., 2017; Muche & Gebremichael, 2020) but contradicts the findings of previous studies (Andersen 

& Özcan, 2021; Muche & Gebremichael, 2020). This fact might be elucidated by the observation that a 

significant proportion of women are employed in the informal sector, which is characterized by relatively low 

impacts on fertility. 

The finding of this study also confirms that there is a negative association between women's income and 

fertility, and this is in agreement with other studies  (Götmark & Andersson, 2020; James et al., 2011; Shiferaw 

et al., 2019), but opposes a study conducted in the east of Iran (Azmoude et al., 2017), which prioritizes the 

demand for children as the key predictor of the effect of the number of children ever born. The relationship 

between income and fertility rates was also reported to be direct by Kolk (2022). The observed inconsistency 

may be attributed to the selection of subjects exclusively from urban areas, where educational resources are 

plentifully available even to individuals with low socioeconomic status. Moreover, urbanization, commonly 

referred to as urbanism, is likely to be linked with a shift in ideas and attitudes concerning larger families. 

Moreover, it is plausible that individuals living in urban areas possess enhanced means to procure contemporary 

contraception methods, consequently empowering them to efficiently implement their intentions to limit fertility 

rates (White et al., 2018). 

The difference in the number of children ever born between contraceptive users and non-users was also found to 

be significant at P < 0.05. Other factors being equal, the difference in the rate of children ever born for 

contraceptive users is 0.641 times lower than for non-users. This finding was consistent with some studies 

(Adhikari, 2010; Aragaw et al., 2023; Götmark & Andersson, 2020; Muche & Gebremichael, 2020; Shiferaw et 

al., 2019) but in contrast with (Atsbaha et al., 2016; Azmoude et al., 2017). The rationale behind the decline in 

fertility rates can be attributed to the crucial role played by contraception in promoting healthy timing and 

spacing of pregnancies. Further, contraception has been proven to increase the likelihood of child survival 

through the spacing of births (Megquier & Belohlav, 2014). 

The findings of this study also reveal that the history of child mortality and the need for children were also 

found to be significant predictors of the effect of the number of children ever born. Holding other factors 

constant, the number of children ever born is higher when women have a history related to child mortality. This 

finding corroborates studies (Adhikari, 2010; Atsbaha et al., 2016; Jara et al., 2013; Mekonnen & Worku, 

2011a; Muche & Gebremichael, 2020; Shiferaw et al., 2019) but opposes the findings of studies (Aragaw et al., 



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2023; Azmoude et al., 2017). The aforementioned phenomenon may be explicable by the fact that women who 

have experienced child mortality have the desire to replenish their children. Nonetheless, they are apprehensive 

of a recurrence of the adverse outcome (Atsbaha et al., 2016; Endriyas et al., 2017). 

 

Conclusions  

 

The current research demonstrates that the ability to access family planning services and effectively manage 

fertility is significantly hindered by food insecurity. Moreover, within households experiencing food insecurity, 

women exhibited a decreased propensity towards utilizing contraceptive techniques in pursuit of attaining a 

suitable and satisfactory family size. The integration of suitable strategies aimed at enhancing the adoption of 

family planning services within food-insecure households is a crucial aspect of interventions geared toward 

regulating household fertility. Therefore, stakeholders are anticipated to engage in collaborative and coordinated 

efforts across various sectors to address the challenges of food insecurity and fertility issues. Such actions will 

prioritize expanding women's education, voluntary family planning initiatives, job creation programs, and 

initiatives to strengthen women's economic empowerment.  

Finally, the study findings have been reinforced by the utilization of rigorous statistical analysis techniques and 

the attainment of high response rates in the data collection process. Moreover, utilizing a thoroughly validated, 

structured questionnaire could have effectively mitigated the presence of instrumental and inter-rater biases. 

Despite the extensive exploration of the interrelationship between household food insecurity and fertility, while 

adjusting for potential confounding variables, the cross-sectional design of the dataset restricts our ability to 

draw definitive cause-and-effect relationships between outcome and independent variables. Continuous, long-

term surveys and standardized measurement tools, such as the Household Food Insecurity Access Scale, need to 

be employed in future studies to ascertain causal relationships among variables and discern the various levels of 

food insecurity. This is imperative to establishing a comprehensive understanding of the phenomenon under 

investigation. 

 

Declaration  

Acknowledgments: Lideta Sub-City of Addis Ababa is acknowledged for providing  demographic data 

Funding: No funding source to declare. 

  

Competing interests: There is no competing interest. 

 

Authors’ Contributions: Conceptualization: Ephrem Tadesse Goda and Terefe Degefa Boshera 

Formal analysis: Ephrem Tadesse Goda and Mengistu Ketema Aredo, Methodology: Ephrem Tadesse Goda, 

Writing – original draft: Ephrem Tadesse Goda , Writing – review & editing: Ephrem Tadesse Goda ,Terefe 

Degefa Boshera and Mengistu Ketema Aredo 

 

Ethics approval and consent to participate: Ethical clearance and a letter of support were obtained from IRB 

of Addis Ababa University, College of Development Studies, and the Center for Population Studies. Letters 

were distributed to all the respective Woredas. Informed consent was obtained from participants before the 

commencement of data collection. The purpose of the study was explained to both the respondents and the 

Woreda experts. 

 



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Consent for publication: There is no restriction on publication  

 

Availability of data and materials: The datasets generated during and/or analyzed during the current study are 

available from the corresponding author on reasonable request. 

Appendices: 

Appendix 1:  Conversion factor for estimation of adult-equivalent calorie requirements 

 

 

 

 

 

 

 

 

 

 

 

                 

Source: Claro et al. (2010). Per capita adult-equivalent estimates of calorie availability in household budget 

surveys. Cademos de Saúde Pública, 26 (11). 

 

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