Determinants of fertility desire among reproductive aged married and cohabiting women in Ethiopia a multilevel analysis of PMAET 2021 data

In Ethiopia, numerous efforts have been undertaken to control the rapid growth of the population and decrease the average number of births per woman, in the last ten years, though it has not been possible to achieve as much change as was planned and intended in the National Health Sector Transformation Plan (HSTP II) and reproductive health (RH 2015-2020) strategies. The annual growth of the population and fertility rates remained at 2.7 and 4.6, respectively. Fertility is one of the fundamental aspects influencing population dynamics, while women fertility desire to have a child plays a crucial role in determining actual fertility rates and can be acts as an indicator for future reproductive behavior, an insightful tool for grasping broader fertility patterns, and a key element in understanding overall demographic trends. Women's fertility desire refers to the number of children they want to have in the near future, based on their evaluation of the cost and benefits of childbearing. This analysis used cross-sectional data from Performance Monitoring for Action Ethiopia (PMA-ET) 2021. A total of 4138 married or cohabiting individual women between the ages of 15 and 49 who were not pregnant were included in this analysis. Sampling weighting factor and design were applied in this analysis, and chi-square test statistics were computed to determine the overall association and to assess the adequacy of the cell sample size. Multilevel binary logistic regression was used to identify important predictors of women's fertility desire. The results were presented as percentages and odds ratios with 95% confidence intervals (CIs). Statistical significance was declared at a significance level of 0.05. Approximately three-quarters (74.1%, 95% CI; 71.5%-76.6%) of reproductive-aged married/cohabiting women in Ethiopia desired to have a child. Remarkably, even among women aged 40 and above and those with six or more children, nearly 40% still reported wanting more children. Fertility desire was also positively associated with having secondary or higher education which is the finding that contrast with previous studies in similar settings. In multivariable analysis, fertility desire was also significantly higher among women who had experienced a forced pregnancy, identified as Muslim, or initiated sexual activity at age 19 or older. Conversely, lower odds of fertility desire were found among older women, those with older partners, higher parity, larger family size, or a history of contraceptive use. The persistently high fertility desire observed in Ethiopia highlights the complex interplay between cultural, religious, and socioeconomic factors, and suggests that simply expanding access to family planning information may not be sufficient to shift reproductive intentions. Policy and program efforts should move beyond a narrow focus on fertility reduction and instead center women's voices, reproductive autonomy, and contextual realities. Our findings suggest that fertility desire in Ethiopia is shaped more by deeply rooted sociocultural and religious norms than by lack of access to family planning information. Accordingly, policy interventions should focus on engaging communities in meaningful dialogue, understanding and addressing the motivations behind high fertility preferences, and supporting reproductive autonomy for all women, including those who wish to have large families.