Fertility Level and Its Determinants Among Women of Reproductive Age Group Before and After the War in Tigray: A Community-Based Cross-Sectional Study

Purpose: Fertility rate, defined as the average number of children born during an individual's reproductive years, remains a global public health concern. Over the past 4 years, Ethiopia's political landscape, particularly in the Tigray, has changed, given the devastating war in the region. These hostilities severely damaged the region's health system. While war has multi-dimensional consequences on population dynamics, it remains unclear if fertility in the region was affected. Originality: This study aimed to understand the fertility status before or after the war in Tigray which is the first of its kind. Methodology: A community-based cross-sectional study was conducted between November 2023 and March 2024 in three administrative zones of the Tigray region, including 935 study participants. A stratified multistage sampling method was employed, and data were collected via structured interviews using the Open Data Kit and analyzed using Stata version 14. Poisson regression was used to examine fertility as the outcome variable. The ethical approval was obtained from the Institutional Review Board of Mekelle University’s College of Health Sciences. Result: The survey showed that the average fertility rate of the region was 4.6 (urban, 6.4; rural, 4.2). Fertility was higher among women aged 35-49 years, and in those age at first marriage ≥26. Conclusions and Implication: Post-war fertility showed an increase compared to the pre-war fertility. Women’s age and age at first marriage were significant fertility determinants. It is essential to implement socially appropriate, universally accessible services to reduce fertility and establish regulations to protect the health and well-being of reproductive-age group women by delaying marriage.