Individual, household, and community-level factors associated with high-risk fertility behaviour among Nigerian women: secondary analysis of the 2018 demographic and health survey data

Background: High-risk fertility behaviour (HRFB) remains a significant public health concern in Nigeria, contributing to increase in maternal and child morbidity and mortality. The existence of HRFB presents significant barrier to accomplishing the Sustainable Development Goals. The objective of this study was to examine the prevalence and contextual factors of HRFB among Nigerian women. Methods: In this study, cross-sectional data with national representativeness from the 2018 Nigeria demographic and health survey (NDHS) were used. The sample was made up of 21,792 women aged 15-49 years selected from 1389 enumeration areas. A multilevel multivariable binary logistic regression model was utilised to examine the factors associated with HRFB. Results: The weighted prevalence of HRFB was 64% (95% CI 62-65%). Women having at least a secondary education had 14% (aOR = 0.86; 95% CI 0.77-0.98) reduction in the odds of HRFB when compared with women with at most a primary education. Muslim women had 20% (aOR = 1.20; 95% CI 1.06-1.36) increase in the odds of HRFB, when compared with the Christian women. Those who had 3-4 living children had 3.97 times higher odds of HRFB, when compared with women with no child (aOR = 3.97; 95% CI 2.92-5.40). Women aged 25-34 and 35-49 years had higher odds of HRFB when compared with women aged 15-24 years respectively. Women exposed to media use had 12% (aOR = 0.88; 95% CI 0.80-0.97) reduction in the odds of HRFB when compared with women not exposed to media use. The non-poor women had 12% (aOR = 0.88; 95% CI 0.79-0.99) reduction in the odds of HRFB when compared with poor women. Respondents from female-headed households had 21% reduction in the odds of HRFB when compared with those from households with male head (aOR = 0.79; 95% CI 0.69-0.92). The geographical region was significantly associated with HRFB among women. Conclusion: The high prevalence of HRFB among Nigerian women underscores the need for policies and programmes targeted to address the issue. Addressing socioeconomic factors, improving education and healthcare access, and promoting family planning could significantly reduce HRFB.