Structural equations modelling to quantify the effect of direct and intermediate factors on fertility changes in Egypt during 2000–2014

Abstract

Background: Egypt's population increased by 10 million between 2011and 2014 and the total fertility rate increased to 3.5 births per woman. Aims: This paper aimed to evaluate the direct and intermediate factors that could explain this increase in the total fertility rate. Methods: Data from the 2000 and 2014 Egypt Demographic and Health Surveys were used. The average number of births per woman in the 3 years before the survey was used as a proxy for total fertility rate. A structural equations model was used to measure the total effect of direct and intermediate variables on number of births per woman. Results: The effect of the intermediate variables on births per woman was stronger than the direct factors in both health surveys. In the 2000 and 2014 surveys, the intermediate factors with the greatest effect were: unmet need for family planning methods, discontinuation of using family planning methods in the 5 years before the survey, number of discontinuations of using family planning methods in the 3 years before the survey and child death under 5 years. In the 2000 survey, the direct factors affecting a decline in births per woman were: exposure to family planning messages, woman's work status, wealth index and woman's age 3 years before the survey. In the 2014 health survey, the effect of these variables on fertility declined. This decrease contributed to increasing the total fertility rate to 3.5 births per woman. Conclusion: Population policies should reintensify efforts to reduce the fertility rate based on the factors that influence fertility, such as family planning messages.