Association between maternal high-risk fertility behavior and anemia among reproductive age women in Ethiopia

Abstract Objectives Anemia constitutes a major public health problem in low- and middle-income countries. The purpose of this study was to examine the individual and combined influence of high-risk fertility behavior on anemia among reproductive age women in Ethiopia.Methods Secondary data analysis was conducted using a nationally representative sample of women aged 15-49 years from the 2016 Ethiopia Demographic and Health Survey (n=5799). Anemia status was the outcome of interest. Maternal high-risk fertility behaviors were measured using maternal age at delivery, birth order and birth interval. Descriptive statistics and multivariable regression models were performed.Results Overall, 28.7% of women had anemia and 71.4% experienced at least one high-risk fertility behavior. In the multivariable model, there was a significant interaction between high-risk fertility behavior and place of residence on anemia. Women with any high-risk fertility behavior were more likely to have anemia than women without any high-risk fertility behavior. However, the strength of association differed by place of residence (AOR: 2.68; 95% CI, 1.26-5.67 for urban and AOR: 1.27; 95% CI, 1.01-1.61 for rural residents). Single high-risk fertility behavior was significantly associated with anemia only among urban residents (AOR: 2.65; 95% CI, 1.20-5.83). Multiple high-risk fertility behavior significantly increased the odds of anemia, with stronger association among urban residents (AOR: 2.82; 95% CI, 1.14-6.95) than rural residents (AOR: 1.56; 95% CI, 1.11-2.19).Conclusions Place of residence moderated the relationship between high-risk fertility behaviors and anemia. Our findings suggest the need for context-specific strategies and interventions to prevent anemia.