Relationship between fertility rates and unmet need for family planning in the Nile Basin countries (1990-2023):

a population geography study

Resumo

High Total Fertility Rates (TFR) in the Nile Basin countries remain a significant demographic and public health challenge. This study examines whether higher TFR is associated with higher unmet need for family planning across 11 Nile basin countries over the period 1990-2023. We conducted an ecological, cross-national analysis using country-level data aggregated over the study period, drawing on publicly available sources from the World Bank, the United Nations Population Division, and the Global Religious Futures database. The study employed Pearson correlation analysis and Principal Component Analysis (PCA) with Varimax rotation to assess the strength and underlying structure of these relationships. A strong and statistically significant positive correlation was found between TFR and unmet need for family planning across the region (r = 0.93, p < 0.0001), with a coefficient of determination of r² = 0.86, indicating that differences in unmet need may contribute to 86% of the cross-national variation in TFR in 2023. This association was especially pronounced in countries such as Kenya, Rwanda, Ethiopia, Eritrea, Egypt, and Uganda. PCA revealed a three-factor solution collectively explaining 78.74% of the total variance across the analytical variables; the first factor, on which unmet need for family planning was among the variables with notable loadings (λ = 0.59), accounted for 38.2% of this total variance. These findings underscore the critical importance of addressing unmet need for family planning as a central strategy for managing population growth in the Nile Basin. Targeted interventions, particularly in underserved rural areas, are essential to reduce TFR and advance reproductive health equity across the region.