Rural-Urban Fertility Disparity in The Gambia: Standardized Rate, Decomposition, Parity Progression, and Determinants

This cross-sectional design study examined rural-urban fertility differences in The Gambia. We used the 2019-20 Gambia Demographic and Health Survey data. A multi-stage sampling technique was used to select women of reproductive age (8,747 urban & 3,119 rural). Data were analyzed using descriptive statistics, Kitagawa’s Decomposition technique, and the negative binomial (NB) model, α = .05. The mean Children Ever Born (CEB) was higher in the rural (3.25 ± 3.02) than in the urban (2.19 ± 2.45) areas. In the urban and rural areas, 82.8% and 95.1% of women aged 45–49 years who had had three children progressed to fourth birth, respectively. The parity progression rate (λ) was lower in the urban (-0.0647) than in the rural (-0.051). The difference between the standardized fertility rates in rural and urban areas was 83.2 in The Gambia, and the effect of the age composition attributable to this difference was 8.11%. The fertility incidence rate ratio (IRR) was 44% (IRR = 1.440, 95% CI [1.371, 1.513], p < .001) higher in the rural than the urban areas. A similar pattern of rural-urban differences in fertility was observed in the full model. Childbearing progression was higher in rural areas than urban areas and rural-urban differences exist in fertility determinants in The Gambia. Thus, rural-urban-specific fertility reduction programs may address the observed fertility differences in the rural and urban areas in The Gambia.