Abstract
Background
Reproductive health inequalities tend to be more marked in large cities because they include neighbourhoods with unequal social and community networks, resources and opportunities. The aim was to describe social inequalities in fertility patterns among women who gave birth between 2007 and 2016 in the city of Barcelona (Spain) by jointly evaluating the effect of individual and socioeconomic neighbourhood characteristics.
Methods
We conducted a multilevel study of women’s individual characteristics (age, educational attainment, and country of origin) and neighbourhood characteristics (disposable household income, percentage of unemployment and percentage of foreigners).
Results
Multilevel modelling revealed significant variability in fertility across neighbourhoods after adjustment for individual explanatory variables. The fertility rate (FR) was higher in better educated women (adjusted relative risk: aRR 2.76), those aged 30–39 years (aRR 2.13), and in those born in Spain in relation to their respective reference groups. The FR was lowest in women with upper to post-secondary, non-tertiary education (aRR 0.86) who were born in high income countries (aRR 0.57). Women living in neighbourhoods with a low income (aRR 1.46) and with a higher unemployment (aRR 1.33) were more likely to have children. In contrast, women living in neighbourhoods with a lower percentage of foreigners had the lowest FR (aRR 0.81).
Conclusions
The neighbourhood’s characteristics played an important role in fertility patterns, independently of women’s individual characteristics. At the contextual level, the highest FR was found in the poorest settings, highlighting inequalities. At the individual level, the FR was highest among women with higher education and in their thirties.
This is a preview of subscription content, log in via an institution to check access.
References
Artazcoz, L., Cortes, I., Puig-Barrachina, V., Benavides, F. G., Escriba-Aguir, V., & Borrell, C. (2014). Combining employment and family in Europe: The role of family policies in health. European Journal of Public Health,24(4), 649–655. https://doi.org/10.1093/eurpub/ckt170.
Baizan, P., Arpino, B., & Delclòs, C. E. (2016). The effect of gender policies on fertility: The moderating role of education and normative context. European Journal of Population,32(1), 1–30. https://doi.org/10.1007/s10680-015-9356-y.
Bartoll, X., Pérez, K., Pasarín, M., Rodríguez-Sanz, M., & Borrell, C. (2018). Resultats de l’Enquesta de Salut de Barcelona 2016/17. Barcelona.
Bernal, E., Sandra, D., Juan, G.-A., Fernando, O., Sánchez Martínez, I., Ramón, J., et al. (2018). Spain: Health system review. Health Systems in Transition, 20(2), 179.
Berrington, A., & Pattaro, S. (2014). Educational differences in fertility desires, intentions and behaviour: A life course perspective. Advances in Life Course Research,21, 10–27. https://doi.org/10.1016/J.ALCR.2013.12.003.
Borrell, C., Pons-Vigués, M., Morrison, J., & Díez, È. (2013). Factors and processes influencing health inequalities in urban areas. Journal of Epidemiology & Community Health,67(5), 389–391. https://doi.org/10.1136/jech-2012-202014.
Buchmann, C., & DiPrete, T. A. (2006). The growing female advantage in college completion: The role of family background and academic achievement. American Sociological Review,71(4), 515–541.
Cottingham, J., Kismodi, E., Hilber, A. M., Lincetto, O., Stahlhofer, M., & Gruskin, S. (2010). Using human rights for sexual and reproductive health: Improving legal and regulatory frameworks. Bulletin of the World Health Organization,88(7), 551–555. https://doi.org/10.2471/BLT.09.063412.
Currie, J., & Schwandt, H. (2014). Short-and long-term effects of unemployment on fertility. Proceedings of the National Academy of Sciences of the United States of America,111(41), 14734–14739. https://doi.org/10.1073/pnas.1408975111.
Devolder, D., & Cabré, A. (2009). Factores de la evolución de la fecundidad en España en los últimos 30 años. Panorama Social,10, 23–39.
Diez-Roux, A. V. (1998). Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. American Journal of Public Health,88(2), 216–222.
Diez-Roux, A. V. (2000). Multilevel analysis in public health research. Annual Review of Public Health,21(1), 171–192. https://doi.org/10.1146/annurev.publhealth.21.1.171.
European Research Infrastructure Consortium. (2006). European Social Survey. Retrieved May 30, 2017, from https://www.europeansocialsurvey.org/.
Eurostat. (2017a). Fertility statistics. Retrieved May 14, 2018, from https://ec.europa.eu/eurostat.
Eurostat. (2017b). Unemployment statistics. Retrieved May 14, 2018, from https://ec.europa.eu/eurostat.
Farooq, G. M., & DeGraff, D. S. (1988). Fertility and development: An introduction to theory, empirical research and policy issues. Human Resources and Development Planning Paper (Vol. 7). Ginebra: International Labour Organisation.
Galster, G., Andersson, R., Musterd, S., & Kauppinen, T. M. (2008). Does neighborhood income mix affect earnings of adults? New evidence from Sweden. Journal of Urban Economics,63(3), 858–870. https://doi.org/10.1016/j.jue.2007.07.002.
Garcia-Subirats, I., Pérez, G., Rodríguez-Sanz, M., Ruiz Muñoz, D., & Salvador, J. (2012). Neighborhood inequalities in adverse pregnancy outcomes in an Urban setting in Spain: A multilevel approach. Journal of Urban Health,89(3), 447–463. https://doi.org/10.1007/s11524-011-9648-4.
Garcia-Subirats, I., Pérez, G., Rodríguez-Sanz, M., Salvador, J., & Jané, M. (2011). Recent immigration and adverse pregnancy outcomes in an Urban setting in Spain. Maternal and Child Health Journal,15(5), 561–569. https://doi.org/10.1007/s10995-010-0614-7.
Harttgen, K., & Vollmer, S. (2014). A reversal in the relationship of human development with fertility? Demography,51(1), 173–184. https://doi.org/10.1007/s13524-013-0252-y.
Hogan, D. P., & Kitagawa, E. M. (1985). The impact of social status, family structure, and neighborhood on the fertility of black adolescents. American Journal of Sociology,90(4), 825–855. https://doi.org/10.1086/228146.
Kim, J. (2016). Female education and its impact on fertility. IZA World of Labor. https://doi.org/10.15185/izawol.228.
Krieger, N. (2003). Genders, sexes, and health: What are the connections—And why does it matter? International Journal of Epidemiology,32(4), 652–657. https://doi.org/10.1093/ije/dyg156.
Lanzieri, G. (2013). Towards a “baby recession” in Europe? Eurostat Statistics in Focus,13, 1–16.
León-Gómez, B. B., Gotsens, M., Marí-Dell’Olmo, M., Dominguez-Berjón, M. F., Luque-Fernández, M. Á., et al. (2019). Bayesian smoothed small-areas analysis of the urban inequalities in fertility across 1999–2013. Fertility Research and Practice,5, 17.
Merlo, J., Chaix, B., Yang, M., Lynch, J., & Råstam, L. (2005). A brief conceptual tutorial of multilevel analysis in social epidemiology: Linking the statistical concept of clustering to the idea of contextual phenomenon. Journal of Epidemiology & Community Health,59(6), 443–449. https://doi.org/10.1136/jech.2004.023473.
Mills, M., Rindfuss, R. R., Mcdonald, P., te Velde, E., & Force, on behalf of the E. R., and S. T. (2011). Why do people postpone parenthood? Reasons and social policy incentives. Human Reproduction Update,17(6), 848–860. https://doi.org/10.1093/humupd/dmr026.
Pérez, G., Ruiz-Muñoz, D., Gotsens, M., Casals Cases, M., & Rodríguez-Sanz, M. (2005). Social and economic inequalities in induced abortion in Spain as a function of individual and contextual factors. European Journal of Public Health,2(1), 162–169. https://doi.org/10.1093/eurpub/ckt104.
Puig-Barrachina, V., Rodríguez-Sanz, M., Domínguez-Berjón, M. F., Martín, U., Luque, M. Á., et al. (2019). Decline in fertility induced by economic recession in Spain. Gaceta Sanitaria. https://doi.org/10.1016/j.gaceta.2019.05.011.
Ramiro-Fariñas, D., Viciana-Fernández, F. J., & Montañés Cobo, V. (2017). Will highly educated women have more children in the future? In Southern Europe, it will largely depend on labour market conditions. Vienna Yearbook of Population Research,15, 49–54. https://doi.org/10.1553/populationyearbook2017s049.
Sobotka, T., Skirbekk, V., & Philipov, D. (2011). Economic recession and fertility in the developed world. Population and Development Review,37(2), 267–306. https://doi.org/10.1111/j.1728-4457.2011.00411.x.
UNESCO. (2012). International standard classification of education 2011. Retrieved from https://www.uis.unesco.org/Education/DOcuments/isced-2011-en.pdf.
WHO. (2004). Infecundity, infertility, and childlessness in developing countries. Calverton, MD. Retrieved from https://www.measuredhs.com.
Acknowledgements
The authors thank Gail Craigie for critical reading and editing of this paper.
Funding
This research has been partially funded by the project "Efecto de la crisis económica en la salud sexual y reproductiva y en las desigualdades sociales y económicas en España y sus Comunidades Autónomas" (PI13/02292) funded by the Instituto de Salud Carlos III (co-financed by the European Regional Development Fund). Also, the program of social determinants of health of the CIBERESP supported this study.
Author information
Authors and Affiliations
Contributions
LLF wrote the drafts and created the database. LLF-D and MG performed the statistical analyses. MG and BBL-G reviewed the article and provided scientific feedback. GP conceived, designed and revised the study, and provided scientific feedback.
Corresponding author
Ethics declarations
Conflict of interest
The authors of this paper do not report any conflict of interest.
Rights and permissions
About this article
Cite this article
Forcadell-Díez, L., Gotsens, M., Leon-Gomez, B.B. et al. Social Inequalities in Fertility in Women Residing in Urban Neighbourhoods in Spain: A Multilevel Approach. Matern Child Health J 24, 267–274 (2020). https://doi.org/10.1007/s10995-020-02875-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-020-02875-w