Abstract
Aims: The rapid economic transition in the Gulf Arab countries has resulted in marked changes in fertility and marriage patterns and a decrease in the number of children per family. Yet little is known about the determinants of family size in urban and less urban areas.
Methods: A cross-sectional study was carried out on 450 Kuwaiti women aged 20-60 years who attended health care centres in Al Asima and Al Jahra governorates. A semi-structured questionnaire was administered through face-to-face interview which included variables on socio-demographic characteristics, family size, actual and ideal spacing, marriage related variables, health conditions and utilization of health services. Both univariate and multivariate analyses were performed to identify the factors that affect family size.
Results: The socio-economic indicators were significantly better in Al Asima, the capital, than in Al Jahra, a less urbanized area. On average, family size for the total sample was 5.97 +/- 0.114 with a larger size (6.27 +/- 0.242) in Al Jahra than in Al Asima (5.80 +/- 0.118) but without a significant difference. Al Jahra women reported a larger number of deliveries and past pregnancies but a lower usage of contraceptive measures. The total fertility rate was 3.65 in Al Asima, 3.84 in Al Jahra and 3.71 births per woman in the total population. Family size was inversely related to the educational level of women and their husbands. Currently employed women had a smaller family size (5.22 +/- 0.119) than the unemployed (6.81 +/- 0.187); p < 0.0005. Health problems in the interviewee or her husband played a minor role in the decision to have more children. Families where the husband was the decision-maker on the number of children had a significantly larger family size (6.91 +/- 0.451) than families where the couple both participated in the decision (5.83 +/- 0.129; p = 0.032). The duration of marriage, ideal number of children, age of women at last delivery, number of rooms and the crowding index had significant positive effects on family size, whereas age at first delivery, duration between two consecutive pregnancies and history of past abortions were inversely related to family size in the stepwise multiple regression analysis.
Conclusions: Although women in the less urbanized areas in the Gulf Arab populations are more disadvantaged with respect to socio-economic characteristics than women in the more urbanized areas, there were no significant differences in family size in these contrasting communities. The impact of socio-demographic characteristics on family size was minor compared to factors related to fertility and the husband's desire to have more children. Fertility and family planning policies should consider these issues in order to promote more effective programmes.