Socio-demographic and cultural determinants of high fertility among women residing in an urban metropolitan slum: a comparative cross-sectional study

Background: High fertility (three or more children) remains a public health concern in socioeconomically vulnerable urban populations. This study compared socio-demographic, reproductive, and cultural factors associated with low and high fertility among women residing in an urban metropolitan slum. Methods: A community-based comparative cross-sectional study was conducted from January 2021 to April 2022 among 322 women in an urban slum of a metropolitan city in India. Women were equally categorized into low-fertility (1-2 children) and high-fertility (≥3 children) groups. Participants were selected by systematic random sampling. Data were collected using a pre-tested structured interview schedule and analysed using Chi-square tests and multivariable logistic regression. Results: Women with high fertility were more likely to have lower maternal and paternal education, lower socioeconomic status, earlier marriage and first pregnancy, more conceptions, lower mass-media exposure, and greater desire for additional children. Contraceptive use was lower among women with high fertility than those with low fertility (87.5% versus 96.3%). In adjusted analysis, higher paternal education was associated with lower odds of high fertility (AOR 0.52), while an unplanned last pregnancy was associated with higher odds (AOR 3.56). Having a male first child and the husband’s desire for another child were also independently associated with fertility status (AOR 0.27 and 0.22, respectively). Conclusions: High fertility in this urban slum was associated with gender preference, spousal fertility intentions, pregnancy planning, and lower paternal education. Couple-centred family-planning counselling, male involvement, delayed marriage, improved education, and access to effective modern contraception should be prioritised.