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Social Inequalities in Fertility in Women Residing in Urban Neighbourhoods in Spain: A Multilevel Approach



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.


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).


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).


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.

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The authors thank Gail Craigie for critical reading and editing of this paper.


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

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.

Correspondence to Gloria Pérez.

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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

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  • Educational status
  • Inequalities
  • Fertility
  • Neighbourhoods
  • Multilevel analysis