placestats

Fertility rate vs. Health coverage index

Fades after adjusting for income

Across 186 countries, Fertility rate and Health coverage index rise and fall together at r = -0.86 (on a scale from −1 to +1, where 0 means no link). Comparing only countries with similar income (GDP per person) shrinks it to -0.51, which could easily be chance (q = 0.070, allowing for the many pairs tested, and allowing for countries in the same region being alike). So the first figure mostly shows richer countries differing from poorer ones, not a link between these two things. Caution: direction is not consistent across regions.

Comparing countries across the middle half of fertility rate, 1.46 to 3.2 births per woman, health coverage index is worse by 18.7 points at the top of that range than the bottom. Comparing only countries with similar national income, the gap is 9.77 points.

Link before adjusting (r)-0.859p = 2.8e-55 · 186 countries
After adjusting for national income-0.510p = 1.2e-13 · likely range [-0.61, -0.40]
p, allowing for regions0.009standard error 0.136 · 7 regions
Check for luck (q)0.070across 12,497 pairs

How to read these.r runs from −1 (one goes up as the other goes down) to +1 (they rise together), and 0 means no link. Adjusting for national income means comparing countries with the same GDP per person, so differences in wealth can’t explain the link. Income is used in percentage terms, since an extra $1,000 means more to a poor country than to a rich one. p is how likely a link this strong would be if there were really none. Below 0.05 means it is unlikely to be chance. Very small values are written in short form: 1.1e-32 means a decimal point followed by 31 zeros and then 11, so very close to zero. The likely range is where the true figure probably lies, and a range that crosses zero means the link could easily be chance. Countries in the same region tend to resemble each other, so the third figure allows for that, which gives a fairer p. The standard error is the typical size of the error in r. Finally, testing this many pairs means some will look strong by luck alone. A q below 0.05 means this link is unlikely to be one of those.

Fertility rate · births per womanlink with income -0.81 · proxy
Health coverage index · index, 0 to 100link with income +0.88 · proxy

Both of these rise and fall closely with national income, so a strong link between them before adjusting was close to certain. Read the adjusted figure, not the first one.

“Link with income” is how closely each measure tracks GDP per person across countries, from −1 to +1.

Every country as a dot

Fertility rate · births per woman →Health coverage index · index, 0 to 100 →0.7486.032692Afghanistan: 4.76 births per woman, 42 index, 0 to 100Angola: 5.05 births per woman, 44 index, 0 to 100Albania: 1.34 births per woman, 71 index, 0 to 100Andorra: 1.09 births per woman, 75 index, 0 to 100United Arab Emirates: 1.21 births per woman, 84 index, 0 to 100Argentina: 1.5 births per woman, 80 index, 0 to 100Armenia: 1.7 births per woman, 69 index, 0 to 100Antigua and Barbuda: 1.58 births per woman, 81 index, 0 to 100Australia: 1.48 births per woman, 89 index, 0 to 100Austria: 1.31 births per woman, 84 index, 0 to 100Azerbaijan: 1.43 births per woman, 67 index, 0 to 100Burundi: 4.79 births per woman, 48 index, 0 to 100Belgium: 1.44 births per woman, 86 index, 0 to 100Benin: 4.48 births per woman, 38 index, 0 to 100Burkina Faso: 4.11 births per woman, 47 index, 0 to 100Bangladesh: 2.14 births per woman, 54 index, 0 to 100Bulgaria: 1.72 births per woman, 73 index, 0 to 100Bahrain: 1.8 births per woman, 78 index, 0 to 100Bahamas, The: 1.37 births per woman, 80 index, 0 to 100Bosnia and Herzegovina: 1.49 births per woman, 64 index, 0 to 100Belarus: 1.22 births per woman, 80 index, 0 to 100Belize: 2.02 births per woman, 70 index, 0 to 100Bolivia: 2.52 births per woman, 67 index, 0 to 100Brazil: 1.61 births per woman, 84 index, 0 to 100Barbados: 1.71 births per woman, 82 index, 0 to 100Brunei Darussalam: 1.73 births per woman, 84 index, 0 to 100Bhutan: 1.45 births per woman, 69 index, 0 to 100Botswana: 2.7 births per woman, 60 index, 0 to 100Central African Republic: 5.95 births per woman, 39 index, 0 to 100Canada: 1.25 births per woman, 92 index, 0 to 100Switzerland: 1.29 births per woman, 87 index, 0 to 100Chile: 1.14 births per woman, 84 index, 0 to 100China: 1.01 births per woman, 85 index, 0 to 100Cote d'Ivoire: 4.23 births per woman, 46 index, 0 to 100Cameroon: 4.26 births per woman, 48 index, 0 to 100Congo, Dem. Rep.: 5.98 births per woman, 41 index, 0 to 100Congo, Rep.: 4.11 births per woman, 45 index, 0 to 100Colombia: 1.63 births per woman, 82 index, 0 to 100Comoros: 3.82 births per woman, 52 index, 0 to 100Cabo Verde: 1.51 births per woman, 71 index, 0 to 100Costa Rica: 1.32 births per woman, 84 index, 0 to 100Cyprus: 1.38 births per woman, 76 index, 0 to 100Czechia: 1.36 births per woman, 83 index, 0 to 100Germany: 1.36 births per woman, 87 index, 0 to 100Djibouti: 2.62 births per woman, 47 index, 0 to 100Dominica: 1.48 births per woman, 75 index, 0 to 100Denmark: 1.47 births per woman, 85 index, 0 to 100Dominican Republic: 2.22 births per woman, 73 index, 0 to 100Algeria: 2.72 births per woman, 70 index, 0 to 100Ecuador: 1.81 births per woman, 78 index, 0 to 100Egypt, Arab Rep.: 2.73 births per woman, 71 index, 0 to 100Spain: 1.1 births per woman, 84 index, 0 to 100Estonia: 1.18 births per woman, 79 index, 0 to 100Ethiopia: 3.91 births per woman, 33 index, 0 to 100Finland: 1.25 births per woman, 86 index, 0 to 100Fiji: 2.27 births per woman, 69 index, 0 to 100France: 1.61 births per woman, 82 index, 0 to 100Micronesia, Fed. Sts.: 2.74 births per woman, 65 index, 0 to 100Gabon: 3.59 births per woman, 48 index, 0 to 100United Kingdom: 1.55 births per woman, 88 index, 0 to 100Georgia: 1.8 births per woman, 71 index, 0 to 100Ghana: 3.34 births per woman, 56 index, 0 to 100Guinea: 4.13 births per woman, 43 index, 0 to 100Gambia, The: 3.91 births per woman, 53 index, 0 to 100Guinea-Bissau: 3.76 births per woman, 43 index, 0 to 100Equatorial Guinea: 4.12 births per woman, 49 index, 0 to 100Greece: 1.24 births per woman, 77 index, 0 to 100Grenada: 1.47 births per woman, 78 index, 0 to 100Guatemala: 2.29 births per woman, 58 index, 0 to 100Guyana: 2.4 births per woman, 73 index, 0 to 100Honduras: 2.48 births per woman, 64 index, 0 to 100Croatia: 1.46 births per woman, 76 index, 0 to 100Haiti: 2.63 births per woman, 44 index, 0 to 100Hungary: 1.41 births per woman, 80 index, 0 to 100Indonesia: 2.12 births per woman, 67 index, 0 to 100India: 1.96 births per woman, 69 index, 0 to 100Ireland: 1.47 births per woman, 82 index, 0 to 100Iran, Islamic Rep.: 1.68 births per woman, 81 index, 0 to 100Iraq: 3.22 births per woman, 64 index, 0 to 100Iceland: 1.56 births per woman, 90 index, 0 to 100Israel: 2.87 births per woman, 85 index, 0 to 100Italy: 1.18 births per woman, 82 index, 0 to 100Jamaica: 1.35 births per woman, 74 index, 0 to 100Jordan: 2.6 births per woman, 74 index, 0 to 100Japan: 1.15 births per woman, 86 index, 0 to 100Kazakhstan: 2.98 births per woman, 83 index, 0 to 100Kenya: 3.17 births per woman, 57 index, 0 to 100Kyrgyz Republic: 2.6 births per woman, 74 index, 0 to 100Cambodia: 2.55 births per woman, 62 index, 0 to 100Kiribati: 3.12 births per woman, 51 index, 0 to 100St. Kitts and Nevis: 1.53 births per woman, 80 index, 0 to 100Korea, Rep.: 0.748 births per woman, 88 index, 0 to 100Kuwait: 1.56 births per woman, 84 index, 0 to 100Lao PDR: 2.4 births per woman, 64 index, 0 to 100Lebanon: 2.23 births per woman, 67 index, 0 to 100Liberia: 3.86 births per woman, 49 index, 0 to 100Libya: 2.3 births per woman, 71 index, 0 to 100St. Lucia: 1.39 births per woman, 75 index, 0 to 100Sri Lanka: 1.95 births per woman, 72 index, 0 to 100Lesotho: 2.66 births per woman, 55 index, 0 to 100Lithuania: 1.11 births per woman, 78 index, 0 to 100Luxembourg: 1.25 births per woman, 83 index, 0 to 100Latvia: 1.24 births per woman, 77 index, 0 to 100Morocco: 2.21 births per woman, 65 index, 0 to 100Moldova: 1.73 births per woman, 71 index, 0 to 100Madagascar: 3.91 births per woman, 33 index, 0 to 100Maldives: 1.56 births per woman, 71 index, 0 to 100Mexico: 1.89 births per woman, 79 index, 0 to 100Marshall Islands: 2.86 births per woman, 66 index, 0 to 100North Macedonia: 1.4 births per woman, 69 index, 0 to 100Mali: 5.51 births per woman, 41 index, 0 to 100Malta: 1.01 births per woman, 82 index, 0 to 100Myanmar: 2.1 births per woman, 52 index, 0 to 100Montenegro: 1.8 births per woman, 70 index, 0 to 100Mongolia: 2.5 births per woman, 70 index, 0 to 100Mozambique: 4.69 births per woman, 50 index, 0 to 100Mauritania: 4.63 births per woman, 40 index, 0 to 100Mauritius: 1.44 births per woman, 75 index, 0 to 100Malawi: 3.59 births per woman, 52 index, 0 to 100Malaysia: 1.54 births per woman, 80 index, 0 to 100Namibia: 3.21 births per woman, 66 index, 0 to 100Niger: 5.93 births per woman, 39 index, 0 to 100Nigeria: 4.38 births per woman, 47 index, 0 to 100Nicaragua: 2.21 births per woman, 70 index, 0 to 100Netherlands: 1.43 births per woman, 85 index, 0 to 100Norway: 1.45 births per woman, 89 index, 0 to 100Nepal: 1.96 births per woman, 58 index, 0 to 100Naoero: 3.29 births per woman, 62 index, 0 to 100New Zealand: 1.57 births per woman, 89 index, 0 to 100Oman: 2.51 births per woman, 73 index, 0 to 100Pakistan: 3.55 births per woman, 56 index, 0 to 100Panama: 2.11 births per woman, 82 index, 0 to 100Peru: 1.97 births per woman, 68 index, 0 to 100Philippines: 1.89 births per woman, 69 index, 0 to 100Palau: 1.88 births per woman, 75 index, 0 to 100Papua New Guinea: 3.07 births per woman, 32 index, 0 to 100Poland: 1.14 births per woman, 82 index, 0 to 100Portugal: 1.41 births per woman, 83 index, 0 to 100Paraguay: 2.42 births per woman, 79 index, 0 to 100West Bank and Gaza: 3.25 births per woman, 65 index, 0 to 100Qatar: 1.72 births per woman, 84 index, 0 to 100Romania: 1.39 births per woman, 77 index, 0 to 100Russian Federation: 1.42 births per woman, 81 index, 0 to 100Rwanda: 3.65 births per woman, 59 index, 0 to 100Saudi Arabia: 2.31 births per woman, 83 index, 0 to 100Sudan: 4.26 births per woman, 48 index, 0 to 100Senegal: 3.77 births per woman, 48 index, 0 to 100Singapore: 0.97 births per woman, 88 index, 0 to 100Solomon Islands: 3.51 births per woman, 47 index, 0 to 100Sierra Leone: 3.7 births per woman, 48 index, 0 to 100El Salvador: 1.77 births per woman, 79 index, 0 to 100San Marino: 1.16 births per woman, 74 index, 0 to 100Somalia, Fed. Rep.: 6.01 births per woman, 30 index, 0 to 100Serbia: 1.64 births per woman, 73 index, 0 to 100Sao Tome and Principe: 3.6 births per woman, 60 index, 0 to 100Suriname: 2.23 births per woman, 74 index, 0 to 100Slovak Republic: 1.46 births per woman, 78 index, 0 to 100Slovenia: 1.52 births per woman, 84 index, 0 to 100Sweden: 1.43 births per woman, 85 index, 0 to 100Eswatini: 2.72 births per woman, 72 index, 0 to 100Seychelles: 1.85 births per woman, 80 index, 0 to 100Syrian Arab Republic: 2.7 births per woman, 70 index, 0 to 100Chad: 6.03 births per woman, 26 index, 0 to 100Togo: 4.12 births per woman, 42 index, 0 to 100Thailand: 1.2 births per woman, 82 index, 0 to 100Tajikistan: 3.04 births per woman, 72 index, 0 to 100Turkmenistan: 2.66 births per woman, 81 index, 0 to 100Timor-Leste: 2.63 births per woman, 48 index, 0 to 100Tonga: 3.1 births per woman, 71 index, 0 to 100Trinidad and Tobago: 1.54 births per woman, 75 index, 0 to 100Tunisia: 1.82 births per woman, 76 index, 0 to 100Turkiye: 1.48 births per woman, 77 index, 0 to 100Tuvalu: 3.17 births per woman, 65 index, 0 to 100Tanzania: 4.54 births per woman, 49 index, 0 to 100Uganda: 4.17 births per woman, 54 index, 0 to 100Ukraine: 0.988 births per woman, 80 index, 0 to 100Uruguay: 1.4 births per woman, 85 index, 0 to 100United States: 1.63 births per woman, 88 index, 0 to 100Uzbekistan: 3.49 births per woman, 79 index, 0 to 100St. Vincent and the Grenadines: 1.76 births per woman, 80 index, 0 to 100Viet Nam: 1.9 births per woman, 71 index, 0 to 100Vanuatu: 3.57 births per woman, 52 index, 0 to 100Samoa: 3.8 births per woman, 62 index, 0 to 100South Africa: 2.21 births per woman, 74 index, 0 to 100Zambia: 4.04 births per woman, 62 index, 0 to 100Zimbabwe: 3.67 births per woman, 59 index, 0 to 100CAFCANHTIISRKAZKORMMRPNGSGPSOMTCDUZB

best-fit line line after adjusting

Four ways to measure the link

MethodrpCountries
Standard (Pearson), not adjusted-0.8592.8e-55186
By rank (Spearman), not adjusted-0.8101.8e-44186
Standard (Pearson), adjusted for national income-0.5101.2e-13186
By rank (Spearman), adjusted for national income-0.3091.9e-5186

The rank version uses only each country’s place in line, from lowest to highest, so a few extreme countries count for less. The adjusted and unadjusted versions use the same 186 countries: those that report both measures and GDP per person. So the gap between them comes from the adjustment, not from a change in which countries are counted. Drop in the size of r after adjusting: +0.348 (a minus sign means it grew).

How solid is it?

Leaving out one country at a time, r ranges from -0.534 (without PNG) to -0.487 (without TCD). The bar above shows that range on a scale from −1 to +1, with the solid line at the full result. The single country that moves r most: TCD (+0.024).

Fragile: this link may not hold up.
  • direction is not consistent across regions

Within each region

Countries are not separate, unrelated cases, and neighbors share a lot. A link that holds inside each region is far more believable than one that shows up only when comparing regions.

nr
East Asia & Pacific29-0.22
Europe & Central Asia50+0.37
Latin America & Caribbean31-0.57
Middle East, North Africa, Afghanistan & Pakistan22-0.39
Sub-Saharan Africa46-0.70

By income third

If the link shows up only in the richest third of countries, it is a feature of rich countries, not a general pattern.

nr
Poorest third62-0.51
Middle third62-0.53
Richest third62-0.11

By largest religious group

Countries grouped by a label they share, such as main religion, rather than by a number. Groups of fewer than twelve countries are not shown. These groups differ in income, region and history all at once. So a gap between them is a place to start asking questions, not an answer.

nr
Christians108-0.53
Muslims49-0.51

By last european coloniser

Countries grouped by a label they share, such as main religion, rather than by a number. Groups of fewer than twelve countries are not shown. These groups differ in income, region and history all at once. So a gap between them is a place to start asking questions, not an answer.

nr
France25-0.66
Never a European colony21-0.19
Spain20-0.78
United Kingdom63-0.40

Without outliers (countries far outside the middle half of countries on either measure, by more than one and a half times the width of that middle half): r = -0.485 after dropping 5 countries.

Two series, one country

Both measures over the years for one country you pick. The two charts are stacked so they share only the years along the bottom.

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Over time, within countries

Everything above compares countries with each other at one moment. This section compares each country only with itself over 24years. So a link here can’t come from anything about a country that stays the same, such as its history, geography, institutions or culture.

The link also shows up within countries over time (r = -0.368). It holds even when looking only at changes from one year to the next (r = -0.070). This is the strongest kind of evidence available here: it holds when each country is compared only with itself, and it is not just a product of shared trends.

Across countries (adjusted)-0.510for comparison
Within countries-0.665each country vs itself
…and vs the same year elsewhere-0.368q = 0.000 · 193 countries
Year-on-year changes-0.070q = 0.002
Read with care.
  • Almost all of this indicator's variation is between countries, not within them, so the within-country estimate rests on a small part of the data.
  • Much of the within-country association disappears once shared global year effects are removed, which points to a common worldwide trend rather than a country-level relationship.
  • The association is much weaker in year-on-year changes than in levels, which points to shared country-specific trends.

4,632 country-years (one country in one year), 193 countries, 2000–2023, about 24 years each on average. Share of the variation that happens within countries over time: 6% for Fertility rate, 9% for Health coverage index. The margins of error allow for each country appearing many times, and for each year’s value being close to the year before.

Year-to-year changes are a cautious test, not a final answer. Looking only at changes from one year to the next removes each country’s own trends. But it also makes measurement mistakes louder, which pulls the results toward zero. A near-zero result here is weak evidence of no link, not proof.

With one measure years behind the other

0.40−0.4-100+10years Health coverage index trails Fertility rate →lag -10: r = -0.366 (n = 2,895)lag -9: r = -0.379 (n = 3,088)lag -8: r = -0.381 (n = 3,281)lag -7: r = -0.385 (n = 3,474)lag -6: r = -0.387 (n = 3,667)lag -5: r = -0.383 (n = 3,860)lag -4: r = -0.380 (n = 4,053)lag -3: r = -0.379 (n = 4,246)lag -2: r = -0.377 (n = 4,439)lag -1: r = -0.377 (n = 4,632)lag +0: r = -0.368 (n = 4,632)lag +1: r = -0.358 (n = 4,632)lag +2: r = -0.348 (n = 4,632)lag +3: r = -0.335 (n = 4,632)lag +4: r = -0.321 (n = 4,632)lag +5: r = -0.304 (n = 4,632)lag +6: r = -0.284 (n = 4,632)lag +7: r = -0.263 (n = 4,632)lag +8: r = -0.239 (n = 4,632)lag +9: r = -0.213 (n = 4,632)lag +10: r = -0.186 (n = 4,632)

Same year (lag 0): -0.368. A peak away from zero does not show which comes first. These series change slowly — this year’s value is close to last year’s. That makes the curve smooth and nearly symmetric, whatever produced the data. Even a sharp peak at one lag (a gap of some years) would not prove that one measure changes the other.

The data


births per woman
index, 0 to 100		Years
Chad TCD6.03262024, 2023
Somalia, Fed. Rep. SOM6.01302024, 2023
Congo, Dem. Rep. COD5.98412024, 2023
Central African Republic CAF5.95392024, 2023
Niger NER5.93392024, 2023
Mali MLI5.51412024, 2023
Angola AGO5.05442024, 2023
Burundi BDI4.79482024, 2023
Afghanistan AFG4.76422024, 2023
Mozambique MOZ4.69502024, 2023
Mauritania MRT4.63402024, 2023
Tanzania TZA4.54492024, 2023
Benin BEN4.48382024, 2023
Nigeria NGA4.38472024, 2023
Sudan SDN4.26482024, 2023

World Bank, World Development Indicators
World Health Organization, Global Health Observatory

Sources

Fertility rate

Fertility rate, total (births per woman)

World Bank · CC BY 4.0 · updated quarterly

Health coverage index

Universal health coverage service coverage index

World Health Organization · via Our World in Data · CC BY-NC-SA 4.0 · updated annual

Fourteen "tracer" measures of basic health services, combined by WHO into one index. They include vaccination, care during pregnancy, treatment of tuberculosis and HIV, and hospital beds and staff. Several of those measures are on the site on their own. So a link with any of them is partly the index matching a part of itself.

How this was computed

Data used: most recent value in 2010-2025; values come from 2023–2024. To adjust for income, each measure is first predicted from GDP per person (in percentage terms, on a log scale) with a straight-line fit. Only what is left over is then compared. This is called a partial correlation. The line is drawn the standard way (ordinary least squares), which picks the line that comes closest to all the countries at once. The error margins allow for countries in the same region resembling each other, using 7 World Bank regions. The q-value corrects for testing all 12,497 pairs at once, using the Benjamini–Hochberg method. Underlying data last updated DYB 2024. How the country data works · explore Fertility rate and Health coverage index

This page shows that two measures go together. It does not show that Fertility rate changes Health coverage index, or the reverse. These figures also describe countries, not individual people. See the ecological fallacy.

More links with Fertility rate or Health coverage index