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Open Access 01-12-2023 | Fertility | Research

Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

Authors: Liness Shasha, Million Phiri, Sibongile Namayawa, Milika Sikaluzwe, Chola Nakazwe, Musonda Lemba, Mikidadi Muhanga

Published in: BMC Women's Health | Issue 1/2023

Abstract

Background

Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women’s and children’s health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA.

Methods

The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20–24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design.

Results

The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15–24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA.

Conclusion

The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women.

Grønvik T, Fossgard Sandøy I. Complications associated with adolescent childbearing in Sub-Saharan Africa: A systematic literature review and meta-analysis. Van Wouwe JP, editor. PLOS ONE. 2018;13(9):e0204327.

Phipps MG, Sowers M. Defining early adolescent childbearing. Am J Public Health. 2002;92(1):125–8.PubMedPubMedCentral

Wado YD, Sully EA, Mumah JN. Pregnancy and early motherhood among adolescents in five east african countries: a multi-level analysis of risk and protective factors. BMC Pregnancy Childbirth. 2019;19(1):59.PubMedPubMedCentral

Seidu AA, Ahinkorah BO, Anjorin SS, Tetteh JK, Hagan JE Jr, Zegeye B et al. High-risk fertility behaviours among women in sub-saharan Africa. J Public Health. 2021;fdab381.

Worku MG, Tessema ZT, Teshale AB, Tesema GA, Yeshaw Y. Prevalence and associated factors of adolescent pregnancy (15–19 years) in East Africa: a multilevel analysis. BMC Pregnancy Childbirth. 2021;21(1):253.PubMedPubMedCentral

Neal S, Channon AA, Chandra-Mouli V, Madise N. Trends in adolescent first births in sub-saharan Africa: a tale of increasing inequity? Int J Equity Health. 2020;19:151.PubMedPubMedCentral

Motsima T, The Risk Factors Associated With Early Age At First Birth Amongst Angolan Women.: Evidence From The 2015–2016 Angola Demographic And Health Survey. Eur J Med Health Sci [Internet]. 2020 Apr 1 [cited 2022 Aug 27];2(2). Available from: https://ej-med.org/index.php/ejmed/article/view/198.

Phiri M, Kasonde ME, Moyo N, Sikaluzwe M, Simona S. A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018). Reprod Health. 2023;20(1):16.PubMedPubMedCentral

Bongaarts J. Trends in fertility and fertility preferences in sub-saharan Africa: the roles of education and family planning programs. Genus. 2020;76(1):32.

10.

United Nations, Population Division. World Population prospects: the 2019 revision. New York: United Nations; 2019.

11.

Ezeh A, Kissling F, Singer P. Why sub-saharan Africa might exceed its projected population size by 2100. The Lancet. 2020;396(10258):1131–3.

12.

United Nations Population Fund. The State of World Population 2021 [Internet]. 605 Third Avenue New York, NY 10158 USA.; 2021. Available from: https://www.unfpa.org/data/world-population-dashboard.

13.

John B. Fertility transition: is sub-saharan Africa different? Popul Dev Rev. 2013;38:153–68.

14.

Shapiro D, Gebreselassie T. Fertility transition in sub-saharan Africa: falling and stalling. Afr Popul Stud. 2008;23(1).

15.

Shapiro D, Hinde A. On the pace of fertility decline in sub-saharan Africa. Demogr Res. 2017;37:1327–38.

16.

Cochrane SH. Fertility and education. What do we really know? Baltimore and London: The John Hopkins University Press; 1979.

17.

May JF, Rotenberg S. A call for Better Integrated Policies to accelerate the fertility decline in Sub-Saharan Africa. Stud Fam Plann. 2020;51(2):193–204.PubMed

18.

Cleland JG, Ndugwa RP, Zulu EM. Family planning in sub-saharan Africa: progress or stagnation? 2011;Bulletin of World Health Organization(89):137–243.

19.

Bongaarts J. The effect of contraception on fertility. Is sub-Saharan Africa different? 2017;37:129–45.

20.

Schoumaker B. African Fertility Changes. In: Groth H, May JF, editors. Africa’s Population: In Search of a Demographic Dividend [Internet]. Cham: Springer International Publishing; 2017 [cited 2021 Dec 1]. p. 197–211. Available from: https://doi.org/10.1007/978-3-319-46889-1_13.

21.

Namukoko H, Likwa RN, Hamoonga TE, Phiri M. Unmet need for family planning among married women in Zambia: lessons from the 2018 demographic and Health Survey. BMC Womens Health. 2022;22(1):137.PubMedPubMedCentral

22.

Kalinda C, Phiri M, Chimpinde K, Ishimwe MCS, Simona SJ. Trends and socio-demographic components of modern contraceptive use among sexually active women in Rwanda: a multivariate decomposition analysis. Reprod Health. 2022;19(1):226.PubMedPubMedCentral

23.

Yaya S, Odusina EK, Bishwajit G. Prevalence of child marriage and its impact on fertility outcomes in 34 sub-saharan african countries. BMC Int Health Hum Rights. 2019;19(1):33.PubMedPubMedCentral

24.

Hertrich V. Trends in Age at Marriage and the onset of fertility transition in sub-saharan Africa. Popul Dev Rev. 2017;43:112–37.

25.

Szreter S. The idea of demographic transition and the study of Fertility Change: a critical intellectual history. Popul Dev Rev. 1993;19(4):659–701.

26.

Galor O. The demographic transition: causes and consequences. Cliometrica. 2012;6(1):1–28.PubMedPubMedCentral

27.

Bongaarts J. Human population growth and the demographic transition. Philos Trans R Soc B Biol Sci. 2009;364(1532):2985–90.

28.

Götmark F, Andersson M. Human fertility in relation to education, economy, religion, contraception, and family planning programs. BMC Public Health. 2020;20(1):265.PubMedPubMedCentral

29.

Akwara E, Pinchoff J, Abularrage T, White C, Ngo TD. The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review. J Urban Health [Internet]. 2023 Apr 13 [cited 2023 May 24]; Available from: https://doi.org/10.1007/s11524-023-00724-z.

30.

Joseph R. The theory of empowerment: a critical analysis with the theory evaluation scale. J Hum Behav Soc Environ. 2020;30(2):138–57.

31.

Perkins DD, Zimmerman MA. Empowerment theory, research, and application. Am J Community Psychol. 1995;23(5):569–79.PubMed

32.

Jejeebhoy SJ. Women’s Education, Autonomy, and Reproductive Behaviour: Experience from Developing Countries [Internet]. OUP Catalogue. Oxford University Press; 1995 [cited 2022 Aug 12]. Available from: https://ideas.repec.org/b/oxp/obooks/9780198290339.html.

33.

Murtin F. Long-term determinants of the demographic transition, 1870–2000. Rev Econ Stat. 2013;95(2):617–31.

34.

Aluga D, Okolie EA. Socioeconomic determinants of teenage pregnancy and early motherhood in the United Kingdom: a perspective. Health Promot Perspect. 2021;11(4):426–9.PubMedPubMedCentral

35.

Okoli CI, Hajizadeh M, Rahman MM, Velayutham E, Khanam R. Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from Demographic Health Survey. BMC Public Health. 2022;22(1):1729.PubMedPubMedCentral

36.

Willan S, Gibbs A, Petersen I, Jewkes R. Exploring young women’s reproductive decision-making, agency and social norms in south african informal settlements. PLoS ONE. 2020;15(4):e0231181.PubMedPubMedCentral

37.

Reed E, Salazar M, Behar AI, Servin AE, Ayala GX, Silverman JG, et al. Economic vulnerability among girls at risk for adolescent pregnancy: qualitative findings among a clinic sample of girls residing in the U.S.–Mexico Border Region. Adolescents. 2022;2(1):101–12.

38.

Nabugoomu J, Seruwagi GK, Hanning R. What can be done to reduce the prevalence of teen pregnancy in rural eastern Uganda?: multi-stakeholder perceptions. Reprod Health. 2020;17(1):134.PubMedPubMedCentral

39.

Lutz W, Skirbekk V. How education drives demography and knowledge informs projections. World Popul Hum Cap Twenty-First Century Overv. 2013;14–38.

40.

Westoff CF. Desired number of children: 2000–2008. DHS Comp Rep [Internet]. 2010 [cited 2022 Aug 12];(No.25). Available from: https://www.cabdirect.org/cabdirect/abstract/20113037779.

41.

Corsi DJ, Neuman M, Finlay JE, Subramanian S. Demographic and health surveys: a profile. Int J Epidemiol. 2012;41(6):1602–13.PubMed

42.

Croft et al. Guide to DHS Statistics [Internet]. Rockville, Maryland, USA: ICF; 2018. Available from: www.DHSprogram.com.

43.

United Nations. Convention on the Rights of the Child [Internet]. United Nationa.; 1990. Available from: https://www.ohchr.org/documents/professionalinterest/crc.pdf.

44.

UNICEF. Global Annual Results Report 2020 [Internet]. New York: UNICEF.; 2021. Available from: https://www.unicef.org/.

45.

MacQuarrie KL, Nahar Q, Khan R, Sultana M. Why So Young? The Social Context of Early Childbearing and Contraception among Young Women in Khulna, Bangladesh. DHS Further Analysis Reports No. 99. Dhaka, Bangladesh and Rockville, Maryland, USA: National Institute of Population Research and Training (NIPORT). Int Cent Diarrhoeal Dis Res Bangladesh Icddr B ICF Int. 2016.

46.

Avogo WA, Somefun OD. Early marriage, Cohabitation, and Childbearing in West Africa. J Environ Public Health. 2019;2019:1–10.

47.

Melesse DY, Cane RM, Mangombe A, Ijadunola MY, Manu A, Bamgboye E, et al. Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-saharan Africa. Reprod Health. 2021;18(S1):117.PubMedPubMedCentral

48.

Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and Meta-analysis. Reprod Health. 2018;15(1):195.PubMedPubMedCentral

49.

Phiri M, Musonda E, Shasha L, Kanyamuna V, Lemba M. Individual and community-level factors associated with early marriage in Zambia: a mixed effect analysis. BMC Womens Health. 2023;23(1):21.PubMedPubMedCentral

50.

Mapoma C, Phiri M, Nyirenda E. FEMALE EDUCATION AND FERTILITY IN ZAMBIA. In UNZA Press; 2018 [cited 2021 Dec 1]. Available from: http://dspace.unza.zm/handle/123456789/6062.

51.

Johnstone M, Lucke J, Hewitt B. Life transitions and women’s desired number of children: the impact of motherhood, relationships and employment. Community Work Fam. 2021;24(5):616–35.

52.

UNICEF. UNICEF Data Warehouse: Early Childbearing Data [Internet]. New York, USA: UNICEF.; 2021. Available from: https://data.unicef.org/resources/.

53.

Ahinkorah BO, Kang M, Perry L, Brooks F, Hayen A. Prevalence of first adolescent pregnancy and its associated factors in sub-saharan Africa: a multi-country analysis. PLoS ONE. 2021;16(2):e0246308.PubMedPubMedCentral

54.

Muhoza DN. The heterogeneous effects of socioeconomic and cultural factors on fertility preferences: evidence from Rwanda and Kenya. J Popul Res. 2019;36(4):347–63.

55.

Ahinkorah BO, Budu E, Aboagye RG, Agbaglo E, Arthur-Holmes F, Adu C, et al. Factors associated with modern contraceptive use among women with no fertility intention in sub-saharan Africa: evidence from cross-sectional surveys of 29 countries. Contracept Reprod Med. 2021;6(1):22.PubMedPubMedCentral

56.

Zegeye B, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA et al. Individual/Household and Community-Level Factors Associated with Child Marriage in Mali: Evidence from Demographic and Health Survey. BioMed Res Int. 2021;2021.

57.

Sheikh SM, Loney T. Is Educating Girls the Best Investment for South Asia? Association Between Female Education and Fertility Choices in South Asia: A Systematic Review of the Literature. Front Public Health [Internet]. 2018 [cited 2022 Sep 3];6. Available from: https://www.frontiersin.org/articles/https://doi.org/10.3389/fpubh.2018.00172.

58.

London School of Economics and Political Science, Ashraf N, Field E, Duke University, Voena A. University of Chicago, How education about maternal health risk can change the gender gap in the demand for family planning in Zambia [Internet]. 2019th ed. International Initiative for Impact Evaluation (3ie); 2019 Nov [cited 2021 Dec 14]. Available from: https://www.3ieimpact.org/evidence-hub/publications/impact-evaluations/how-education-about-maternal-health-risk-can-change.

59.

Saleem S, Bobak M. Women’s autonomy, education and contraception use in Pakistan: a national study. Reprod Health. 2005;2(1):8.PubMedPubMedCentral

60.

Poudel S, Upadhaya N, Khatri RB, Ghimire PR. Trends and factors associated with pregnancies among adolescent women in Nepal: pooled analysis of Nepal demographic and health surveys (2006, 2011 and 2016). PLoS ONE. 2018;13(8):e0202107.PubMedPubMedCentral

61.

Misunas C, Erulkar A, Apicella L, Ngô T, Psaki S. What influences girls’ age at marriage in Burkina Faso and Tanzania? Exploring the contribution of Individual, Household, and Community Level factors. J Adolesc Health. 2021;69(6):46–56.

62.

Aychiluhm SB, Tesema AK, Tadesse AW. Early marriage and its determinants among Married Reproductive Age Group Women in Amhara Regional State, Ethiopia: a Multilevel Analysis. BioMed Res Int. 2021;2021:e1969721.

63.

Mobolaji JW, Fatusi AO, Adedini SA. Ethnicity, religious affiliation and girl-child marriage: a cross-sectional study of nationally representative sample of female adolescents in Nigeria. BMC Public Health. 2020;20(1):1–10.

64.

Chauhan S, Sekher TV, Kumar P, Srivastava S, Patel R. Prevalence, determinants and socio-economic inequality of early marriage among men in India. Child Youth Serv Rev. 2020;116:105273.

65.

Ltd IIB. Fertility desires of adolescents and young adults living in large families. Eur J Ment Health. 2017;12(01):41–52.

66.

Martin TC, Juarez F. The impact of women’s education on Fertility in Latin America: searching for explanations. Int Fam Plan Perspect. 1995;21(2):52–80.

67.

Ahonsi B, Fuseini K, Nai D, Goldson E, Owusu S, Ndifuna I, et al. Child marriage in Ghana: evidence from a multi-method study. BMC Womens Health. 2019;19(1):1–15.

68.

Baumgartner JN, Waszak Geary C, Tucker H, Wedderburn M. The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case-control study in Jamaica. Int Perspect Sex Reprod Health. 2009;35(1):21–8.PubMed

69.

Yakubu I, Salisu WJ. Determinants of adolescent pregnancy in sub-saharan Africa: a systematic review. Reprod Health. 2018;15(1):15.PubMedPubMedCentral

70.

Durowade KA, Babatunde OA, Omokanye LO, Elegbede OE, Ayodele LM, Adewoye KR, et al. Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria. Afr Health Sci. 2017;17(3):614–22.PubMedPubMedCentral

71.

Habito CM, Vaughan C, Morgan A. Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines? BMC Public Health. 2019;19(1):1142.PubMedPubMedCentral

72.

Ayanaw Habitu Y, Yalew A, Azale Bisetegn T. Prevalence and factors Associated with teenage pregnancy, Northeast Ethiopia, 2017: a cross-sectional study. J Pregnancy. 2018;2018:e1714527.

73.

Silva ALR, Nakagawa JTT, Silva MJP. A composição familiar e sua associação com a ocorrência da gravidez na adolescência: estudo caso-controle [The family composition and its association with the occurrence of pregnancy in adolescence: case-control study] [La composición familiar y su asociación con la ocurrencia del embarazo adolescente: estudio caso-control]. Rev Enferm UERJ. 2020;28(0):36283.

74.

Tabei K, Cuisia-Cruz ESS, Smith C, Seposo X. Association between teenage pregnancy and family factors: an analysis of the Philippine National Demographic and Health Survey 2017. Healthcare. 2021;9(12):1720.PubMedPubMedCentral

75.

Uwizeye D, Muhayiteto R, Kantarama E, Wiehler S, Murangwa Y. Prevalence of teenage pregnancy and the associated contextual correlates in Rwanda. Heliyon. 2020;6(10):e05037.PubMedPubMedCentral

76.

Ahinkorah BO, Budu E, Seidu AA, Bolarinwa OA, Agbaglo E, Adu C, et al. Girl child marriage and its association with maternal healthcare services utilization in sub-saharan Africa. BMC Health Serv Res. 2022;22(1):777.PubMedPubMedCentral

Title: Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries
Authors: Liness Shasha
Million Phiri
Sibongile Namayawa
Milika Sikaluzwe
Chola Nakazwe
Musonda Lemba
Mikidadi Muhanga
Publication date: 01-12-2023
Publisher: BioMed Central
Keyword: Fertility
Published in: BMC Women's Health / Issue 1/2023
Electronic ISSN: 1472-6874
DOI: https://doi.org/10.1186/s12905-023-02581-z

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Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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