Peer-reviewed article
Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries.
F Iacoella, N Tirivayi ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined what factors influence whether married adolescents in 13 Sub-Saharan African countries use maternal healthcare services like antenatal care, safe delivery, and postnatal care. Using data from nearly 4,300 married adolescents, the researchers found that wealth, education, media access, and urban residence were key enablers of healthcare use. However, having multiple children and certain types of autonomy in decision-making created barriers to care-seeking.
Key points
- Wealth and media access were positively associated with use of all types of maternal healthcare services
- Urban residence increased the odds of safe delivery use (1.87 times) and postnatal care use (1.35 times)
- Female education was associated with antenatal care and safe delivery use
- Autonomy in decisions about money and relationships supported healthcare use, but autonomy over personal health decisions was associated with reduced care-seeking
- Second or third birth order and associated birth intervals were strong barriers to maternal healthcare utilization
Limitations
This is a cross-sectional analysis, so it cannot determine causality or establish whether these factors directly cause changes in healthcare use. The study relies on demographic survey data which may not capture all contextual factors affecting adolescent mothers' healthcare decisions.
Abstract
OBJECTIVES: Child and adolescent marriage are widely prevalent in some developing countries, and yet evidence on the maternal healthcare utilization of married adolescents is sparse. This study sought to identify the determinants of maternal healthcare utilization among married adolescents in 13 countries with the highest adolescent marriage rates in Sub-Saharan Africa. STUDY DESIGN: This is a multicountry cross-sectional analysis. METHODS: Demographic and Health Survey data on 4288 married adolescents were used. Multivariable logistic regressions were used to identify the individual- and household-level predictors of the utilization of antenatal care, safe delivery and postnatal care. RESULTS: Wealth and access to media were positively associated with the utilization of all types of maternal healthcare services. Female education and partner education were positively associated with antenatal care. Predictors of safe delivery included urban residence (odds ratio [OR] = 1.87; 95% confidence interval [CI] = 1.15-3.03), female education (OR = 1.37; 95% CI = 1.16-1.60) and number of living children (OR = 1.25; 95% CI = 1.01,1.54), whereas positive correlates of postnatal care were urban residence (OR = 1.35; 95% CI = 1.00-1.82), partner education (OR = 1.32; 95% CI = 1.12-1.56) and employment (OR = 1.43; 95% CI = 1.07,1.89). Full antenatal care and safe delivery utilization were associated with increased postnatal care utilization. Second or third birth order and associated birth intervals were strong barriers to maternal healthcare utilization. Although autonomy in decision-making over financial spending and relationships were positively associated with full antenatal care (OR = 1.09; 95% CI = 1.03-1.14), the results suggest that autonomy over personal healthcare decisions had an opposite relationship (OR = 0.76; 95% CI = 0.58-1.01). CONCLUSIONS: Living conditions and autonomy in decision-making over resources and relationships are facilitators of maternal healthcare utilization among married adolescents. Determinants observed in this multicountry study can help shape maternal healthcare interventions in context with high child and teenage marriage rates.