Peer-reviewed article
Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa
Dessalegn Y. Melesse, Réka Maulide Cane, Aveneni Mangombe, Macellina Yinyinade Ijadunola, Adom Manu et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzes trends in early marriage, childbearing and sexual debut among adolescents aged 15-24 across 37 sub-Saharan African countries using national household survey data from 1990-2018. In 2015, 28% of adolescent girls were married before age 18 and 47% had given birth before age 20, both declining but at slow rates. Large inequalities persist between rural and urban adolescents and between poorest and richest households, with these gaps remaining stagnant or widening during 2000-2015, particularly in West and Central Africa.
Key points
- 28% of adolescent girls in SSA were married before age 18 in 2015, declining at 1.5% annually during 2000-2015
- 47% of girls gave birth before age 20 in 2015, declining at only 0.6% per year
- 54% of girls and 43% of boys had sexual debut before age 18
- Rural girls and those from poorest households faced markedly higher risks than urban and wealthier peers, with inequalities widening over time
- West and Central Africa had the highest prevalence and greatest disparities in early marriage and childbearing
Limitations
The study is observational and identifies trends and inequalities but does not evaluate any intervention or establish causation for the observed patterns. Regional variation within countries and other intersecting factors beyond wealth, residence and education are not examined.
Abstract
BACKGROUND: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. METHODS: We analyzed national household surveys from 37 countries in SSA, conducted during 1990-2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15-24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban-rural residence and educational status (primary or less versus secondary or higher education). RESULTS: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000-2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10-14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban-rural and wealth-related inequalities remained stagnant or widened during 2000-2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. CONCLUSION: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.