Peer-reviewed article

Prevalence and Determinants of Early Adolescent Childbearing in High Maternal Mortality Sub-Saharan Africa: A Multilevel Analysis of DHS Data.

Jejaw M, Demissie KA, Tafere TZ, Tiruneh MG, Hagos A et al. · 22 Apr 2025

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This study analysed data from five sub-Saharan African countries with high maternal mortality to understand why adolescent girls aged 15 to 19 become pregnant. Across these countries, about one in five adolescent girls had given birth or were pregnant. The research found that girls with little or no education, those living in rural areas, girls from poorer households, and those without knowledge of contraception were more likely to have children early. Better access to health services and education reduced early childbearing.

Key points

Overall prevalence of early adolescent childbearing was 20.74% across extremely high and very high maternal mortality SSA countries, ranging from 13.7% in Kenya to 31.67% in Chad
Lack of formal education increased risk 3.5 times; primary education increased risk 2.3 times compared to secondary or higher education
Visiting a health facility for reproductive health services reduced childbearing risk by 80% (AOR=0.2)
Knowledge about contraceptives reduced risk by 50% (AOR=0.5)
Rural residence, poverty, small household size (1-3 members), and male household heads were significant risk factors

Limitations

This is a cross-sectional analysis of survey data that identifies associations but cannot prove causation. The study cannot explain the mechanisms behind these associations or account for unmeasured confounders that may explain the observed relationships.

Abstract

Background Preventable complications related to early adolescent childbearing continue to be a major contributor to maternal mortality in Sub-Saharan Africa, necessitating targeted interventions. Despite the high burden of early adolescent childbearing in Sub-Saharan Africa, there is limited pooled evidence on its prevalence and determinants in high maternal mortality regions, necessitating this study. Thus, this study aimed to assess the prevalence and determinants of early adolescent childbearing in extremely high and very high maternal mortality rates in SSA countries. Methods This study used nationally representative demographic health survey data from 2013 to 2022 from adolescent women in extremely high and very high SSA countries. A total of 31, 512 weighted samples adolescents (15 to 19 years) of women were included. The Stata version 14 statistical package was used. Multilevel logistic regression was employed to assess individual and community-level factors associated with early adolescent childbearing, adjusting for clustering effects within DHS data, at p values < 0.05 with adjusted odd ratios at 95% confidence intervals (CIs). Results The overall prevalence of early adolescent childbearing in extremely high and very high maternal mortality SSA countries was 20.74% (95% CI: 20.3%, 21.2%). Chad had the highest prevalence (31.67%), while Kenya had the lowest (13.7%). Residence (AOR = 1.3, 95% CI: 1.19, 1.45), education: no formal education (AOR = 3.5, 95% CI: 3.09, 3.87), primary education (AOR = 2.3, 95%CI:2.11, 2.55), adolescent age group of 18-19(AOR = 4.9, 95% CI:4.6, 5.33), religion: Islam followers (AOR = 1.3, 95% CI:1.13, 1.48), no religion (AOR = 2.0, 95% CI:1.51, 2.71), household wealth: poor (AOR = 1.8, 95% CI: 1.59, 1.96), middle (AOR = 1.5, 95% CI: 1.32, 1.64), household size:1 to 3 (AOR = 3.5, 95% CI: 3.22, 3.84), 4 to 5 (AOR = 1.3, 95% CI:1.19, 1.42), never had media exposure (AOR = 1.2, 95% CI: 1.06, 1.28), had own mobile (AOR = 1.5, 95% CI: 1.34,1.64), never used internet (AOR = 1.6, 95% CI: 1.43, 1.89), male household head (AOR = 1.62, 95% CI: 1.49, 1.77), undecided fertility preference (AOR = 2.5, 95% CI: 2.17, 2.92), contraception: ever used methods (AOR = 1.9, 95% CI:1.7, 2.18), nonuser intend to use later (AOR=,1.4 95% CI: 1.32, 1.56), countries: Liberia (AOR = 1.6, 95% CI:1.3, 1.99) and Chad (AOR = 2.2, 95% CI: 1.82, 2.59) were positively associated with early adolescent childbearing whereas not having work (AOR = 0.9, 95% CI: 0.85, 0.99), not visited by community health worker (AOR = 0.8, 95% CI: 0.69, 0.89), ever visited health facility for reproductive health service (AOR = 0.2, 95% CI: 0.19, 0.22), had knowledge about contraceptive (AOR = 0.5, 95% CI:0.48, 0.60) and countries: Kenya (AOR = 0.54, 95% CI: 0.45, 0.65), Lesotho (AOR = 0.73, 95% CI:0.58, 0.95) and Nigeria (AOR = 0.72, 95% CI:0.62, 0.85) were factors negatively associated with early adolescent childbearing. Conclusion This study showed that the prevalence of early adolescent childbearing in extremely high and very high maternal mortality SSA countries remains high. Level of education, age, religion, residence, household wealth, household size, media exposure, own mobile, internet use, fertility preference, contraception use and intention, working status, visited by community health worker, knowledge of contraceptive, visited health facility for reproductive health service and countries were associated with early adolescent childbearing. Hence, these findings underscore the need for policies that enhance education access, reproductive health services, and economic opportunities to mitigate early adolescent childbearing.