Peer-reviewed article
An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi.
Gowokani Chijere Chirwa, Jacob Mazalale, Gloria Likupe, Dominic Nkhoma, Levison Chiwaula et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from three national surveys in Malawi (2004, 2010, 2015-16) covering over 12,000 women to understand why teenage pregnancy and childbearing rates differ between poor and wealthy families. The teenage pregnancy rate averaged 29% across the period, with rates highest among the poorest households. The main drivers of inequality were early marriage (50%), early sexual activity (15.5%), and poverty (13.8%).
Key points
- Teenage pregnancy and childbearing rates averaged 29% between 2004 and 2015-16, with a U-shaped trend (34.1% in 2004, 25.6% in 2010, 29% in 2016)
- Inequality worsened over time, disproportionately affecting poor households (concentration indices: -0.207 in 2004, -0.133 in 2010, -0.217 in 2015-16)
- Early marriage accounts for 50% of the inequality in teenage childbearing
- Early sexual debut accounts for 15.5% of inequality
- Wealth status accounts for 13.8% of inequality
Limitations
This is a descriptive analysis of trends and contributing factors, not an evaluation of interventions to reduce teenage pregnancy. The study identifies associations but cannot demonstrate causation or test the effectiveness of specific policies or programmes.
Abstract
BACKGROUND: Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi. METHODS: The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing. RESULTS: The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%). CONCLUSION: The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.