An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

Chirwa, Gowokani Chijere; Mazalale, Jacob; Likupe, Gloria; Nkhoma, Dominic; Chiwaula, Levison; Chintsanya, Jesman

doi:10.1371/journal.pone.0225374

Cited by 49 publications

(60 citation statements)

References 32 publications

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“…This study proves the continued inequality influencing adolescent fertility rate to the advantage of adolescent girls in better socioeconomic classes and who are located in urban settings, with rising up of disparity over the time period of the study. This study’s findings support available evidence suggesting that socioeconomic positions play key roles in disparities observed in AFR [ 11 , 38 , 41 ]. Policy makers need to stop worsening disparities by targeting subgroups which are highly disadvantaged.…”

Section: Resultssupporting

confidence: 89%

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Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

Yaya

Zegeye²,

Oladimeji

et al. 2020

Arch Public Health

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Background Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance. Results We found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively. Conclusions This study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.

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Section: Resultssupporting

confidence: 89%

“…In this country, adolescent pregnancy is more likely to occur in vulnerable communities, mainly driven by poverty, sexual violence, lack of education and poor access to modern contraceptives [6,9]. At the community level, adolescents in rich households are more likely to delay childbirth and achieve powerful levels of employment [38].…”

Section: Discussionmentioning

confidence: 99%

Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

Yaya

Zegeye²,

Oladimeji

et al. 2020

Arch Public Health

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“…54 Therefore, adolescents might have lower education levels, especially if they dropped out of education due to pregnancy and childrearing, and they might be more likely to supplement or wean earlier if they are returning back to school after childbirth. The effect of lower wealth among adolescent mothers compared with older mothers, [55][56][57][58] particularly availability of disposable income to purchase formula and other items necessary to formula feed, might contribute to higher rates and duration of breast feeding among adolescents. Examination of the effect of marital status on lactational amenorrhoea in general, and understanding of lactational amenorrhoea among unmarried adolescents in particular, is completely absent from the identified literature.…”

Section: Discussionmentioning

confidence: 99%

Lactational amenorrhoea among adolescent girls in low-income and middle-income countries: a systematic scoping review

Figaroa

Bellizzi²,

Delvaux

et al. 2020

BMJ Glob Health

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IntroductionFertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).MethodsWe searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.ResultsWe screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.ConclusionThe available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

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“…Essentially, vulnerable communities where there is increased poverty, lack of education, little access to modern contraceptives as well as sexual violence tend to experience higher rates of adolescent pregnancy [ 19 ]. Adolescents from wealthy households tend to have employment and therefore, they can access modern contraceptives and increase likelihood of delayed childbearing [ 34 ]. Similar reports have been found in Latin American and the Caribbean [ 35 ] as well as across LMICs [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000–2016

et al. 2021

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Background One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. This study assessed the magnitude and trends of socioeconomic and area-based AFR inequalities in Ethiopia. Methods The 2000 and 2016 Ethiopia Demographic and Health surveys (EDHS) was analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. Adolescent fertility rates were disaggregated using three equity stratifiers (economic status, education and residence) and analyzed through four summary measures (Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF)) to assess inequality. To measure statistical significance, point estimates were constructed using a 95% Uncertainty Interval (UI). Results Large socio-economic and urban-rural inequalities were observed within the 16-year period. Adolescents in less well-off socio-economic groups (PAF: -62.9 [95% UI; − 64.3, − 61.4], D: 96.4 [95% UI; 47.7, 145.1]), uneducated (R: 8.5 [95% UI; 4.8, 12.2], PAR: -76.4 [95% UI;-77.7, − 75.0]) and those from rural areas (D: 81.2 [95% UI; 67.9, 94.6], PAF: -74.2 [95% UI, − 75.7, − 72.7]) had a higher chance of pregnancy and more births than their counterparts. Conclusions Socioeconomic (education and economic status) and place of residence determine adolescents’ pregnancy and childbearing. Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities. More emphasis should be placed on subpopulations with disproportionately higher adolescent pregnancy and childbirth.

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An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

Cited by 49 publications

References 32 publications

Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

Lactational amenorrhoea among adolescent girls in low-income and middle-income countries: a systematic scoping review

Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000–2016

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