Effect of maternal age on facility-based delivery: analysis of first-order births in 34 countries of sub-Saharan Africa using demographic and health survey data

Abstract

ObjectivesIncreasing access to skilled birth attendance, usually via childbirth in health facilities, is a key intervention to reduce maternal and perinatal mortality and morbidity. Yet, in some countries of sub-Saharan Africa, the uptake is <50%. Age and parity are determinants of facility-based delivery, but are strongly correlated in high fertility settings. This analysis assessed the independent effect of age on facility-based delivery by restricting to first-order births. It was hypothesised that older first-time mothers in this setting might have lower uptake of facility-based deliveries than women in the most common age groups for first birth.SettingThe most recent Demographic and Health Surveys from 34 sub-Saharan African countries were used to assess women’s delivery locations.Participants72 772 women having their first birth in the 5 years preceding the surveys were included in the analysis.Primary and secondary outcome measuresProportions and 95% CIs of facility-based deliveries were estimated overall and by country. Multivariable logistic regression was used to calculate the odds of facility-based delivery for different maternal age groups (15–19, 20–24 and ≥25 years) for a pooled sample of all countries.Results59.9% of women had a facility-based delivery for their first birth (95% CI 58.6 to 61.2), ranging from 19.4% in Chad to 96.6% in Rwanda. Compared with women aged 15–19 years, the adjusted odds of having a facility-based delivery for those aged 20–24 was 1.4 (95% CI 1.3 to 1.5, p<0.001) and for those aged ≥25, 1.9 (95% CI 1.6 to 2.2, p<0.001).ConclusionsOlder age at first birth was independently associated with significantly higher odds of facility-based delivery. This went against the hypothesis. Further mixed-method research is needed to explore how increased age improves uptake of facility-based delivery. Promoting facility-based delivery, while ensuring quality of care, should be prioritised to improve birth outcomes in sub-Saharan Africa.

Adding It Up: Investing in Sexual and Reproductive Health 2019

“…Other research shows that in Sub-Saharan Africa, adolescent first-time mothers are less likely than older first-time mothers to deliver at a health facility. 134 Cesarean delivery. Cesarean deliveries represent 14% of all adolescent women's deliveries, and levels vary sharply by country income group.…”

Does women’s age matter in the SDGs era: coverage of demand for family planning satisfied with modern methods and institutional delivery in 91 low- and middle-income countries

“…Our first indicator, demand for family planning satisfied with modern methods (DFPSm), was defined as the percentage of married women (or in union) in need of contraception who were using (or whose partner is using) any modern method of contraception. Women in need of contraception were those who are fecund and do not want to become pregnant within the next two years or who are unsure about whether or when they want to become pregnant [14,15]. Pills, condoms (male and female), intrauterine devices (IUD), sterilization (male and female), injectables, implants, diaphragms, spermicidal agents (foam/jelly) and patches and emergency contraception were considered modern contraceptive methods.…”

“…There is strong evidence that use of effective family planning methods and institutional delivery contribute to reducing maternal and newborn deaths [10][11][12][13]. Further, engagement in these behaviors appear to vary generationally and by age, with adolescent and older women theoretically less likely to utilize both services in many national contexts [14,15].…”

Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

“…To assess the modifying effect of covariates we collected sociodemographic and reproductive health information, including: age, education level, employment status, marital status, parity, prior facility delivery (among those who previously delivered), and facility location of first ANC visit. Maternal age may worsen maternal and fetal outcomes, increasing the propensity of older women to seek care or establish contact with health facilities earlier in pregnancy [29]. Sociodemographic characteristics such as education level, employment status and marital status may impact the likelihood of facility delivery as these variables serve as proxies for socio-economic status.…”