Impact of High-Risk Fertility Behavior on Under-five Mortality in Asia and Africa: Evidence from Demographic and Health Surveys

Abstract

Background High-risk fertility behaviors (HRFBs) are common in African and South Asian countries and can potentially affect child survival. This study examines the high-risk fertility behaviors concerning child mortality across the countries. Method Data from a series of Demographic and Health Surveys from the year 1987 to 2016 from 24 South Asian and African countries (N=1,224,832) were included in this study. Four HRFB parameters - women’s age <18 or >=34 years at childbirth, birth spacing <24 months, and child order of birth >3, were categorized into three exposure levels: i) exposure to any HRFBs category (exposure to any of four parameters); ii) exposure to single and multiple HRFB category (a combination of two or more parameters); and iii) the specific type of HRFB category (either single or multiple HRFB categories). Bivariate descriptive analysis and a multivariate logistic regression model were used to examine the association between under-five child mortality and various measures of HRFBs. Results Our pooled data analysis reported that HRFBs was associated with an increased risk of under-five child mortality in Asian and African countries. Children of women exposed to HRFBs were at increased risk of under-five mortality by 77% (Adjusted Odds Ratio (AOR) = 1.771, 95% confidence interval (CI): 1.722 - 1.821). Children born within 24 months’ birth interval were four times more likely to die (AOR = 4.995, 95% CI: 4.842-5.152) than their counterparts. However, a single high-risk category was not associated with under-five mortality, and birth order was found to be a protective factor against under-five mortality. Age of women (<18 or >=34 years) was found to be a risk factor of Under-five child mortality in 16 countries. The association between under-five mortality risk and birth interval of less than 24 months was highly significant in all countries. Conclusion Women’s age at childbirth, birth interval, and birth order were significantly associated with under-five mortality. Quality care for women and newborns need to be ensured through investment in the healthcare system, and by promoting health services with more focus given to the valuable populations through sexual and reproductive health education programs and empowering women.

Preventable Multiple High-Risk Birth Behaviour and Infant Survival in Nigeria

“…Furthermore, other predictors of infant death found in our study are being a male child, small birth size, living in the North west and North East regions, rural place of resident, failure to receive tetanus injection and presence of unskilled birth delivery assistant. This is consistent with research ndings from similar studies [26,29,30]. Our study also found that non-use of contraceptive commodities among the mothers increased the risk of infant mortality as compared with mothers that used contraceptives.…”

Association of maternal high-risk fertility behavior and under-five mortality in Ethiopia: Community-based survey

“…Children born to women who engaged in double high-risk fertility behaviors were more likely to die as compared to children born to women who were no high-risk fertility behavior. This finding was supported by previous studies [16,24]. Moreover, the odds of under-five mortality among children of women who were engaged in three high-risk fertility behaviors was higher compared to children of women who have not engaged in any high-risk fertility behavior [16].…”

“…However, the current study shows that single high-risk fertility behavior was not associated with under-five mortality. This finding was agreed with the previous study; too early childbearing (<18 years) [16], too late childbearing age [24], and too many births (>3) [16,24] were not associated with under-five mortality. However, short birth interval space (<24 months) [16,24] and too late childbearing age (>40) [16] were associated with under-five mortality.…”

“…Covariates. Variables such as current age of women (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), number of household members (�4, �5), religion (non-Muslim, Muslim), residence (urban, rural), women's educational status (no education, primary, secondary or above) women's occupation (not working, working), wealth index (poor, middle, rich), marital status (single, married), type of toilet (unimproved, improved), type of water source(unprotected, protected), sex of household head (male, female), covered by health insurance (no, yes), face health care access problem (no, yes), pregnancy intention (want then, want later, wanted never), type of birth (single, multiple), place of delivery (home, health facility), sex of the baby (male, female), apply any things on the umbilical cord after delivery (no, yes), and perceived size of baby) were included as covariates. The poor wealth index category was created by merging poorer and poorest and the variable rich was constructed by merging richer and richest.…”

Determinants associated high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study

“…Maternal HRFB is a bio-demographic risk factor that impedes the achievement of lower maternal and child morbidity and mortality [4][5][6][7][8]. Some demographic variables, such as women's age, parity, and birth spacing are the crucial parameters of measuring HRBF including too-early (<18 years) or too-late (>34 years) childbearing, short birth intervals (<24 months) and a higher number of live births (4 or higher) [4,5,[8][9][10]. Although the total fertility rate (TFR) of Bangladesh declined from 3.7 in 1995 to 2.04 in 2020 [1].…”