Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Abstract

Background Maternal age < 18 or > 34 years, short inter-pregnancy birth interval, and higher birth order are considered to be high-risk fertility behaviours (HRFB). Underfive mortality being disproportionately concentrated in Asia and Africa, this study analyses the association between HRFB and underfive mortality in selected Asian and African countries. Methods This study used Integrated Public Microdata Series-Demographic and Health Surveys (IPUMS-DHS) data from 32 countries in sub-Saharan Africa, Middle East, North Africa and South Asia from 1986 to 2017 (N = 1,467,728). Previous evidence hints at four markers of HRFB: women’s age at birth of index child < 18 or > 34 years, preceding birth interval < 24 months and child’s birth order > 3. Using logistic regression, we analysed change in the odds of underfive mortality as a result of i) exposure to HRFB individually, ii) exposure to any single HRFB risk factor, iii) exposure to multiple HRFB risk factors, and iv) exposure to specific combinations of HRFB risk factors. Results Mother’s age at birth of index child < 18 years and preceding birth interval (PBI) < 24 months were significant risk factors of underfive mortality, while a child’s birth order > 3 was a protective factor. Presence of any single HRFB was associated with 7% higher risk of underfive mortality (OR 1.07; 95% CI 1.04–1.09). Presence of multiple HRFBs was associated with 39% higher risk of underfive mortality (OR 1.39; 95% CI 1.36–1.43). Some specific combinations of HRFB such as maternal age < 18 years and preceding birth interval < 24 month significantly increased the odds of underfive mortality (OR 2.07; 95% CI 1.88–2.28). Conclusion Maternal age < 18 years and short preceding birth interval significantly increase the risk of underfive mortality. This highlights the need for an effective legislation to curb child marriages and increased public investment in reproductive healthcare with a focus on higher contraceptive use for optimal birth spacing.

Individual-and community-level factors associated with anemia among children aged 6–23 months in sub-Saharan Africa: evidence from 32 sub-Saharan African countries

“…Higher birth order was significantly associated with increased odds of having higher levels of anemia compared to first-order birth. This was in concordance with study findings in SSA [ 39 ], India [ 87 , 88 ], this is because higher birth order is related to extensive maternal nutrition depletion including iron, folate, and vitamin B12 and this could increase the risk of childhood anemia [ 89 , 90 ]. In addition, a large number of children are associated with increased socio-economic and health problems due to competition for food, infections, and cross contaminations.…”

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

“…Women's high-risk fertility behaviour (HRFB), which is defined by "narrow birth intervals, high birth order, and younger maternal age at birth, have been associated with negative health outcomes for both the mother and the child" [1,2]. Maternal HRFB is a bio-demographic risk factor that impedes the achievement of lower maternal and child morbidity and mortality [3][4][5][6][7]. 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) [3,4,7,8].…”

“…Maternal HRFB is a bio-demographic risk factor that impedes the achievement of lower maternal and child morbidity and mortality [3][4][5][6][7]. 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) [3,4,7,8]. Although the total fertility rate (TFR) of Bangladesh declined from 3.7 in 1995 to 2.04 in 2020 [9].…”

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

“…Women's high-risk fertility behaviour (HRFB), which is de ned by "narrow birth intervals, high birth order, and younger maternal age at birth, have been associated with negative health outcomes for both the mother and the child" [2,3]. 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].…”

“…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].…”