Influence of Maternal Education on Second Childbirth Interval Among Women in South Africa: Rural-Urban Differential Using Survival Analysis

Abstract

Inter-birth interval lengthening is a key component of fertility decline. Although South Africa fertility rate remains the lowest in sub-Saharan Africa, information on the effect of education on the interval between first- and second-birth across residential contexts is rarely documented. The study investigated the relationship between maternal education and second-birth interval (SbI) by residence among South African women. The study analyzed the 2016 South Africa Demographic and Health Survey data on 6,039 women aged 15 to 49 years who had reported at least one childbirth at the time of survey. Survival analysis methods were applied at 5% significance level. The SbI was significantly longer ( p < 0.001) among urban (76 months) relative to rural (66 months) women. About a fifth of rural women and about a tenth of urban women had at most a primary education. Women who had a secondary education (aHR = 0.86; 95% CI [0.76, 0.96]) were 14% times more likely to delay second-birth compared to those who had at most a primary education in rural setting. Other determinants of SbI included region in rural; age at-first-birth and household wealth in urban; ethnicity, marital status at-first-birth and employment in both residential settings. The length of SbI remains long in both residential contexts, but longer in urban. Findings demonstrated rural-urban differentials in the relationship between maternal education and second birth interval, suggesting contextual impact. Fertility strategies targeted at strengthening health education for improved maternal and child health should be residential-context specific.