The impact of young maternal age at birth on neonatal mortality: Evidence from 45 low and middle income countries

Abstract

ObjectivesThis study explores the impact of early motherhood on neonatal mortality, and how this differs between countries and regions. It assesses whether the risk of neonatal mortality is greater for younger adolescent mothers compared with mothers in later adolescence, and explores if differences reflect confounding socio-economic and health care utilisation factors. It also examines how the risks differ for first or subsequent pregnancies.MethodsThe analysis uses 64 Demographic and Health Surveys collected between 2005 and 2015 from 45 countries to explore the relationship between adolescent motherhood (disaggregated as <16 years, 16/17 years and 18/19 years) and neonatal mortality. Both unadjusted bivariate association and logistic regression are used. Regional level multivariate models that adjust for a range of socio-economic, demographic and health service utilisation variables are estimated. Further stratified models are created to examine the excess risk for first and subsequent births separately.FindingsThe risk of neonatal mortality in all regions was markedly greater for infants with mothers under 16 years old, although there was marked heterogeneity in patterns between regions. Adjusting for socio-economic, demographic and health service utilisation variables did not markedly change the odds ratios associated with age. The increased risks associated with adolescent motherhood are lowest for first births.ConclusionOur findings particularly highlight the importance of reducing adolescent births among the youngest age group as a strategy for addressing the problem of neonatal mortality, as well ensuring pregnant adolescents have access to quality maternal health services to protect the health of both themselves and their infants. The regional differences in increased risk are a novel finding which requires more exploration.

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

“…In the last 5 years of the MDGs era and in the first 5 years of the SDGs era, a number of global initiatives and partnerships, such as Every Woman Every Child, 3 Family Planning 2020, 4 [14] and the Global Financing Facility 5 , have advocated and facilitated increased action on adolescent pregnancy. Evidence about the consequences of early motherhood related to other global health concerns (e.g., neonatal mortality) further contributed to the arguments to prevent pregnancy among adolescents [17]. These efforts have focused on preventing adolescent pregnancy through raising awareness and providing CSE and contraceptive services.…”

“…These efforts succeeded in stimulating the establishment of laws forbidding child marriage [124] and sporadic efforts to improve girls' access to education [125]. Although larger efforts to end child marriage began to emerge in the 1990s [126], it was not until the 2000s that there was significant growth in the number and coverage of community-based programsdfor example, Berhane Hewan in Ethiopia 16 , Ishraq in Egypt 17 , the Social Cash Transfer Programme known locally as Mtukula Pakhoma in Malawi 18 , and Prachar in India 19 [127e130]. These programs were implemented by NGOs.…”

Perinatal outcomes in adolescent pregnancy

“…7 Though it has been widely studied, consensus opinion is still lacking on perinatal outcomes and optimal perinatal care to adolescent pregnant women; it is evident that particularly the younger adolescent (age <16 years) are at higher risk of adverse outcomes. 10,11 Inherent biological immaturity 12 or poor socioeconomic factors 11 have been implicated for the higher rates of perinatal complications in adolescent pregnancies.…”

Competition for nutrients in pregnant adolescents: consequences for maternal, conceptus and offspring endocrine systems

“…Irrespective of geographical location there is commonality in the hazards associated with early childbearing, and systematic reviews, multi-country surveys and population-based studies consistently report a higher risk of premature delivery, low birthweight and neonatal morbidity and mortality in adolescent pregnancies (Salihu et al 2006, Gibbs et al 2012, Malabarey et al 2012, Kozuki et al 2013, Ganchimeg et al 2014, De Azevedo et al 2015. Relative to adult women, pregnancy at any age during adolescence is associated with a greater possibility of experiencing anaemia, eclampsia, puerperal endometritis and systemic infections, while heightened risk of preterm delivery, low birthweight and neonatal mortality is most pronounced in very young girls (≤15 years of age and/or within 2 years of first menses) who are biologically immature (Ganchimeg et al 2014, Weng et al 2014, Torvie et al 2015, Neal et al 2018. A short cervix, small uterine volume and immature pelvis leading to cephalopelvic disproportion are more common in younger mothers and may predispose them to early delivery and complications such as obstetric fistula and other maternal near-miss events (Moerman 1982, Stevens-Simon et al 2000, Gadelha Da Costa et al 2004, Tebeu et al 2012, Ganchimeg et al 2014, Oliveira et al 2014.…”