Using three indicators to understand the parity-specific contribution of adolescent childbearing to all births

Effect of adolescent pregnancy on child mortality in 46 countries

INTRODUCTION

Adolescent pregnancy is a known health risk to mother and child. Statements and reports of health outcomes typically group mothers under 20 years old together. Few studies examined this risk at a finer age resolution, none of them comprehensively, and with differing results.

METHODS

We analysed Demographic and Health Surveys data from 2004 to 2018 in sub-Saharan Africa (SSA) and South Asia, on firstborn children of mothers 25 years old or younger. We examined the association between maternal age and stillbirths, and neonatal mortality rate (NNMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR), using mixed-effects logistic regression adjusting for major demographic variables and exploring the impact of maternal health-seeking.

RESULTS

In both regions and across all endpoints, mortality rates of children born to mothers aged <16 years, 16-17 years and 18-19 years at first birth were about 2-4 times, 1.5-2 times and 1.2-1.5 times higher, respectively, than among firstborn children of mothers aged 23-25. Absolute mortality rates declined over time, but the age gradient remained similar across time periods and regions. Adjusting for rural/urban residence and maternal education, in SSA in 2014-2018 having a <16-year-old mother was associated with ORs of 3.71 (95% CI: 2.50 to 5.51) for stillbirth, 1.92 (1.60-2.30) for NNMR, 2.13 (1.85-2.46) for IMR and 2.39 (2.13-2.68) for U5MR, compared with having a mother aged 23-25. In South Asia, in 2014-2018 ORs were 5.12 (2.85-9.20) for stillbirth, 2.46 (2.03-2.97) for NNMR, 2.62 (2.22-3.08) for IMR and 2.59 (2.22-3.03) for U5MR. Part of the effect on NNMR and IMR may be mediated by a lower maternal health-seeking rate.

CONCLUSIONS

Adolescent pregnancy is associated with dramatically worse child survival and mitigated by health-seeking behaviour, likely reflecting a combination of biological and social factors. Refining maternal age reporting will avoid masking the increased risk to children born to very young adolescent mothers. Collection of additional biological and social data may better reveal mediators of this relationship. Targeted intervention strategies to reduce unintended pregnancy at earlier ages may also improve child survival.

"… I would have left that man long time ago but, …" exploring circumstances of and motivators for repeat adolescent birth in Eastern Uganda

BACKGROUND

First birth before 18 years has declined in Uganda unlike repeat adolescent birth (=second or more births before age 20 years). We explored the circumstances of and motivators for repeat adolescent birth in Eastern Uganda.

METHODS

Between January and March 2020, we conducted a qualitative study involving 70 individual in-depth interviews with purposively selected respondents - 20-25-year-old women with and without repeat adolescent birth, their partners, and parents, in the communities of Teso sub-region. We conducted latent content analysis.

RESULTS

Four major themes emerged: poverty, vulnerability, domestic violence, and demotivators. Sub-themes identified under poverty were: "limited provisions", "peasantry", "large families", "dropping out of school", "alcohol abuse", and "broken family structure". Vulnerability included "marital entrapment" and "partner coercion". Demotivators included: "abandonment", "stern warning", "objection to marriage", and "empowerment". Extreme poverty resulted in inadequate provision of basic needs leading to unprotected sexual activity in a bid to secure financial support. Following the first birth, more than three quarters of the women with repeat adolescent birth reported increased economic distress that forced them to remain in unwanted marriage/union, often characterized by partner coercion, despite wanting to delay that repeat birth. Women without repeat adolescent birth avoided a second birth by empowerment through: an economic activity, contraception use, and resumption of schooling.

CONCLUSION

Repeat adolescent birth in Uganda is premised around attempts to address the economic distress precipitated by first birth. Many women want to delay that repeat birth but the challenges robbed them of their reproductive autonomy. Beyond efforts to prevent first birth, programs need to address economic empowerment, ensure contraceptive access, and school re-integration for adolescent mothers in order to prevent shortly-spaced repeat births.

Trends in teenage motherhood in Ecuador: challenges and inequalities

OBJECTIVES

To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012.

METHODS

We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI.

RESULTS

The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador.

CONCLUSIONS

Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

Trends in contraceptive use, unmet need and associated factors of modern contraceptive use among urban adolescents and young women in Guinea

BACKGROUND

In Guinea, high fertility among adolescents and young women in urban areas remains a public health concern. This study describes trends in contraceptive use, unmet need, and factors associated with the use of modern family planning (FP) methods among urban adolescents and young women in Guinea.

METHODS

We used four Guinea Demographic and Health Surveys (DHS) conducted in 1999, 2005, 2012, and 2018. Among urban adolescents and young women (15-24 years), we examined trends over time in three key indicators: 1. Modern Contraceptive use, 2. Unmet need for FP and 3. Modern contraceptive use among those in need of FP (demand satisfied). We used multivariable logistic regression to examine association between socio-demographic factors and modern FP use on the most recent DHS dataset (2018).

RESULTS

We found statistically significant changes over the time period examined with an increase in modern contraceptive use (8.4% in 1999, 12.8% in 2018, p < 0.01) and demand satisfied (29.0% in 1999, 54.1% in 2018, p < 0.001), and a decrease in unmet need for FP (15.8% in 1999, 8.6% in 2018, p < 0.001). Factors significantly associated with modern FP use were; young women aged 20-24 years (AOR 2.8, 95% CI: 1.9-4.1), living in urban areas of Faranah (AOR: 2.6, 95% CI: 1.1-6.5) and Kankan (AOR: 3.6, 95% CI: 1.7-7.8), living in households in the middle (AOR: 7.7, 95% CI: 1.4-42.2) and richer wealth quintiles (AOR: 6.3, 95% CI: 1.0-38.1). Ever-married women (AOR: 0.5, 95% CI: 0.3-0.9) were less likely to use modern FP methods than never married as were those from the Peulh (0.3, 95% CI: 0.2-0.4) and Malinke (0.5, 95% CI: 0.3-0.8) ethnic groups compared to Soussou ethnic group.

CONCLUSION

Despite some progress, efforts are still needed to improve FP method use among urban adolescent and young women. Age, administrative region, wealth index, marital status, and ethnic group are significantly associated with modern FP use. Future policies and interventions should place emphasis on improving adolescents' reproductive health knowledge, increasing FP availability and strengthening provision. Efforts should target adolescents aged 15-19 years in particular, and address disparities between administrative regions and ethnic groups, and health-related inequalities.

Lactational amenorrhoea among adolescent girls in low-income and middle-income countries: a systematic scoping review

Introduction

Fertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).

Methods

We searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.

Results

We screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.

Conclusion

The available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review

BACKGROUND

Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents.

METHODS

We used the standardized systematic review methodology based on the process outlined in the World Health Organization's Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence.

RESULTS

We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries.

CONCLUSION

Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings.

Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys

Background

Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors.

Methods

We analyzed Uganda Demographic and Health Survey data of women age 20–24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression.

Results

At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth.

Conclusion

Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.