Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa

Abstract Background Despite the numerous policy interventions targeted at preventing early age at first childbirth globally, the prevalence of adolescent childbirth remains high. Meanwhile, skilled birth attendance is considered essential in preventing childbirth-related complications and deaths among adolescent mothers. Therefore, we estimated the prevalence of early age at first childbirth and skilled birth attendance among young women in sub-Saharan Africa and investigated the association between them. Methods Demographic and Health Survey data of 29 sub-Saharan African countries was utilized. Skilled birth attendance and age at first birth were the outcome and the key explanatory variables in this study respectively. Overall, a total of 52,875 young women aged 20-24 years were included in our study. A multilevel binary logistic regression analysis was performed and the results presented as crude and adjusted odds ratios at 95% confidence interval. Results Approximately 73% of young women had their first birth when they were less than 20 years with Chad having the highest proportion (85.7%) and Rwanda recording the lowest (43.3%). The average proportion of those who had skilled assistance during delivery in the 29 sub-Saharan African countries was 75.3% and this ranged from 38.4% in Chad to 93.7% in Rwanda. Young women who had their first birth at the age of 20-24 were more likely to have skilled birth attendance during delivery (aOR = 2.4, CI = 2.24-2.53) than those who had their first birth before 20 years. Conclusion Early age at first childbirth has been found to be associated with low skilled assistance during delivery. These findings re-emphasize the need for sub-Saharan African countries to implement programs that will sensitize and encourage the patronage of skilled birth attendance among young women in order to reduce complications and maternal mortalities. The lower likelihood of skilled birth attendance among young women who had their first birth when they were adolescents could mean that this cohort of young women face some barriers in accessing maternal healthcare services.

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Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis

PLoS ONE ◽

10.1371/journal.pone.0254281 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254281

Author(s):

Kwamena Sekyi Dickson ◽

Kenneth Setorwu Adde ◽

Edward Kwabena Ameyaw

Keyword(s):

Urban Areas ◽

Working Women ◽

Skilled Birth Attendance ◽

Sub Saharan Africa ◽

Wife Beating ◽

Demographic And Health Surveys ◽

Women Empowerment ◽

Maternal Deaths ◽

Birth Attendance ◽

Sub Saharan

Introduction In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. Materials and methods This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). Results The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance. Conclusion These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

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TIMING OF SEXUAL DEBUT AMONG UNMARRIED YOUTHS AGED 15–24 YEARS IN SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s0021932017000098 ◽

2017 ◽

Vol 50 (2) ◽

pp. 161-177 ◽

Cited By ~ 8

Author(s):

Joshua Amo-Adjei ◽

Derek Anamaale Tuoyire

Keyword(s):

Young People ◽

Young Women ◽

Rural Areas ◽

Sexual Debut ◽

Household Wealth ◽

Sub Saharan Africa ◽

African Countries ◽

Sub Saharan ◽

Female Headed Households ◽

The Impact

SummaryThis study aimed to contribute to the evidence on the timing of sexual debut in young people in sub-Saharan African countries. Data were extracted from 34 nationally representative surveys conducted in the region between 2006 and 2014. The study sample comprised unmarried women (n=167,932) and men (n=76,900) aged 15–24 years. Descriptive techniques and Cox proportional regression models were used to estimate the timing of sexual debut, and Kaplan–Meier hazard curves were used to describe the patterns of sexual debut in each country by sex. For the countries studied, sexual debut for both women and men occurred between the ages of 15 and 18 years, with median ages of 16 for women and 17 for men. Overall, education and household wealth provided significant protection against early sexual debut among women, but the reverse was found among men for wealth. Women in rural areas, in female-headed households and in Central, South and West Africa reported higher hazards of early commencement of sexual activity than their counterparts in urban, male-headed households and East Africa. However, the impact of these variables on male sexual debut did not follow a consistent pattern. Varied timing, as well as country-specific risk factors associated with sexual debut for young women and men across sub-Saharan Africa, were identified. Sexual health programmes and interventions for young people may require different approaches for young women and men.

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Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys

Reproductive Health ◽

10.1186/s12978-020-01018-2 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu

Keyword(s):

Young Women ◽

Formal Education ◽

Economic Status ◽

Unmet Need ◽

Wealth Quintile ◽

Sub Saharan Africa ◽

African Countries ◽

Socio Economic Status ◽

Sub Saharan ◽

Unmet Need For Contraception

Abstract Introduction Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.

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Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2021-007074 ◽

2021 ◽

Vol 6 (10) ◽

pp. e007074

Author(s):

Firew Tekle Bobo ◽

Augustine Asante ◽

Mirkuzie Woldie ◽

Angela Dawson ◽

Andrew Hayen

Keyword(s):

South Africa ◽

Caesarean Section ◽

Spatial Patterns ◽

Caesarean Delivery ◽

Skilled Birth Attendance ◽

Health Facilities ◽

Sub Saharan Africa ◽

Skilled Attendant ◽

Birth Attendance ◽

Sub Saharan

BackgroundImproved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.MethodsWe analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.ResultsThe rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section.ConclusionsThere were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.

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Beyond counting intended pregnancies among young women to understanding their associated factors in sub-Saharan Africa

International Health ◽

10.1093/inthealth/ihab056 ◽

2021 ◽

Author(s):

Luchuo Engelbert Bain ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Eugene Budu ◽

Joshua Okyere ◽

...

Keyword(s):

Young Women ◽

Formal Education ◽

Binary Logistic Regression ◽

Wealth Quintile ◽

Cross Sectional Study ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Cross Sectional ◽

Sub Saharan

Abstract Background In this article we report the prevalence and determinants of intended or wanted pregnancies among young women 15–24 y of age in selected sub-Saharan African countries. Methods This cross-sectional study used pooled data from current Demographic and Health Surveys conducted between 1 January 2010 and 31 December 2019 in 29 countries in sub-Saharan Africa (SSA). The sample size comprised 14 257 young women (15–24 y of age). Multivariable binary logistic regression models were used to present the results as adjusted odds ratios. Results The prevalence of intended pregnancies was 67.7%, with the highest and lowest prevalence in Gambia (89.9%) and Namibia (37.7%), respectively. Intended pregnancy was lower among young women who had knowledge of modern contraceptives, those with a secondary/higher education and those with four or more births. Lower odds of intended pregnancy were observed among young women in the richer wealth quintile and those who lived in southern Africa. Conclusions To reduce intended pregnancies in sub-Saharan African countries such as Gambia, Burkina Faso and Nigeria, there is a need for government and non-governmental organisations to recalibrate current and past interventions such as investment in increasing formal education for women and poverty alleviation programmes, as well as augmenting job creation, including skill-building. These interventions have to be sensitive to the cultural realities of each setting, especially with regards to early marriages and womanhood.

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The social landscape of education and work in rural sub-Saharan Africa.

Youth and the rural economy in Africa: hard work and hazard ◽

10.1079/9781789245011.0007 ◽

2021 ◽

pp. 125-140

Author(s):

Barbara Crossouard ◽

Máiréad Dunne ◽

Carolina Szyp

Keyword(s):

Qualitative Research ◽

Young Women ◽

Lived Experiences ◽

Rural Economy ◽

Social Dynamics ◽

Sub Saharan Africa ◽

African Countries ◽

The Social ◽

Social Landscape ◽

Sub Saharan

Abstract This chapter draws on qualitative research into youth livelihoods in four sub-Saharan African countries that has addressed the local social dynamics of work and education from the perspectives of young people themselves. Firstly, it illuminates the extent to which the youth in the four different national contexts value education. It then turns to young people's lived experiences of juggling both schooling and work from an early age, highlighting the wide disparity between idealized notions of 'transition' and the complexities of youth livelihoods. Finally, it explores the gendered dimensions of this social landscape, and how these produce different pressures that force young women in particular out of education. The chapter concludes with implications for young people's current and future engagement with the rural economy, and for education policy.

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Early Marriage and Correlates among Young Women in Sub-Saharan African Countries

Journal of Asian and African Studies ◽

10.1177/0021909620966778 ◽

2020 ◽

pp. 002190962096677

Author(s):

Jacques M. Elengemoke ◽

A. Sathiya Susuman

Keyword(s):

Young Women ◽

Formal Education ◽

Basic Education ◽

Democratic Republic ◽

Democratic Republic Of Congo ◽

Sub Saharan Africa ◽

Early Marriage ◽

African Countries ◽

Sub Saharan ◽

Ssa Countries

Though several countries have adopted the sexual violence law which criminalizes child marriage, the practice of early marriage persists in Sub-Saharan Africa. This paper examined the socio-economic and demographic determinants of early marriage among young women in four Sub-Saharan African (SSA) countries, namely Niger, Democratic Republic of Congo, Mali and Malawi. Descriptive and multivariate analyses were performed to show that young women without formal education have 1.62, 1.59, 1.55 and 2.08 times more risk of early union than their secondary or higher educated counterparts. The study recommends the implementation of a universal, free and compulsory basic education in SSA countries.

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Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys

BMJ Open ◽

10.1136/bmjopen-2021-051583 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051583

Author(s):

Bright Opoku Ahinkorah ◽

Matthew Tobiloba Obisesan ◽

Abdul-Aziz Seidu ◽

Anthony Idowu Ajayi

Keyword(s):

Adolescent Girls ◽

Adolescent Mothers ◽

Contraceptive Use ◽

Well Being ◽

Sub Saharan Africa ◽

Binary Logistic Regression Analysis ◽

Demographic And Health Surveys ◽

Significant Heterogeneity ◽

African Countries ◽

Sub Saharan

ObjectiveWe examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries.DesignWe included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use.Outcome measuresContraceptive use.ResultsWe found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results.ConclusionAfrican countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.

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