Levels and socioeconomic correlates of nonmarital fertility in Ghana

Childbirth outside marriage has several negative implications for the well-being of children, women, and families globally. In sub-Saharan Africa, however, the phenomenon appears to be under-studied. In this study, we examine the levels and socioeconomic correlates of nonmarital fertility in Ghana. Using pooled data from the 2003, 2008, and the 2014 Ghana Demographic and Health Surveys, logistic regression models were used in determining significantly predictive factors of nonmarital fertility. The results show that nonmarital fertility levels have been on the rise over time without any sign of reduction (24.0%, 33.0%, and 40.0% for 2003, 2008, and 2014, respectively). Some socioeconomic characteristics are linked to nonmarital fertility levels with women without formal education, women from poor households, and self-employed women having significantly higher nonmarital fertility risks. Also, older unmarried women, women who have an early sexual debut, cohabiters, women with unmet need for family planning are all associated with considerably higher risks of nonmarital childbearing. A few significant regional disparities also exist, with the Central Region having higher whereas the Upper West Region has lower risks of nonmarital fertility compared to the Greater Accra Region. Childbirth outside marriage is a social concern among women in Ghana. The findings have possible implications for bridging socioeconomic disparities among unmarried women.

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Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

PLoS ONE ◽

10.1371/journal.pone.0246308 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246308

Author(s):

Bright Opoku Ahinkorah ◽

Melissa Kang ◽

Lin Perry ◽

Fiona Brooks ◽

Andrew Hayen

Keyword(s):

Adolescent Pregnancy ◽

Rural Areas ◽

Associated Factors ◽

Unmet Need ◽

Well Being ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Relationship Education ◽

African Countries ◽

Sub Saharan

Introduction In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa. Methods We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy. Results Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy. Conclusion The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

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The paradox of water accessibility: understanding the temporal and spatial dimensions of access to improved water sources in Rwanda

Journal of Water Sanitation and Hygiene for Development ◽

10.2166/washdev.2015.029 ◽

2015 ◽

Vol 5 (4) ◽

pp. 553-564 ◽

Cited By ~ 4

Author(s):

Lydia Osei ◽

Jonathan Amoyaw ◽

Godfred Odei Boateng ◽

Sheila Boamah ◽

Isaac Luginaah

Keyword(s):

Drinking Water ◽

Water Sources ◽

Regional Disparities ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Logistic Regression Models ◽

The People ◽

Spatial Dimensions ◽

Sub Saharan ◽

Over Time

According to the United Nations, the world has met the Millennium Development Goal target of halving the proportion of people without access to safe drinking water. However, global figures mask massive disparities between regions and countries, and within countries. For instance, only 64% of the people in sub-Saharan Africa have access to improved water sources. Over 40% of all people globally who lack access to drinking water live in sub-Saharan Africa. Rwanda is used as a case in point in this study. Despite the abundance of water resources in the country, access to improved water sources is limited. Using the Rwandan Demographic and Health Surveys (2000–2010), we examined regional disparities in access to improved water sources. Results from logistic regression models show that overall, access to improved water has declined between 2000 and 2010; except in the western region, where access to water marginally improved. Educated individuals, wealthier and urban dwellers were more likely to have access to improved water sources over time compared to their uneducated, poor and rural counterparts. The persistence of regional disparities in access to improved water over time suggests the need for policy to address insufficient investments in water infrastructure in Rwanda.

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Prognostic Factors of Time to First Abortion After Sexual Debut Among Fragile State Congolese Women: A Survival Analysis

10.21203/rs.3.rs-62236/v1 ◽

2020 ◽

Author(s):

Michael Ekholuenetale ◽

Charity Ehimwenma Ekholuenetale ◽

Amadou Barrow

Keyword(s):

Formal Education ◽

Cox Regression ◽

Sexual Debut ◽

Statistical Significance ◽

Unwanted Pregnancy ◽

Total Sample ◽

Sub Saharan Africa ◽

High Prevalence ◽

Sub Saharan ◽

Adverse Pregnancy

Abstract Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to first abortion after sexual debut among Congolese women.Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p<0.05.Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households. Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union. In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education. Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

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Circumcision Status and Time to Sexual Debut Among Youth in Sub-Saharan Africa: Evidence from Six Demographic and Health Surveys

AIDS and Behavior ◽

10.1007/s10461-015-1141-8 ◽

2015 ◽

Vol 20 (11) ◽

pp. 2514-2528 ◽

Cited By ~ 3

Author(s):

Joseph Kangmennaang ◽

Lydia Osei ◽

Paul Mkandawire ◽

Isaac Luginaah

Keyword(s):

Health Surveys ◽

Sexual Debut ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sub Saharan

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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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Child Marriage and Sexual Autonomy among Women in Sub-Saharan Africa: Evidence from 31 Demographic and Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073754 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3754

Author(s):

Eugene Budu ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

John Elvis Hagan ◽

Wonder Agbemavi ◽

...

Keyword(s):

Odds Ratio ◽

Health Surveys ◽

Formal Education ◽

Basic Education ◽

Sub Saharan Africa ◽

Child Marriage ◽

Demographic And Health Surveys ◽

Crude Odds Ratio ◽

Sexual Autonomy ◽

Sub Saharan

Child marriage has a variety of undesirable consequences at the peril of women’s health and autonomy. In this study, we examined the association between child marriage and sexual autonomy among women in sub-Saharan Africa. We utilised data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2019. A total of 218,578 women aged 20–49 were included in this study. Multivariable binary logistic regression models were used to show the association between child marriage and sexual autonomy. Crude odds ratio (cOR) and adjusted odds ratio (aOR) were used in presenting the results. The prevalence of child marriage and sexual autonomy was 44.51% and 83.35%, respectively. Compared to women who married at 18 years or above, those who married at less than 18 were less likely to have sexual autonomy, and this persisted after controlling for important covariates. In terms of the country-specific results, women who experienced child marriage were less likely to have sexual autonomy in Burundi, Congo DR, Nigeria, and Niger. With the covariates, lower odds of sexual autonomy were found among women with no formal education, those whose partners had no formal education, those who were not exposed to media, and non-working women. Child marriage was found to be associated with sexual autonomy. There is a need to strengthen policies and programmes such as compulsory basic education, poverty alleviation, and an increase in access to media that aim at reducing child marriage. These interventions will help to improve sexual autonomy among women, especially in this 21st century where individuals and organisations incessantly advocate for gender equality.

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Prognostic factors of time to first abortion after sexual debut among fragile State Congolese women: a survival analysis

10.21203/rs.3.rs-62236/v2 ◽

2020 ◽

Author(s):

Michael Ekholuenetale ◽

Charity Ehimwenma Ekholuenetale ◽

Amadou Barrow

Keyword(s):

Formal Education ◽

Cox Regression ◽

Sexual Debut ◽

Statistical Significance ◽

Unwanted Pregnancy ◽

Total Sample ◽

Sub Saharan Africa ◽

High Prevalence ◽

Sub Saharan ◽

Adverse Pregnancy

Abstract Background: Despite the common restrictive abortion laws, abortion remains widespread in sub-Saharan Africa (SSA) countries. Women still utilize abortion services and put their lives and health at risk because abortion can only be procured illegally in private facilities such as mid-level or small patent medicine store that may be manned by unskilled providers or through a non-medicated approach. The objective of this study was to determine median years and factors of time to first abortion after sexual debut among Congolese women.Methods: We used data from the most recent Republic of Congo Demographic and Health Survey (DHS). A total sample of 3,622 women aged 15-49 years was analyzed. We estimated the overall prevalence of abortion and median years to first abortion. Furthermore, we examined the factors of time to first abortion after sexual debut using multivariable Cox regression and reported the estimates using adjusted Hazard Ratio (aHR) and 95% confidence intervals (CI). Statistical significance was determined at p<0.05.Results: The prevalence of abortion was 60.0% and median years of time to first abortion after sexual debut was 9.0. The prominent reasons for abortion were due to too short birth interval (23.8%), lack of money (21.0%) and that husband/partner did not need a child at that time (14.0%). Women’s age and region were notable factors in timing to first abortion. Furthermore, women from poorer, middle, richer and richest households had 34%, 67%, 86% and 94% higher risk of abortion respectively, when compared with women from poorest households (aHR estimates). Women currently in union/living with a man and formerly in union had 41% and 29% reduction in the risk of abortion respectively, when compared with those never in union (aHR estimates). In addition, women with primary and secondary+ education had 42% and 76% higher risk of abortion respectively, when compared with women with no formal education (aHR estimates).Conclusion: There was high prevalence of abortion with short years at first abortion. Abortion was associated with women’s characteristics. There is need for unwanted pregnancy prevention intervention and the improvement in pregnancy care to reduce adverse pregnancy outcomes among women.

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Treatment-seeking for vaginal fistula in sub-Saharan Africa

10.1101/623520 ◽

2019 ◽

Author(s):

Samson Gebremedhin ◽

Anteneh Asefa

Keyword(s):

Formal Education ◽

Obstetric Fistula ◽

Sub Saharan Africa ◽

Pelvic Surgery ◽

Treatment Seeking ◽

Demographic And Health Surveys ◽

Vaginal Fistula ◽

Fistula Repair ◽

Health Seeking ◽

Sub Saharan

AbstractBackgroundThere is dearth of data regarding the treatment-seeking practice of women living with vaginal fistula. The paper describes the health-seeking behaviour of fistula cases in the sub-Saharan Africa (SSA) where the burden of the problem is high.MethodsWe analysed the data of 1,317 women who ever experienced vaginal fistula, extracted from 16 national Demographic and Health Surveys carried out in SSA between 2010 and 2017. The association between treatment-seeking and basic socio-demographic characteristics assessed via mixed-effects logistic regression and the outputs are provided using adjusted odds ratio (AOR) with 95% confidence intervals (CI).ResultsTwo-thirds (67.6%) of the women encountered the fistula soon after delivery implying obstetric fistula. Fewer identified sexual assault (3.8%) and pelvic surgery (2.7%) as the cause. In 25.8% of the cases clear-cut causes couldn’t be ascertained and excluding these ambiguous causes, 91.2% of the women had obstetric fistula. Among those who ever had fistula, 60.3% (95% CI: 56.9-63.6%) sought treatment and 28.5% (95% CI: 25.3-31.6%) underwent fistula-repair surgery. The leading reasons for not seeking treatment were: unaware that it can be repaired (21.4%), don’t know where to get the treatment (17.4%), economic constraints (11.9%), healed by itself (11.9%) and embarrassment (7.9%). The regression analysis indicated, teenagers as compared to adults 35 years or older [AOR=0.31 (95 % CI: 0.20-47)]; and women devoid of formal education when compared to women with any formal education [AOR=0.69 (95% CI: 0.51-0.93)], had reduced odds of treatment-seeking. In 25.9% of the women who underweight fistula-repair surgery, complete continence after surgery was not achieved.ConclusionTreatment-seeking for fistula remains low and it should be augmented via mix of strategies for abridging health-system, psycho-social, economic and awareness barriers.

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Unmet Need For Family Planning Among Married Women In Sub-Sahara Africa: A Meta-Analysis of DHS Data (1995 – 2020)

10.21203/rs.3.rs-955281/v1 ◽

2021 ◽

Author(s):

Million Phiri ◽

Clifford Odimegwu ◽

Chester Kalinda

Keyword(s):

Family Planning ◽

Unmet Needs ◽

Unmet Need ◽

Central Africa ◽

Married Women ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Women Of Reproductive Age ◽

Sub Saharan

Abstract Background: Closing the gap of unmet needs for family planning (FP) in sub-Saharan Africa remains critical in improving maternal and child health outcomes. Determining the prevalence of unmet needs for family planning among married women in the reproductive age is vital for designing effective sexual reproductive health interventions and programmes. Here, we use nationally representative data drawn from sub-Saharan countries to estimate and examine heterogeneity of unmet needs for family planning among currently married women of reproductive age. Methods: This study used secondary data from Demographic and Health Surveys (DHS) conducted between January 1, 1995 to December 31, 2020 from 37 countries in sub-Saharan African. An Inverse Heterogeneity model (IVhet) in MetaXL application was used to estimate country and sub-regional level pooled estimates and confidence intervals of unmet needs for FP in SSA. Results: The overall prevalence of unmet need for family planning among married women of reproductive age in the sub-region for the period under study was 22.9% (95% CI: 20.9–25.0). The prevalence varied across countries from 10% (95% CI: 10–11%) in Zimbabwe to 38% (95% CI: 35–40) and 38 (95% CI: 37–39) (I2 = 99.8% and p-value < 0.0001) in Sao Tome and Principe and Angola, respectively. Unmet needs due to limiting ranged from 6%; (95% CI: 3–9) in Central Africa to 9%; (95% CI: 8–11) in East Africa. On the other hand, the prevalence of unmet needs due to spacing was highest in Central Africa (Prev: 18; 95% CI: 16–21) and lowest in Southern Africa (Prev: 12%; 95% CI: 8–16). Our study indicates that there was no publication bias because the Luis Furuya-Kanamori index (0.79) was within the symmetry range of -1 and +1. Conclusion: The prevalence of unmet need for FP remains high in sub-Saharan Africa suggesting the need for health policymakers to consider re-evaluating the current SRH policies and programmes with the view of redesigning the present successful strategies to address the problem.

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Determinants of unmet need for family planning in Gambia & Mozambique: implications for women’s health

BMC Women s Health ◽

10.1186/s12905-021-01267-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sanni Yaya ◽

Dina Idriss-Wheeler ◽

Olalekan A. Uthman ◽

Ghose Bishwajit

Keyword(s):

Family Planning ◽

Unmet Need ◽

Household Wealth ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sample Population ◽

Inverse Association ◽

Low Middle Income Countries ◽

Sub Saharan ◽

Female Headed Households

Abstract Background In low-middle-income countries, unmet need for family planning (FP) constitutes a major challenge for prevention of unintended pregnancies and associated health and psychological morbidities for women. The factors associated with unmet need for family planning have been studied for several countries in sub-Saharan Africa, but not much is known about the situation in Gambia and Mozambique. The purpose of this study was to perform a comparative analysis of the prevalence of unmet need for FP, and its sociodemographic correlates in Gambia and Mozambique to better inform FP policies and programs aimed at reducing associated negative health outcomes for women and their families. Methods In this analysis we used nationally representative data from Demographic and Health Surveys in Gambia (2013) and Mozambique (2011). Sample population were 23,978 women (n = 10,037 for Gambia and 13,745 for Mozambique) aged 15–49 years. Women who want to stop or delay childbearing but were not using any contraceptive method were considered to have unmet need for FP. Association between unmet need for FP and the explanatory variables was measured using binary logistic regression models Results Prevalence of unmet need for FP was 17.86% and 20.79% for Gambia and Mozambique, respectively. Having employment in professional/technical/managerial position showed an inverse association with unmet need both in Gambia [OR = 0.843, 95% CI 0.730, 0.974] and Mozambique [OR = 0.886, 95% CI 0.786, 0.999]. Education and household wealth level did not show any significant association with unmet need. The only positive association was observed for rural [OR = 1.213, 95% CI 1.022, 1.441] women in the richer households in Gambia. Having access to electronic media [OR = 0.698, 95% CI 0.582, 0.835] showed a negative effect on having unmet need in Mozambique. Women from female headed households in Gambia [OR = 0.780, 95% CI 0.617, 0.986] and Mozambique [OR = 0.865, 95% CI 0.768, 0.973] had lower odds of unmet need for FP. Conclusion The situation of unmet need for FP in Gambia and Mozambique was better than the Sub-Saharan African average (25%). Nonetheless, there is room for improvement in both countries. Significant assocations with lower unmet need for family planning and women’s occupational status (more education & higher skilled employment), access to mass media communication, and female-headed households provide possible areas for intervention for improved FP opportunities in the region.

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