Association between socioeconomic status and fertility among adolescents aged 15 to 19: An analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS)

Abstract

Background: Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections and unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contribute to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility. Methods: Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n=3,666).Results: Overall, 23.1 % of adolescents had given birth at least once in the five years leading to the survey (n= 3,666, 99.4% response), and 49.8 % were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR= 6-10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (95% CI 1.5, 3.7 p<0.001). Although odds of giving birth were much higher among rural married adolescents (aOR 8.0, 95% CI 5.4, 11.9 p<0.001) compared to urban married adolescents (aOR 5.5, 95%CI 8.3, 16.0, p<0.001), and these relationship both statistically significant, higher educational attainment (aOR 0.7 95% CI 0.6, 0.8 p<0.001) and abortion (aOR 0.3 95% CI 0.1, 0.8 p=0.020) reduced these odds, particularly for rural-based adolescents. Conclusion: Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address access to sexual and reproductive health needs of urban adolescents with a lower socioeconomic status.

A Multilevel Analysis of Trends and Predictors Associated with Teenage Pregnancy and Early Motherhood in Zambia (2001 - 2018)

“…Teenagers that reported being currently married or those living with partners were more likely to be pregnant compared to their never-married counterparts. These ndings are consistent with evidence from other previous studies in Zambia (4,20) and Africa (3). The relationship between marital status and early pregnancy has long been held in literature (6).…”

“…Even more startling is the nding that place of residence, which has always been found to be associated with teenage pregnancy was not the case in our study. A Zambian study focusing on a similar population group reported that rural young women are more likely to have early pregnancy compared to their urban counterparts (4,29). However, our study is signi cantly different as it pools data from four surveys compared to just one analysed by Munakampe and colleagues.…”

“…The prevalence rates for teenage pregnancy stands at 18.8% while that of sub-Saharan Africa is around 19.3% (3). The drivers of teenage pregnancy are several and multifaceted and these include poverty, inadequate education and employment opportunities, gender inequalities, rural residence, poor access to contraceptives and inadequate sexual and reproductive health information among others (3)(4)(5). Marital status is another major factor associated with teenage pregnancy.…”

Framing Contraceptive Use Motivations Among Adolescents and Young Adults Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda

“…Unique to adolescents in informal settlements is the increased need for economic and social emancipation, sometimes sought from sexual relationships ( 52 ), due to socio-economic inequalities such as low access to education- a most cited factor associated with delayed onset of childbearing among women ( 54 , 55 ). Interestingly, the confidence in discussing contraceptives with their peers was compromised by the negative community perceptions of adolescent contraceptive usage.…”

Intersections between adolescent fertility and obesity—pathways and research gaps focusing on Latin American populations

“…Children from impoverished backgrounds are more likely to be in poor nutritional status, 57,74 and they are also more likely to experience an early pregnancy. 75,76 Pregnancy then might accentuate health issues and health may deteriorate more rapidly over time than would be expected based on either risk alone. Although there are increased trends of pregnancy among younger adolescents, 2,77 as well as childhood obesity and malnutrition in Latin America, 6 the interaction between them has not been the focus of previous research.…”