The Effect of Adolescent Pregnancy on Child Mortality in 46 Low- and Middle-Income Countries

Abstract

Background The World Health Organization (WHO) has highlighted the health risks to adolescent mothers and their children. Statements and reports typically group all mothers aged under 20 together. Some studies have examined the risk variations within this age group, and several child health outcomes have yet to be examined. Methods We analyzed data from Demographic and Health Surveys (DHS) collected between 2004 and 2018 in Sub–Saharan Africa (SSA) and South Asia, on children born to mothers 25 years old or younger. We examined the association between maternal age at first birth and deaths of neonates, infants, under –5 years old, and stillbirths, using mixed effects logistic regression and adjusting for common demographic and health–seeking variables. Findings The mortality rates at all early–life stages 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 1.2–1.3 times higher, respectively, than among children born to mothers aged 23–25 in both regions. Absolute mortality rates decreased over time, but the risk gradient versus age remained similar across time periods, regions, and most child mortality endpoints. After adjustment for rural/urban residence and maternal education, in SSA in 2014–2018 having a mother under 16 (10–15) years old was associated with stillbirth odds ratio (OR) 3.71 [95% CI 2.50–5.51], neonatal mortality OR 1.92 [1.60–2.30], infant mortality OR 2.13 [1.85–2.46], and under–5 mortality OR 2.39 [2.13–2.68]), compared with first children of mothers aged 23–25 years. For the same time period in South Asia ORs were stillbirths 5.12 [2.85–9.20], neonatal mortality 2.46 [2.03–2.97)], infant mortality 2.62 [2.22–3.08], and under–5 mortality 2.59 [2.22–3.03]. Adjustment for additional risk factors did not affect the estimates substantially. Interpretation Adolescent motherhood is associated with dramatically worse child survival, likely reflecting a combination of biological and social factors. Revising maternal age reporting conventions will help to highlight this burden. Targeted intervention strategies to eliminate underage pregnancy are warranted.

Uncertainties in the path to 2030: Increasing trends of under-five mortality in the aftermath of Millennium Development Goal in Eastern Ethiopia

“…Children born to adolescent mothers had higher hazard of mortality compared to those 25-34 years old. This is in accord with recent studies indicating up to 4 times increased of risk of death of children born to adolescent mothers compared to those born to young adult mothers [ 28 , 29 ]. Given that more than six in ten women included in this study gave their first birth before 20 years of age, still an unexpectedly high proportion of rural Ethiopian girls are suffering from teenage pregnancy.…”

“…Given that more than six in ten women included in this study gave their first birth before 20 years of age, still an unexpectedly high proportion of rural Ethiopian girls are suffering from teenage pregnancy. The observed dramatically worsening survival of children born to adolescent mothers is likely attributed to combination of biological and social factors: poor reproductive maturity and low decision making power of the teens to access sexual and reproductive health services for themselves or their children [ 29 ]. There is, therefore, a definite need for reducing adolescent births and its complications as a strategy for addressing the problem of neonatal and child mortality through prevention of early marriage, and ensuring access to quality maternal health services, including use of contraception for delaying teen age pregnancy.…”

Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol

“…A significant consequence of adolescent pregnancy is the high risk of adverse health outcomes for both adolescent mothers and their children, mainly because of complications during pregnancy and childbirth, limited access to prenatal care, and a higher likelihood of living in poverty for adolescent mothers [9,10]. Adolescent mothers may suffer from eclampsia, puerperal endometritis, and systemic infections, and their children might be at risk of low birthweight, preterm birth, severe neonatal conditions, and newborn mortality [5,11,12]. Early marriage, lack of sex education and health services, poor socioeconomic background, and sexual risk behaviours are vital predictors of the high prevalence of adolescent pregnancies in LMICs [13].…”

Can cash transfer interventions increase contraceptive use and reduce adolescent birth and pregnancy in low and middle income countries? A systematic review and meta-analysis

“…Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children across a range of different settings, including elevated rates of maternal and neonatal mortality, with the negative health impacts in particular thought to be exacerbated in low income settings [1][2][3]. Reducing adolescent birth is a global priority, and an indicator of Sustainable Development Goal 3 (SDG3) to 'ensure healthy lives and promote wellbeing for all at all ages' [4].…”