Summary measures of socioeconomic and area-based inequalities in fertility rates among adolescents: evidence from Ethiopian demographic and health surveys 2000\u20132016

Sanni Yaya,Gebretsadik Shibre,Dina Idriss-Wheeler,Betregiorgis Zegeye,Edward Kwabena Ameyaw

doi:10.1186/s12889-021-10729-5

Abstract

BackgroundOne of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. This study assessed the magnitude and trends of socioeconomic and area-based AFR inequalities in Ethiopia.MethodsThe 2000 and 2016 Ethiopia Demographic and Health surveys (EDHS) was analyzed using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software. Adolescent fertility rates were disaggregated using three equity stratifiers (economic status, education and residence) and analyzed through four summary measures (Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF)) to assess inequality. To measure statistical significance, point estimates were constructed using a 95% Uncertainty Interval (UI).ResultsLarge socio-economic and urban-rural inequalities were observed within the 16-year period. Adolescents in less well-off socio-economic groups (PAF: -62.9 [95% UI; − 64.3, − 61.4], D: 96.4 [95% UI; 47.7, 145.1]), uneducated (R: 8.5 [95% UI; 4.8, 12.2], PAR: -76.4 [95% UI;-77.7, − 75.0]) and those from rural areas (D: 81.2 [95% UI; 67.9, 94.6], PAF: -74.2 [95% UI, − 75.7, − 72.7]) had a higher chance of pregnancy and more births than their counterparts.ConclusionsSocioeconomic (education and economic status) and place of residence determine adolescents’ pregnancy and childbearing. Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities. More emphasis should be placed on subpopulations with disproportionately higher adolescent pregnancy and childbirth.

Highlights

One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa
Policies and programs should be directed at preventing child marriage and early fertility so that adolescents continue to access education, sexual and reproductive health care as well as access employment opportunities
The current study showed disparities in adolescent fertility rates (AFR) across socioeconomic and place of residence over the 16 years in Ethiopia

Summary

Introduction

One of the highest rates of adolescent pregnancies in the world is in sub-Saharan Africa. Most adolescent pregnancies in the region are unintended or unwanted, due to poor access to information and services on sexual and reproductive health for adolescents. Ethiopia has high adolescent fertility rates (AFR) with disparities across socioeconomic subgroups and regions. Sub-Saharan Africa has one of the largest populations of adolescent girls in the world, many of whom are exposed to unintended pregnancy [1, 2]. Adolescent Fertility Rate (AFR) is defined as the “number of births per 1,000 women aged 15 to 19” [3, 4] and remains high in the World Health Organisation (WHO) African Region; 99.1 per 1000 compared with a global average of 43.9 per 1000, over the period 2007–2016 [5]. Births to adolescents and the associated negative outcomes continue to be serious problems in many LMICs [6]

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Results

Conclusion