Abstract
BackgroundHigh maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival.MethodsA community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan–Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05.ResultsThe overall median age at first birth was found to be 20 years (IQR, 16–24 years). The independent predictors of time to first birth were: married 15–17 years (AHR = 2.33, 95% CI 2.08–2.63), secondary education level (AHR = 0.84, 95% CI 0.78–0.96), higher education level (AHR = 0.75, 95% CI 0.65–0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22–25.64), intercourse 15–17 years in married stratum (AHR = 5.56, 95% CI 5.26–5.88), spousal age difference (AHR = 1.11, 95% CI 1.05–1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86–0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13–1.20) than low risk clusters adjusting for other factors.ConclusionIn this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.
Highlights
High maternal and child death with high fertility rate have been reported in Ethiopia
The data collectors and study participants were blind to the study hypothesis since the analysis considered later
67.37% had more than 5 years of a spousal age difference
Summary
High maternal and child death with high fertility rate have been reported in Ethiopia. When a woman became pregnant in the adolescent period, her present and future life rarely became for better [5, 6] It results in cessation of education, joblessness, deprived maternal and child health outcomes, an numerous children per women, gender inequity, destitution of adolescent mothers and their families and the communities at large [2, 5, 7,8,9,10,11,12,13]. Girls under 15 years are five times at higher risk of death and those 15–19 years are twice more likely to die than women aged 20–24 years in pregnancy or childbirth [15, 16]. Complications from Pregnancy and childbirth are the primary cause of decease (1 out of 7 girls) among under 19 years in third world countries [17]
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