Abstract
IntroductionUganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women.MethodsWe estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey.ResultsAmong these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant decline occurred (− 16.0 pp., p < 0.001). First childbirth < 18 years of age declined by − 13.5 pp. (p < 0.001) between 2000/01 and 2016. There was no change over time in the percentage of adolescents 18–19.9 years of age having first childbirth. Among rural residents, childbirth < 18 years declined from 43.8% in 1988/89 to 32.7% in 2016 (− 11.1 pp., p < 0.001), in urban it declined from 28.3 to 18.2% (− 10.1 pp., p = 0.006). There was an increase over time in the percentage of women, both rural and urban, who wanted to delay their first pregnancy. Independent determinants of reporting an adolescent childbirth in both urban and rural residents were: no education/incomplete primary and younger age at first sex. Additional determinants for rural women were residence in Eastern region, Muslim religion, and poor household wealth index.ConclusionIn the 30-year period examined, adolescent childbirth in Uganda declined from highs of 7 in 10 to approximately 5 in 10 women, with more wanting to delay the pregnancy. The decline started after the 2000/01 survey and affected predominantly younger adolescent childbirth < 18 years among both rural and urban residence women. Efforts need to be intensified to sustain the decline in adolescent pregnancies. Targeted and specific strategies for urban and rural areas might be required.
Highlights
Over 70% of the women at each survey point were from rural residence and this proportion declined from 86.7% in 1988/89 to 70.1% in 2016 (− 16.6 percentage points, p < 0.001) in the 30 years
67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively
Levels and time trends of adolescent childbirth We found that adolescent childbirth is high; with approximately 1 in every 2 women age 20–24 reporting having had a live childbirth before the age of 20 years
Summary
The details of adolescent childbirth and urban/rural patterns are scarce. Time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women. Approximately 17 million adolescent births occur annually and 95% of these occur in low- and middle-income (LMIC) countries [1,2,3]. Adolescent childbirth is associated with adverse health, social and economic outcomes to the girl and her offspring [2, 4, 5]. The adolescent girls from poorer settings are at higher risk of adverse outcomes [3, 6]. The poor outcomes can be immediate or continue into later life [7,8,9,10]. Sub-Saharan Africa has the highest proportion of adolescents - 23% of its population - and bears 50% of the global adolescent births’ burden [2, 3, 13,14,15]
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