Early Childbirth Research Articles

Study on Adolescents Reproductive Health & Problems in a Tertiary Care Hospital, Chattogram

Background: Adolescence is a stage where the physical and psychological development of a child takes place. Inother words, teenagers passing the years between the puberty and adulthood, from ages 10-19 years. Adolescents are likely to face a range of health and social challenges, for instance initiation of sexual activity while there is still lack of adequate knowledge and skill. High prevalence of early marriage and child bearing are associated with higher rate of morbidity and mortality. They are also in higher risk of unwanted pregnancy, unsafe abortion and sexually transmitted infections. The main objective of this study is to suggest the strategies for improvement of adolescents reproductive health status in Bangladesh. Materials and methods: This retrospective observational study was conducted in the Obs and Gynae Department of Chattagram Maa-O-Shushu Hospital Medical College (CMOSHMC) from July to December 2022. Total 436 adolescents were included in this study who were admitted in Obs and Gynae Department instudy period. All cases reviewed retrospectively from in patients records. An inclusion criterion of age in this study is 10-19 years. Results: A Total 436 patients were enrolled in this study with age limit between 10- 19 years. Total Obstetric patients were 360 (82.57 %). Among them antenatal patients were 348 (97 %), postnatal patients were 12 (3%). Among antenatal patients primipara 344 (99 %), multi para (2nd pregnancy) 4 (1%). Total delivery occurred in 302 patients. Vaginal delivery occurred in 147 patients (49 %), cesarean section were needed in 140 patients (46%). Repair of perineal tear done in 2 post natal patients. Secondary wound closure was done in 1 patient. Conservative management was given to 70 patients. Sexual abuse in 3 patients, came with 14, 16 and 25 weeks of pregnancy and medical termination were done in all cases. Maternal death was 1 (4.2%) due to primary PPH following LSCS due to central placenta Previa with postoperative cardiac arrest. Total baby delivered 302, alive 287(95%), intrauterine death 15 (5%). LBW (Low Birth Weight) 49 (17 % of alive baby ), IUGR (Intrauterine Growth Restriction) 6 (2%), NND (Neonatal Death) 5 (1.7%). Total Gynae patients admitted were 76 (17.43%), abortion related complications were 52 (68%), menstrual abnormality were 7(9.2%), ruptured ectopic pregnancy following sexual abuse was 1 (0.92% of total patients ) . Conclusion: There is growing attention being paid to improving access to quality maternal care for pregnant and parenting adolescents preventing pregnancy among adolescents are fundamental to achieving positive health outcomes across the life course and imperative for achieving the SDGS (Sustainable Developmental Goals) related to maternal and newborn health. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 60-63

Roma mothers of infant children in the health system - a qualitative study

Abstract Background The Roma in Bulgaria constitute the third largest group - 4% of the population. Data on demographic processes by ethnicity are scarce. A national survey in 2003 found significant differences in infant mortality - 9.9‰ for Bulgarian, 18‰ for Turkish, and 28‰ for Roma infants. Poverty among Roma children, risk of poor education, especially for girls, barriers to accessing health services remain high. We aim to reveal the cultural specificity in prenatal behavior and infant care among Roma mothers in the context of the role of the Bulgarian health service. Methods In-depth interviews with Roma mothers of infants up to 1 year were utilized for data collection. To ensure heterogeneity among the interviewees, several “nests” with varying socio-cultural status in the Varna district were identified in advance for participants recruitment. A list of interview themes concerning respondents’ relationships with the public health system with an emphasis on the experiences of mothers was drawn up. Results Ten interviews with mothers having between 1 and 7 children were conducted in 2023. The mothers recounted discriminatory experiences during their interactions with certain health facilities (maternity wards), which act as barriers to accessing and utilizing health services. Maternity and infant counselling services are highly esteemed with favorable influence on child health outcomes. There has been a positive shift away from early marriage and childbirth towards prioritizing education for Roma girls. Mothers prioritize their children, and there is no neglect in their care. Family relations and support are being upgraded, with Roma fathers becoming involved in child care. Respondents express their educational needs and hopes for community-based support to better cope with their roles as mothers. Conclusions Ethno-cultural factors shaping the mother’s role maintain traditional family support, while also reflecting significant modernization that needs societal support. Key messages • A glimpse into people’s experiences of the healthcare system - a clue to its effectiveness. • Тhe ethno-cultural factors in Roma are subject to modernization.

Early menarche and childbirth accelerate aging-related outcomes and age-related diseases: Evidence for antagonistic pleiotropy in humans.

Aging can be understood as a consequence of the declining force of natural selection with age. Consistent with this the antagonistic pleiotropic theory of aging suggests that aging results from the trade-offs that promote early growth and reproduction. However, evidence for antagonistic pleiotropy in humans is largely lacking. Using Mendelian Randomization (MR), we demonstrated that later ages of menarche or first childbirth were genetically associated with longer parental lifespan, decreased frailty index, slower epigenetic aging, later menopause, and reduced facial aging. Moreover, later menarche or first childbirth were also genetically associated with a lower risk of several age-related diseases, including late-onset Alzheimer's disease (LOAD), type 2 diabetes, heart disease, essential hypertension, and chronic obstructive pulmonary disease (COPD). We validated the associations between the age of menarche, childbirth, and the number of childbirths with several age-related outcomes in the UK Biobank by conducting regression analysis of nearly 200,000 subjects. Our results demonstrated that menarche before the age 11 and childbirth before 21 significantly accelerated the risk of several diseases, and almost doubled the risk for diabetes, heart failure, and quadrupled the risk of obesity, supporting the antagonistic pleiotropy theory. We identified 128 significant single nucleotide polymorphisms (SNPs) that influenced age-related outcomes, some of which were involved in known longevity pathways, including IGF1, growth hormone, AMPK, and mTOR signaling. Our study also identified higher BMI as a mediating factor in causing the increased risk of certain diseases, such as type 2 diabetes and heart failure, in women with early menarche or early pregnancy, emphasizing the importance of the thrifty gene hypothesis in explaining in part the mechanisms behind antagonistic pleiotropy. Our study highlights the complex relationship between genetic legacies and modern diseases, emphasizing the need for gender-sensitive healthcare strategies that consider the unique connections between female reproductive health and aging.

Adolescent pregnancy, maternal and child anaemia: Empirical analysis from India, Bangladesh, and Nigeria.

Early childbearing poses several potential risks to maternal and child health. This paper empirically analyses the association between teenage pregnancy and child nutritional status, maternal and child anaemia in three countries (Nigeria, India and Bangladesh) that account for the highest proportion of teenage births and/or total number of malnourished teenage mothers and children. Data were sourced from nine waves of Demographic and Health Surveys conducted in Bangladesh, India, and Nigeria from 2005-2018, covering a sample of 27,705 children from Bangladesh, 266,308 children from India and 54,719 children from Nigeria. Our outcome measures of maternal and child nutrition include (i) a composite measure of anthropometric failure for children (CIAF), (ii) maternal anaemia, (iii) childhood anaemia, and (iv) anaemia in maternal-child pairs. Using multivariate regression analysis, we examine the associations between early childbirth, child nutrition, and maternal and child anaemia, controlling for an array of household-level socioeconomic and demographic characteristics. Across all three countries, the prevalence of CIAF (childhood anthropometric failure) is significantly higher among children born to women aged below 17 at first birth. We further find that early pregnancy and childbearing are associated with significantly higher rates of severe/moderate anaemia among both mothers and children in Bangladesh and Nigeria. In the three countries studied, the proportions of teenage mothers with vulnerable socioeconomic status and suboptimal pre-conception care are relatively high, which raises the risk of maternal and child morbidity as well as mortality.

Child health outcomes and associated factors among under five years children in Ethiopia: a population attributable fractions analysis of Ethiopia demographic and health survey (2005–2016)

IntroductionIn Ethiopia, more than half (57%) of children aged 6–59 months were estimated to be anemic in 2016 alone. The country had about 37% of under-five children suffering from stunting and under-five mortality rate of 59 deaths per 1000 live births in 2019. The main purpose of this paper was to estimate the proportion of under-five children prevented from childhood undernutrition, anemia, and under-five mortality by removing the risk factors or inequalities.MethodThis cross-sectional study was based on a pooled total sample of 29,831 children aged 0–59 months drawn from three rounds of the Ethiopian Demography and Health Surveys (2005–2016). We employed multiple logistic regression analysis to identify the modifiable risk factors associated with childhood anemia, undernutrition, and under-five mortality among under-five children. We also used Population Attributable Fractions (PAFs) to estimate the proportion of under-five children that could be prevented from childhood undernutrition, anemia, and under-five mortality by removing inequalities.ResultPAF analyses of risk factors of childhood anemia confirmed that 38.5% of occurrence of childhood anemia was attributed to five selected risk factors, which include having a large household size (5+), being in a poor household, being born from anemic and unemployed mothers, and being breastfed for less than six months. About 45.6% of occurrences of childhood undernutrition were attributed to unimproved toilet facility, solid cooking fuel, and home delivery. About 72% of the reported under-five mortality could possibly be averted by removing the use of unimproved toilet facilities, early age childbirth (< 18 years old mothers), and a large number of children ever born to mothers and less than six months breastfeeding practice at the population level.ConclusionThe present study suggests that a substantial reduction in the prevalence of childhood anemia, undernutrition, and under-five mortality in the country is attainable if child survival-focused program interventions and policies target households and mothers with low socioeconomic status and those who have low awareness of child healthcare, including breastfeeding practice and use of safe sanitation facilities.

Improving access to utilize the healthcare services facilitated by ASHAs, ANMs and medical officers of PHC among scheduled tribe pregnant women: An interventional study.

Early marriages, early childbirth, low BMI and high incidence of anaemia are known factors for high maternal mortality among tribal pregnant women. This was a mixed method study (qualitative and quantitative) undertaken to evaluate educational intervention package among tribal pregnant women in Chittoor District of Andhra Pradesh State in South India. A baseline household survey with the help of a semi-structured questionnaire was conducted in both intervention group (n = 109) and control group (n = 119) of ST habitations. An educational intervention was implemented through health education approach to bring about awareness and behavioural change among pregnant women regarding healthcare practices and utilization of health services. Qualitative data collection tool included semi-structured FGD. Quantitative data was analysed using SPSS version 26.0. Content analysis was done for qualitative data. The findings of this study show that awareness and utilization with respect to various services facilitated by ASHAs, ANMs and medical officers are improved postintervention among tribal pregnant women, and the various reasons for non-utilization of services were lack of awareness, long distance of health facility, no transportation, poor socio-economic status, inadequate facilities at PHC, etc. This study shows that intervention to improve awareness and health services utilization, and continuous health education should be imparted to all the pregnant mothers. For this healthcare providers like ASHA and ANM and medical officers should be trained and motivated to educate the community.

Vitamin D deficiency, pregnancy, and childbirth in early medieval Milan

This paper explores the burden of osteomalacia on pregnancy and childbirth through two cases from early medieval urban Milan. Two skeletons of female individuals with skeletal deformities and associated with 25–36 gestational weeks fetuses, excavated from the Ad Martyres and San Vittore al Corpo urban cemeteries and dated to the Early Middle Ages, were examined. Paleopathological and historical analyses were performed in a biocultural approach to investigate the impact of clinical complications and skeletal deformities on their daily life, the course of their pregnancy, and childbirth. The women showed severe skeletal deformities attributable to osteomalacia including scoliosis, reduced rib-neck angle, coxavara, severe bending of the pelvic bones, protrusio acetabuli, and narrowed pelvic outlet. The condition and its biomechanical complications impacted the health of both mothers and fetuses, the quality of life of the women (i.e., gait alteration, difficult and limited mobility, compression of internal organs), as well as pregnancy outcomes. It is possible that both the mothers and fetuses died due to childbirth complications. Bioarchaeological cases of osteomalacia, pregnancy, and death during childbirth are excessively rare. This paper also provides insight into how maternal experiences and biocultural environments in early medieval Milan impacted childbirth outcome. The study of the Ad Martyres and San Vittore al Corpo necropolises is still ongoing and could provide further insight. Isotopic and paleogenomic analyses may shed more light into the factors that led to vitamin D deficiency in these women.

The Role of Early Childbearing on Child Health Outcomes in Punjab

Early Childbearing is a major social and public health concern in developing countries. The study explores the role of early childbearing on child health outcomes in Punjab, Pakistan. Using the newly available data, Multiple Index Cluster Survey for Punjab 2017-18, the paper aims to test the association between early childbearing and child health outcomes both in the short and long term. Since early childbearing decision is influenced by a wide array of factors which include individual, household as well as social and cultural norms; the paper employs cluster &amp; household fixed effects model to deal with the issue of omitted variable bias. The empirical results suggest that early childbearing exerts a negative impact on child health outcomes. The findings of the study are also robust to changing the specification of early childbearing as well as the data set. This study adds to the existing literature by providing insights into the strong influence of social and cultural norms in influencing childbearing decisions.

Dynamics of caste and early childbearing in India: a perspective of three decades

BackgroundEarly childbearing disrupts girls’ otherwise healthy growth into adulthood and adversely affects their education, livelihood, and health. Individual, sociocultural, economic, environmental, and health service-related factors contribute to childbearing among young females. In India, caste affects health outcomes despite several affirmative policies aimed at improving the health and welfare of the backward castes/tribes. However, there is a dearth of empirical evidence about the impact of caste on early childbearing, more specifically, regarding the trajectory of inter-caste disparities in early childbearing.MethodThis study used data from all five rounds of the National Family Health Survey (NFHS) in India to assess the association between caste and early childbearing over the last three decades. All women aged 20–24 [NFHS-1 (n = 17,218), NFHS-2 (n = 15,973), NFHS-3 (n = 22,807), NFHS-4 (n = 122,955) and NFHS-5 (n = 118,700)] were considered to create a pooled data set (n = 297,653) for analysis. Bivariate analysis and binary logistic regression were conducted using Stata (v17). ArcMap (v10.8) presented the caste-wise prevalence of early childbearing among the states and Union Territories (UTs).ResultsMany women continue to have early childbearing despite a considerable reduction over the last three decades from 47% in 1992-93 to 15% in 2019-21. Compared to NFHS-1, the odds of early childbearing increased by 15% in NFHS-2 and, after that, declined by 42% in NFHS-3 and 64% in NFHS-4 and NFHS-5. The inter-caste disparity in early childbearing persists, albeit with a narrowing gap, with the Scheduled castes (SC) remaining the most vulnerable group. Adjusting the effects of socio-demographic and economic characteristics, SC women had significantly higher odds of early childbearing (OR = 1.07, CI = 1.04–1.11) than those from the General caste.ConclusionTo decrease early childbirth, a focus on adolescent marriage prevention and increasing contraceptive use among young SC women is necessary. Strengthening ongoing programs and policies targeting educational and economic empowerment of the socially weaker castes/tribes will help in reducing early childbearing. Efforts to prevent early childbearing will accelerate the achievement of the Sustainable Development Goals (SDGs)-especially those related to health, poverty, nutrition, education, and general wellbeing, in addition to protecting women’s reproductive rights.

Determinants of unintended pregnancy and induced abortion among adolescent women in Ethiopia: Evidence from multilevel mixed-effects decomposition analysis of 2000-2016 Ethiopian demographic and health survey data.

Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades. Trends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents. The trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion. The trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.

Prevalence and risk factors of pelvic organ prolapse among women in Sidama region, Ethiopia: A community-based survey.

Pelvic organ prolapse is a descent of the vaginal compartments and the surrounding organ due to loss of support of the vaginal tissue. It has a significant psychological, physical, and social impact that affects women's quality of life. However, its true prevalence is unknown due to the variability in the methods used to diagnose the disorder. This study aimed to determine the prevalence of pelvic organ prolapse and its associated risk factors among women in Sidama region, Ethiopia. A community-based cross-sectional survey was conducted in the Dale-Wonsho Health and Demographic Surveillance Site, Sidama region, from March to October 2023. A multi-stage stratified cluster sampling was used to select a sample of 816 women. Anatomical prolapse was diagnosed based on the standardized pelvic organ prolapse quantification method, and symptomatic prolapse was assessed by patient-reported symptoms. A complex survey-based modified Poisson regression was used to assess the risk factors associated with prolapse. A total of 815 participated in the interview, and 779 (95.6%) underwent pelvic examination to assess for prolapse status. Anatomical prolapse (Stages II-IV) was observed in 241 (30.9%; 95% confidence interval = 24-38.7) of the participants. The prevalence of symptomatic pelvic organ prolapse was 78.5% (95% confidence interval = 69.1-85.7) among women with anatomical prolapse (189/241). This prevalence falls to 24.27% (95% confidence interval = 19.98-29.16) for the total sample population. Higher frequency of childbirth, prolonged heavy lifting activities, and prolonged labor increased the likelihood of developing anatomical prolapse. Childbirth at an early age and prolonged heavy lifting activities were significantly associated with symptomatic prolapse. Anatomical prolapse and symptomatic prolapse are high in the study area. Parity, prolonged heavy lifting, prolonged labor, and early age childbirth were associated with pelvic organ prolapse. Community-based education and interventions that focus on the modification of risk factors are needed.

Adolescent fertility and its impact on educational attainment in Nigeria: A propensity score matching approach

ABSTRACT Teenage childbearing remains a persistent challenge in Nigeria, characterized by a high rate of early adolescent births. This study examines the impact of teenage fertility on educational attainment of young mothers in Nigeria. Utilizing data from the 2018 Nigerian Demographic and Health Survey, we applied propensity score matching techniques to construct a matched sample of non-fertile teenagers aged 15 to19 years that closely corresponds to a sample of fertile teenagers. The results of our analysis reveal that the average treatment effect of teenage fertility is a reduction in education attainment by nearly two and half years. Furthermore, being fertile during the teenage years is associated with a 25 percent decrease in the probability of completing secondary school. This underscores the significant educational challenges faced by young mothers in Nigeria due to early childbirth. Addressing the challenge of early childbearing among adolescent girls in Nigeria is critical not only for the well-being of these girls but also for the country's overall development and future prospects.

Roots of change: intergenerational cycle of adolescent fatherhood in rural Jharkhand and Odisha

Background: Numerous studies have documented an intergenerational cycle of adolescent motherhood, wherein daughters of adolescent mothers are more likely to follow suit. This pattern may result from biological predisposition, heritable attitudes, or the socioeconomic environment influenced by early childbirth. Surprisingly, the same cycle among young fathers remains unexplored in India. This research paper seeks to enrich the existing body of knowledge by shedding light on the intergenerational cycle of adolescent fatherhood in the rural Jharkhand and Odisha, possibly as a first of its kind study. Methods: A case control study was conducted between June 2023 to August 2023 amongst adolescent males residing in rural areas of Jharkhand and Odisha states with sample size of 228 using multi-stage sampling technique. Results: The study did not reveal statistically significant association between adolescent fathers of this generation and adolescent fathers or adolescent mothers of previous generation, unlike in the case of adolescent mothers. Conclusions: To address adolescent reproductive sexual Health challenges in rural Jharkhand and Odisha effectively, it is imperative to emphasize targeted educational campaigns with cultural sensitivity, actively involve adolescent males and maintain a steadfast long-term commitment to fostering cultural transformation.

‘Send the midwife’: The Birth of Blackness in Titus Andronicus

AbstractThis article examines a neglected context for understanding the ontology and epistemology of race in Shakespeare's drama: the role of the midwife. Early modern midwives performed an important cultural function by not only assisting women in labour, but also pronouncing the sex and paternity of a newborn. As Caroline Bicks has shown, this was a time when a midwife was thought to have significant influence over how a body was literally shaped and interpreted at the moment of its birth, thereby determining its reception in the community. Nowhere in Shakespeare's canon is the midwife's authority more manifest – and threatening – than in Titus Andronicus, where the midwife's role includes establishing an infant's race. After Tamora, Empress of Rome, delivers a baby fathered by her lover, Aaron ‘the Moor’, he asks: ‘How many saw the child?’ By subsequently killing the birth attendants, Aaron calls attention to how controlling the destiny of his son will depend upon rewriting the script of his nativity. Merging critical interest in early modern childbirth with Shakespeare scholarship on race and performance, I show how newly born bodies are midwived into racialized subjects, illuminating how midwifery discourses can broaden our understanding of early modern racecraft. My specific claim is that the statements made by Tamora's nurse concerning Aaron's ‘black’ son can be read as a performative utterance that confers, constitutes and attempts to naturalize the newborn's raced identity.

Effects of focused ultrasound on human cervical cancer HeLa cells in vitro.

Cervical cancer is the fourth most common malignant tumor in women. Many studies have confirmed that early childbirth, prolificacy, HPV infection, and smoking are some risk factors. This article explored the effects of exposing human cervical cancer HeLa cells to different focused ultrasound intensities in vitro. The study employed three groups of cells: 1- a high-intensity treated group, 2- a low-intensity treated group, and 3- a control group. Results showed that after 12 hours of focused ultrasound treatment, the growth inhibi-tion rate of the low-intensity group was 55.6% higher than that of the control group, and the growth inhibition rate of the high-intensity group was 41.2% higher than that of the low-intensity group. Therefore, focused ultrasound had a specific inhibitory effect on the growth of HeLa cells, and the higher the intensity of focused ultrasound, the higher the inhibition rate on cancer cells. In addition, the Cycle Threshold (Ct) values of the three groups of cells before treatment were the same, but the Ct values after treatment had changed. The Ct value of the low-intensity group was 18.1% lower than that of the control group, and the Ct value of the high-intensity group was lower than that of the low-intensity group by 27.8%, showing that focused ultrasound can effectively reduce the activity of HeLa cells in vitro.

Fertility rate in Brazil and in adolescents in the last 20 years

Objective: to discuss the downward trend in the fertility rate in Brazil in the last two decades and the factors that contributed to this reduction. Methods: review study with data collection from secondary sources, such as the Brazilian Institute of Geography and Statistics (IBGE) and the Department of Informatics of the Unified Health System (DATASUS). Results: there was a significant drop in the average number of children per woman of childbearing age, from 2.4 in 2000 to 1.7 in 2020, due to several factors, such as higher education, participation of women in the labor market, availability of methods contraceptives and access to information. However, the fertility rate among adolescents is still considered high, at 45.9 births per thousand women aged 15 to 19 in 2020. The reduction in the fertility rate in Brazil is a positive trend, but there is still concern about the high rates of early pregnancy and childbirth among adolescents. Conclusions: It is crucial to invest in sexual and reproductive health services, as well as in initiatives that promote gender equality and empower women and girls, creating opportunities for them to participate fully in the social, economic and political life of the country.

Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019.

Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level. Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors. The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086). The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.

Early Childbearing of Immigrant Women and Their Descendants in Spain

Early Childbearing of Immigrant Women and Their Descendants in Spain

The Effects of Early Marriage on the Utilization of Maternal Health Services in Nigeria

Antenatal and delivery care are essential maternal health services (MHS) for survival and wellbeing. Nigeria has the highest global burden of maternal mortality with low utilization antenatal and delivery services. Though early marriage is a strong predictor of early pregnancy and childbirth, it is not clear if it is associated with low use of MHS. This study assessed early marriage as a determinant of poor MHS utilization in Nigeria. This study used data from the 2018 Nigeria Demographic and Health Survey (NDHS) which is based on descriptive cross-sectional survey design. The data was limited to ever married women aged 15-24 years. Data was analyzed using SPSS version 20. This study indicates lower likelihood of women who marry early to use antenatal care (OR=0.25, 95%CI=0.21-0.31), receive minimum 4 ANC (OR=0.22, 95% CI=0.18-0.26), receive iron supplementation (OR=0.38, 95%CI=0.33-0.45) and IPTp for malaria prevention (OR=0.57, 95%CI=0.50-0.66). Conversely, Early marriage was found to be associated with higher likelihood of facility delivery (OR=4.6, 95%CI=4.02-5.26) and lower likelihood of delivery by unskilled attendant (OR=0.31, 95%CI=0.26-0.31). These associations disappear in the adjusted model. Nevertheless, the nuanced analysis showed association in the adjusted odd ratio for use of antenatal care (AOR=0.44, 95%CI=0.20-0.99) and number of antenatal care visits (AOR=0.37, 95%CI=0.14-0.95) among women who married at less than fourteen years. Early marriage below age 14 years negatively affect utilization of MHS. There is the need to strengthen legislation against early marriage below 14 years and address socioeconomic challenges that exacerbate vulnerability. Keywords: Antenatal care, Child marriage, Delivery, Early marriage, Maternal health services, Nigeria.

GENDER ASPECT OF THE PROBLEM OF CHILD MARRIAGES IN THE WORLD AND UZBEKISTAN

The problems of child marriages in the modern world are becoming more and more relevant. In the article, based on numerous data from many countries, as well as for Uzbekistan, the problems of early marriages, early childbirth, their negative impact on the health of young mothers and their children are considered. Child marriage is considered a form of forced marriage, provided that both parties have not expressed full, free and informed consent to the marriage and are under 18 years of age, widely accepted as the age at which a person becomes an adult and receives full civil rights.