Early Childbirth Research Articles

First Births to Maltreated Adolescent Girls: Differences Associated With Spending Time in Foster Care.

Few studies have examined early parenting among girls receiving child welfare services (CWS) or disentangled the relationship between maltreatment, spending time in foster care, and adolescent childbirth. Using population-based, linked administrative data, this study calculated birth rates among maltreated adolescent girls and assessed differences in birth rates associated with spending time in foster care. Of the 85,766 girls with substantiated allegations of maltreatment during adolescence, nearly 18% subsequently gave birth. Among girls who spent time in foster care, the proportion was higher (19.5%). Significant variations ( p < .001) were observed in the rate of childbirth across demographic characteristics and maltreatment experiences. When accounting for all of the covariates, spending time in foster care was associated with a modestly higher rate of a first birth (Hazard Ratio [HR] = 1.10; 95% confidence interval = [1.06, 1.14]). While age at first substantiated allegation of maltreatment and race/ethnicity were significant predictors of adolescent childbirth, specific maltreatment experiences were associated with minimal or no differences in birth rates. The findings of this study suggest that the experience of spending time in care may not be a meaningful predictor of giving birth as a teen among CWS-involved adolescent girls and highlight subgroups of this population who may be more vulnerable to early childbirth.

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.

Prevalence of communication between mothers and daughters on sexuality and associated factors in Sagamu, southwest Nigeria.

As adolescents transition from childhood to adulthood, effective mother-daughter communication on sexuality plays a role in reducing high-risk behaviours linked to human immunodeficiency virus (HIV) infection and early pregnancy and childbirth. The objective of the study was to examine the prevalence of mother-daughter communication on sexuality and associated factors in Sagamu, southwest Nigeria. Using multistage sampling, surveys were conducted using 234 female youth enrolled at a secondary school. The chi-square or Fisher's exact test was used to examine associations between categorical variables. The independent sample t-test was used to compare mean values of variables with reported evidence of mother-daughter communication on sexuality. The mean age of respondents was 16+1.56 years. The majority (89.7%) had engaged in mother-daughter communication on sexuality, but three-quarters (80.8%) of the respondents could not freely discuss sexuality with their mothers. About one-third (31.6%) of the respondents reported at least one sexual encounter with the mean age of sexual debut of 14.23±2.12 years. Mother-daughter communication on sexuality was significantly associated with religion (p=0.047), mother's age (p=0.019), who the respondents live with (p=0.029), mother's highest educational status (p<0.001), age of sexual debut (p=0.030), and condom use (p<0.001), but not with freedom to discuss sexuality with their mother (p=0.552) or freedom to introduce male friends to their mother (p=0.077). Despite the high prevalence of mother-daughter communication on sexuality, mothers' approach appeared unfriendly, as most girls could not freely discuss topics concerning sexuality with their mothers. Poor communication on sexuality was associated with sexual risk behaviours. Mothers should engage in adolescent-friendly transferring of knowledge on sexuality in order to reduce pregnancy rates and HIV transmission in female adolescents.

Demographic Dynamics of Maternal and Child Health among the people of Todapur-Dasghara, Delhi

Fertility is generally used to indicate the actual reproductive performance of a woman or a group of women. The present study was conducted to study the demographic profile of Todapur and Dasghara women and children in Delhi. The data were collected from Jat dominated villages in different months of the year 2013–2014 from 900 households. The main focus of the interview was the ever married women in the reproductive age group of 15 to 55 years and their hildren. The data was collected through interviews and observations. Data on reproductive history, vital events, family planning etc was collected. The results revealed that 38.6% of people are original inhabitants of Todapur, 17.4% from Dasghara and the rest from Bihar. The age at marriage is as low that is as 15 years. More than 5.3% of the woman in the age group of 15 to 19 years have ever had a child reflecting the past pattern of relatively early marriage and child bearing. The mean duration of postpartum amenorrhoea is 4.9 months and the mean age at Menarche is 13.99 years.

Early Childhood Development in the Context of the Family: The Case of Child Marriage

Early childhood is a critical period in a child’s development. Poor conditions early in life affect not only children’s physical growth, but also their brain development and capabilities, with lasting consequences in adulthood. A child’s family is the first and most important support system to ensure healthy growth and development. This also means that when the family and especially the mother is vulnerable, this can have lasting negative consequences for young children. This article illustrates the impact that family conditions can have on early childhood development by considering the specific case of child marriage, defined as a girl marrying before the age of 18, as well as early childbirth, defined as a girl having a child before the age of 18, itself in most cases a consequence of child marriage. The article also discusses interventions that could help in reducing both the likelihood of child marriage and its intergenerational impacts on young children.

Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.

One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates.

Performance de l’échographie dans l’estimation du poids fœtal à terme

ObjectivesOur aim was to evaluate the accuracy of estimated fetal weight (EFW) by ultrasound at due date and the factors that could affect it. MethodsWe performed a retrospective study of 233 patients in 2014. An ultrasound was performed at due date consultation around 41 weeks of amenorrhea by midwives sonographer. EFW was calculated using the Hadlock's formula with 3 parameters (biparietal diameter, abdominal circumference and femur length) and then adjusted including the growth from the due date consultation to the day of delivery (25g/day) and finally compared to birth weight (BW). ResultsThe mean absolute weight difference between EFW adjusted and BW was 256g [0; 910]. The mean absolute percentage error was 7.2 % [0; 24.5] and the proportion of the EFW adjusted within 10 % of BW was 69.1 %. There was a strong correlation between EFW adjusted and BW (R=0.79). Obesity in early pregnancy or childbirth, excessive weight gain, the presence of oligoanamnios and fetal macrosomia had no influence on the estimated fetal weight. Indeed, the mean absolute percentage error of child who were macrosome and those were not, was similars (7.9 % vs 7.1 %, P=0.407). ConclusionsEFW by ultrasound at due date is performant. However, the adjustment by the effect growth does not improve accuracy. Fetal macrosomia do not decrease the accuracy of ultrasound to estimate the fetal weight at term.

Caring the Primary Care-Givers Determinants of Farmwomen’s Health: A View from Rural Punjab-Pakistan

A person’s physical and mental well-being or ill-being is an outcome of multi-level (individual, household, neighborhood, local, national, and global) social, economic, environmental and political milieus under which the person is living. The present study is primarily in search of finding the non-income determinants of farmwomen’s health in rural areas of district Bahawalnagar (Punjab-Pakistan). SRH is used to gauge the state of respondents’ health. The study reveals that farmwomen’s health determinants are particular to them and their families. The study concludes that marriages at early age may result in serious health concerns for a farmwoman. More participation in activities relating to livestock management may increase a rural woman’s work burden that may ultimately result in poor health status. The study also reveals that greater the number of pregnancies, higher the chances to have poor health status of that working woman. Living under joint family system, increases a woman’s likelihood to have good health status. Husband’s higher education status is found to be associating with wife’s good health status. Availability of labor-saving home appliances may save efforts and energies of domestic women and are found to be increasing the likelihood to have good health. The study suggests that at household level, a farmwoman’s health concerns could be minimized by lowering her productive and reproductive work burdens. In reducing her burden relating to productive work, the use of labor or effort saving ways of working through the use of technology is imperative. While a woman’s reproductive work burden could be reduced through discouraging early and excessive child bearing. A woman’s level of education and that of her spouse may positively contribute not only for her own health but for the good health of a farm family.

Survival analysis and prognostic factors of timing of first childbirth among women in Nigeria

BackgroundFirst childbirth in a woman’s life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing.MethodsWe hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level.ResultsAbout 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15–19 years age bracket and 38.1 % within 20–29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1.15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3.17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives.ConclusionsThis study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria.

Developmental influences on fertility decisions by women: an evolutionary perspective.

Developmental environments are crucial for shaping our life course. Elements of the early social and biological environments have been consistently associated with reproduction in humans. To date, a strong focus has been on the relationship between early stress, earlier menarche and first child birth in women. These associations, found predominately in high-income countries, have been usefully interpreted within life-history theory frameworks. Fertility, on the other hand--a missing link between an individual's early environment, reproductive strategy and fitness--has received little attention. Here, we synthesize this literature by examining the associations between early adversity, age at menarche and fertility and fecundity in women. We examine the evidence that potential mechanisms such as birth weight, childhood body composition, risky health behaviours and developmental influences on attractiveness link the early environment and fecundity and fertility. The evidence that menarche is associated with fertility and fecundity is good. Currently, owing to the small number of correlational studies and mixed methodologies, the evidence that early adversity predicts fecundity and fertility is not conclusive. This area of research is in its infancy; studies examining early adversity and adult fertility decisions that can also examine likely biological, social and psychological pathways present opportunities for future fertility research.

Determinants of High Fertility among Ever Married Women in Enderta District, Tigray Region, Northern Ethiopia

Background: Fertility is one of the major components of population dynamics, which determine the size and structure of a population. According to Ethiopian Demographic and Health Survey 2011 report, the total fertility rate is decreasing from 5.5 children in 2000 to 4.8 in 2011. However, the rate of decline has been very slow as compared to the developed world. Thus, the objective of this study was to determine the magnitude and factors associated with high fertility among ever married women aged 25-49 years in Northern Ethiopia. Methods: A community based cross-sectional study was conducted on randomly selected 531 subjects in Enderta district using an interviewer administered questionnaire. A multistage sampling technique was used to draw the study participants. Data were collected using a pretested and structured questionnaire from March 10-19/2013. The study participants’ fertility was categorized as high and low. The collected data were coded, entered, and cleaned. Bivariate and multivariable logistic regression was used to analyze the variables at p-value <0.05. Results: This study showed that 51% of the respondents had high fertility. Women who got married at the age of less than 18 years were 2.63 times (AOR=2.63, 95% CI: ([1.526, 4.528]) more likely to have higher fertility as compared to those who got married at 18 years or more. Similarly, women with history of under five child mortality were 3.57 times (AOR=3.57, 95% CI: [1.884, 6.779]) more likely to have higher fertility when compared to those who had no history of under-five child mortality. Conclusion: About half of the respondents had high fertility. Age at first marriage, under five child mortality, educational status of the women, current age of the women and age at first birth were found to be statistically significant. Thus, information, education and communication (IEC) should be strengthened to create awareness mainly among women and their husbands about the negative consequence of early marriage, early child birth and high fertility rate.

Too young to date! The origins of zaolian (early love) as a social problem in 20th-century China

Zaolian (literally means “early love,” “zao” for “early”, “lian” for “love”) refers to courtship or dating among young people in elementary and secondary school systems. In today’s China, it is regarded as a serious social problem related to minors/adolescents. To safeguard their moral, hygiene and promising future, it is believed that zaolian should be prevented and controlled by school regulations, family pressures, and even state laws. This paper attempts to provide a historical explanation to origins of this specific juvenile delinquency in China’s long twentieth century. Firstly, it offers a critical discussion on current scholarships, which dismiss zaolian either as a Freudian sexual repression by the Chinese Communist regime since 1949 or as a product of this regime’s social control efforts in the early 1980s. Unconvinced by these explanations, it then presents a new approach to examine “moral, ideological and structural” origins of zaolian. The moral and ideological origins include traditional Confucian patriarchy and its sexual norms, a new regime of western medical sciences, and the sexual repressive regime of the Chinese Communist Party, and all of them could be traced at least in the early 20th century. Lastly, it turns to the more crucial structural origins, or the three institutional-buildings responding to globally circulating discourses since the early 20th century: modern marriage against zaohun (early marriage), family planning policy against zaoyu (early childbirth) and modern educational system. Zaolian as a social problem was fledged in the 1980s when the three institutions had been well-established in China.

The Effect of Early Marriages and Early Childbearing on Women's Nutritional Status in India.

The consequences of early childbearing on the growth and nutritional status of women in India has not been quantified in previous studies. Our study aimed to fill this gap by analysing the association between early marriage and early childbearing on nutritional status of Indian women, with a focus on Bihar and Andhra Pradesh, the two states accounting for the highest proportion of women marrying and giving first birth before 18 years of age. Our findings revealed that a substantial number of women were married before 18 years and thereby exposed to early pregnancy. Furthermore, a significantly higher proportion of women in the 'thin' category were married before 18 years, both in the Indian sample (33 %, p < 0.001) and in the selected states, Andhra Pradesh (31 %, p < 0.001) and Bihar (43 %, p < 0.001), compared to those women married at higher ages. Similarly, across all our samples women whose first birth was before age 18 years also had a significantly higher probability of being in the 'thin' category across all our samples. This pattern was also observed for associations between early childbirth and anemia levels. We conclude that the net effect of the early age at marriage and age at first birth on nutritional status is significant. Our results underline the need for preventing early marriages and the consequent high adolescent pregnancies in India, particularly in high prevalence states. This will help to improve nutritional status and health care utilisation among women, thereby, prevent maternal and child mortality and thus, achieve the MDGs 4-5.

Sociocultural factors perpetuating the practices of early marriage and childbirth in Sylhet District, Bangladesh.

The practice of adolescent marriage continues in communities throughout Bangladesh, with adolescent childbearing a common result. This early childbearing is associated with increased medical risks for both mothers and their newborns. Because of the need to understand the persistence of these behaviors in spite of the risks, various qualitative research methods were used to identify and better understand the various socio cultural factors perpetuating the practices of early marriage and childbirth. Delaying the first birth after marriage can cause rumors of infertility, bring shame on the family, and in some cases lead the husband's family to seek another wife for their son. In addition, social stigma for childless women, emigration of husbands, and the belief that using modern contraceptives prior to the birth of the first child results in infertility also inhibits couples from delaying their first pregnancy. Future efforts to promote delay in marriage and subsequent early childbearing should focus on allaying the fears of infertility related to delay in childbearing or secondary to contraceptive use, both for newly married couples and household decision-makers such as mothers-in-law.

Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps.

To examine levels and patterns of HIV prevalence, knowledge, sexual behavior, and coverage of selected HIV services among adolescents aged 10-19 years and highlight data gaps and challenges. Data were reviewed from Joint United Nations Programme on HIV/AIDS HIV estimates, nationally representative household surveys, behavioral surveillance surveys, and published literature. A number of gaps exist for adolescent-specific HIV-related data; however, important implications for programming can be drawn. Eighty-two percent of the estimated 2.1 million adolescents aged 10-19 years living with HIV in 2012 were in sub-Saharan Africa, and the majority of these (58%) were females. Comprehensive accurate knowledge about HIV, condom use, HIV testing, and antiretroviral treatment coverage remain low in most countries. Early sexual debut (sex before 15 years of age) is more common among adolescent girls than boys in low- and middle-income countries, consistent with early marriage and early childbirth in these countries. In low and concentrated epidemic countries, HIV prevalence is highest among key populations. Although the available HIV-related data on adolescents are limited, increased HIV vulnerability in the second decade of life is evident in the data. Improving data gathering, analysis, and reporting systems specific to adolescents is essential to monitoring progress and improving health outcomes for adolescents. More systematic and better quality disaggregated data are needed to understand differences by sex, age, geography, and socioeconomic factors and to address equity and human rights obligations, especially for key populations.

Early Marriage;A Root of Current Physiological and Psychosocial Health Burdens

It is confirmed that early marriage and early childbirth leads to higher rates of adolescent fertility and pregnancy related complications. According to UNICEF (1994) unfortunately the mortality rate of the married girls aged between 15-19 years is twice as compare to the girls who marry after the age of 20 years. As their bodies are immature that’s why their health is affected by giving birth to a child. Millions of children are affected by the tradition of early marriage at is being practiced and widespread in many regions of South Asia. Early marriage is also called as child marriage that is marriage below the age of 18 when girls are too weak to shoulder their responsibilities physiologically, psychologically and socially. Early married females are more prone to diseases like HIV/AIDS and obstetrics obstacles. They are also affected psychologically and they may become victim of depression, anxiety and other mood disorders. An observational study was conducted between married and unmarried female to know their perspective about getting married early and to highlight whether it is a positive response according to them. Results showed that in relation to unmarried girls the married females were also not in favor of getting married early as they are equally invaded by health problems. Mental distress and depressive symptoms are more common in married females. Girls prefer doctors for concerning their reproductive health problems while girls can also concerned their mothers but they are in minority. Many health consequences are being reported by early married females and they were hesitated to share them with their in laws. Most of them approached lady doctors whereas few were relying on their mothers for their problems to be solved. Marriages below the age of 18 is not helping the females infract its demolishing their self esteem, their will to study and their physiological well being also.

“An African way of doing things”: reproducing gender and generation

In this article I draw on ethnographic research conducted in the townships of Nyanga East and Khayelitsha, South Africa, to suggest a link between normative ideals about the relations between children and adults, normative practises around the care of children, and the high rates of early child bearing. I argue that the attempt to uphold these ideals is what creates fertile ground for the occurrence of a pregnancy during the teenage years. My investigation of the occurrence and management of teenage pregnancy draws attention to a marked and persistent discrepancy between normative ideals and practices. It suggests that the normative practices around the management of a teenage pregnancy and the care of children that have emerged contribute to the reproduction of a larger social system that allows for a pregnant teenager's successful moral transition to motherhood in the township.

Determinants of Neonatal Mortality in Ethiopia: A Case Control Study, 2013

Introduction: Neonatal mortality is an obstacle to the continued step down of under-five mortality and the attainment of the Millennium Development Goal four. In Ethiopia, the neonatal mortality rate is decreased from 49 in 2000 to 39 deaths per 1000 live births in 2005, remaining stable at 37 deaths per 1000 live births in 2011 accounting for about 42% of under-five mortality. The aim of the study was to identify determinants of neonatal mortality in Ethiopia. Methods: Unmatched case-control study design was used to identify determinants of neonatal mortality in Ethiopia from February to June 2013 using the 2011 EDHS data. Cases were all died neonates and controls were all survived live births born within the last five years prior to 2011 EDHS. The total sample size was 11,195 with 2239 cases and 8956 controls. Logistic regression was used to identify determinants of neonatal mortality. Odds ratios with 95% CI and p-value was computed to measure the associations between the outcome variable and the independent variables. A p-value of less than 0.05 was considered as a significant result. Result: A total of 2239 (20%) cases and 8956 (80%) controls were included in this study. Mothers with no education (AOR = 1.89, CI: 1.32 - 2.72), short birth interval (AOR = 2.85, CI: 2.28 - 3.56), age of mother at birth (AOR = 0.18, CI: 0.04 - 0.86), multiple birth (AOR = 5.89, CI: 4.23 - 8.20), unemployed mothers (AOR = 1.39, CI: 1.07 - 1.67), unemployed fathers (AOR = 5.50, CI: 3.20 - 9.44) and place of residence (AOR = 1.63, CI: 1.42 - 1.87) were found to be determinants of neonatal mortality. Conclusion: The major determinants of neonatal mortality were maternal education, birth interval, multiple birth, and age at birth, maternal and paternal employment and place of residence. Emphasis needs to be given on women’s education, access to family planning, health education on consequences of early marriage and child bearing, and creating job opportunities to improve neonatal survival.

Variations in Women’s Heights across Social and Religious Groups Among Indian States

This paper uses the Indian National Family Health Survey data for the year 2005–2006 to draw comparisons of height among adult women across regions for minority groups like caste and religion. Inter-personal, regional and temporal comparisons are easier and effective using a non-monetary indicator of well-being like height which is also an indicator of long term nutritional status. The results of this study show that Muslim women have significant height advantage but with substantial variations across Indian states. Compared to Hindu women, differences in mean heights are lower across wealth quintiles and levels of educational attainment among Muslim women. Child birth during teens affects the final heights attained but only for the Hindus wherein this difference disappears after education level of the woman is controlled for, indicating that schooling delays early childbirth. The quantile regression model shows that Muslim women are taller than Hindu women across bottom, middle and top quartiles after controlling for other factors and that the gap increases over the quartiles.

A Bayesian semiparametric multilevel survival modelling of age at first birth in Nigeria

Background: The age at which childbearing begins influences the total number of children a woman bears throughout her reproductive period, in the absence of any active fertility control. For countries in sub-Saharan Africa where contraceptive prevalence rate is still low, younger ages at first birth tend to increase the number of children a woman will have thereby hindering the process of fertility decline. Research has also shown that early childbearing can endanger the health of the mother and her offspring, which can in turn lead to high child and maternal mortality. Objective: In this paper, an attempt was made to explore possible trends, geographical variation and determinants of timing of first birth in Nigeria, using the 1999 - 2008 Nigeria Demographic and Health Survey data sets. Methods: A structured additive survival model for continuous time data, an approach that simultaneously estimates the nonlinear effect of metrical covariates, fixed effects, spatial effects and smoothing parameters within a Bayesian context in one step is employed for all estimations. All analyses were carried out using BayesX - a software package for Bayesian modelling techniques. Results: Results from this paper reveal that variation in age at first birth in Nigeria is determined more by individual household than by community, and that substantial geographical variations in timing of first birth also exist. Comments: These findings can guide policymakers in identifying states or districts that are associated with significant risk of early childbirth, which can in turn be used in designing effective strategies and in decision making.