Socioeconomic and residence-based inequalities in adolescent fertility in 39 African countries

Bright Opoku Ahinkorah, Richard Gyan Aboagye, Aliu Mohammed, Precious A Duodu, Qorinah Estiningtyas Sakilah Adnani, Abdul-Aziz Seidu

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Despite the advancement of sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, sub-Saharan Africa (SSA) still exhibits a higher adolescent fertility rate than other low-and middle-income countries. This study examined the disparities in adolescent fertility among thirty-nine (39) countries in SSA, focusing on socioeconomic and residence-based factors.

This study involved a secondary analysis of data obtained from 39 recent Demographic Health Surveys conducted in SSA. The measurement of difference (D), ratio (R), population-attributable fraction (PAF), and population-attributable ratio (PAR) were conducted using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization (WHO) and Stata software version 17.0. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based indicators.

Out of the 39 countries included in the study, Guinea (D=27.7), Niger (D=27.5), Nigeria (D=23.9), and Côte d’Ivoire (D=23.6) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the burden of adolescent fertility, with a value of D = -0.8. The burden of adolescent fertility was disproportionately higher among women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.7), Madagascar (D=41.1), Guinea (D=41), and Cameroon (D=40.2). There exist significant disparities in educational attainment that contribute to unequal burdens of adolescent fertility, particularly among women who lack access to formal education. Countries such as Madagascar (D=59.5), Chad (D=55.3), Cameroon (D=54.6), and Zimbabwe (D=50.3) had the most significant absolute disparities.

This study revealed that women residing in rural regions, characterised by low economic status and limited educational opportunities, experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable healthcare services to the populace, particularly adolescent women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislations pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rate to mitigate the adverse maternal and child outcomes associated with high adolescent fertility rate in SSA.
Original languageEnglish
JournalReproductive Health
Publication statusAccepted/In press - 2 May 2024

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