Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from Demographic Health Survey

Teenage pregnancy is a global public health concern. It is an undesirable occurrence and seems to be one of the social problems facing several countries, including Nigeria. Previous studies suggest socioeconomic differences in teenage pregnancy in Nigeria. However, relatively few studies have examined the socioeconomic inequality in teenage pregnancy in the country. This study focuses on measuring and explaining predictors of socioeconomic inequality in teenage pregnancy in Nigeria using the Nigeria Demographic Health Survey conducted in 2018. Findings suggest that teenage pregnancy is more concentrated among poor teenagers, while the most important factor contributing to the teenage pregnancy in Nigeria were marital status, wealth index of households, exposure to information and communication technology, and religion. These findings emphasise the need for targeted intervention to reduce teenage pregnancy among low socioeconomic status women in Nigeria to break the intergenerational cycle that expose teenagers to unwanted pregnancy. Since, empowered girls are better prepared to handle reproductive health issues. In addition, religious bodies, parents and schools should give teenagers counselling, and guidance that will promote positive reproductive and sexual health behaviours.

Approximately 21 million teenage girls aged 15–19 years become pregnant each year and the prevalence of teenage pregnancies is 95% higher in low- and middle-income countries (LMICs) compared with high-income countries [1]. Globally teenage pregnancy poses a profound public health concern [2‐5]. For instance, pregnancy and childbirth complications are the major cause of death in teenage girls and 99% of all teenage maternal death occurs in LMICs [1, 6].

Teenage pregnancy constitutes a significant economic, health, and social cost to the mothers and newborn children, their families, and the wider society [4]. Specifically, early motherhood has far-reaching consequences including an increased risk of antenatal complications and mortality, failure to complete schooling, socioeconomic disadvantage, welfare dependence, marital difficulties, maternal depression and less competent parenting [7, 8]. Children born to teenage mothers have higher rates of health problems (preterm birth, low birth weight, intra-uterine growth retardation, neonatal death, etc.), physical injury, behavioural difficulties, cognitive problems, and educational underachievement compared to children born to the adult mothers [6, 8‐10]. Indeed, teenage pregnancy is an undesirable phenomenon and seems to be one of the social problems facing several countries, including Nigeria [11].

In Nigeria, according to the National Population Commission, 23 percent of girls aged 15 to 19 years have started childbearing [12, 13]. About 400,000 unplanned births occur annually in Nigeria and half of these births are to teenage girls between the ages of 15 and 19 years [11]. Pregnant schoolchildren in Nigeria are often victims of ridicule in school, which forces them to drop out of school even before school authorities expel them for being pregnant [14].

The high rate of teenage pregnancy rate (106 adolescent births per 1000 population) is a major concern for the government and other stakeholders [2]. To reduce the unintended pregnancies among schoolchildren, a curriculum for sex education was introduced in Nigerian schools in 2002 [15]. However, the poor attitude of the teachers and inadequate support from parents and religious leaders has led to the failure to implement this curriculum [15]. Specifically, many policymakers, government officials, religious leaders and parents fear that talking about sex with young people will only encourage promiscuous behaviour [16]. In fact, none of the sex education mandates had made any significant contribution to the decline of teenage pregnancy [17, 18].

Studies suggest that there are geographical differences in teenage pregnancy in Nigeria [2, 12]. While every three adolescent/teenage girls in Northern Nigeria get pregnant, the corresponding figure is one out of ten girls in the South [12]. Also, teenage girls with lower levels of education, lower-income households and living in rural areas are more likely to experience adolescent pregnancy compared with those from high socioeconomic status (SES) backgrounds [3, 5, 12, 19].

Despite the high rate of teenage pregnancy and host of negative medical and socioeconomic consequences that are associated with the problem in Nigeria and sub-Saharan Africa in general, relatively few studies have examined the socioeconomic inequality in teenage pregnancy in the region [2‐5, 19]. This study focuses on measuring and explaining predictors of socioeconomic inequality in teenage pregnancy in Nigeria. Understanding the key factors associated with socioeconomic inequality in teenage pregnancy is essential in designing effective policies in reducing teenage pregnancy [3]. This is particularly crucial given that the high teenage pregnancy rate in Nigeria and other African countries portends danger to the actualization of the Sustainable Development Goal 5 (i.e., achieve gender equality and empower all women and girls) by 2030.

Understanding the predictors of the observed socioeconomic inequality in teenage pregnancy is vital in designing effective policies [3]. As the high teenage pregnancy rate in Nigeria portends danger to the actualization of SDG 5.3 by 2030, this study aimed at measuring and identifying factors associated with socioeconomic inequality in teenage pregnancy in Nigeria using the Concentration index approach.

The key findings show teenage pregnancy in Nigeria is more concentrated among the poor teenagers. The finding is in tandem with studies in Malawi [3] and Tanzania [5] that teenage pregnancy and childbearing rate was higher among teenagers from poorer household than those from richer households. It also aligns with the finding, which states that teenagers from low SES background are twice more likely to get pregnant as a teenager when compared with those from high SES background [19].

Findings further indicate that the most important predictors contributing to observed concentration of teenage pregnancy among the low SES in Nigeria were marital status, wealth index of households, frequency of watching TV, use of internet, and religion. This finding suggests that low SES (high level of poverty) makes teenagers susceptible to early pregnancy [2]. It is also traceable to the prevailing cultural norms and religious practices that prohibit teenagers from accessing family planning services and having premarital sex [2]. More so, access to reproductive health products is constrained by social stigma [33], thereby leading to unintended pregnancies. Hence, interventions sensitive to religious beliefs and cultural peculiarities should be designed to tackle the challenges of teenage pregnancies among the poor [19]. Religious leaders may set the pace through moral instructions in churches and mosques [11], coupled with counselling and guidance on risk associated with teenage pregnancy.

Our findings show over half of the teenagers are Muslims residing in rural areas in the northern geopolitical zones of the country. Study indicates that girls in the poorest wealth quintile are 2.5 times more likely to get married in childhood than those living in the richest quintile [34]. This is more prevalent among girls who live in rural areas than their urban counterparts due to economic, social, cultural, and religious factors [35]. Often marriage attracts a dowry for the bride’s family and in Nigeria, there is a real economic incentive for early marriage owing to dismal economic circumstances and strong cultural traditions in the region [35]. Even, young girls residing in rural areas are forcefully married because parents believe that it would save their daughters from sexual abuse [6]. Early marriage is one of the main contributors to teenage pregnancy among the low SES. Measures to delay age at marriage can help reduce early pregnancies. Therefore, eliminating child marriage needs to be part of family planning campaigns to facilitate the attainment of SDG 5.3 by 2030 [35]. This is important because teenagers who are at the risk of becoming pregnant is the relevant population from a policy viewpoint [36].

There is a need for formal education empowerment to address the high prevalence of teenage pregnancy among low SES girls in Nigeria. Empowered girls or women are more likely to delay marriage, and plan their pregnancies [34, 37]. Study shows that teenagers with higher education were 94% less likely to experience teenage pregnancy compared to those without education [12]. Also, it is a fact that teenagers who have higher education levels are protected from unwanted pregnancies due to the empowerment that accompany higher education [2]. Indeed, education plays a vital role given that those with low or no education tend to fall victim of early pregnancy compared to those who acquired higher education [12]. Given the high proportion of teenage pregnancy in the northern part of the country, due to low-level of education and high level of poverty, a targeted formal education intervention is warranted. It would help break the intergenerational cycle of poverty [37] and reduce the risk of early marriage, and teenage pregnancy [35].

The main strength of this paper is the use of the concentration index to identify key predictors of the observed socioeconomic inequality in teenage pregnancy in Nigeria. In addition, the paper used the latest NDHS 2018 dataset, which is nationally representative and generalizable to Nigeria as a whole. A major limitation of this paper is that, we cannot establish temporality between explanatory factors and socioeconomic inequality in teenage pregnancy given the cross-sectional design of the study. Thus, it precludes establishing causal inference. Further, since the survey data was self-reported, the issue of recall bias and social desirability may occur.

There is a need for targeted intervention (i.e. increased girls’ enrolment and completion of high education), especially in the northern geopolitical zones of Nigeria. This may help break the intergenerational cycle of poverty that make teenagers’ susceptible to unintended pregnancy and parents forcing the girl-child into early marriage. Economic and education empowerment is recommended, as empowered girls/women are better prepared to handle reproductive health issues. Moreover, religious bodies, parents and schools should provide counselling, and guidance that will promote positive reproductive and sexual health behaviours to teenagers.