Introduction
Early childbearing refers to a practice of a woman giving her first birth at a relatively young age, that is an age before 18 years [
1,
2]. Early childbearing can pose health risks to both the mother and child, as well as social and economic challenges for the family. The prevalence of early childbearing is considered being high in many sub-Saharan (SSA) countries [
3‐
8]. This is one reason why the SSA region has persistently high fertility and population growth. The region, according to the United Nations estimates, is reported to have the highest total fertility rate (TFR) in the world, at 4.7 births per woman during the period 2015 to 2020 [
9,
10]. As a result, it is anticipated that the continent’s population would grow from 1 billion in 2015 to over 2 billion in 2050 and close to 4 billion in 2100 [
10]. It is expected that the region’s population will experience a significant increase in the negative impacts on human welfare and the environment [
11,
12]. Fertility is one of the three main factors in population dynamics that affect SSA population size and composition [
13‐
15]. One of the most common findings in demographic studies from SSA has been differences in fertility levels and behaviour across sub-regions, population strata, and characteristics [
13,
16].
Although the reproductive health outcomes in SSA have significantly improved, the total fertility rate is still high compared to other developing regions [
17‐
20]. These improvements include a decrease in maternal and infant mortality; a rise in the prevalence of contraception; and increased use of health services by married women [
17,
19,
21,
22]. The high proportion of women who start childbearing in adolescence age is one of the main reasons for the high fertility rates in most countries in the region [
20,
23]. Other factors contributing to the high fertility rate in SSA are early and universal marriage, as well as the desire for males for both cultural (performing rites) and economic (to reap immediate financial benefits and ensure old age security) reasons [
4,
23,
24]. To better understand the causes of early childbearing in SSA and tailor reproductive health programmes to these needs, more research and inquiry are required.
Most governments in SSA have made significant investments in family planning programming, provision of education, and strengthening frameworks to discourage early sexual debut and child marriage. However, reducing the prevalence of early childbearing in SSA will require strengthening of sexual and reproductive health interventions to ensure adequate access and utilisation of family planning services, especially among adolescents and vulnerable young women. Recent demographic data are expected to reveal new patterns of early childbearing levels in the region. Nevertheless, it should be emphasised that some countries in SSA have not carried out recent Demographic and Health Surveys. As a result, this study is limited in its ability to thoroughly investigate emerging trends in early childbearing rates across the region.
Considering that SSA has the highest fertility rate in the world, early childbearing has the potential to disrupt a girl’s education and limit her future social and economic opportunities. Studying the factors associated with early childbearing can inform designing of interventions to promote comprehensive sexuality education, reproductive health services, and programmes that empower girls to delay childbearing and pursue education and career goals. Thus, this study used recent fertility data from demographic and health surveys conducted in 31 SSA countries between 2010 and 2021 to establish differentials and examine factors associated with early childbearing in SSA. It should be noted that a comprehensive understanding of the factors associated with early childbearing is essential for designing appropriate interventions to further reduce fertility in SSA. The findings could also inform the strengthening of existing sexual reproductive health policies and strategies aimed at increasing access and utilisation of sexual reproductive health care services in SSA.
Theoretical framework
Theoretically, early childbearing can be understood within the theoretical underpinnings of the Classical Demographic Transition theory and the Empowerment theory. The two theories contribute valuable insights to understanding the complex factors that explain early childbearing experience among women in SSA. The Classical Demographic Transition Theory was initially proposed by Warren Thompson in 1929 and later refined by Frank W. Notestein in the mid-20th century [
25]. This theory suggests that countries go through a predictable sequence of demographic changes as they undergo economic and social development [
25‐
27]. One of the central assumption is that birth rates decline due to various factors associated with modernisation and socio-economic development [
26,
27]. These factors often include increased urbanisation, improved education for women, greater access to contraception, and changes in cultural and social norms [
28,
29]. The Demographic Transition Model remains a valuable framework for understanding historical population trends and provides insights into the potential demographic changes that countries may experience as they undergo social and economic transformations.
The Empowerment theory is a sociological and psychological framework that focuses on enhancing the power and agency of individuals and groups in order to promote social change and improve their well-being. It emerged as a response to traditional deficit-oriented approaches that viewed individuals and communities as passive recipients of services or interventions [
30,
31].
Both theories hypothesise that social development such as improvements in female education and women’s empowerment are key in influencing early childbearing among women of reproductive age [
9,
17,
32,
33]. Women who have low levels of education and low economic opportunities may be more likely to experience early childbearing [
34,
35]. Further, structural inequalities such as living in rural areas may present women with less access to family planning services, which increases their risk to early pregnancy. Gender norms may also limit women’s agency and decision-making power to make informed choice about their reproductive goals, hence contributing to early childbearing [
36]. Economic vulnerability and limited opportunities for education and employment may push women towards early childbearing as they may perceive motherhood as a more viable path than pursuing other life goals [
37,
38].
Based on the theoretical framework used in this study, it is expected that women who belong to vulnerable groups such as those with low level of education, reside in rural regions, the poorest, and know the least about contraceptives are more likely to fall pregnant during adolescence stage [
32,
33,
39,
40]. Therefore, identification of the risk factors linked to experience of early childbearing and understanding of the framework through which these factors operate, as well identifying which groups of women are at risk of experiencing early childbearing in SSA, is key. This information is crucial for designing reproductive interventions aimed at controlling high fertility in the region.
Discussion
Early childbearing has been a significant barrier to reducing fertility in SSA [
4,
6,
14,
23]. This is because early childbearing often leads to adolescent girls dropping out of school or being unable to pursue higher education. The lack of education can limit adolescents’ access to information and services for family planning, making it harder for them to make informed decisions about their reproductive health such as limiting or spacing children.
This study was conducted using pooled DHS data for 31 countries in sub-Saharan Africa to better understand the factors associated with early childbearing. Study results revealed that the prevalence of women who experienced early childbirth in SSA was still high at 39.0% (95% CI: 35, 43). This finding is similar to what has been reported by previous studies. A study of 2021 by Melesse and others reported a prevalence of 47% in SSA [
47]. UNICEF in 2021 estimated that 26.7% of women aged 20–24 experienced early child bearing in SSA [
52]. Literature also shows that there are country variations in the prevalence of early childbearing in SSA. Avogo and Somefun in 2019 found that 13% of Nigerian adolescents, 12% in Burkina Faso, and 27% in Niger have had a first birth [
46]. Wado and others in 2019 found that the prevalence of early motherhood ranged from 18% in Kenya to 29% in Malawi and Zambia [
3].
Similar to what has been reported in literature, this study shows that Rwanda had the lowest proportion of adolescent births 8.4% (95% CI: 7, 9) while Chad had the highest prevalence at 58% (95% CI: 56, 59). The high prevalence of early childbirth observed in Chad confirms the findings of a similar study conducted by Ahinkora (2021) in 32 SSA countries, which also found that Chad had the highest prevalence of adolescent pregnancy (76.6%) while Rwanda had the lowest at 9.2% [
53]. The low prevalence of early childbirth in Rwanda could be attributed to the high prevalence of contraceptive use among adolescents, while the high prevalence in Chad could be explained by low contraceptive use among adolescents [
54,
55]. Furthermore, Sara (2020) found that Chad, Niger, and Benin had the highest proportions of adolescents who gave birth before the age 16 [
6]. Our study further found that a young woman’s education level, age at first sex, family size desire and household size were significantly associated with early childbearing in SSA countries.
Several studies have reported the association of education with early childbearing and other reproductive health outcomes [
9,
28,
32,
49,
50,
53,
56,
57] in SSA and elsewhere. Literature shows that increasing a woman’s education is one factor that has been associated with improved contraception uptake, hence reducing the risk of teenage pregnancy [
28,
32,
58,
59]. In this current analysis, women with a secondary or tertiary level of education were less likely to experience early childbirth. This suggests that increased schooling opportunities for women have the potential to further reduce the high prevalence of early childbirth in SSA. This is because educated women have the potential to make an informed decision about delaying the onset of sexual relationships, averting early marriages and can influence contraception uptake beacause of easy access to appropriate reproductive health information as well understanding of fundamental child rights [
60]. Our finding is consistent with earlier studies in SSA, Asia, and other parts of the world [
53,
57,
61‐
66] which also reported education as a significant factor in reducing exposure to early childbirth, child marriage as well as early sexual debut. Additionally, literature shows that women whose partners had secondary or higher education are less likely to experience early childbirth compared to those whose partners have a lower level of education [
56,
67].
Our findings reveal that a higher age at first sexual debut was significantly associated with lower rates of early childbirth in SSA. This finding is supported by earlier studies conducted elsewhere in the world [
68‐
70]. The fact that delaying sexual debut is linked to lower exposure to teenage pregnancy could be the possible explanation for this finding [
71]. Other possible explanations include the fact that older adolescent girls may be better able to negotiate safer sex with their partners and hence increase the chances of frequent and effective use of contraceptives to avoid pregnancy [
53,
69,
72].
Lastly, findings show that adolescents from the households with 4 members or more were highly likely to experience early childbirth compared to their counterparts from households with 3 members or fewer. It is anticipated that households with 4 members or more may not have adequate resources to support access to education, especially for a girl child; hence, girls from these families are less likely to access and comprehend health education messages leading to a low understanding of the consequences of early childbirth and marriage [
73‐
75]. Therefore, strategies for preventing teenage childbirth should not only be directed to teens themselves but also consider household-level contextual factors that fall into two general categories: empowering parents with sexual and reproductive health information; and encouraging open discussions about SRH issues between parents and girl children [
4,
53,
75,
76].
Increased access to education for female adolescents and young women together with strengthening access to sexual reproductive health information through social media and community-based interventions will be key to addressing the problem of adolescent child bearing in SSA. As evidenced by the results, women with a secondary or higher levels of education were less likely to have experienced early childbirth, suggesting that keeping girls in school is a significant factor in reducing adolescent fertility. Early sexual debut is another deterrent factor to reducing adolescent fertility in SSA. There is a need for deliberate policy actions aimed at integrating comprehensive sexual education into the early school curriculum and a thorough community profiling to identify cultural barriers that impede girls from advancing their education prospects. Furthermore, interventions to curb adolescent childbearing require approaches that will strengthen SRH programming through community engagement among relevant stakeholders such as parents, teachers, civic leaders, traditional leaders, community leaders, and religious institutions.
This study utilised the theoretical underpinnings of the Classical Demographic Transition Theory and the Empowerment Theory. The two theories have provided the framework for understanding how individual and household socio-economic factors have influenced early childbearing experienced among women in SSA. In this regard, the study shows that having formal education reduces the risk of early childbearing among women. Therefore, the findings of the study affirm that empowering women through education opportunities has the potential to reduce the prevalence of early childbearing in SSA. Education attainment for women in this sense can be viewed as an empowerment tool to help young women get employment opportunities which in turn can enhance access to sexual reproductive health services. Access to sexual reproductive health services will enable women to make informed choice about meeting their reproductive goals. The findings of this current study have significant implications for the theoretical understanding of determinants of high fertility in SSA. Furthermore, the findings are significant for strengthening of sexual reproductive health interventions to prevent adolescent pregnancies in the region. Thus, the evidence generated by this study will guide health policymakers in designing health policies and interventions that address the unique sexual reproductive health care needs of adolescent girls in the region.
Although the study has provided useful findings that have the potential to inform the strengthening of existing sexual reproductive policies and programming targeting at changing reproductive health behaviour among women in SSA, designing of tailor-made SRH interventions to address country-level specific fertility problems will require a detailed decomposition analysis of both individual and community factors to delineate factors that explain heterogeneity in the observed prevalence of early childbirth across countries in SSA. Countries that have a high prevalence of adolescent fertility may consider adopting and customising SRH policies for countries where the problem is minimal.
Study strengths and limitations
Since the study comprised nationally representative samples of women from 31 countries in SSA, the current findings can apply to the entire population of women in the age range 20–24 years in the region. Our study has contributed to the literature by conducting a comprehensive examination of pooled data. This has enhanced a holistic understanding of the factors that affect the reproductive decision behaviour of young women using recent demographic data. However, it is important to note that a good number of countries in SSA do not have recent DHS data, thus making our findings not able to present a comprehensive recent picture of early childbearing in SSA. Additionally, because of the cross-sectional nature of the DHS data, causality cannot be inferred from this study. There is also a possibility of recall bias, since the DHS participants were asked to report events that happened in the past. The study could not bring out factors that explain observed differentials in the prevalence of early childbearing because of divergent socio-cultural factors prevailing in the region.
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