Department of Economics, University of Malawi, Chancellor College, Zomba, Malawi.
Health Nursing and Midwifery, University of Hull, Hull, United Kingdom.
PLoS One. 2019 Nov 20;14(11):e0225374. doi: 10.1371/journal.pone.0225374. eCollection 2019.
Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.
The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.
The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%).
The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.
青少年怀孕和生育是包括马拉维在内的中低收入国家（LMICs）的重要健康问题。解决这些挑战需要了解导致这些结果不平等的社会经济决定因素和促成因素。本研究调查了不平等的趋势，并分解了造成马拉维青少年怀孕和生育不平等的关键社会经济因素。
本研究使用了 2004 年、2010 年和 2015-16 年全国代表性的马拉维人口健康调查系列，涵盖了 12719 名妇女。我们使用集中曲线来检验不平等的存在，并使用 Erreygers 集中指数来量化青少年怀孕和生育不平等的程度。最后，我们对集中指数进行分解，以找出决定因素对青少年怀孕和生育社会经济不平等的贡献。
2004 年至 2015-16 年，青少年怀孕和生育率平均为 29%（p<0.01）。趋势显示，青少年怀孕和生育率呈“U 形”，尽管幅度很小（34.1%；p<0.01），2004 年为（25.6%；p<0.01），2010 年为（29%；p<0.01）。计算得出的集中指数-0.207（p<0.01）在 2004 年，-0.133（p<0.01）在 2010 年，和-0.217（p<0.01）在 2015-16 年表明，青少年怀孕和生育的不平等状况恶化，使该国的穷人处于不利地位。此外，分解练习表明，导致青少年怀孕和生育不平等的主要驱动因素是：性初露（15.5%）、已婚（50%）和财富状况（13.8%）。
研究结果表明，需要持续投资于对年轻女性进行性初露和早婚弊端以及财富不平等问题的教育，以减少青少年怀孕和生育的发生。
