School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
BMC Health Serv Res. 2022 Jun 13;22(1):777. doi: 10.1186/s12913-022-08117-9.
Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa.
We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval.
Young women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors.
Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including antenatal care visit and the use of skilled birth attendance during child delivery. Hence, there is a need to develop an intervention to address child marriage in sub-Saharan Africa and strengthen existing ones. In addition, framework that considers child marriage as a key determinant of maternal healthcare utilization must be developed as part of policies in sub-Saharan African countries to enable universal achievement of low maternal mortality ratio by 2030 as a target of the Sustainable Development Goals.
先前关于童婚的研究表明，其与不良健康行为和结果相关，如增加生育率、降低现代计划生育、减少安全分娩、心理健康障碍、自杀企图和意念、较差的社会经济地位、五岁以下儿童的发病率和死亡率。在这项研究中，我们调查了童婚与撒哈拉以南非洲地区产妇保健服务利用之间的关联。
我们利用了 2010 年至 2018 年期间在 29 个撒哈拉以南非洲国家进行的人口与健康调查的数据。我们的样本量由 36215 名年龄在 20-24 岁之间的生育年轻女性组成。采用多水平二项逻辑回归分析，检验童婚与产妇保健服务利用之间的关联，结果以 95%置信区间的粗比和调整比值比呈现。
与未经历童婚的女性相比，经历过童婚的年轻女性在怀孕期间接受≥4 次产前保健检查的可能性较低[cOR=0.60，95%CI=0.57-0.63]，而在控制了个体和社区层面的因素后，这一关联仍然存在[aOR=0.88，95%CI=0.84-0.93]。与未经历童婚的女性相比，经历过童婚的年轻女性在分娩时接受熟练助产护理的可能性较低[cOR=0.45，95%CI=0.43-0.48]，而在控制了个体和社区层面的因素后，这一关联仍然存在[aOR=0.87，95%CI=0.82-0.93]。与未经历童婚的女性相比，经历过童婚的年轻女性在分娩后接受产后保健服务的可能性较低[cOR=0.79，95%CI=0.75-0.82]，但在控制了个体和社区层面的因素后，这一关联不再显著。
我们的研究发现，童婚是导致产妇保健服务利用率低的主要原因之一，包括产前保健检查和在分娩时使用熟练助产护理。因此，需要制定一项干预措施来解决撒哈拉以南非洲的童婚问题，并加强现有的干预措施。此外，必须制定一个框架，将童婚视为产妇保健服务利用的关键决定因素，作为撒哈拉以南非洲国家政策的一部分，以实现到 2030 年将母婴死亡率降低到低水平的目标，这是可持续发展目标的一个目标。
