Huda M Mamun, Finlay Jocelyn E, O'Flaherty Martin, Al Mamun Abdullah
Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia.
ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Queensland, Australia.
PLOS Glob Public Health. 2022 May 11;2(5):e0000170. doi: 10.1371/journal.pgph.0000170. eCollection 2022.
Understanding the dynamics of social risk factors in the occurrence of adolescent motherhood is vital in designing more appropriate prevention initiatives in low-income and middle-income countries (LMICs). We aimed this study to examine the transition of social risk factors and their association with adolescent motherhood in LMICs since the initiation of the MDGs. We analysed 119967 adolescent girls (15-19 years) from 40-nationally representative Demographic Health Surveys in 20 LMICs that had at least two surveys: a survey in 1996-2003(baseline, near MDGs started) and another in 2014-2018(endline). Adolescent motherhood (having a live birth or being pregnant before age 20) was the outcome of interest, whereas social risk factors including household wealth, girls' level of education, and area of residence were the exposures. The association between adolescent motherhood and the social risk factors, as well as changes in the strength of the association over time were observed using multilevel logistic regression analysis. On an average, the proportion of adolescent mothers without education decreased by -15·61% (95% CI: -16·84, -14·38), whereas the poorest adolescent mother increased by 5·87% (95% CI: 4·74, 7·00). The national prevalence of adolescent motherhood remained unchanged or increased in 55·00% (11/20) of the studied countries. Comparing baseline to endline, the overall adjusted odds ratio (AOR) of adolescent motherhood increased for both poorest (AOR = 1·42, 95% CI: 1·28, 1·59) and rural residences (AOR = 1·09, 95% CI: 1·01, 1·17), and decreased, but not statistically significant for the low level of education (AOR = 0·92, 95% CI: 0·84, 1·01 for no education). Our study concludes that social risk factors of the adolescent mother had shifted in different directions during MDGs and SDGs eras, and adolescent mothers remained more disadvantaged than non-mothers in LMICs. Efforts need to be enhanced to improve adolescent girls' education. Intervention should be prioritised in disadvantaged communities to delay adolescent first birth and prevent adolescent motherhood in LMICs.
了解青少年母亲生育现象中社会风险因素的动态变化，对于在低收入和中等收入国家（LMICs）设计更合适的预防举措至关重要。本研究旨在考察自千年发展目标启动以来，LMICs中社会风险因素的转变及其与青少年母亲生育现象的关联。我们分析了来自20个LMICs的40项具有全国代表性的人口与健康调查中的119967名青春期女孩（15 - 19岁），这些国家至少进行了两次调查：一次是在1996 - 2003年（基线，接近千年发展目标启动时），另一次是在2014 - 2018年（终线）。青少年母亲生育现象（在20岁之前生育活产婴儿或怀孕）是感兴趣的结果，而社会风险因素包括家庭财富、女孩的教育水平和居住地区则是暴露因素。使用多水平逻辑回归分析观察青少年母亲生育现象与社会风险因素之间的关联，以及随着时间推移这种关联强度的变化。平均而言，未受过教育的青少年母亲比例下降了 - 15.61%（95%置信区间：- 16.84，- 14.38），而最贫困的青少年母亲比例增加了5.87%（95%置信区间：4.74，7.00）。在所研究的国家中，55.00%（11/20）的国家青少年母亲生育现象的全国患病率保持不变或有所上升。将基线与终线进行比较，最贫困者（调整后的优势比[AOR] = 1.42，95%置信区间：1.28，1.59）和农村居民（AOR = 1.09，95%置信区间：1.01，1.17）的青少年母亲生育现象的总体调整后优势比均有所增加，而教育水平低者（未受过教育者的AOR = 0.92，95%置信区间：0.84，1.01）的调整后优势比有所下降，但无统计学意义。我们的研究得出结论，在千年发展目标和可持续发展目标时代，青少年母亲的社会风险因素朝着不同方向转变，并且在LMICs中，青少年母亲仍然比非母亲处于更不利地位。需要加大力度提高青少年女孩的教育水平。应优先在弱势社区进行干预，以推迟青少年的首次生育并预防LMICs中的青少年母亲生育现象。
