School of Clinical Medicine, University of New South Wales, Sydney, Australia.
REMS Consultancy Services, Takoradi, Western Region, Ghana.
Reprod Health. 2024 May 31;21(1):72. doi: 10.1186/s12978-024-01806-0.
Despite the advancement in sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, countries in sub-Saharan Africa (SSA) still experience higher adolescent fertility rates than other low-and middle-income countries. This study examined the disparities in adolescent fertility in 39 countries in SSA, focusing on socioeconomic and residence-based dimensions.
This study involved a secondary analysis of data obtained from 39 recent Demographic and Health Surveys conducted in SSA. The measures of difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were estimated using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based dimensions.
Out of the 39 countries included in the study, Guinea (D=27.70), Niger (D=27.50), Nigeria (D=23.90), and Côte d'Ivoire (D=23.60) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with the higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the rate of adolescent fertility, with a value of D = -0.80. The burden of adolescent fertility was disproportionately higher among young women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.70), Madagascar (D=41.10), Guinea (D=41.00), and Cameroon (D=40.20). We found significant disparities in educational attainment contributing to unequal inequalities in adolescent fertility, particularly among young women who lack access to formal education. Countries such as Madagascar (D=59.50), Chad (D=55.30), Cameroon (D=54.60), and Zimbabwe (D=50.30) had the most significant absolute disparities.
This study revealed that young women residing in rural areas, those in households with low economic status and those with limited educational opportunities experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable sexual and reproductive health services to the populace, particularly for young women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislation pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rates and mitigate the adverse maternal and child outcomes associated with high adolescent fertility in SSA.
尽管性健康和生殖健康服务有所进步，并且采取了多项公共卫生措施来控制生育率，但撒哈拉以南非洲（SSA）国家的青少年生育率仍高于其他低收入和中等收入国家。本研究考察了 SSA 39 个国家在青少年生育方面的差异，重点关注社会经济和居住维度。
本研究对 SSA 进行的 39 项最近的人口与健康调查中的数据进行了二次分析。使用世界卫生组织开发的卫生公平评估工具（HEAT）软件版本 3.1 估计差异（D）、比率（R）、人群归因分数（PAF）和人群归因风险（PAR）。使用 D、R、PAF 和 PAR 来检查社会经济和居住维度上青少年生育的不平等。
在所研究的 39 个国家中，几内亚（D=27.70）、尼日尔（D=27.50）、尼日利亚（D=23.90）和科特迪瓦（D=23.60）在农村地区的青少年生育率方面表现出最显著的居住差异，农村地区的青少年生育率较高。卢旺达是唯一一个在青少年生育率方面显示出轻微农村不平等倾向的国家，其 D 值为-0.80。所有国家中，经济地位较低的年轻女性都面临着不成比例的较高的青少年生育负担，加剧了基于财富的不平等。差异绝对值最大的国家是尼日利亚（D=44.70）、马达加斯加（D=41.10）、几内亚（D=41.00）和喀麦隆（D=40.20）。我们发现，教育程度的差异导致了青少年生育方面的不平等，尤其是在那些无法接受正规教育的年轻女性中。马达加斯加（D=59.50）、乍得（D=55.30）、喀麦隆（D=54.60）和津巴布韦（D=50.30）等国家的差异最为显著。
本研究表明，在 SSA 的 39 个国家中，居住在农村地区的年轻女性、经济地位较低的家庭中的年轻女性以及受教育机会有限的年轻女性面临着不成比例的高青少年生育负担。目前的研究结果为各级政府提供了有价值的信息，需要确保向民众提供公平、可及和可靠的性健康和生殖健康服务，特别是向年轻女性提供。因此，各利益攸关方需要加强与农村地区青少年妇女、经济弱势群体以及缺乏或无法接受正规教育的青少年妇女相关的卫生政策和立法的有效性。这些干预措施可能会降低青少年生育率，并减轻与撒哈拉以南非洲地区青少年生育率较高相关的不良母婴结局。
