Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries

F. Iacoella*, N. Tirivayi

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review


    Objectives: Child and adolescent marriage are widely prevalent in some developing countries, and yet evidence on the maternal healthcare utilization of married adolescents is sparse. This study sought to identify the determinants of maternal healthcare utilization among married adolescents in 13 countries with the highest adolescent marriage rates in Sub-Saharan Africa. Study design: This is a multicountry cross-sectional analysis. Methods: Demographic and Health Survey data on 4288 married adolescents were used. Multivariable logistic regressions were used to identify the individual- and household-level predictors of the utilization of antenatal care, safe delivery and postnatal care. Results: Wealth and access to media were positively associated with the utilization of all types of maternal healthcare services. Female education and partner education were positively associated with antenatal care. Predictors of safe delivery included urban residence (odds ratio [OR] = 1.87; 95% confidence interval [CI] = 1.15–3.03), female education (OR = 1.37; 95% CI = 1.16–1.60) and number of living children (OR = 1.25; 95% CI = 1.01,1.54), whereas positive correlates of postnatal care were urban residence (OR = 1.35; 95% CI = 1.00–1.82), partner education (OR = 1.32; 95% CI = 1.12–1.56) and employment (OR = 1.43; 95% CI = 1.07,1.89). Full antenatal care and safe delivery utilization were associated with increased postnatal care utilization. Second or third birth order and associated birth intervals were strong barriers to maternal healthcare utilization. Although autonomy in decision-making over financial spending and relationships were positively associated with full antenatal care (OR = 1.09; 95% CI = 1.03–1.14), the results suggest that autonomy over personal healthcare decisions had an opposite relationship (OR = 0.76; 95% CI = 0.58–1.01). Conclusions: Living conditions and autonomy in decision-making over resources and relationships are facilitators of maternal healthcare utilization among married adolescents. Determinants observed in this multicountry study can help shape maternal healthcare interventions in context with high child and teenage marriage rates.
    Original languageEnglish
    Pages (from-to)1-9
    Number of pages9
    JournalPublic Health
    Publication statusPublished - Dec 2019

    JEL classifications

    • i15 - Health and Economic Development


    • Adolescent
    • Africa South of the Sahara
    • Africa south of the Sahara
    • Cross-Sectional Studies
    • Decision Making
    • Demography
    • Female
    • Humans
    • Marriage
    • Married adolescents
    • Maternal Health Services
    • Maternal health care
    • Multi-country analysis
    • Patient Acceptance of Health Care
    • Personal Autonomy
    • Pregnancy
    • Social Conditions
    • Sub-Saharan Africa
    • accessibility
    • adolescence
    • adolescent
    • article
    • autonomy
    • birth order
    • child
    • controlled study
    • cross-sectional study
    • decision making
    • demography
    • developing world
    • education
    • employment
    • family planning
    • female
    • health care
    • health care utilization
    • health policy
    • health survey
    • household
    • human
    • human experiment
    • major clinical study
    • male
    • marriage
    • married person
    • maternal care
    • maternal health
    • maternal health service
    • patient attitude
    • personal autonomy
    • policy approach
    • postnatal care
    • pregnancy
    • prenatal care
    • social status
    • young population
    • CHILD
    • WOMEN


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