Abstract
Original language | English |
---|---|
Pages (from-to) | 1-9 |
Number of pages | 9 |
Journal | Public Health |
Volume | 177 |
DOIs | |
Publication status | Published - Dec 2019 |
JEL classifications
- i15 - Health and Economic Development
Keywords
- 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
- SERVICES
- MOTHERS
- CHILD
- WOMEN
- MORTALITY
- ANTENATAL CARE
Access to Document
Fingerprint
Dive into the research topics of 'Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: Public Health, Vol. 177, 12.2019, p. 1-9.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries
AU - Iacoella, F.
AU - Tirivayi, N.
N1 - Correspondence Address: Iacoella, F.; Unu-Merit (United Nations University), Boschstraat 24, Netherlands; email: [email protected] References: United Nations, TRANSFORMING OUR WORLD: the 2030 agenda for sustainable development goals [Internet]. Geneva (2015), pp. 1-41. , https://sustainabledevelopment.un.org/content/documents/21252030 Agenda for Sustainable Development web.pdf, [cited 2018 Apr 27]; WHO, Trends in maternal mortality: 1990 to 2015 [Internet]. Geneva (2015), www.who.int/about/licensing/, [cited 2018 Feb 19]. Available from:; Ayiga, N., Rampagane, V., Determinants of age at first marriage in sub-Saharan Africa : a comparative study of Uganda and South Africa (2013) J Soc Dev Afr, 28 (1); Palamuleni, M.E., Socioeconomic determinants of age at marriage in Malawi (2011) Int J Sociol Anthropol, 3 (July), pp. 224-235; Morgan, J., Family honour and shattered dreams: girl brides in Mali, Niger and Senegal [Internet] (2016), https://www.girlsnotbrides.org/wp-content/uploads/2017/08/Plan_Family-honour-and-shattered-dreams_Web.pdf, Dakar [cited 2019 May 22]. Available from:; Walker, J.-A., Mapping early marriage in West Africa [Internet] (2013), https://www.girlsnotbrides.org/wp-content/uploads/2013/10/Ford-Foundation-CM-West-Africa-2013_09.pdf, [cited 2019 May 22]. Available from:; Lake, I.R.C., Chad basin crisis: an analysis of violence against women, children and displaced populations in the region [Internet] (2017), https://www.rescue-uk.org/sites/default/files/document/1328/reportoslo-analysisofviolenceagainstwomenchildrenanddisplacedpopulations-17march2017.pdf, [cited 2019 May 22]. Available from:; Why does child marriage happen? [Internet] (2018), https://www.girlsnotbrides.org/why-does-it-happen/, Available from:; Clark, S., Bruce, J., Dude, A., Protecting young women from HIV/AIDS: the case against child and adolescent marriage (2006) Int Fam Plan Perspect, 32 (2); Glynn, J., Carael, M., Auvert, B., Kahindo, M., Chege, J., Musonda, R., Why do young women have a much higher prevalence of HIV than young men? A study in Kisumu, Kenya and Ndola, Zambia (2001), AIDS; The State if the World's Children: Maternal and Newborn Health (2009), UNICEF, 3 United Nations Plaza New York, NY 10017, USA; Santhya, K., Erulkar, A., Supporting married girls: calling attention to a neglected group [Internet] (2011), http://www.popcouncil.org/uploads/pdfs/TABriefs/03_MarriedGirls.pdf, [cited 2018 Jul 2]. Available from:; Gavin, L., Galavotti, C., Dube, H., Mcnaghten, A.D., Murwirwa, M., Khan, R., Factors associated with HIV infection in adolescent females in Zimbabwe (2006) J Adolesc Heal [Internet], 39 (596), pp. 11-596. , https://ac.els-cdn.com/S1054139X06000826/1-s2.0-S1054139X06000826-main.pdf?_tid=597f2d27-0976-4dba-b252-91fbd345450b&acdnat=1530610592_8ccda7c929f52065d0b491e699f484ce, [cited 2018 Jul 3]; WHO, Early marriages, adolescent and young pregnancies [Internet]. New York (2011), http://apps.who.int/gb/ebwha/pdf_files/EB130/B130_12-en.pdf, [cited 2018 Feb 6]. Available from:; Graft, A., Haverland, N., Goldber, R., Married adolescents: a review of programmes, paper presented at the WHO/UNFPA/Population Council Technical Consultation on married adolescents (2003), Geneva; Reynolds, H.W., Wong, E.L., Tucker, H., Adolescents' use of maternal and child health services in developing countries (2006) Int Fam Plan Perspect [Internet], 32 (1), pp. 6-16. , https://www.guttmacher.org/sites/default/files/article_files/3200606.pdf, [cited 2018 Feb 6];; Chopra, M., Daviaud, E., Pattinson, R., Fonn, S., Lawn, J.E., Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? (2009) Lancet [Internet], , https://ac.els-cdn.com/S0140673609611235/1-s2.0-S0140673609611235-main.pdf?_tid=1c48b3a2-0361-452e-bd6f-49e90e93fba9&acdnat=1524820905_a21bef6d45d1f58a6490cb66851fb4ef, [cited 2018 Apr 27];374:835–46. Available from:; Temin, M., Levine, R., START with a girl a new agenda for global health a girls count report ON adolescent girls [Internet] (2009), https://www.cgdev.org/files/1422899_file_Start_with_a_Girl_FINAL.pdf, [cited 2018 Jul 2]. Available from:; Canning, D., Finlay, J., Ozaltin, E., Adolescent girls health agenda: study on Intergenerational health Impacts (2009), Harvard Sch Public Heal Unpubl; Prakash, R., Singh, A., Pathak, P., Parasuraman, S., Early marriage, poor reproductive health status of mother and child well-being in India (2011) J Fam Plan Reprod Health Care, 37 (3); Finlay, J.E., Zaltin, E., Canning, D., The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low-and middle-income countries (2011) Br Med J [Internet], , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191600/pdf/bmjopen-2011-000226.pdf, [cited 2018 Jul 1];1(2); Available from:; Sawyer, S., Afifi, R., Bearinger, L., Blakemore, S., Dick, B., Ezeh, A., Adolescence: a foundation for future health (2012) Lancet, 279 (9826), pp. 1630-1640; Bhutta, Z.A., Darmstadt, G.L., Hasan, B.S., Haws, R.A., Community-based interventions for improving Perinatal and neonatal health outcomes in developing countries: a review of the evidence (2005) Pediatrics [Internet], , http://pediatrics.aappublications.org/, [cited 2018 Apr 27];115(519). Available from:; Tura, G., Fantahun, M., Worku, A., The effect of health facility delivery on neonatal mortality: systematic review and meta-analysis (2013) BMC Pregnancy Childbirth [Internet], , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584809/pdf/1471-2393-13-18.pdf, [cited 2018 Feb 28];13:1:1–9. Available from:; Adolescent girls task force terms of reference [Internet] (2010), http://unesco.org.pk/education/documents/UNAGTF/UN_Adolescent_Girls_Task_Force.pdf; THE global strategy for WOMEN'S, CHILDREN'S and adolescents’ health (2016-2030) [Internet] (2016), https://data.unicef.org/wp-content/uploads/2017/02/EWEC_globalstrategyreport_200915_FINAL_WEB.pdf, [cited 2018 Feb 19]. Available from:; Rai, R.K., Singh, P.K., Kumar, C., Parasuraman, S., Teenage childbearing: a growing public health concern in need of urgent policy and program action (2013) J Public Health (Bangkok) [Internet], , https://link.springer.com/content/pdf/10.1007/s10389-012-0551-6.pdf, [cited 2018 Feb 28];21(4):379–84. Available from:; Patton, G.C., Coff, C., Cappa, C., Currie, D., Riley, L., Gore, F., Health of the world's adolescents: a synthesis of internationally comparable data (2012) Lancet [Internet], , https://ac.els-cdn.com/S0140673612602037/1-s2.0-S0140673612602037-main.pdf?_tid=8776daff-5097-4977-bfb6-f2d1384f28b7&acdnat=1530798457_f688c429cfe2d58dd3d9cf3ecb23eef3, [cited 2018 Jul 5];379(9826):1665–75. Available from:; WHO, Standards for maternal and neonatal care [Internet]. Geneva (2007), http://apps.who.int/iris/bitstream/10665/69735/1/a91272.pdf, [cited 2018 Feb 6]. Available from:; Rutaremwa, G., Wandera, S.O., Jhamba, T., Akiror, E., Kiconco, A., Determinants of maternal health services utilization in Uganda (2015) BMC Heal Secvices Res [Internet], , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504353/pdf/12913_2015_Article_943.pdf, [cited 2018 Feb 6];15(271):1–8. Available from:; Alam, N., Hajizadeh, M., Dumont, A., Fournier, P., Inequalities in maternal health care utilization in sub-saharan African countries: a multiyear and multi-country analysis (2015) PLoS One [Internet], , http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0120922&type=printable, [cited 2018 Feb 6];10(4):1–16. Available from:; Rai, R.K., Singh, P.K., Singh, L., Kumar, C., Individual characteristics and use of maternal and child health services by adolescent mothers in Niger (2014) Matern Child Health J, 18 (3), pp. 592-603; Rai, R.K., Singh, P.K., Singh, L., Utilization of maternal health care services among married adolescent women: Insights from the Nigeria demographic and health survey, 2008 (2012) Women's Heal Issues [Internet], 22 (4). , e407–14. Available from:; Singh, P.K., Rai, R.K., Alagarajan, M., Singh, L., Determinants of maternity care services utilization among married adolescents in rural India (2012) PLoS One, 7 (2); Wall, L., Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria (1998) Wall Source Stud Fam Plan [Internet], , https://www.jstor.org/stable/pdf/172248.pdf?refreqid=excelsior%3A9587a8f0a9e99b31f9c37ea29a5df98b, [cited 2018 Jul 5];29(4):341–59.. Available from:; Ghose, B., Feng, D., Tang, S., Yaya, S., He, Z., Udenigwe, O., Women's decision-making autonomy and utilisation of maternal healthcare services: results from the Bangladesh Demographic and Health Survey (2017) BMJ Open [Internet], , https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5595179/pdf/bmjopen-2017-017142.pdf, [cited 2018 Jul 4];7:1–8.. Available from:; Brabin, L., Verhoeff, F.H., Kazembe, P., Brabin, B.J., Chimsuku, L., Broadhead, R., Improving antenatal care for pregnant adolescents in southern Malawi (1998) Acta Obstet Gynecol Scand, 77 (4), pp. 402-409; Ramezani Tehrani, F., Hajizadeh, S., Simbar, M., Farzadfar, F., Factors influencing the use of prenatal care: a systematic review (2016) J Midwifery Reprod Heal, 4 (1), pp. 544-557; Simkhada, B., Van Teijlingen, E.R., Porter, M., Simkhada, P., Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature (2008) J Adv Nurs, 61 (3), pp. 244-260; Valente, T.W., Poppe, P.R., Merritt, A.P., Mass-media-generated interpersonal communication as sources of information about family planning (1996) J Health Commun [Internet], , http://www.ncbi.nlm.nih.gov/pubmed/10947363, [cited 2019 May 22];1(3):247–66.. Available from:; Rani, M., Lule, E., Exploring the socioeconomic dimension of adolescent reproductive health: a multicountry analysis (2004) Int Fam Plan Perspect [Internet], , http://www.ncbi.nlm.nih.gov/pubmed/15381465, [cited 2019 May 22];30(3):110–17.. Available from: 10.1363/ifpp.30.110.04; Khanal, V., Adhikari, M., K, R., G, T., Factors associated with the utilisation of postnatal care services among the mothers of Nepal (2014) BMC Women's Health [Internet] 2014, 14 (19), pp. 1-13. , http://www.biomedcentral.com/1472-6874/14/19, Available from:; Tiruneh, F.N., Chuang, K.-Y., Chuang, Y.-C., Women's autonomy and maternal healthcare service utilization in Ethiopia (2017) BMC Health Serv Res [Internet], 17 (1), p. 718. , https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2670-9, [cited 2019 Jun 12]; Danforth, E., Kruk, P., Mbaruku, G., Galea, S., Household decision – making about delivery in health facilities: evidence from Tanzania (2009) J Health Popul Nutr, 27 (5), pp. 696-703; Shimazaki, A., Honda, S., Dulnuan, M.M., Chunanon, J.B., Matsuyama, A., Factors associated with facility-based delivery in mayoyao, ifugao province, Philippines (2013) Asia Pac Fam Med [Internet], 12 (1), p. 1. , [Available from: Asia Pacific Family Medicine]; Babalola, S., Fatusi, A., Determinants of use of maternal health services in Nigeria -looking beyond individual and household factors (2009) BMC Pregnancy Childbirth [Internet], , http://www.biomedcentral.com/1471-2393/9/43, [cited 2018 Feb 27];9(9):43. Available from:; Akin, A., Bertan, M., Contraception, abortion, and maternal health services in Turkey [Internet] (1996), http://pdf.usaid.gov/pdf_docs/PNACA069.pdf, [cited 2018 Feb 27]. Available from:; Mohan, D., Gupta, S., LeFevre, A., Bazant, E., Killewo, J., Baqui, A.H., Determinants of postnatal care use at health facilities in rural Tanzania: multilevel analysis of a household survey (2015) BMC Pregnancy Childbirth [Internet], 15 (1), pp. 1-10. , Available from:; Ronsmans, C., Etard, J.F., Walraven, G., Høj, L., Dumont, A., Bernis, L., Kodio, B., Maternal mortality and access to obstetric services in West Africa (2003) Trop Med Int Health, 8, pp. 940-948
PY - 2019/12
Y1 - 2019/12
N2 - 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.
AB - 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.
KW - Adolescent
KW - Africa South of the Sahara
KW - Africa south of the Sahara
KW - Cross-Sectional Studies
KW - Decision Making
KW - Demography
KW - Female
KW - Humans
KW - Marriage
KW - Married adolescents
KW - Maternal Health Services
KW - Maternal health care
KW - Multi-country analysis
KW - Patient Acceptance of Health Care
KW - Personal Autonomy
KW - Pregnancy
KW - Social Conditions
KW - Sub-Saharan Africa
KW - accessibility
KW - adolescence
KW - adolescent
KW - article
KW - autonomy
KW - birth order
KW - child
KW - controlled study
KW - cross-sectional study
KW - decision making
KW - demography
KW - developing world
KW - education
KW - employment
KW - family planning
KW - female
KW - health care
KW - health care utilization
KW - health policy
KW - health survey
KW - household
KW - human
KW - human experiment
KW - major clinical study
KW - male
KW - marriage
KW - married person
KW - maternal care
KW - maternal health
KW - maternal health service
KW - patient attitude
KW - personal autonomy
KW - policy approach
KW - postnatal care
KW - pregnancy
KW - prenatal care
KW - social status
KW - young population
KW - SERVICES
KW - MOTHERS
KW - CHILD
KW - WOMEN
KW - MORTALITY
KW - ANTENATAL CARE
U2 - 10.1016/j.puhe.2019.07.002
DO - 10.1016/j.puhe.2019.07.002
M3 - Article
C2 - 31470265
SN - 0033-3506
VL - 177
SP - 1
EP - 9
JO - Public Health
JF - Public Health
ER -