Adolescent Fertility and Child Health: The Interaction of Maternal Age, Parity and Birth Intervals in Determining Child Health Outcomes
Keywords:Maternal age, parity, birth intervals, child health, sub-Saharan Africa.
Introduction: Contributing to the Sustainable Development Goals, Global Goals, Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-2030, we clarify the interaction between maternal age, parity and birth intervals to examine the effects on child health.
Methods: We use Demographic and Health Survey data from 33 sub-Saharan African countries, and apply multivariate Poisson and logistic models to first examine the effect of maternal age (15-17, 18-19, 20-24, 25-29, 30-39) on infant mortality and stunting, then modify this relationship by parity and account for the confounding effects of short birth intervals.
Results: We find that poor infant mortality outcomes of children born to teen mothers are driven by higher parity children, not first-born children. While first-born children of teen mothers are at a high risk of stunting, they are likely to survive. Short birth intervals have a negative effect on infant survival and stunting outcomes. But controlling for short birth intervals does not completely offset the effect of young age at birth on child survival outcomes.
Discussion: High parity children of young mothers are at a high risk of infant mortality, driven in part – but not completely – by short birth intervals. Policies aimed at delaying first birth are warranted, but should not overshadow the need to support adolescent mothers at risk of multiple births that are tightly spaced.
 Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: cross-sectional study. Am J Obstet Gynecol 2005; 192(2): 342-9.
 Soares NN, Mattar R, Camano L, Torloni MR. Iron deficiency anemia and iron stores in adult and adolescent women in pregnancy. Acta Obstet Gynecol Scand 2010; 89(3): 343-9.
 Alam N. Teenage motherhood and infant mortality in Bangladesh: Maternal age-dependent effect of parity one. J Biosoc Sci 2000; 32(2): 229-36.
 Borja JB, Adair LS. Assessing the net effect of young maternal age on birthweight. Am J Hum Biol 2003; 15(6): 733-40.
 Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol 2007; 36(2): 368-73.
 de Vienne CM, Creveuil C, Dreyfus M. Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol 2009; 147(2): 151-6.
 DuPlessis HM, Bell R, Richards T. Adolescent pregnancy: understanding the impact of age and race on outcomes. J Adolesc Health 1997; 20(3): 187-97.
 Gibbs CM, Wendt A, Peters S, Hogue CJ. The impact of early age at first childbirth on maternal and infant health. Paediatr Perinat Epidemiol 2012; 26: 259-84.
 Lawlor DA, Mortensen L, Andersen A-MN. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: a sibling study of 264 695 Danish women and their firstborn offspring. Int J Epidemiol 2011; 40(5): 1205-14.
 Legrand TK, Mbacke CSM. Teenage pregnancy and child health in the urban sahel. Stud Fam Plann 1993; 24(3): 137-49.
 Markovitz BP, Cook R, Flick LH, Leet TL. Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths? BMC Public Health [Internet] 2005 Jul 25; 5: [7 p.]. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-5-79.
 Paranjothy S, Broughton H, Adappa R, Fone D. Teenage pregnancy: who suffers? Arch Dis Child 2009; 94(3): 239-45.
 Restrepo-Mendez MC, Barros AJD, Santos I, Menezes AMB, Matijasevich A, Barros FC, et al. Childbearing during adolescence and offspring mortality: findings from three population-based cohorts in southern Brazil. BMC Public Health [Internet] 2011; 11: [12 p.]. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-781
 Sharma V, Katz J, Mullany LC, Khatry SK, LeClerq SC, Shrestha SR, et al. Young maternal age and the risk of neonatal mortality in rural Nepal. Arch Pediatr Adolesc Med 2008; 162(9): 828-35.
 Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). Lancet Glob Health 2015; 3(7): e366-77.
 Finlay JE, Ozaltin 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. BMJ Open [Internet] 2011; 1: [24 p.]. Available from: http://bmjopen.bmj.com/content/1/2/ e000226
 Kodzi IA, Kravdal O. What has high fertility got to do with the low birth weight problem in Africa? Demogr Res 2013; 28: 713-31.
 Hinkle SN, Albert PS, Mendola P, Sjaarda LA, Yeung E, Boghossian NS, et al. The association between parity and birthweight in a longitudinal consecutive pregnancy cohort. Paediatr Perinat Epidemiol 2014; 28(2): 106-15.
 Shah PS, Knowledge Synth Grp Determinants L. Parity and low birth weight and preterm birth: a systematic review and meta-analyses. Acta Obstet Gynecol Scand 2010; 89(7): 862-75.
 Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006; 295(15): 1809-23.
 Conde-Agudelo A, Rosas-Bermudez A, Castano F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann 2012; 43(2): 93-114.
 Dewey KG, Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr 2007; 3(3): 151-73.
 Haaga J. Mechanisms for the association of maternal age, parity, and birth spacing with infant health. Santa Monica, CA: Rand 1991; v: p. 44.
 Rutstein S, Winter R. The Effects of Fertility Behavior on Child Survival and Child Nutritional Status: Evidence from the Demographic and Health Surveys, 2006 to 2012. DHS Analytical Studies No. 37. Rockville, Maryland, USA: ICF International 2014.
 Fink G, Sudfeld CR, Danaei G, Ezzati M, Fawzi WW. Scaling-up access to family planning may improve linear growth and child development in low and middle income countries. PLoS One [Internet] 2014; 9(7): [9 p.].
 Kozuki N, Lee AC, Silveira MF, Sania A, Vogel JP, Adair L, et al. The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis. BMC Public Health [Internet] 2013; 13(Suppl 3): [10 p.].
 Deddens JA, Petersen MR. Approaches for estimating prevalence ratios. Occup Environ Med 2008; 65(7): 481, 501-486.
 Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol 2008; 8(9).
 Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiology 2004; 159(7): 702-6.
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