A Study of Some Determinants of Adolescent Reproductive Health in Bangladesh

Abstract

Adolescent reproductive health is an important agenda for any developing countries due to population momentum- a consequence of the increasing numbers of adolescents in this region. The generation entering the adolescent years now is the largest in human history. During adolescent period many girls experience critical and various life events such as first marriage, first sexual cohabitation, motherhood, pregnancy complications, early neonatal mortality etc. Adolescents should be able to protect themselves from unwanted sex, unplanned pregnancy, early childbearing, pregnancy complications, unsafe abortion and others adverse reproductive health outcomes. However, early pregnancy and motherhood among adolescent is still a major public health concern in worldwide especially in developing countries. One third of women give birth during adolescent periods in low-income countries. Adolescent pregnancy is a potential threat of mother, offspring and also lead high fertility in resource-limited countries like Bangladesh. Therefore, critical assessment of adolescent childbearing and consequences of early pregnancy may helpful for policy makers to identify risk group in Bangladesh. The objectives of this study was to determine the potential risk factors for adolescent childbearing, and then assess the association between adolescent age at birth and risk of adverse birth and health outcomes through empirical and review analysis. The data for this study was extracted from Bangladesh Demographic and Health Survey (BDHS) 2011. This is a cross-sectional population study based on a two-stage, stratified, cluster-sampling design, which collected information from 17,141 households during May to October 2011. The maternal age at birth especially adolescent versus adult was the main dependent variable when determine the potential determinants. The study modeled adolescent childbearing as a function of individual, household, and community characteristics. In analyzing adverse birth and health outcomes, maternal childbearing age was treated as main exposure variable. Descriptive statistics were calculated for continuous data using the mean (confidence interval) for normally distributed data and the median (inter-quartile range) for non-normally distributed data. Determinants of adolescent childbearing were estimated using a multilevel logistic regression models with random intercept term household and community. In addition the multilevel poisson regression was used to determine the risk factors of adverse birth and health outcomes among adolescent childbearing mothers. It is worthwhile to mention that systematic review was done to know the association between adverse birth and health outcomes among adolescents in South East Asia including Bangladesh. Meta-analysis and meta- regression were used to get pool results. All analyses at both the univariate and multilevel analysis at different stages were adjusted for the probability sample design. The study finding indicates that on average, mean age at childbearing was 26 years, years of schooling 5.54 years, children ever born 2.52, age at first marriage 15.94 years and 35% of women give birth before reaching age 20 years i.e during adolescence. Adolescent’s age of childbearing was affected by social factors at personal, family, community, and national levels. The multilevel logistic regression models indicated that women with lower education, early age at first cohabitation, and poor economic conditions were more likely to influence early childbearing compared to adult women. However, the multilevel poisson regression models indicated that higher risk of low birth weight (adjusted relative risk (aRR), 1.15; 95% CI, 1.00–1.33), childhood stunting (aRR, 1.06; 95% CI, 0.98–1.14) and early neonatal mortality (aRR, 1.60; 95% CI, 0.85–1.27) is observed among the adolescent mother compared to young adult mother. Maternal aged 35 years or over found to be risk factor of pregnancy termination (aRR, 1.31; 95% CI, 1.09–1.56), cesarean delivery (aRR, 1.35; 95% CI, 1.02–1.79) and menstrual irregularities (aRR, 1.35; 95% CI, 1.02–1.79) than young adult mother. The systematic review and meta-analysis suggested that adolescent pregnancy had an increased risk of low birth weight, preterm birth, small for gestational age and neonatal mortality; however, lower risk is to be found in case of cesarean delivery and perinatal mortality. Finally, it may be concluded that maternal education, age at first cohabitation and socioeconomic conditions are the key determinants of adolescent childbearing in Bangladesh. In this systematic review and meta-analysis along with empirical data analysis, conclude that adolescence pregnancy increase the risk of low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA) and early neonatal mortality. The risk of cesarean delivery and perinatal mortality are found to be lower among adolescent mothers. The author feels that the results obtained in the thesis may be useful for policy planners for appropriate policy decisions. It is expected that the result presented in this thesis will be helpful for researchers who are interested to work in the field of adolescent childbearing and adverse birth and health outcomes among adolescent mothers.