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. 2019 Nov 20;14(11):e0225374.
doi: 10.1371/journal.pone.0225374. eCollection 2019.

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

Gowokani Chijere Chirwa  1 , Jacob Mazalale  1 , Gloria Likupe  2 , Dominic Nkhoma  3 , Levison Chiwaula  1 , Jesman Chintsanya  4
Affiliations

An evolution of socioeconomic related inequality in teenage pregnancy and childbearing in Malawi

Gowokani Chijere Chirwa et al. PLoS One. .

Abstract

Background: Teenage pregnancies and childbearing are important health concerns in low-and middle-income countries (LMICs) including Malawi. Addressing these challenges requires, among other things, an understanding of the socioeconomic determinants of and contributors to the inequalities relating to these outcomes. This study investigated the trends of the inequalities and decomposed the underlying key socioeconomic factors which accounted for the inequalities in teenage pregnancy and childbearing in Malawi.

Methods: The study used the 2004, 2010 and 2015-16 series of nationally representative Malawi Demographic Health Survey covering 12,719 women. We used concentration curves to examine the existence of inequalities, and then quantified the extent of inequalities in teenage pregnancies and childbearing using the Erreygers concentration index. Finally, we decomposed concentration index to find out the contribution of the determinants to socioeconomic inequality in teenage pregnancy and childbearing.

Results: The teenage pregnancy and childbearing rate averaged 29% (p<0.01) between 2004 and 2015-16. Trends showed a "u-shape" in teenage pregnancy and childbearing rates, albeit a small one (34.1%; p<0.01) in 2004: (25.6%; p<0.01) in 2010, and (29%; p<0.01) in 2016. The calculated concentration indices -0.207 (p<0.01) in 2004, -0.133 (p<0.01) in 2010, and -0.217 (p<0.01) in 2015-16 indicated that inequality in teenage pregnancy and childbearing worsened to the disadvantage of the poor in the country. Additionally, the decomposition exercise suggested that the primary drivers to inequality in teenage pregnancy and child bearing were, early sexual debut (15.5%), being married (50%), and wealth status (13.8%).

Conclusion: The findings suggest that there is a need for sustained investment in the education of young women concerning the disadvantages of early sexual debut and early marriages, and in addressing the wealth inequalities in order to reduce the incidences of teenage pregnancies and childbearing.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Teenage pregnancy and childbearing trend by wealth status 2004-2015-16.
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 2
Fig 2. Teenage pregnancy and childbearing trend by region and residence 2004-2015-16.
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 3
Fig 3. Concentration curve for teenage pregnancy and childbearing (Pooled data).
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 4
Fig 4. Concentration curve for teenage pregnancy and childbearing 2004–2016.
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 5
Fig 5. Decomposition of the concentration index for the pooled data.
Constructed by authors from MDHS 2004, 2010, 2016.
Fig 6
Fig 6. Decomposition of the concentration index for year 2004.
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 7
Fig 7. Decomposition of the concentration index for year 2010.
Constructed by authors from MDHS 2004, 2010, 2015–16.
Fig 8
Fig 8. Decomposition of the concentration index for year 2016.
Constructed by authors from MDHS 2004, 2010, 2015–16.
See this image and copyright information in PMC

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