Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Abstract

Background: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival.

Methods: A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05.

Results: The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR = 2.33, 95% CI 2.08-2.63), secondary education level (AHR = 0.84, 95% CI 0.78-0.96), higher education level (AHR = 0.75, 95% CI 0.65-0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22-25.64), intercourse 15-17 years in married stratum (AHR = 5.56, 95% CI 5.26-5.88), spousal age difference (AHR = 1.11, 95% CI 1.05-1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13-1.20) than low risk clusters adjusting for other factors.

Conclusion: In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

Keywords: Ethiopia; Predictors; Reproductive age-women; Time to first birth.

Fig. 1

Sampling procedure of time to first birth and its predictors among reproductive age women in Ethiopia, 2016 EDHS

Fig. 2

Kaplan–Meier failure estimates of time to first birth among reproductive-age women in Ethiopia, 2016 EDHS. a Overall Kaplan–Meier failure estimate. b Early, optimal and advanced age at first birth estimates among respondents

Fig. 3

Kaplan–Meier failure estimates difference and log-rank equality of survival tests of time to first birth among reproductive-age women in Ethiopia, 2016, EDHS. a Kaplan–Meier estimate of time to first birth by age at first marriage. b Kaplan–Meier estimate of time to first birth by education level

Fig. 4

Base line hazard estimate of time to first birth among reproductive-age women in Ethiopia, 2016, EDHS

Fig. 5

Cox–Snell residual and Nelson Aalen cumulative hazard plots of time to first birth in Ethiopia, 2016, EDHS. a Inverse-Weibull gamma shared frailty. b Log–logistic inverse Gaussian shared frailty. c Lognormal gamma shared frailty. d Cox gamma shared