Adolescent childbirth and mobility disability among women ages 15-49: an analysis of population health surveys from 14 low-income and middle-income countries

Abstract

Objectives: Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability.

Design: Cross-sectional analysis.

Setting: Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana.

Participants: The sample included 157 988 women ages 15-49 years.

Primary outcome measure: Adolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth.

Results: Prevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31).

Conclusions: This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.

Keywords: EPIDEMIOLOGIC STUDIES; Epidemiology; Public health.

Figure 1

Unadjusted (black diamonds) and adjusted (blue squares) associations between adolescent childbirth and mobility disability, stratified by use of standard disability question in 14 countries. For each country, the first row indicates the crude PR, and the second row indicates the adjusted PR. DHS, Demographic Health Surveys; PR, prevalence ratio.

Figure 2

Pooled prevalence (marginal predictions) of mobility disability comparing women with first birth during adolescence and first birth in adulthood based on countries that used standard disability question (n=8).