Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
BMC
Abstract
Background: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan
Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in
part due to limited data. In this study, we examine inequalities in key ASRH indicators.
Methods: We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to exam ine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among
adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain
estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and
2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence
and educational status (primary or less versus secondary or higher education).
Results: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of
1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was
rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines
were greater for the indicators of early adolescence (10–14 years). Large diferences in marriage and childbearing
were observed between adolescent girls from rural versus urban areas and the poorest versus richest households,
with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban–
rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively
slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators
did not decline or increase in either education categories.
Conclusion: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high,
especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated
and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in
ASRH is needed for better targeting of interventions and monitoring of progress.
Description
Research Article
Keywords
Adolescents, Girls, Boys, Child marriage, Childbearing, Sexual debut, Sub-Saharan Africa, Inequalities, Trends and patterns, Geographical disparities