High-risk fertility behaviours among women in sub-Saharan Africa

Journal of public health (Oxford, England), Volume 45, No. 1, Year 2023

Interprétation

BACKGROUND: High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA). METHODS: Data on 200 716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged <18 years at the time of delivery; mother aged >34 years at the time of delivery; mother of a child born after a short birth interval (<24 months) and mother of high parity (>3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval. RESULTS: Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education. CONCLUSION: Family structure, women’s decision-making power, access to family planning, women’s level of education and partners’ level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours.

Résumé de l’IA

Study Justification:

This study aimed to investigate high-risk fertility behaviors among women in sub-Saharan Africa (SSA) and identify associated factors. Understanding these behaviors is crucial for addressing maternal and child health outcomes in the region. By analyzing data from demographic and health surveys conducted between 2010 and 2020, the study provides valuable insights into the prevalence and predictors of high-risk fertility behaviors in SSA.

Highlights:

1. The study found that women in polygamous marriages had higher odds of engaging in high-risk fertility behaviors compared to those in monogamous marriages.
2. Women with middle or high decision-making power were more likely to exhibit high-risk fertility behaviors than those with low decision-making power.
3. Access to family planning, as well as the education level of women and their partners, played significant roles in reducing the likelihood of high-risk fertility behaviors.
4. The study identified family structure, women’s decision-making power, access to family planning, and education levels as key predictors of high-risk fertility behaviors in SSA.

Recommendations for Lay Readers:

1. Policy makers and stakeholders should prioritize programs aimed at reducing the prevalence of high-risk fertility behaviors in countries with high rates of high parity and short birth intervals.
2. Efforts should be made to promote monogamous marriages and empower women to make informed decisions regarding their reproductive health.
3. Access to family planning services should be improved to enable women to make choices about the timing and spacing of their pregnancies.
4. Education, both for women and their partners, should be promoted as a means to reduce high-risk fertility behaviors.

Recommendations for Policy Makers:

1. Develop and implement targeted programs to address high-risk fertility behaviors, focusing on countries with high prevalence rates.
2. Allocate resources to promote monogamous marriages and empower women to have control over their reproductive choices.
3. Strengthen family planning services and ensure their accessibility to all women, particularly those with limited education and resources.
4. Invest in educational initiatives that promote reproductive health knowledge and awareness among women and their partners.

Key Role Players:

1. Policy makers and government officials responsible for reproductive health policies and programs.
2. Non-governmental organizations (NGOs) working in the field of maternal and child health.
3. Healthcare providers, including doctors, nurses, and midwives, who play a crucial role in delivering reproductive health services.
4. Community leaders and influencers who can help disseminate information and promote positive reproductive health behaviors.

Cost Items for Planning Recommendations:

1. Funding for the development and implementation of targeted programs addressing high-risk fertility behaviors.
2. Resources for training healthcare providers and community leaders on reproductive health education and counseling.
3. Budget allocation for improving access to family planning services, including the provision of contraceptives and related infrastructure.
4. Investments in educational initiatives, such as awareness campaigns and workshops, to promote reproductive health knowledge among women and their partners.

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study analyzes data from a large sample size of over 200,000 women in sub-Saharan Africa. It uses multi-level multi-variable logistic regression analyses to identify predictors of high-risk fertility behaviors. The adjusted odds ratios are presented with a 95% confidence interval. However, the abstract does not provide information on the specific methodology used in the demographic and health surveys, which could affect the reliability of the findings. To improve the strength of the evidence, it would be helpful to include more details on the sampling methods, data collection procedures, and statistical analysis techniques used in the study.

Abstrait

BACKGROUND: High-risk fertility behaviours such as too early or advanced age at delivery, shorter birth interval, birth order and a higher number of live births to a woman often lead to adverse maternal and child health outcomes. We assessed high-risk fertility behaviours and their associated factors among women in sub-Saharan Africa (SSA). METHODS: Data on 200 716 women pooled from the demographic and health surveys of 27 countries conducted between 2010 and 2020 in SSA were analysed. High-risk fertility behaviour from four indicators, mother aged 34 years at the time of delivery; mother of a child born after a short birth interval (3 children), was derived. Multi-level multi-variable logistic regression analyses were carried out and the results were presented as adjusted odds ratios at 95% confidence interval. RESULTS: Women who were in polygamous marriages had higher odds of single and multiple high-risk fertility behaviour compared with their counterparts who were in monogamous marriages. Women with middle or high maternal decision-making power had higher odds of single and multiple high-risk fertility behaviours compared with those with low decision-making power. Single and multiple high-risk fertility behaviours were lower among women with access to family planning, those with at least primary education and those whose partners had at least primary education compared with their counterparts who had no access to family planning, those with no formal education and those whose partners had no formal education. CONCLUSION: Family structure, women’s decision-making power, access to family planning, women’s level of education and partners’ level of education were identified as predictors of high-risk fertility behaviours in SSA. These findings are crucial in addressing maternal health and fertility challenges. Policy makers, maternal health and fertility stakeholders in countries with high prevalence of high parity and short birth intervals should organize programs that will help to reduce the prevalence of these high-risk factors, taking into consideration the factors that predispose women to high-risk fertility behaviours.

Matériaux

N/A

Innovations

Based on the research findings, the following innovations can be developed to improve access to maternal health:

1. Mobile Health (mHealth) Interventions: Utilize mobile technology to deliver educational campaigns and raise awareness about maternal health and family planning. This can include text messages, voice calls, and mobile applications that provide information on pregnancy spacing, birth control methods, and the importance of antenatal and postnatal care.

2. Community Health Workers (CHWs): Train and deploy CHWs to provide education and counseling on maternal health and family planning within communities. CHWs can play a crucial role in reaching remote and underserved areas, conducting home visits, and facilitating access to family planning services.

3. Task-Shifting: Expand the role of midwives and nurses to provide comprehensive maternal health services, including family planning counseling and services. This can help address the shortage of healthcare providers and increase access to essential maternal health services.

4. Public-Private Partnerships: Collaborate with private healthcare providers and organizations to improve access to maternal health services. This can involve subsidizing or providing vouchers for family planning services, establishing partnerships for training healthcare providers, and leveraging private sector resources to strengthen healthcare systems.

5. Telemedicine: Utilize telemedicine platforms to provide remote consultations and follow-up care for pregnant women, especially in areas with limited access to healthcare facilities. This can help reduce barriers to accessing maternal health services and ensure continuity of care.

6. Innovative Financing Models: Explore innovative financing models, such as social impact bonds or results-based financing, to incentivize the delivery of high-quality maternal health services. This can help mobilize resources and improve the sustainability of maternal health programs.

7. Community-Based Distribution of Contraceptives: Train community members, including traditional birth attendants and community health workers, to distribute contraceptives and provide basic family planning counseling. This can increase access to contraceptives in remote areas and empower women to make informed decisions about their reproductive health.

8. Digital Health Records: Implement electronic health records systems to improve the tracking and monitoring of maternal health services. This can help identify gaps in care, improve coordination between healthcare providers, and ensure timely and appropriate interventions.

By implementing these innovations, countries can enhance access to maternal health services, reduce high-risk fertility behaviors, and improve maternal and child health outcomes.

AI Innovations Description

Based on the research findings, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Title: Integrated Maternal Health and Family Planning Program

Description: To address the high prevalence of high-risk fertility behaviors in sub-Saharan Africa (SSA) and improve maternal health outcomes, it is recommended to implement an integrated maternal health and family planning program. This program should consider the factors identified as predictors of high-risk fertility behaviors, including family structure, women’s decision-making power, access to family planning, women’s level of education, and partners’ level of education.

The program should include the following components:

1. Education and Awareness: Develop comprehensive educational campaigns to raise awareness about the importance of spacing pregnancies, delaying early or advanced age at delivery, and limiting the number of high-risk pregnancies. These campaigns should target both women and men, emphasizing the benefits of family planning and the role of male partners in supporting maternal health.

2. Access to Family Planning: Strengthen existing family planning services and ensure their availability and accessibility in both urban and rural areas. This can be achieved by increasing the number of healthcare facilities that provide family planning services, training healthcare providers, and improving the supply chain management of contraceptives.

3. Empowerment of Women: Implement interventions to empower women and enhance their decision-making power regarding reproductive health choices. This can be done through community-based programs that promote women’s education, economic empowerment, and involvement in decision-making processes related to their own health and family planning.

4. Partner Involvement: Engage male partners in the maternal health and family planning program by providing them with information and resources. Encourage men to actively participate in family planning discussions, support their partners in accessing services, and promote gender equality within relationships.

5. Strengthen Health Systems: Improve the capacity of healthcare systems to provide quality maternal health services, including antenatal care, skilled birth attendance, and postnatal care. This can be achieved by training healthcare providers, ensuring the availability of essential medical supplies and equipment, and strengthening referral systems for high-risk pregnancies.

6. Monitoring and Evaluation: Establish a robust monitoring and evaluation system to track the progress of the program and identify areas for improvement. Regular data collection and analysis will help measure the impact of the interventions and guide evidence-based decision-making.

By implementing this integrated maternal health and family planning program, countries in SSA can effectively reduce the prevalence of high-risk fertility behaviors and improve access to maternal health services. This will contribute to better maternal and child health outcomes in the region.

AI Innovations Methodology

To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Study Design: Conduct a prospective cohort study to assess the impact of the integrated maternal health and family planning program on access to maternal health services. The study should include a pre-intervention phase to establish baseline data and a post-intervention phase to measure the program’s impact.

2. Study Population: Select a representative sample of women of reproductive age (15-49 years) from sub-Saharan African countries. Ensure that the sample includes women from both urban and rural areas to capture the diverse population.

3. Data Collection: Administer structured questionnaires to collect data on various variables, including demographic characteristics, family structure, women’s decision-making power, access to family planning, women’s level of education, partners’ level of education, and utilization of maternal health services. Use standardized tools and techniques to ensure data reliability and validity.

4. Intervention Implementation: Implement the integrated maternal health and family planning program in selected intervention areas. Ensure that the program components, as outlined in the abstract, are implemented effectively and consistently.

5. Monitoring and Evaluation: Establish a monitoring and evaluation framework to track the implementation of the program and measure its impact. Regularly collect data on program indicators, such as the number of educational campaigns conducted, the availability of family planning services, women’s empowerment indicators, male partner involvement, healthcare system strengthening, and program coverage.

6. Data Analysis: Analyze the collected data using appropriate statistical methods. Conduct descriptive analyses to summarize the characteristics of the study population and assess the baseline levels of high-risk fertility behaviors and access to maternal health services. Use regression analyses to examine the association between the program components and the outcomes of interest, such as improved access to family planning and increased utilization of maternal health services.

7. Results Interpretation: Interpret the findings of the data analysis to determine the impact of the integrated maternal health and family planning program on access to maternal health services. Assess the significance of the program components in reducing high-risk fertility behaviors and improving maternal health outcomes.

8. Recommendations: Based on the study findings, provide evidence-based recommendations for scaling up the integrated maternal health and family planning program in sub-Saharan African countries. Highlight the key program components that have shown the most significant impact on improving access to maternal health services.

By following this methodology, researchers can simulate the impact of the main recommendations outlined in the abstract and provide valuable insights into the effectiveness of the integrated maternal health and family planning program in improving access to maternal health services in sub-Saharan Africa.

Auteurs et co-auteurs

Statistics:

Citations: 2

Authors: 8

Identifiers:

DOI: 10.1093/pubmed/fdab381

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health

Study Design:

Cross Sectional Study

Participants Gender:

Female

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