Later life outcomes of women by adolescent birth history: analysis of the 2016 Uganda Demographic and Health Survey

BMJ Open. 2021 Feb 10;11(2):e041545. doi: 10.1136/bmjopen-2020-041545.


Objectives: To describe the long-term socioeconomic and reproductive health outcomes of women in Uganda by adolescent birth history.

Design: Cross-sectional study.

Setting: Uganda.

Participants: Women aged 40-49 years at the 2016 Uganda Demographic and Health Survey.

Outcome measures: We compared socioeconomic and reproductive outcomes among those with first birth <18 years versus not. Among those with a first birth <18 years, we compared those with and without repeat adolescent births (another birth <20 years). We used two-sample test for proportions, linear regression and Poisson regression.

Findings: Among the 2814 women aged 40-49 years analysed, 36.2% reported a first birth <18 years and 85.9% of these had a repeat adolescent birth. Compared with women with no birth <18 years, those with first birth <18 years were less likely to have completed primary education (16.3% vs 32.2%, p<0.001), more likely to be illiterate (55.0% vs 44.0%, p<0.001), to report challenges seeking healthcare (67.6% vs 61.8%, p=0.002) and had higher mean number of births by age 40 years (6.6 vs 5.3, p<0.001). Among women married at time of survey, those with birth <18 years had older husbands (p<0.001) who also had lower educational attainment (p<0.001). Educational attainment, household wealth score, total number of births and under-5 mortality among women with one adolescent birth were similar, and sometimes better, than among those with no birth <18 years.

Conclusions: Results suggest lifelong adverse socioeconomic and reproductive outcomes among women with adolescent birth, primarily in the category with repeat adolescent birth. While our results might be birth-cohort specific, they underscore the need to support adolescent mothers to have the same possibilities to develop their potentials, by supporting school continuation and prevention of further unwanted pregnancies.

Keywords: obstetrics; public health; reproductive medicine; sexual medicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Birth Order*
  • Cross-Sectional Studies
  • Educational Status
  • Female
  • Humans
  • Middle Aged
  • Parturition*
  • Pregnancy
  • Socioeconomic Factors
  • Uganda / epidemiology