The Effect of Adolescent Pregnancy on Child Mortality in 46 Low- and Middle-Income Countries

Background The World Health Organization (WHO) has highlighted the health risks to adolescent mothers and their children. Statements and reports typically group all mothers aged under 20 together. Some studies have examined the risk variations within this age group, and several child health outcomes have yet to be examined. Methods We analyzed data from Demographic and Health Surveys (DHS) collected between 2004 and 2018 in Sub–Saharan Africa (SSA) and South Asia, on children born to mothers 25 years old or younger. We examined the association between maternal age at first birth and deaths of neonates, infants, under –5 years old, and stillbirths, using mixed effects logistic regression and adjusting for common demographic and health–seeking variables. Findings The mortality rates at all early–life stages of children born to mothers aged <16 years, 16–17 years, and 18–19 years at first birth were about 2–4 times, 1.5–2 times, and 1.2–1.3 times higher, respectively, than among children born to mothers aged 23–25 in both regions. Absolute mortality rates decreased over time, but the risk gradient versus age remained similar across time periods, regions, and most child mortality endpoints. After adjustment for rural/urban residence and maternal education, in SSA in 2014–2018 having a mother under 16 (10–15) years old was associated with stillbirth odds ratio (OR) 3.71 [95% CI 2.50–5.51], neonatal mortality OR 1.92 [1.60–2.30], infant mortality OR 2.13 [1.85–2.46], and under–5 mortality OR 2.39 [2.13–2.68]), compared with first children of mothers aged 23–25 years. For the same time period in South Asia ORs were stillbirths 5.12 [2.85–9.20], neonatal mortality 2.46 [2.03–2.97)], infant mortality 2.62 [2.22–3.08], and under–5 mortality 2.59 [2.22–3.03]. Adjustment for additional risk factors did not affect the estimates substantially. Interpretation Adolescent motherhood is associated with dramatically worse child survival, likely reflecting a combination of biological and social factors. Revising maternal age reporting conventions will help to highlight this burden. Targeted intervention strategies to eliminate underage pregnancy are warranted.