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The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries
  1. Jocelyn E Finlay,
  2. Emre Özaltin,
  3. David Canning
  1. Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Jocelyn E Finlay; jfinlay{at}


Objective To examine the association between maternal age at first birth and infant mortality, stunting, underweight, wasting, diarrhoea and anaemia in children in low- and middle-income countries.

Design Cross-sectional analysis of nationally representative household samples. A modified Poisson regression model is used to estimate unadjusted and adjusted RR ratios.

Setting Low- and middle-income countries.

Population First births to women aged 12–35 where this birth occurred 12–60 months prior to interview. The sample for analysing infant mortality is comprised of 176 583 children in 55 low- and middle-income countries across 118 Demographic and Health Surveys conducted between 1990 and 2008.

Main outcome measures Infant mortality in children under 12 months and stunting, underweight, wasting, diarrhoea and anaemia in children under 5 years.

Results The investigation reveals two salient findings. First, in the sample of women who had their first birth between the ages of 12 and 35, the risk of poor child health outcome is lowest for women who have their first birth between the ages of 27 and 29. Second, the results indicate that both biological and social mechanisms play a role in explaining why children of young mothers have poorer outcomes.

Conclusions The first-born children of adolescent mothers are the most vulnerable to infant mortality and poor child health outcomes. Additionally, first time mothers up to the age of 27 have a higher risk of having a child who has stunting, diarrhoea and moderate or severe anaemia. Maternal and child health programs should take account of this increased risk even for mothers in their early 20s. Increasing the age at first birth in developing countries may have large benefits in terms of child health.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).

  • To cite: Finlay JE, Özaltin E, Canning D. The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anaemia for first births: evidence from 55 low- and middle-income countries. BMJ Open 2011;1:e000226. doi:10.1136/bmjopen-2011-000226

  • Funding We thank the William and Flora Hewlett Foundation for support of this research. Conception of this paper was funded by the Center for Global Development. Researchers operated independently from the funders of this work, and funders neither provided nor were required to provide review and approval of this research.

  • Competing interests None.

  • Ethics approval The Demographic and Health Surveys data collection procedures were approved by ICF Macro International (Calverton, Maryland, USA) Institutional Review Board as well as by the relevant body in each country which approves research studies on human subjects. Oral informed consent for the interview/survey was obtained from respondents by interviewers. The current study was reviewed by the Harvard School of Public Health Institutional Review Board (Protocol #20069-101) and was ruled exempt from full review because the study was based on an anonymous public use data set with no identifiable information on the survey participants.

  • Contributors JEF co-led the conception and interpretation of results in this study. She assisted with drafting the manuscript. She prepared the data, empirical analysis and tables presented in the paper. As guarantor, she accepts full responsibility for this submitted work, had access to the data and controlled the decision to publish. EÖ assisted with conception of the article themes, compilation of the data set and empirical analysis for this study, and critical revision of the paper. DC led the conception of this study and interpretation of study findings as well as assisting with the drafting of the manuscript. All authors have seen and approved the final version of the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available on request to Macro ICF at