Article Text

Original research
Later life outcomes of women by adolescent birth history: analysis of the 2016 Uganda Demographic and Health Survey
  1. Dinah Amongin1,2,
  2. Anna Kågesten3,
  3. Özge Tunçalp4,
  4. A Nakimuli2,
  5. Mary Nakafeero5,
  6. Lynn Atuyambe6,
  7. Claudia Hanson3,7,
  8. Lenka Benova8,9
  1. 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
  2. 2Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
  3. 3Department of Global Public Health, Karolinska Institute, Solna, Sweden
  4. 4Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland
  5. 5Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
  6. 6Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, Kampala, Uganda
  7. 7Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  8. 8Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
  9. 9Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Dinah Amongin; amongdinah2003{at}


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.

  • obstetrics
  • reproductive medicine
  • public health
  • sexual medicine

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  • Contributors DA conceived and designed the study, obtained permission to use data set from DHS program, conducted analysis, presented and interpreted results, drafted and finalised the article. AK conceived the study, conducted the literature review, reviewed and interpreted the results, and reviewed the article. OT conceived the study, drafted the analysis plan, reviewed and interpreted the results, and reviewed the article. AN was involved reviewing the study design, the results and drafting the article. MN was involved in data analysis, presentation and interpretation of the results. LA was involved in reviewing and interpreting the results, and reviewing the manuscript. CH was involved in designing the study and the analysis, presenting and interpreting the results, drafting the article and reviewing the manuscript. LB was involved in conceiving the study, designing the analysis plan and data analysis, interpreting the results and substantially reviewing the article. All the authors reviewed and approved the manuscript. All the authors take responsibility for their contributions.

  • Funding This work was supported through the Developing Excellence in Leadership, Training and Science (DELTAS) Africa Initiative grant # DEL-15-011 to THRiVE-2. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust grant #107742/Z/15/Z and the UK government.

  • Disclaimer The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval We obtained permission to use the data sets from the DHS programme. During the survey data collection process, implemented by the Uganda Bureau of Statistics, written informed consent was obtained from all the respondents.

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

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplemental information. Data used for this analysis can be accessed, with permission, from the Demographic and Health Survey programme website

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.