Factors associated with repeat childbirth among adolescent mothers in Soroti district, Teso sub-region, Uganda a mixed methods study.

Abstract

The percentage of adolescent mothers aged 15 to 19 years with a repeat childbirth in Uganda (26.1%) is higher than the global estimate (18.5%). Soroti district tops Teso (region with highest adolescent childbearing rate nationally) in adolescent childbearing. Adolescent repeat childbearing (ARC) is associated with poor health outcomes; increased risk of stillbirth, maternal and child mortality, thus a public health problem. The factors associated with, and the burden, of ARC remains unknown in Soroti district. Consequently, interventions which combat ARC in Soroti district have not been informed by empirical data. This study determined the current proportion of adolescent mothers with, and factors associated with, repeat childbirth among adolescent mothers aged 15 to 19 years in Soroti district, to inform policy makers and preventive programs of ARC and guide planning and budgeting. We conducted a cross-sectional study involving mixed methods of data collection. Interviewer-administered structured interviews were conducted amongst 422 adolescent mothers aged 15 to 19 years. Demographic and socio-economic data of respondents, data regarding respondents’ family and peer related factors was collected. Chi-square was the test statistics used. Multivariate analysis was by logistic regression. Qualitatively, theoretical saturation was achieved with 3 focus group discussions; each comprised of 8 respondents. Transcripts were organized and analyzed by QSR Nvivo following deductive approach. Of the 422 respondents, 31.28% (132) were married. Proportion of respondents with repeat childbirth was at 30.81% (95%CI: 26.57%-35.39%). Risk factors of ARC were; (a) being married, AOR 5.70 (95%CI: 3.05-10.63), (b) incorrect knowledge of rhythm method, AOR 2.23 (95%CI: 1.25-3.97), (c) Age at first at birth, AOR 0.49 (95%CI: 0.37-0.64), (d) Alcohol consumption, AOR 2.41(95%CI: 1.27-4.58), (e) being raped, AOR 5.64(95%CI: 1.87-17.07), having first childbirth from home, AOR 2.68 (95%CI: 1.29-5.57) and father of first baby without multiple sexual partners, AOR 0.40(95%CI: 0.22-0.72). Perceived risk factors for ARC included; view of Adolescent marriage as a privilege and family planning methods as non-functional. Participants’ view of man’s demand for sex as unchallengeable and non-supportive families including mistreatment of the participants by their families, were yet other perceived risk factors for ARC. In conclusion, the high-risk factors for repeat adolescent childbirth included having a first childbirth from home, starting childbearing at a young age, adolescent mothers who drink alcohol, adolescent marriage, and incorrect knowledge about rhythm family planning method. Qualitative findings further showed that adolescent mothers perceived adolescent marriages as a privilege following their first childbirth, and childbearing in adolescent marriages was to be determined by their sexual partners, and had varying myths ranging from failure of family planning methods to confirmation of sexual functionality following their first childbirth. This therefore suggest the following; 1. develop an intervention to prevent repeat adolescent childbearing in Soroti district by the district stakeholders. 2. involvement of males in preventive programs of reproductive health of 3. Involve adolescents and parents in family planning. Adolescent marriages, strengthen sexual/reproductive education including family planning programs to address the identified myths about the family planning methods (that family planning methods are non-functional) and (such as family planning) of adolescent repeat childbearing since sexual partner characteristics were associated with repeat childbirth among the participants. our study findings suggest the need to awaken and strengthen the implementation of the anti-teen marriage programs and policies including measures to delay age at first childbirth, measures towards mindset change regarding transformation of social norms and practices around 4. reinforce programs that ban alcohol consumption among adolescents in Soroti district by the different interventions aimed at preventing ARC and stakeholders including Soroti district health office and ministry of health. The study results further suggest the need to instate measures to delay age at first delivery among adolescent mothers so as prevent adolescent repeat childbearing by the various interventions aimed at preventing ARC in Soroti district. 5. We also recommend further research to be done in Uganda, especially in other districts of Teso region to validate the association of alcohol consumption and rape with ARC.