Briefing: Prevalence and impact of early childbearing on maternal health in Sudan: revisiting the Sudan Household Health Survey for 2010.
Musa, Awatif El Awad
Introduction
Research findings of Population Council, 2015 indicate that, each
year, more than 14 million girls around the world get married before the
age of 18, in sub-Saharan Africa, more than 1 in 10 girls are married
before the age of 15 and four in ten are married before the age of 18.
Traditionally, girls in Arab region marry at an early age close to the
age of menarche (Millaat & Shawky 2001), Sudan is not an exception
(38% of girls married before their 18th birthday. This briefing review
made use of data provided in the Sudan Data Health Household Survey 2010
and aims to estimate the prevalence of child marriage and early
childbearing in Sudan, and to identify the relationship between early
childbearing and maternal health with specific emphasis on complications
during pregnancy and labor. Chi square test is used to examine the
significance level of relationship between early childbearing and
complications during pregnancy and labor.
Marriage before the age of 18 is a reality for many young girls.
According to UNICEF's, worldwide estimates 2012, over 64 million
women age 20-24 were married/in union before the age of 18 (SHHS 2010
Report). Factors that influence child marriage rates include: the state
of the country's civil registration system, which provides proof of
age for children; the existence of an adequate legislative framework
with an accompanying enforcement mechanism to address cases of child
marriage; and the existence of customary or religious laws that condone
the practice.
Research findings of Population Council, 2015 indicate that, each
year, more than 14 million girls around the world get married before the
age of 18 and, in sub-Saharan Africa, more than 1 in 10 girls are
married before the age of 15. Traditionally girls in Arab region marry
at an early age close to the age of menarche (Millaat & Shawky
2001). Sudan is not an exception, where 38% of women married before age
18 and 10% before age 15 (SHHS 2010 Report).
According to the World Health Organization (WHO) 2014, 16 million
of girls aged 15-19 years give birth every year-most in low and
middle-income countries (10% of adolescent girls give birth every year
in developing countries compared to 2% in developed countries). Early
childbearing is an outcome of child marriage, whereby women who are
married before the age of 15 or 18 years tend to have more children than
those who marry later in life.
Several studies in developed and developing countries have
adequately demonstrated that being a young mother along with social,
economic and cultural factors are responsible for poor maternal and
child health outcomes (Eguale 2014).
This briefing review aims to: Estimate the prevalence of child
marriage and early childbearing in Sudan and identify the relationship
between early childbearing and maternal health, with specific emphasis
on complications during pregnancy and labor among young mothers who have
given birth during the two years preceding the SHHS 2010.
The Sudan Household Health Survey 2010 raw dataset and report are
used. Characteristics of 5119 women age 20-49 years who were early
married (before age 18) were obtained from SHHS 2010 Report. Moreover,
the characteristics of 3321 women age 20-24 that have had live births
before their 18th birthday were also studied (SHHS 2010).
The raw dataset was analyzed for 263 young women age 15-18 years,
1412 women age 19-24 years and 1601 women age 25-29 years at the date of
the survey. This classification is intentionally made to detect the
effect of age on women's risk of experiencing certain types of
complications during both pregnancy and labor.
It is worth noting that information on complications pertains to
women who had given births during the two years preceding the SHHS,
2010, as the questions on complications were asked only to women given
births during that period.
Chi square test is used to examine the statistical significance
level of relationship between early childbearing and women exposure to
complications during pregnancy and labor.
Background characteristics of those women, state and place of
residence, educational level and wealth status are studied. According to
state of residence, there are substantial states differences in early
marriage, ranges from 20.5% in Northern State to 62.2% in Blue Nile
State.
The proportion of child marriage varied considerably between those
in urban areas (29.1%) and those in rural area (42.0 %). The educational
status of the woman appears to have an influence on the incidence of
early marriage. The percentage of women married before 18 years of age
declined steadily from 53.8 % among women with no formal education to
39.0% among women with primary education and to 8.9% among women who had
secondary or higher level of education.
The household wealth status also appears to have an influence on
the prevalence of early marriage. The percentage of women married before
18 years of age was 17.3% among women from richest households compared
to 53.8% among women belonging to poorest households.
Early child bearing in Sudan
The prevalence of early childbearing (women have had given births
before age 18) among women age 20-24 years is 14%. However, it is high
(27.6%) among women age 15-18 years.
The SHHS, 2010 findings in Table 1, and figure 1 below, indicate
high differentials between states in early childbearing, with the lowest
prevalence observed in Northern state (2.7%) and the highest in Blue
Nile state (26.9%). Interestingly to note that this is consistent with
the findings of early marriage, where Northern state has the lowest
level of early marriage and Blue Nile has the highest level, which is an
expected result, as early childbearing is an outcome of early marriage.
There are also urban rural variations in early childbearing, with lower
prevalence in among urban women than rural ones (9.6 %to 16.3%
respectively), it is also the same pattern of early marriage.
The education level of the women emerge to be a significant factor
in early childbearing, with the highest level observed among illiterate
women and those who had informal education (adult/khalwa) (38.1%) and
the lowest among women possess secondary or higher education (2.7%). The
household wealth status exerts considerable variations on prevalence of
childbearing with substantially high level among women belong to poor
households (42%) and considerably lower among those of richest
households (2.9%). The education level and wealth status have consistent
impact on early marriage and early childbearing.
[FIGURE 1 OMITTED]
Complications associated with early childbearing
The impact of early childbearing on women's exposure to
complications during pregnancy and labor is examined in table 2, figure
2, and table 3, figure 3 respectively. The impact of early age at
childbearing is detected by grouping women into three age groups, the
girls mothers (who had given births at ages 15-18), and those who had
given births at relatively older ages (19-24 and 25-29 years).
Complications during pregnancy
Table 2, and Figure 2, below indicate the variations in
complications experienced by pregnant women in the three age groups. It
is apparent that children mothers experience relatively higher rates in
almost all types of complications compared to relatively older ones,
which manifest the fact that early childbearing increases the chances of
women's risk of developing certain complications and confirms the
fact that girls who married as teenagers fall into a high-risk group, as
they are physically, biologically and psychologically too immature to
cope with needs of the period of childbearing. The chi-square test
confirms the significant relationship between early childbearing and
pregnant women's risk of exposure to almost all selected
complications at .05 level and lower.
[FIGURE 2 OMITTED]
Complications during labor
Women's risk for developing complications during labor is
displayed in Table 3 and Figure 3 below. The results demonstrate the
fact that young girls have relatively higher risk of having
complications during labor than their older counterparts in all types of
complications. However, the highest impact is observed in exposure to
prolonged lasting labor, whereby the risk of young girls' (15-18
years old) to prolonged lasting labor is almost double the one to women
in age group 25-29 years (22.4% to 11.9% respectively), followed by
convulsion (8% to 4.4% respectively for these two age groups).
The same explanation for pregnancy is valid here for labor
concerning the physically and biologically immaturity for labor. The
chi-square test indicates the high significant relationship between
early childbearing and maternal risk's of experiencing
complications during labor at levels (001-05).
[FIGURE 3 OMITTED]
Conclusion
The findings of this study indicate that child marriage is common
in Sudan (38%). There are considerable variations by state and place of
residence, with the highest prevalence observed in Blue Nile and the
lowest in Northern state; and with higher prevalence in rural areas than
in urban ones..
Child marriage steadily decreases as women educational level
increases (53.8%) for women with no formal education to 8.9 % for women
who have secondary or higher education. These findings demonstrate the
importance of women education in raising their age at marriage and
consistent with other studies undertaken in Middle East on the adverse
impact of women's illiteracy on early marriage and maternal and
infants health (Millaat and Shawky 2001; Harfouche 1983).
Big differences are also observed for household wealth status with
lowest prevalence among women belong to richest households (17.3%), and
highest (53.8%) among those of poorest households which confirms the
impact of poverty on families' encouragement of early marriage of
their daughters to reduce their financial burden.
Early childbearing is high (27.6%) among young girls (15-18 years
old). Socioeconomic differentials in early childbearing indicate
variations in prevalence of early childbearing between states, with the
lowest prevalence observed in Northern state (2.7%) and the highest in
Blue Nile state (26.9%). Also, place of residence shows big differences
with higher prevalence among rural women (16.3%) and lower among urban
ones (9.6%). Substantial discrepancies are found also observed for
household wealth status, with highest level (42.2%) among women of
poorest households and lowest among those belong to richest households
(2.9%).
Findings of complications associated with early childbearing prove
that, there is higher risk for young girls of developing certain
complications during pregnancy and labor than their relatively older
counterparts. However, the variations in complications are more
pronounced and significant in labor than in pregnancy.
The findings of this study confirm consistency in pattern of child
marriage, early childbearing and women's risk of developing
complications during pregnancy and labor, as follows: the earlier the
age at marriage, the earlier is the childbearing and the higher is the
maternal health risk (experiencing complications during pregnancy and
labor).
Child marriage reduces the woman's chances of education and
employment, increases her reproductive life span, as she starts
pregnancy at earlier age, as it is apparent that women who married at
early ages did not postpone childbearing at later ages which increases
their burden through frequent pregnancies, high parity, child rearing,
responsible for raising children while still children themselves,
besides additional responsibilities of domestic work as housewives.
In view of the above findings, delay of child marriage is of high
priority and should be given high consideration by policy and decision
makers as a policy issue through legislations and adequate legislative
framework with an accompanying enforcement mechanism to address cases of
child marriage.
Special awareness programs targeting parents, girls and community
as a whole on the negative maternal health and socioeconomic
consequences of early marriage and early child bearing should be
directed to different community segments and social change agents.
Promotion of girls' education is of high priority, as girl
education increases her age at marriage, her chances to employment and
become an independent decision maker on her life choices. Moreover,
education improves mother's knowledge, and information on her and
her child health issues, and consequently improves the quality of life
for her and her siblings.
Future studies and research on maternal health risk factors
associated with early childbearing throughout women's reproductive
life are encouraged at all levels (national, state and locality) in
Sudan.
Note on contributor
Awatif El Awad is an assistant professor of statistics works at AL
Neelain University at Khartoum Sudan.
References
Eguale, T. 2014. The impact of early childbearing on maternal
behavior and infant health in Ethiopia. Published Master Thesis.
Stockholm University. Demography Unit Department of Sociology.
Stockholm, Sweden.
Harfouche, K. & Verhoestrate, J. 1983. The state of child
health in Eastern Mediterranean Region. WHO/EMRO Technical Publications.
Millaat A. & Shawky H. 2001. The cumulative impact of early
maternal marital age during the childbearing period. Research Gate:
http://www.researchGate.net/publications/1209502 Accessed: 22/10/2015.
Population Council, 2015. Child marriage prevention and supporting
married girls, http://www.popcouncil.org. Accessed: 25/11/2015.
SHHS: Sudan Household Health Survey, 2010. Report. Sudan Federal
Ministry of Health and Central Bureau of Statistics. Khartoum, Sudan.
UNICEF, 2012. Child protection from violence, exploitation and
abuse. UNICEF.
WHO, 2014. Adolescent pregnancy.
WWW.Who.int/mediacentre/factsheet/. Accessed: 01/10/2015.
Table (1) Socioeconomic differentials in early childbearing, Sudan,
2010.
State Percentage of Number of women
women age 20-24 age 20-24 years
who have had a
live birth before
age 18 years
Northern 2.7 55
River Nile 7.8 124
Red Sea 10.2 85
Kassala 13.6 186
Gadarif 18.3 157
Khartoum 10.1 596
Gezira 9.0 573
Wite Nile 16.6 175
Sinnar 14.2 155
Blue Nile 26.9 110
North Kordofan 16.3 362
South Kordofan 17.9 136
North Darfur 19.0 162
West Darfur 16.3 135
South Darfur 20.4 310
Place of Residence
Urban 9.6 1153
Rural 16.3 2169
Education
Illiterate/Adult edu/khalwa 38.1 1038
Primary 19.0 1091
Secondary + 2.7 1192
Wealth index quintiles
Poorest/poor 42.2 1115
Middle 17.1 711
Rich 11.8 767
Richest 2.9 729
Total 14.0 3321
Source: SHHS, 2010 Report, 2012
Table (2) Selected types f complications during pregnancy
in Sudan 2010
Complications Women's Age groups in years
15-18 19-24 25-29
Excessive Vaginal Bleeding 7.0 4.0 5.0
Painful Urination 26.0 21.3 21.0
Jaundice 10.3 7.4 8.1
High fever 37.3 32.5 32.9
Convulsion 5.3 3.5 3.5
Lower abdominal back pain 37.0 34.1 35.0
Table (3) Selected types of complications during labor, Sudan 2010
Complications Women's Age groups in years
15-18 19-24 25-29
Excessive Vaginal Bleeding 12.2 10.0 09.7
Convulsion 08.0 04.7 04.4
Painful Urination 17.9 13.7 13.7
Jaundice 03.8 02.5 03.2
Prolonged lasting labor 22.4 15.4 11.9
Swelling pain/redness in legs 09.8 07.1 08.0
Swollen painful breast 14.4 09.1 09.8
Source: Computed from raw dataset of SHHS, 2010
