Yvette Efevbera’s research while affiliated with Bill & Melinda Gates Foundation and other places

Introduction: Adolescent pregnancy is a known health risk to mother and child. Statements and reports of health outcomes typically group mothers under 20 years old together. Few studies examined this risk at a finer age resolution, none of them comprehensively, and with differing results. Methods: We analysed Demographic and Health Surveys data from 2004 to 2018 in sub-Saharan Africa (SSA) and South Asia, on firstborn children of mothers 25 years old or younger. We examined the association between maternal age and stillbirths, and neonatal mortality rate (NNMR), infant mortality rate (IMR) and under-5 mortality rate (U5MR), using mixed-effects logistic regression adjusting for major demographic variables and exploring the impact of maternal health-seeking. Results: In both regions and across all endpoints, mortality rates 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 1.2-1.5 times higher, respectively, than among firstborn children of mothers aged 23-25. Absolute mortality rates declined over time, but the age gradient remained similar across time periods and regions. Adjusting for rural/urban residence and maternal education, in SSA in 2014-2018 having a <16-year-old mother was associated with ORs of 3.71 (95% CI: 2.50 to 5.51) for stillbirth, 1.92 (1.60-2.30) for NNMR, 2.13 (1.85-2.46) for IMR and 2.39 (2.13-2.68) for U5MR, compared with having a mother aged 23-25. In South Asia, in 2014-2018 ORs were 5.12 (2.85-9.20) for stillbirth, 2.46 (2.03-2.97) for NNMR, 2.62 (2.22-3.08) for IMR and 2.59 (2.22-3.03) for U5MR. Part of the effect on NNMR and IMR may be mediated by a lower maternal health-seeking rate. Conclusions: Adolescent pregnancy is associated with dramatically worse child survival and mitigated by health-seeking behaviour, likely reflecting a combination of biological and social factors. Refining maternal age reporting will avoid masking the increased risk to children born to very young adolescent mothers. Collection of additional biological and social data may better reveal mediators of this relationship. Targeted intervention strategies to reduce unintended pregnancy at earlier ages may also improve child survival.

This article provides an overview of the social determinants of adolescents and young adults' (AYAs') sexual and reproductive health (SRH), from a global health perspective. The status of AYAs' SRH constitutes leading health indicators across nations and globally, and reveals the well-being of this population. Throughout the article, AYAs' SRH is approached from a health equity perspective, which includes SRH health rights and reproductive justice. Using this health equity lens, salient topics are presented: sexual abuse/assault among AYAs; immigrant and refugee populations; child, early, and forced marriage; human trafficking; and female genital mutilation. The article also discusses access to SRH services and comprehensive education. Practical implications and resources are offered for healthcare providers for their daily encounters with AYAs, as well as for community, institutional level, and advocacy action. Healthcare providers are well positioned to advance AYAs SRH through mitigating inequities and in so doing, they are assuring the health of the population and future generations.

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.

Guinea has the eighth highest rate of girl child marriage, as 1 in 2 girls marry before age 18. The aim of this study was to qualitatively explore how women married as children in Conakry, Guinea see their marriage as related to their health and their children’s health. This study draws from grounded theory. The primary data sources were in-depth interviews collected from August 2016 to January 2017; during that time, we also conducted brief ethnographic interviews, observation, and participant observation. Purposive sampling was used to identify 19 participants who first married before age 18. We used open coding for data analysis. At the first level of coding, key categories were identified. At the second level of coding, categories were grouped. We secured ethical board approval for all study procedures. Through this study, a new picture emerges about health experiences within girl child marriage. We found that most women perceived health disadvantages of their early marriages (n=16), captured through themes of poor sexual and reproductive health, intimate partner violence and long-term consequences, poor mental health and psychosocial well-being, and other physical health conditions. Most women also perceived health advantages of their early marriages (n=15), captured through themes of having children, “good health for me and my children,” access to health care, delaying first pregnancy and birth spacing, and positive mental health and psychosocial well-being. Sixty-three percent of participants articulated both disadvantages and advantages of their early marriages as related to health outcomes. These findings could be considered in the context of many marital experiences in several contexts, yet women’s reflections point toward the importance of the timing of their early marriages in their experiences. Change in preventing this practice and addressing its full set of consequences will not happen effectively without incorporating the voices and experiences of women affected.

An estimated 650 million girls and women alive today married before their 18th birthday. Referred to as girl child marriage, the formal or informal union of the girl-child before age 18, the practice is increasingly recognized as a key roadblock to global health, development, and gender equality. Although more research than ever has focused on girl child marriage, an important gap remains in deconstructing the construct. Through an extensive review of primary and secondary sources, including legal documents, peer-reviewed articles, books, and grey literature across disciplines, we explore what the term “girl child marriage” means and why it more accurately captures current global efforts than other terms like early, teenage, or adolescent marriage. To do this, we dive into different framings on marriage, children, and gender. We find that there has been historical change in the understanding of girl child marriage in published literature since the late 1800s, and that it is a political, sociocultural, and value-laden term that serves a purpose in different contexts at different moments in time. The lack of harmonized terminology, particularly in the global public health, prevents alignment amongst different stakeholders in understanding what the problem is in order to determine how to measure it and create solutions on how to address it. Our intent is to encourage more intentional use of language in global public health research.