Adolescents’ Use of Maternal and Child Health Services in Developing Countries

Heidi W. Reynolds, Family Health International
Shyam Thapa, Family Health International
Emily Wong, Family Health International
Catherine Harcum
Heidi Toms

Introduction: It is well known that adolescents have an increased risk for poor pregnancy outcomes both for the mother and for her child. Because there is mounting evidence that—except possibly in the case of the very youngest adolescents—their increased risk for poor outcomes is due to the social context in which childbearing occurs rather than any physiological or biological immaturity, researchers need to account for those factors that may be associated with age. If adolescents underutilize MCH services, this may explain to some extent the observation that adolescents are at increased risk for poor pregnancy outcomes. Although there is some evidence of adolescents’ use of family planning services and prenatal care services, there is a dearth of studies of adolescents’ use of delivery and postnatal care. To better inform programs and policies and to aid in interpretation of research findings, more insight is needed into what extent pregnant adolescents use MCH care services. The main objective of this study is to examine the extent to which adolescents’ use of prenatal care (PNC), use of delivery care, and infant immunization services vary relative to older women’s taking into account the potential interaction of marital status and age. This study isolates the effect of age on the outcomes of interest by taking into account factors such as birth order, education, socio-economic status, and place of residence that may mediate the relationship between age and MCH service use. Methodology: This study uses the Demographic and Health Survey data from several developing countries. The unit of analysis for this study is children born in the last five years to women who were interviewed during the Demographic and Health Surveys in countries meeting the following criteria: 1. Latest DHS survey available for a particular country and since 1992 2. Surveys with all women (those not restricted to ever-married women) 3. Countries chosen based on the following combination of characteristics: largest sample size and lowest mean age at first birth (to obtain a large sample of adolescent mothers) A composite variable consisting of mean age at first birth and number of eligible women interviewed is created to select the top countries. Logistic regression models with adjustments for complex sampling procedures explore the relationship between age and the MCH care use. The main dependent variables are: attended at least once during pregnancy by skilled personnel; immunized against tetanus; screened during ANC for syphilis, attended during delivery by skilled personnel; immunized against DPT in first year; immunized against measles in first year; and, immunized against TB in first year. Age (15-30) is the independent variable of interest. Adolescence is represented by age dummy variables where the interval is precise as possible to be able to analyze the year-to-year differences in the probability of health care use. The precise intervals depend on sample size at each age and distributions relative to the dependent variables. Adolescents are compared to two groups of women, those ages 19 to 24 and 25 to 29. The age ranges include those ages subject to age heaping. Other control variables include marital status, education and an index variable to represent socio-economic status. The effects of interactions of age with control variables on selected pregnancy outcomes will be tested in both bivariate and multivariate models. Results: The results show the relationship between age and MCH health care use factors and add to our knowledge of the factors that can serve to moderate the relationship between age and poor pregnancy outcomes. Programmatic implications of the results are addressed. Recommendations are made for additional indicators, including measure of postpartum care, in population-based health surveys to better measure adolescents’ use of health services.