Vanessa Moonga

Grand multiparity, defined as having five or more births, is a significant public health problem, especially in low resource settings where fertility rates are generally higher than in high-resource settings due to socio-economic factors such as poverty and low levels of women’s education, as well as disparities in access to modern contraceptives and advanced medical care. The study aimed to investigate the factors associated with grand multiparity in Zambia. The study analysed data from the 2018 Zambia Demographic and Health Survey (ZDHS) using a weighted sample of 13,683 women aged 15–49 years. Univariate analysis was used to present percent distributions of the selected background characteristics of women. Bivariate analysis was used to examine the association between selected background characteristics and grand multiparity. Multivariable logistic regression was then performed to identify factors of grand multiparity among women aged 15–49 years in Zambia. The prevalence of grand multiparity among women in Zambia was estimated at 24%. Women aged 25–29 years, 30–34 years, and 35 years or older had significantly higher odds of grand multiparity compared to women aged 15–24 years, with the highest odds observed in women aged 35 years or older (aOR=56.31, 95% CI: 11.626–272.780). Women with a first birth at age 25 years or older were 86% less likely to experience grand multiparity (aOR=0.14, 95% CI: 0.084–0.238). Higher education and wealth were protective factors, with women who attained secondary education (aOR=0.28, 95% CI: 0.182–0.418) and higher education (aOR=0.09, 95% CI: 0.046–0.174) having reduced odds of grand multiparity. Women from richer households were also less likely to experience grand multiparity (aOR=0.48, 95% CI: 0.337–0.701). Rural residence (aOR=1.46, 95% CI: 1.111–1.911) and contraceptive use (aOR=1.29, 95% CI: 1.074–1.545) were associated with increased odds of grand multiparity. Women with shorter birth intervals (less than 24 months) were almost three times more likely to be grand multiparous (aOR=2.74, 95% CI: 1.741–4.326). The findings underscore the complex interplay of socio-demographic factors in shaping reproductive patterns in Zambia. Strategies to reduce grand multiparity should consider promoting delayed marriage, increasing access to education and addressing rural-urban disparities in healthcare access and family planning services.

Globally, 12 million girls aged 15–19 give birth each year, and Africa hosts 19% of youth aged 15–24. In Zambia, 29% of adolescents experience childbirth, with variations by age. Projections suggest a continued rise in these trends by 2030. Zambia came up with Adolescent Health Strategic Plan 2011–2015 among the specific policies being advocated for was Adolescent-Friendly Health Services (ADFHS) in order to mitigate among others adolescent fertility. The study aims to investigate socio-economic disparities and predictors of fertility in Zambian adolescents aged 15 to 19. The study used a cross-sectional study design utilized the 2018 Zambia Demographic Health Survey (ZDHS). The variable of interest in this study is “total number of children ever born” among adolescents aged 15 to 19 years. The explanatory variables that were used in the study were demographic, socio-economic, behavioral and community level factors. The Rao–Scott Chi-square test was used to test for association between categorical variables. Determinants of adolescent fertility were identified through a multilevel ordinal logistic regression conducted at a significance level of 5%. Analysis in the study was carried out using Stata version 14.2. A total of 3,000 adolescents were involved in the study, revealing that 75.88% had not given birth, 21.14% had one child, and 2.98% had at least two children. The findings revealed that education played a protective role, with adjusted odds ratios (AOR) of 0.47 (95% CI, 0.23–0.97), 0.21 (95% CI, 0.10–0.47), and 0.03 (95% CI, 0.00–0.54) for primary, secondary, and tertiary education, respectively. On the other hand, certain factors were associated with an elevated risk of fertility. These included the age of adolescents, educational attainment, marital status, wealth index, contraceptive use, exposure to family planning (FP) messages, being educated about FP at health facilities, and age at first sexual encounter. Among contextual factors, only community age at first birth was identified as a predictor of fertility, AOR, 1.59 (95% CI, 1.01–2.52). The study highlights sociodemographic disparities in adolescent fertility, emphasizing the need for targeted sexual reproductive health policies. Education protects against having more than one child, while marital status significantly influences fertility, particularly for married adolescents. The research provides valuable insights into the complex factors shaping adolescent fertility in Zambia, offering guidance for interventions and policies to support this vulnerable demographic.

Background Annually, 12 million girls aged 15-19 give birth globally, with Africa hosting 19% of the youth aged 15-24. Zambia sees 29% of adolescents experiencing childbirth, with notable variations among age groups. Predictors of adolescent fertility include age, residential area, education, contraceptive use, and socioeconomic status. Studies emphasize increased health risks for adolescent mothers, including eclampsia and systemic infections, while infants face elevated risks such as low birth weight and severe neonatal conditions. Projections anticipate a continued rise in these trends by 2030. Method The analysis utilized the 2018 Zambia Demographic Health Survey (ZDHS). The association between dependent and independent variables was assessed using the Rao–Scott Chi-square test. Determinants of adolescent fertility were identified through a multilevel ordinal logistic regression conducted at a significance level of 5%. Graphs were generated using Excel, and the analysis was carried out using Stata version 14.2. Results A total of 3,112 adolescents were involved in the study, revealing that 75.88% had not given birth, 21.14% had one child, and 2.98% had at least two children. The findings revealed that education played a protective role, with adjusted odds ratios (AOR) of 0.47 (95% CI, 0.23 – 0.97), 0.21 (95% CI, 0.10 – 0.47), and 0.03 (95% CI, 0.00 – 0.54) for primary, secondary, and tertiary education, respectively. On the other hand, certain factors were associated with an elevated risk of fertility. These included the age of adolescents, educational attainment, marital status, wealth index, contraceptive use, exposure to family planning (FP) messages, being educated about FP at health facilities, and age at first sexual encounter. Among contextual factors, only community age at first birth was identified as a predictor of fertility, AOR, 1.59 (95% CI, 1.01 – 2.52). Conclusion The study highlights sociodemographic disparities in adolescent fertility, emphasizing the need for targeted sexual reproductive health policies. Education protects against having more than one child, while marital status significantly influences fertility, particularly for married adolescents. The research provides valuable insights into the complex factors shaping adolescent fertility in Zambia, offering guidance for interventions and policies to support this vulnerable demographic.