Individual-, family-, and neighbourhood-level effects on adolescent childbearing in KwaZulu-Natal, South Africa: A multilevel analysis
Description
The persisting high level of adolescent pregnancy and childbearing in South Africa is a major concern for national public health and social policies. Accordingly, reducing the incidence of teen pregnancy and childbearing is one the priorities of the South African national adolescent reproductive health program. To inform teen pregnancy prevention program managers and policy makers about their needs, research on the risk and protective factors associated with teenage childbearing is necessary. Based on a framework that places adolescent childbearing under the influence of contextual factors (e.g., peers, sexual partners, family, and community), this study investigates the influence of individual-, family-, and community-level characteristics on teenage childbearing among adolescents in KwaZulu-Natal, South Africa. Using a representative cross-sectional sample of African young women from the Transitions to Adulthood Study (2001), the study found that the individual-level factors associated with higher risk of childbirth among the sexually initiated respondents were comparatively earlier age at sexual debut, being single compared to being married or cohabiting with a boyfriend, comparatively low education, and not using contraceptives during first sex. Among the household-level factors, larger household size was associated with higher risk of childbirth. Among the community-level factors, comparatively socio-economically well-off neighbourhoods were associated with lower risk of childbirth among respondents from wealthier households. Additionally, higher level of participation by community members in local social activities, which indicates higher level of social capital, was associated with lower risk of childbirth; this effect is also limited to respondents from wealthier households. Contrary to expectations, however, comparatively high level of support and trustworthiness among adults in the community was associated with higher risk of childbirth. The individual-level factors explained the major portion of the explainable variances in reported childbearing among the study sample, while the rest of the variances were explained with equal contribution by the household- and community-level factors. No significant unobserved household- or community-level influence on adolescent childbearing was detected. The results of the study have implications for the teen pregnancy prevention program and social policy, as well as future research needs