Fertility Behaviour of Adolescent Mothers in Northern Nigeria and Neonatal Mortality Risk: Mediating Effect of Quality Maternal Health Services

Abstract

Background: Despite rising prevalence of high-risk birth and adverse birth outcome among adolescent mothers in Nigeria, there is paucity of studies relating childhood mortality risk with fertility behaviour of adolescent mothers. This study examines fertility behaviour of adolescent mothers in northern Nigeria and neonatal mortality risk. Methods: Data were derived by pooling together the three most recent Nigeria Demographic and Health Surveys (NDHS, 2008, 2013 and 2018). The sample size comprises of weighted sample of 3,739 adolescent mothers 15-19 years with 5, 274 live births for the period under consideration. Survival analysis (cox proportional hazard model) was used to estimate the hazard of neonatal mortality risk as a result of risky fertility behaviour. Results: Quality of maternal health service utilization was poor among (73.0%) of the adolescent mothers. The independent effect of adolescent fertility behaviour revealed a rise in hazard for neonatal mortality, with increasing high risk fertility behaviour, single high-risk (HR=2.69, p<0.001) and multiple high risk (HR=6.04, p<0.001). Adjusting for quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though the result did not reach statistical significance (p>0.05). Adjusting for maternal, child characteristics and quality of maternal health service utilization, resulted in reduced hazard for neonatal mortality, though, the effect of risky fertility behaviour remained insignificant. Multiple birth babies were however, associated with elevated hazard for neonatal mortality (HR=11.4, p<0.05) relative to single birth babies. Conclusion: Adolescent fertility behaviour was associated with elevated hazard for neonatal mortality.