Direct and Indirect Effects of Adolescent Motherhood on Under-Five Mortality in Pakistan: Evidence From a Nationally Representative Survey

IF 1.9 4区医学 Q1 ANTHROPOLOGY

American Journal of Human Biology Pub Date : 2026-09-07 DOI:10.1002/ajhb.70332

Naeem Rabbani, Zhongliang Zhou, Rashed Nawaz, Neelum Khalid

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引用次数: 0

Abstract

Background

Adolescent motherhood is associated with adverse child survival outcomes, particularly in low- and middle-income settings. Maternal and child health (MCH) service utilization may represent an important pathway linking adolescent motherhood with child survival, but evidence from Pakistan remains limited. This study examined the association between adolescent motherhood and under-five mortality and assessed the statistical indirect association through MCH service utilization.

Methods

We analyzed nationally representative data from the 2018 Pakistan Demographic and Health Survey, including 8159 mother–child observations. Under-five mortality was examined as a time-to-event outcome. We used multivariable generalized structural equation modeling with a Weibull proportional hazards specification to estimate associations between adolescent motherhood, MCH service utilization, and under-five mortality. We constructed the MCH service utilization index from indicators of antenatal care, skilled delivery care, and postnatal care. Indirect associations were evaluated using 5000 bootstrap replications and 95% bias-corrected bootstrap confidence intervals. All analyses were conducted using STATA version 17.1.

Results

Overall, 4.09% of children died before age five, and 37.55% were born to adolescent mothers. After adjustment for prespecified covariates, adolescent motherhood was associated with higher under-five mortality (HR = 2.05, p < 0.001) and lower MCH service utilization (β = −0.02, p = 0.044). Higher MCH service utilization was associated with lower under-five mortality (HR = 0.26, p < 0.001). After accounting for MCH service utilization, adolescent motherhood remained associated with higher under-five mortality (HR = 1.99, p < 0.001). The indirect association through MCH service utilization was positive and statistically supported (β = 0.0223; bootstrap SE = 0.0103; 95% [BCCI: 0.0038–0.0398]).

Conclusion

Adolescent motherhood was associated with higher under-five mortality and lower MCH service utilization, while greater MCH service utilization was associated with lower under-five mortality. The findings suggest that differences in MCH service utilization account for part of the observed association between adolescent motherhood and under-five mortality. Improving access to and utilization of MCH services, alongside interventions addressing adolescent pregnancy and broader social determinants of child health, may contribute to improved child survival in Pakistan.

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巴基斯坦青少年母亲对五岁以下儿童死亡率的直接和间接影响：来自全国代表性调查的证据。

背景：青少年母亲与不良的儿童生存结果有关，特别是在低收入和中等收入环境中。妇幼保健服务的利用可能是将青少年孕产与儿童生存联系起来的重要途径，但来自巴基斯坦的证据仍然有限。本研究考察了青少年母亲与五岁以下儿童死亡率之间的关系，并通过妇幼保健服务的利用评估了统计上的间接关联。方法：我们分析了2018年巴基斯坦人口与健康调查中具有全国代表性的数据，包括8159名母婴观察结果。将五岁以下儿童死亡率作为事件发生时间的结果进行检查。我们使用多变量广义结构方程模型和威布尔比例风险规范来估计青少年母亲、妇幼保健服务利用和五岁以下儿童死亡率之间的关系。我们从产前护理、熟练分娩护理和产后护理三个指标构建妇幼保健服务利用指数。使用5000次自举重复和95%偏差校正自举置信区间评估间接关联。所有分析均使用STATA 17.1版本进行。结果：总体而言，4.09%的儿童在5岁前死亡，37.55%的儿童是由青少年母亲所生。在调整了预先设定的协变量后，青少年母亲与较高的5岁以下儿童死亡率相关（HR = 2.05, p）。结论：青少年母亲与较高的5岁以下儿童死亡率和较低的妇幼保健服务利用率相关，而较高的妇幼保健服务利用率与较低的5岁以下儿童死亡率相关。研究结果表明，妇幼保健服务利用的差异是观察到的青春期母亲与五岁以下儿童死亡率之间关联的部分原因。改善妇幼保健服务的获取和利用，同时采取措施解决青少年怀孕问题和儿童健康的更广泛的社会决定因素，可能有助于改善巴基斯坦的儿童存活率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Human Biology 生物-生物学

CiteScore

4.80

自引率

13.80%

发文量

124

审稿时长

4-8 weeks

期刊介绍： The American Journal of Human Biology is the Official Journal of the Human Biology Association. The American Journal of Human Biology is a bimonthly, peer-reviewed, internationally circulated journal that publishes reports of original research, theoretical articles and timely reviews, and brief communications in the interdisciplinary field of human biology. As the official journal of the Human Biology Association, the Journal also publishes abstracts of research presented at its annual scientific meeting and book reviews relevant to the field. The Journal seeks scholarly manuscripts that address all aspects of human biology, health, and disease, particularly those that stress comparative, developmental, ecological, or evolutionary perspectives. The transdisciplinary areas covered in the Journal include, but are not limited to, epidemiology, genetic variation, population biology and demography, physiology, anatomy, nutrition, growth and aging, physical performance, physical activity and fitness, ecology, and evolution, along with their interactions. The Journal publishes basic, applied, and methodologically oriented research from all areas, including measurement, analytical techniques and strategies, and computer applications in human biology. Like many other biologically oriented disciplines, the field of human biology has undergone considerable growth and diversification in recent years, and the expansion of the aims and scope of the Journal is a reflection of this growth and membership diversification. The Journal is committed to prompt review, and priority publication is given to manuscripts with novel or timely findings, and to manuscripts of unusual interest.