Exploring adolescent fertility inequality in Southern Africa

Background. Globally, adolescent fertility rates (AFR) vary widely, with stark inequality in the Southern African subregion. Orphanhood and parental absence are key social factors studied in relation to adolescent fertility, but research focusing on girls aged 15 - 19 years is constrained by the international age cap of 17 years for collecting direct orphanhood and living arrangement data. Objectives. To characterise fertility among adolescents largely excluded from research because of age restrictions in the data. Methods. The study uses the cross-sectional household-based Demographic and Health Survey (DHS) data for Southern Africa, defined according to both local and international geoschemes. It models parental absence and intrahousehold effects on fertility for adolescents aged 15 - 19 years old, using the fixed effects logistic regression, adjusting for inter-country differences. Results. The relationship between orphanhood, parental absence and rates of adolescent childbearing varied across countries. Parent absence was associated with a higher likelihood of childbearing (adjusted odds ratio (aOR) 3.07, p<0.05). Conversely, having an orphaned child(ren) in the household was associated with a 36% lower likelihood of childbearing, though not statistically significant. Compared with South Africa (SA), all the countries in the study showed significantly higher odds of adolescent childbearing (aOR 1.4 - 5.4, p<0.05). The probability of adolescents giving birth was generally lower when residing with orphaned children in the household, with Angola, Malawi and Zambia showing the highest differences, and SA the smallest. Conclusions. The study underscores the critical role of household living arrangements and parental absence in understanding and addressing adolescent fertility in Southern Africa. Addressing this issue necessitates a dual approach, encompassing interventions for adolescents in general and specifically targeting those with absent parents.