Age at initiation of childbearing and maternal healthcare utilisation in South and Southeast Asia: a multi-country analysis of demographic and health surveys

Raza Mohammad; Dhananjay W. Bansod

doi:10.18203/2394-6040.ijcmph20264236

Authors

Raza Mohammad Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India https://orcid.org/0000-0001-8316-3435
Dhananjay W. Bansod Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20264236

Keywords:

Age at first birth, Antenatal care, Maternal healthcare utilisation, Demographic and health surveys, South and Southeast Asia

Abstract

Background: Age at initiation of childbearing (AICB) may be associated with maternal healthcare utilisation. This study examined AICB patterns and their associations with maternal healthcare use across eight South and Southeast Asian countries.

Methods: Data were drawn from the latest available Demographic and Health Survey rounds in Bangladesh, India, Indonesia, Maldives, Nepal, Pakistan, the Philippines and Timor-Leste. The analysis included women aged 15-49 whose first live birth occurred within five years before the survey. AICB was classified as early (<20 years), mid (20-29 years) or late (≥30 years). Country-specific logistic regression models assessed the outcomes: four or more antenatal care (ANC) visits, first-trimester ANC, full ANC, institutional delivery and a postnatal check, adjusting for sociodemographic and partner-related characteristics.

Results: Mean AICB ranged from 19.98 years in Bangladesh to 24.38 years in Maldives. Early AICB was most prevalent in Bangladesh (54.3%) and Nepal (36.5%); late AICB was most common in the Philippines (15.0%) and Maldives (10.4%). Associations varied by country and outcome. Early AICB was associated with lower adjusted odds of four or more ANC visits in Bangladesh, Indonesia and Pakistan, and lower odds of first-trimester ANC in India, Indonesia, Nepal and the Philippines. Late AICB was associated with higher odds of full ANC in Bangladesh, India and Nepal. Postnatal care associations differed across countries.

Conclusions: Associations between AICB and maternal healthcare utilisation were heterogeneous across countries and service indicators. Context-specific strategies should address gaps in timely ANC, completion of recommended ANC components, institutional delivery and postnatal follow-up.

Author Biography

Dhananjay W. Bansod, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India

²Professor, Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India

References

Bloom DE, Trussell J. What are the determinants of delayed childbearing and permanent childlessness in the United States? Demography. 1984;21(4):591-611.

Lesthaeghe R. The Unfolding Story of the Second Demographic Transition. Population and Development Review. 2010;36(2):211-51.

Van De Kaa DJ. Europe’s second demographic transition. Popul Bull. 1987;42(1):1-59.

Liu L, Lu Y, Zhang P, Sun Y, Ma C, Li Y, et al. The Risk of Advanced Maternal Age: Causes and Overview. J Gynecological Res Obstet. 2020;6(1):019-23.

WHO. Adolescent pregnancy. 2022. Available at: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy. Accessed on 28 October 2026.

UNICEF. Early childbearing and teenage pregnancy rates by country. UNICEF DATA. 2024. Available at: https://data.unicef.org/topic/child-health/early-childbearing/. Accessed on 28 October 2026.

Hailu BA, Beyene J. Adolescent marriage, maternity, and limited access to education in 106 countries: Bayesian analysis of prevalence, trend, and prediction. Sci Rep. 2025;15(1):9584.

ICF. Funded by USAID. 2015. The DHS Program STATcompiler. Available at: http://www.statcompiler.com. Accessed on 28 October 2026.

UNFPA. STAte of world population 2019: Unfinished Business-the Pursuit of Rights and Choices for All. United Nations Publication; 2019. Available at: https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA_PUB_2019_EN_State_of_World_Population.pdf. Accessed on 28 October 2026.

Marphatia A, Amable G, Reid A. Women’s Marriage Age Matters for Public Health: A Review of the Broader Health and Social Implications in South Asia. Frontiers in Public Health. 2017;5:269.

Scott S, Nguyen PH, Neupane S, Pramanik P, Nanda P, Bhutta ZA, et al. Early marriage and early childbearing in South Asia: trends, inequalities, and drivers from 2005 to 2018. Annals New York Academy Sci. 2021;1491(1):60-73.

Poudel S, Razee H, Dobbins T, Akombi-Inyang B. Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies. Int J Environmental Res Public Health. 2022;19(22):15004.

Poudel S, Dobbins T, Razee H, Akombi-Inyang B. Adolescent Pregnancy in South Asia: A Pooled Analysis of Demographic and Health Surveys. IJERPH. 2023;20(12):6099.

Subramanee SD, Agho K, Lakshmi J, Huda MdN, Joshi R, Akombi-Inyang B. Child Marriage in South Asia: A Systematic Review. IJERPH. 2022;19(22):15138.

Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2017;17:65.

Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(s1):40-8.

Rahman MdM, Taniguchi H, Nsashiyi RS, Islam R, Mahmud SR, Rahman S, et al. Trend and projection of skilled birth attendants and institutional delivery coverage for adolescents in 54 low- and middle-income countries, 2000-2030. BMC Med. 2022;20:46.

Rahman M, Hossain F, Islam R, Jung J, Mahmud SR, Hashizume M. Equity in antenatal care visits among adolescent mothers: An analysis of 54 country levels trend and projection of coverage from 2000 to 2030. J Glob Health. 2022;12:04016.

Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005;105(5 Pt 1):983-90.

Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod. 2000;15(11):2433-7.

Londero AP, Rossetti E, Pittini C, Cagnacci A, Driul L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth. 2019;19(1):261.

Yaman FK, Ezveci H, Dogru S, Harmanci MS, Bahçeci P, Gezginç K. The Impact of Advanced Maternal Age on Pregnancy Complications and Neonatal Outcomes. J Clin Med. 2025;14(15):5387.

Abedin S, Arunachalam D. Maternal autonomy and high-risk pregnancy in Bangladesh: the mediating influences of childbearing practices and antenatal care. BMC Pregnancy Childbirth. 2020;20:555.

Aguayo VM, Menon P. Stop stunting: improving child feeding, women’s nutrition and household sanitation in South Asia. Maternal Child Nutrit. 2016;12(S1):3-11.

Goli S, Rammohan A, Singh D. The Effect of Early Marriages and Early Childbearing on Women’s Nutritional Status in India. Matern Child Health J. 2015;19(8):1864-80.

Croft TN, Marshall AM, Allen CK, Arnold F, Assaf S, Balian S, et al. Guide to DHS statistics. Rockville: ICF. 2018;645.

UN. Age-Specific Fertility Rate, Total Fertility and Mean Age at Childbearing. United Nations publication: World Fertility Report 2012;2013. (Department of Economic and Social Affairs, Population Division). Available at: https://www.un.org/en/development/desa/population/publications/dataset/fertility/wfr2012/Metadata/Metadata_ASFR-TF-MAC.pdf. Accessed on 28 October 2026.