Socio-economic disparities and predictors of fertility among adolescents aged 15 to 19 in Zambia: Evidence from the Zambia demographic and health survey (2018)

Background Annually, 12 million girls aged 15-19 give birth globally, with Africa hosting 19% of the youth aged 15-24. Zambia sees 29% of adolescents experiencing childbirth, with notable variations among age groups. Predictors of adolescent fertility include age, residential area, education, contraceptive use, and socioeconomic status. Studies emphasize increased health risks for adolescent mothers, including eclampsia and systemic infections, while infants face elevated risks such as low birth weight and severe neonatal conditions. Projections anticipate a continued rise in these trends by 2030. Method The analysis utilized the 2018 Zambia Demographic Health Survey (ZDHS). The association between dependent and independent variables was assessed using the Rao–Scott Chi-square test. Determinants of adolescent fertility were identified through a multilevel ordinal logistic regression conducted at a significance level of 5%. Graphs were generated using Excel, and the analysis was carried out using Stata version 14.2. Results A total of 3,112 adolescents were involved in the study, revealing that 75.88% had not given birth, 21.14% had one child, and 2.98% had at least two children. The findings revealed that education played a protective role, with adjusted odds ratios (AOR) of 0.47 (95% CI, 0.23 – 0.97), 0.21 (95% CI, 0.10 – 0.47), and 0.03 (95% CI, 0.00 – 0.54) for primary, secondary, and tertiary education, respectively. On the other hand, certain factors were associated with an elevated risk of fertility. These included the age of adolescents, educational attainment, marital status, wealth index, contraceptive use, exposure to family planning (FP) messages, being educated about FP at health facilities, and age at first sexual encounter. Among contextual factors, only community age at first birth was identified as a predictor of fertility, AOR, 1.59 (95% CI, 1.01 – 2.52). Conclusion The study highlights sociodemographic disparities in adolescent fertility, emphasizing the need for targeted sexual reproductive health policies. Education protects against having more than one child, while marital status significantly influences fertility, particularly for married adolescents. The research provides valuable insights into the complex factors shaping adolescent fertility in Zambia, offering guidance for interventions and policies to support this vulnerable demographic.