Marriage, schooling and poverty shape teen births in Mozambique, survey finds

Adolescent girls in Mozambique who are married, older, or living in large households with limited access to basic utilities face markedly higher odds of having given birth before age 20, according to a new analysis of nationally representative survey data. The study, published in Discover Public Health, used the 2022–2023 Mozambican Demographic and Health Survey to identify which socioeconomic and demographic factors are associated with early childbearing among girls aged 15 to 19. Its central findings are striking: currently married adolescents had roughly eleven times the odds of early childbearing compared with those who had never married, formerly married adolescents nearly nineteen times the odds, and girls with secondary or higher education had about a fifth the odds of their peers without schooling.

The research team, led by Tshaudi Motsima, analysed responses from 3,027 adolescent girls drawn from the women’s individual recode dataset of the Demographic and Health Survey. The survey, a cross-sectional nationwide exercise, sampled 619 enumeration areas and selected 16,045 households, of which 14,250 were interviewed, yielding 13,183 female participants overall. After excluding 82 adolescents who were not de jure residents, the study sample was restricted to girls aged 15 to 19. Early childbearing was operationalised as a binary outcome based on self-reported age at first live birth: respondents who reported a first birth at age 19 or younger were coded as having experienced early childbearing, while those who had never given birth were coded as not. The authors deliberately used age at first live birth rather than age at first pregnancy, since pregnancies begun in adolescence can end in births after the adolescent period, a choice intended to minimise misclassification.

Statistically, the investigators fitted a multivariable binary logistic regression model, entering all candidate covariates simultaneously to control for potential confounding. The analysis applied sampling weights to adjust for unequal probabilities of selection and differential non-response, and multicollinearity among the independent variables was checked with variance inflation factors, which ranged from 1.02 to 1.79, well below the conventional threshold of 5.0. Adjusted odds ratios with 95 percent confidence intervals were estimated, and associations were deemed significant at the five percent level. All analyses were performed in STATA 18.

The descriptive picture underscores how concentrated early childbearing is among certain groups. Within the sample, whose average age was 17.1 years and whose average household size was 6.4 members, the highest prevalence of early childbearing appeared among formerly married adolescents at 81.7 percent and currently married adolescents at 67.6 percent. Prevalence was also elevated among girls from poor households at 44.5 percent, those with no formal education at 44.2 percent, and those with primary education at 39.2 percent. At the other extreme, the lowest prevalence was recorded among adolescents from households with access to all utilities, at 3.2 percent, and among those who had never married, at 8.0 percent.

In the adjusted model, several factors were associated with increased odds of early childbearing: being an older adolescent (adjusted odds ratio 1.71), living in a larger household (odds ratio 1.07 per member), being currently in a union (odds ratio 10.9), being formerly married (odds ratio 19.42), lacking access to all utilities (odds ratio 2.93), using contraceptives (odds ratio 2.86), and having limited exposure to television and radio (odds ratio 1.67). Household wealth status, employment status, housing type, and place of residence were not significantly associated with the outcome once other variables were controlled.

Several associations ran in the opposite direction. Having secondary or higher education (odds ratio 0.21), desiring one to two children (odds ratio 0.34), desiring three or more children (odds ratio 0.48), being undecided about having children (odds ratio 0.36), having no contraceptive knowledge (odds ratio 0.34), and not visiting a health facility in the previous twelve months (odds ratio 0.38) were each linked to lower odds of early childbearing. The authors frame these results through the Social Ecological Framework, which situates individual behaviour within nested personal, relationship, community, and societal levels; education and fertility desires sat at the individual level, household size and marital status at the interpersonal level, and utility access and health facility use at the community or institutional level.

Three of the significant findings are, on their face, counterintuitive, and the authors are careful about how they interpret them. Contraceptive use, contraceptive knowledge, and recent health facility visits were all associated with higher odds of early childbearing, the reverse of what one might expect if these were purely protective behaviours. Because the Demographic and Health Survey is cross-sectional, collecting data at a single point in time, the study cannot establish temporal order. The authors explicitly discuss reverse causation as a plausible explanation: adolescents who have already given birth may subsequently acquire contraceptive knowledge or adopt contraception through contact with antenatal and postnatal services, and those who have given birth are inherently more likely to have visited a health facility during pregnancy. They also note that unmeasured factors such as education, socioeconomic status, and service access may have confounded these relationships, and that some adolescents may not yet have been sexually active or in contact with health services at all.

The interpretation of the education and fertility-desire findings is similarly cautious. Girls with secondary or higher education showed substantially lower odds of early childbearing, a pattern the authors attribute in part to the entanglement of poverty, low education, and early marriage; adolescents with more schooling may also possess greater reproductive health knowledge and stronger skills to negotiate protective sexual behaviour. Somewhat unexpectedly, desiring children, whether one to two or three or more, and being undecided about future children were associated with lower odds, which the authors suggest may reflect future aspirations, including educational ambitions, and more cautious sexual behaviour among girls who have not yet completed their families of origin in their own timing. Marriage, by contrast, carries strong social expectations of childbearing, which the authors offer as a partial explanation for the very large odds ratios observed for married and formerly married adolescents.

The study’s strengths lie in its use of recent, nationally representative data, allowing generalisation across Mozambique, and in its use of weighted, adjusted logistic regression. Its limitations are acknowledged plainly: the DHS relies on respondent recall, so some women may not remember the exact age at first birth or the timing of health facility visits, and the cross-sectional design limits temporal inference, particularly for contraceptive use, contraceptive knowledge, and recent health facility visits. The authors also situate their findings in a sobering regional context. Sub-Saharan Africa has the highest adolescent birth rates in the world, with 93 births per 1,000 girls aged 15 to 19, and roughly 24 percent of adolescent girls and young women in the region give birth before age 18. In Mozambique specifically, approximately 153 of every 1,000 adolescents aged 15 to 19 gave birth in 2023, according to World Bank figures cited in the paper. Adolescent childbearing carries documented health risks, including obstetric fistula, eclampsia, and elevated maternal mortality, as well as risks to infants such as preterm birth, low birth weight, and neonatal sepsis, alongside socioeconomic consequences including school dropout and persistent poverty.

On the basis of these associations, the authors point to policy levers rather than causal claims. They argue for making basic education through grade 12 affordable and accessible, strengthening school retention programmes such as Mozambique’s Eu Sou Capaz initiative, expanding adolescent sexual and reproductive health education particularly for married or formerly married adolescents, improving access to electricity, piped water, and flush toilets in disadvantaged areas, and enforcing the country’s anti-child marriage law, which prohibits marriages or unions involving anyone under 18. Because the study measured associations at one point in time rather than testing interventions, the authors present these as evidence-informed directions for policymakers aiming to reduce adolescent births and to help Mozambique progress toward Sustainable Development Goal indicator 3.7.2, which tracks adolescent birth rates, rather than as proven prescriptions.

Subject of Research: Factors associated with early childbearing among Mozambican adolescents aged 15–19, analysed using the 2022–2023 Mozambican Demographic and Health Survey

Article Title: Factors associated with early childbearing among adolescents aged 15–19 in Mozambique

Article References: Motsima, T. (2026). Factors associated with early childbearing among adolescents aged 15–19 in Mozambique. Discover Public Health, 23(1), 1729. https://doi.org/10.1186/s12982-026-02805-1

Image Credits: AI Generated

DOI: 10.1186/s12982-026-02805-1

Keywords: Mozambique, early childbearing, adolescent health, Demographic and Health Survey, logistic regression, sub-Saharan Africa, education, child marriage, contraception, public health, cross-sectional study, social ecological framework