Date of Award

January 2016

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Anne Marie Jukic

Abstract

Abstract

Introduction

In Bangladesh, there is a high prevalence of child marriage, early initiation of childbirth, and high rates of undernutrition among adolescents. Pregnancy and childbirth pose unique risks for adolescents due to the intersection of reproductive and physical development.

Objective

This analysis sought to describe the relationship of parity and other reproductive exposures with nutritional outcomes for adolescents and older women ages 20-35 years, describing both the similarities and differences between the two age groups. The overall objective was to help inform improved adolescent health interventions and direct future needed research.

Methods

A secondary data analysis of the Bangladesh Demographic Health Survey 2011 was conducted. In all analyses, the complex survey design and appropriate weighting procedures were taken into account. The association of parity with anemia and underweight was described by bivariate analysis and logistic regressions, stratified by the age categories of adolescents and older women. Other reproductive exposures such as time since last birth, early adolescent versus later adolescent childbearing, and access to family planning were also assessed in relation to acute and chronic nutritional status using bivariate analysis and regression analysis. Adolescence was also evaluated as a possible effect modifier in all relevant analyses.

Findings

Of adolescents that were nulliparous, 32.4% (n=205) were underweight while 34.7% (n=286) of adolescents with one birth were underweight, and 44.8% (n=67) of adolescents with two births or more were underweight. The prevalence of underweight increased with parity for older women 20-35 years, similar to adolescents, but the absolute levels of underweight were much less. Parity was not found to be significant predictor of anemia or underweight for either adolescents or women ages 20-35 years. Adolescence was not found to be an effect modifier of the relationship of parity and anemia or underweight, but in the collapsed model for all women being an adolescent was associated with increased odds of being underweight of 76% (OR 1.76; 95% CI 1.47-2.11). For women 20-35 years, having given birth in the last 2 months was associated with an increased odds of anemia of 23% (OR 2.23; 95% CI 1.22-4.07). Among women ages 20-35, short stature was found to be significantly associated with a woman’s first birth occurring when she was an adolescent 15-19 years (p=0.0008). For older women ages 20-35 years, access to family planning was associated with a lower prevalence of underweight, but access to family planning was not associated with underweight for adolescents.

Conclusions

This analysis suggests that the relationship of parity and associated reproductive exposures with the acute nutritional outcomes of underweight and anemia differ for adolescents than for older women. In addition, this analysis also suggests that married women who do become parous during adolescence, and especially during early adolescence, face possible long-term negative effects on attained height. Overall, this study suggests that there is a need to improve the nutritional status of adolescents in the preconception and periconception stage. Family planning providers may be one pathway to begin targeting adolescents with nutritional interventions, but additional research is needed to identify cost-effective nutrition interventions for adolescents.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018

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