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The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia.

ABSTRACT: Global investments in girls' education have been motivated, in part, by an expectation that more-educated women will have smaller and healthier families. However, in many low- and middle-income countries, the timing of school dropout and first birth coincide, resulting in a rapid transition from the role of student to the role of mother for adolescent girls. Despite growing interest in the effects of pregnancy on levels of school dropout, researchers have largely overlooked the potential effect of adolescent childbearing on literacy and numeracy. We hypothesize that becoming a mother soon after leaving school may cause the deterioration of skills gained in school. Using longitudinal data from Bangladesh, Malawi, and Zambia, we test our hypothesis by estimating fixed-effects linear regression models to address the endogeneity in the relationship between childbearing and academic skills. To our knowledge, this is the first study to examine the effects of adolescent childbearing on academic skills in low- and middle-income countries. Our results indicate that among those with low levels of grade attainment, first birth has a negative effect on English literacy and numeracy. Among those with higher levels of grade attainment, we find little evidence of effects of childbearing on academic skills. Childbearing also has little effect on local language literacy. Beyond the immediate loss of English literacy and numeracy, if these skills lead to better health and more economic productivity, then adolescent childbearing may have longer-term repercussions than previously understood. In addition to ongoing efforts to increase educational attainment and school quality in low- and middle-income countries, investments are needed to strengthen the academic skills of adolescent mothers to secure the demographic and economic promise of expanded education for girls and women.

SUBMITTER: Psaki SR

PROVIDER: S-EPMC6797635 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia.

Psaki Stephanie R SR Soler-Hampejsek Erica E Saha Jyotirmoy J Mensch Barbara S BS Amin Sajeda S

Demography 20191001 5

Global investments in girls' education have been motivated, in part, by an expectation that more-educated women will have smaller and healthier families. However, in many low- and middle-income countries, the timing of school dropout and first birth coincide, resulting in a rapid transition from the role of student to the role of mother for adolescent girls. Despite growing interest in the effects of pregnancy on levels of school dropout, researchers have largely overlooked the potential effect ...[more]

PMID: 31502232

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Project description:ObjectivesBangladesh has one of the highest adolescent childbearing rates in South Asia, which prevent women from realizing their full potential in life. This study aimed to compare the prevalence and determinants of adolescent childbearing in Bangladesh using data from the 2014 and 2017-18 Bangladesh Demographic and Health Survey (BDHS).MethodsNationally representative surveys of respondents were selected using a two-stage sampling process. The study recruited 2,023 and 1,951 ever-married women aged 15-19 from 2014 and 2017-18 BDHS surveys, respectively, from rural and urban settings from all eight geographic divisions of Bangladesh. Univariate and multivariate logistic regression models were fit to determine the factors associated with adolescent childbearing.ResultThe adolescent childbearing prevalence rate was 30.8% in 2014 BDHS and 27.6% in 2017-18 BDHS. Marriage at age 13 years or less also reduced significantly in 2017-18 compared to 2014 (12.7% vs. 17.4%, respectively). Significantly higher odds of adolescent childbearing were found in 2014 among women in the Sylhet Division (adjusted odds ratio (AOR) = 3.0; 95% confidence interval (CI): 1.6-6.1) and the Chittagong Division (AOR = 1.8; 95% CI: 1.8-2.7) compared to the Barisal Region; however, in 2017, there were no significant differences was found across the geographic Divisions. Compared to women in the lowest wealth quintile, women in all other quintiles had lower odds of adolescent childbearing, with the lowest odds found among women in the wealthiest quintile (AOR = 0.3; 95% CI: 0.2-0.6). Women who married at age 14-17 had 60% lower odds of adolescent childbearing compared to the women who married at age 10-13.ConclusionNearly one-third of married adolescents in Bangladesh were pregnant or had at least one child in 2014, and it was reduced only marginally in 2017-18. Marriage at an early age and income inequalities among families were significant predictors of adolescent childbearing in Bangladesh. This study highlighted change in the magnitude and determinants of adolescent childbearing in Bangladesh taken data from two nationally representative surveys conducted 4 years apart.

Project description:BackgroundHealth coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.ObjectiveTo determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).DesignSecondary analysis of a randomized controlled trial.ParticipantsFour hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly.MethodsA single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy.ResultsThe coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04).ConclusionsWe suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.Gov identifierNCT01828567.

Project description:BackgroundNon-steroidal anti-inflammatory drugs are widely used and have a potential for over-the-counter misuse. Limited health literacy is associated with poor health outcomes. Identification of new strategies to assess literacy and numeracy could be useful in targeting effective education initiatives.ObjectiveTo characterize numeracy and literacy skills related to non-steroidal anti-inflammatory drug labels in primary care patients.MethodsPatients were recruited and consented over an 8-month period after their regular primary care visit. Demographic information was collected and two instruments were administered to assess literacy and numeracy skills: (1) a medication label literacy instrument focused on non-steroidal anti-inflammatory drugs (MedLit-NSAID) and (2) a general healthy literacy-screening tool, the Newest Vital Sign. Two questions on the MedLit-NSAID instrument evaluated understanding of the Food and Drug Administration medication guide for non-steroidal anti-inflammatory drugs and the Food and Drug Administration approved over-the-counter label.ResultsA total of 145 patients were enrolled. Mean MedLit-NSAID and Newest Vital Sign scores were 6.8 (scale range 0-8) and 4.2 (scale range 0-6), respectively. Higher education level was associated with higher scores for both tools (p ⩽ 0.05). Total MedLit-NSAID scores on average were higher in females compared with males (6.5 vs 6, p = 0.05). Patients with decreased kidney function (n = 18) had significantly lower MedLit-NSAID scores (p ⩽ 0.05). Test-retest scores were not significantly different for MedLit-NSAID (p = 0.32). The correlation between the tools was 0.54 and internal consistency MedLit-NSAID was 0.61.ConclusionA medication information focused instrument provided specific information to assess health literacy related to non-steroidal anti-inflammatory drug labels. This information could be utilized to develop patient education initiatives for medication label comprehension.

Dataset Information

The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia.

Publications

The Effects of Adolescent Childbearing on Literacy and Numeracy in Bangladesh, Malawi, and Zambia.

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