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      ENTRY INTO MOTHERHOOD AMONG ADOLESCENT GIRLS IN TWO INFORMAL SETTLEMENTS IN NAIROBI, KENYA

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          Summary

          The contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15–19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan–Meier estimates and Cox regression models. About 15% of these adolescents have had a child. The findings show that marriage, being out of school and having negative models in peer, family and school contexts are associated with early childbearing among females aged 15–17 years. For adolescents aged 18–19 years, school attendance considerably delays entry into motherhood while marriage hastens its timing. Furthermore, older adolescents with high levels of social controls (parental monitoring or perceived peer orientation to or approval of prosocial behaviours) and individual controls (high religiosity and positive orientation to schooling) are likely to delay childbearing. Programmes aiming to reduce risky sexual behaviours that could lead to childbearing among adolescents should be introduced very early, and before the onset of sexual activity. Also, the findings underscore the need to identify and address the risky factors and reinforce the protective ones in order to improve sexual and reproductive health outcomes of adolescent girls in Nairobi slum settlements.

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          The effects of race/ethnicity, income, and family structure on adolescent risk behaviors.

          The study examined the unique and combined contributions of race/ethnicity, income, and family structure to adolescent cigarette smoking, alcohol use, involvement with violence, suicidal thoughts or attempts, and sexual intercourse. Analyses were based on the National Longitudinal Study of Adolescent Health. A nationally representative sample of 7th to 12th graders participated in in-home interviews, as did a resident parent for 85.6% of the adolescent subjects. The final sample included 10,803 White, Black, and Hispanic 7th to 12th graders. White adolescents were more likely to smoke cigarettes, drink alcohol, and attempt suicide in the younger years than were Black and Hispanic youths. Black youths were more likely to have had sexual intercourse; both Black and Hispanic youths were more likely than White teens to engage in violence. Controlling for gender, race/ethnicity, income, and family structure together explained no more than 10% of the variance in each of the 5 risk behaviors among younger adolescents and no more than 7% among older youths. Findings suggest that when taken together, race/ethnicity, income, and family structure provide only limited understanding of adolescent risk behaviors.
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            Provision and use of maternal health services among urban poor women in Kenya: what do we know and what can we do?

            In sub-Saharan Africa, the unprecedented population growth that started in the second half of the twentieth century has evolved into unparalleled urbanization and an increasing proportion of urban dwellers living in slums and shanty towns, making it imperative to pay greater attention to the health problems of the urban poor. In particular, urgent efforts need to focus on maternal health. Despite the lack of reliable trend data on maternal mortality, some investigators now believe that progress in maternal health has been very slow in sub-Saharan Africa. This study uses a unique combination of health facility- and individual-level data collected in the slums of Nairobi, Kenya to: (1) describe the provision of obstetric care in the Nairobi informal settlements; (2) describe the patterns of antenatal and delivery care, notably in terms of timing, frequency, and quality of care; and (3) draw policy implications aimed at improving maternal health among the rapidly growing urban poor populations. It shows that the study area is deprived of public health services, a finding which supports the view that low-income urban residents in developing countries face significant obstacles in accessing health care. This study also shows that despite the high prevalence of antenatal care (ANC), the proportion of women who made the recommended number of visits or who initiated the visit in the first trimester of pregnancy remains low compared to Nairobi as a whole and, more importantly, compared to rural populations. Bivariate analyses show that household wealth, education, parity, and place of residence were closely associated with frequency and timing of ANC and with place of delivery. Finally, there is a strong linkage between use of antenatal care and place of delivery. The findings of this study call for urgent attention by Kenya's Ministry of Health and local authorities to the void of quality health services in poor urban communities and the need to provide focused and sustained health education geared towards promoting use of obstetric services.
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              Adolescent childbearing in developing countries: a global review.

              S. Singh (1998)
              This article discusses the current levels and recent trends in the rate of adolescent childbearing, the timing of the first birth, and births to unmarried women for 43 developing countries. Differences in rates of adolescent childbearing by residence and level of education are also examined. The analysis is based on nationally representative fertility surveys. Substantial declines in adolescent fertility have occurred in North Africa and Asia, but levels are still high in some countries. Declines are beginning to occur in sub-Saharan Africa, but current levels are still high in most countries of this region, and the proportion of births to unmarried adolescents is increasing in some countries. In Latin America, where the level of teenage childbearing is moderate, declines are less prevalent and some small increases have occurred. Higher education is associated with lower rates of adolescent childbearing, but other socioeconomic changes cancel or reduce this effect in several countries.
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                Author and article information

                Journal
                J Biosoc Sci
                J Biosoc Sci
                JBS
                Journal of Biosocial Science
                Cambridge University Press (Cambridge, UK )
                0021-9320
                1469-7599
                November 2013
                21 May 2013
                : 45
                : 6
                : 721-742
                Affiliations
                [* ]African Population and Health Research Center (APHRC) , Nairobi, Kenya
                []Strategic Planning, Monitoring & Evaluation Section, United Nations Children's Fund (UNICEF), Kenya
                Author notes
                [1 ]Corresponding author. Email: dbeguy@ 123456aphrc.org
                Article
                S0021932013000199 00019
                10.1017/S0021932013000199
                3785175
                23688912
                aaefbf8c-17e5-471c-bf03-0cfac69157ba
                © Cambridge University Press 2013

                The online version of this article is published within an Open Access environment subject to the conditions of the Creative Commons Attribution-NonCommercial-ShareAlike licence < http://creativecommons.org/licenses/by-nc-sa/3.0/>. The written permission of Cambridge University Press must be obtained for commercial re-use.

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