Annals of African Medicine

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 21  |  Issue : 4  |  Page : 456--460

Marriage to first pregnancy interval and related factors among women in North Central Nigeria


Nkeiruka Ameh1, Adegboyega Moses Oyefabi2, Madugu Nana Hawwa1,  
1 Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, Kaduna State University, Kaduna, Nigeria

Correspondence Address:
Nkeiruka Ameh
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria

Abstract

Background: The age at which a woman gets married may affect the timing and occurrence of her first pregnancy as well as the total number of children she will have in her lifetime. Factors which affect the marriage to first pregnancy interval include the age at marriage of the woman, her educational level, and cultural and religious beliefs among others. This study seeks to find out the marriage to first pregnancy interval and factors that affect this interval as well as the average number of children of women in North Central Nigeria. Materials and Methods: This was a cross-sectional community survey utilizing structured questionnaires. Information on marriage to first pregnancy interval as well as related factors was obtained from 300 currently or ever-married women in Abuja, North Central Nigeria. Results: The women were aged 13–72 years (mean: 28.67 years); the mean age at first marriage was 21.57 years, and the mean age at first pregnancy was 22.48 years. Marriage to first pregnancy interval was <3 months in 68 (22.6%), 1 year in 86 (28.6%), and ≥2 years in 154 (51.3%). The mean number of children for 45 years and above was 4.5. Overall, women who are artisans were found to be more likely to have a pregnancy soon after marriage. Husband's place of residence, educational qualification of the woman, age at marriage, tribe, and religion did not significantly affect first marriage to first pregnancy interval. Conclusion: Women in this part of Nigeria marry in early adulthood and are likely to want to have their first pregnancy soon after marriage. This has social implications for population dynamics and planning.



How to cite this article:
Ameh N, Oyefabi AM, Hawwa MN. Marriage to first pregnancy interval and related factors among women in North Central Nigeria.Ann Afr Med 2022;21:456-460


How to cite this URL:
Ameh N, Oyefabi AM, Hawwa MN. Marriage to first pregnancy interval and related factors among women in North Central Nigeria. Ann Afr Med [serial online] 2022 [cited 2023 Jan 29 ];21:456-460
Available from: https://www.annalsafrmed.org/text.asp?2022/21/4/456/361261


Full Text



 Introduction



The time interval between a marriage and the first pregnancy affects the total fertility rate (TFR) of a region or country. First pregnancy in teenage years may cause a high fertility rate, whereas first pregnancy at 34 years may lead to reduced fertility.[1] The TFR for Nigeria dropped from 6.0 children per woman in 1990 to 5.7 in 2008.[2],[3] Urbanization and increased educational level of women were found to be contributory factors, as the proportion of births occurring in urban areas of Nigeria is only 30% of the total. Women above secondary education had a TFR of 2.9, whereas women with no education had a TFR of 7.3.[3],[4]

The aim of this study was to determine the marriage to first pregnancy interval and the related factors in a Nigerian population. This will form a basis for advocacy for inclusion of infertility management in the Primary Health Care Program of North Central Nigeria.

 Materials and Methods



Setting

Abuja is the Federal Capital of Nigeria, located in the North Central region of the country with an estimated population of 2.23 million from the 2011 National Population Council data, and is divided into six area councils.

Methods

This was a cross-sectional survey carried out in August 2016 using a pretested structured questionnaire. Systematic random sampling technique was used to select the population. By random sampling, three area councils (Bwari, Abuja Municipal, and Kuje) were chosen out of the six area councils. The sample size was calculated using the formula Z2 pq/d2 (where Z is standard normal deviation at 95% confidence interval = 1.96, p – prevalence of women who got pregnant within the first 3 months after marriage from another study,[5] q = 1–p, and d = precision limit [0.05]). The calculated sample size was 300. The sampling interval was determined by R = N/n 2,230,000/300 = 7.4 (where R = the sampling interval, N = the total population, and n = the required sample size). In every seventh house, consenting currently or ever-married women were interviewed until the sample size was attained. Questionnaires were administered by two trained interviewers for each of the area councils.

Participants

Consenting women who were currently or ever married participated in the study, whereas those who declined were excluded. There were no other exclusion criteria.

Ethical approval for the study was obtained from the National Health Research and Ethics Committee of the Federal Ministry of Health.

Data management

Data were analyzed using the Statistical Package for the Social Sciences SPSS version 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.). The level of statistical significance was set at a 95% confidence interval (P < 0.05).

 Results



Demographics

There were 300 respondents aged 13–72 years (mean age of 28.67 years) [Table 1]. Two hundred and seventy-four (91.3%) were married, 9 (3%) widowed, 6 (2%) separated, and 5 (1.7%) were divorced. One hundred and forty-six (48.7%) were from minor Nigerian tribes, 60 (20%) were Igbo, 44 (14.7%) Yoruba, 35 (11.7%) Hausa, and 15 (5%) Fulani. Two hundred and one (67%) were Christians, 90 (30%) Muslims, and 9 (3%) other religions.{Table 1}

One hundred and twenty-seven respondents (42.3%) had tertiary education, 105 (35%) secondary education, 38 (12.7%) primary education, 24 (8%) no formal education, and 6 (2%) had other forms of education. One hundred and thirteen (37.7%) were traders, 98 (32.7%) housewives, 64 (21%) civil servants, and 26 (8.7%) artisans.

Marriage, pregnancy, and living children

Two hundred and forty-two respondents (90.3%) were in monogamous marriages, 29 (9.7%) polygamous, and 29 (9.7%) were divorced. The age at first marriage and the age at first pregnancy are summarized in [Table 2]. The mean age at first marriage was 21.57 years (range: 13–34 years), whereas the mean age at first pregnancy was 22.8 years (range: 13–39 years). Two hundred and sixty-eight respondents (89.3%) conceived their pregnancies naturally, 24 (8%) were not naturally conceived, while 8 (2.7%) did not specify the nature of conception. Two hundred and sixty-one (72%) of the pregnancies were wanted, 16 (5.3%) were unwanted, whereas 68 (22.7%) were undecided on whether they wanted the pregnancy or not. The average number of children was 3.2; 19 respondents (6.3%) had no children, 110 (36.7%) had 1‒2 children, 113 (37.7%) had 3–4 children, 44 (14.7%) had 5–6 children, 12 (4%) had 7–8 children, and 2 (0.6%) had 9–10 children. Women in the age group of ≥45 years had an average of 4.5 children.{Table 2}

Marriage to first pregnancy interval

The marriage to first pregnancy interval is summarized in [Figure 1]. Sixty-eight respondents (22.6%) had conceived by the first 3 months after marriage and another 86 (28.6%) had conceived by the end of the 1st year. By the 2nd year of marriage, 154 (51.3%) had conceived.{Figure 1}

Contraception and sexual practice

Two hundred and two (67.3%) did not use contraceptives before their first pregnancy, 67 (22.3%) did not specify, and 31 (10.3%) used contraceptives. Two hundred and twenty (73.3%) did not delay their first pregnancy, 47 (15.7%) delayed, and 33 (11%) did not specify. The methods of delaying pregnancy were natural 8 (2.7%), injectables 4 (1.3%), intrauterine device and pills, 3 each (1%), implant, condom, and withdrawal-1 each (0.3%).

Two hundred and forty-six of the respondents (82%) resided in the same house with their husbands, whereas 54 (18.0%) resided in a different town/state. Twenty-two (7.3%) had sexual intercourse with their husbands once/week, 126 (42%) 2–3 times/week, 127 (42.3%) more than 3 times/week, 15 (5%) once in 4 weeks, and 10 (3.4%) less frequently than once in a month.

Treatment for infertility and effect on marriage

Fifty-nine respondents (19.7%) were seeking treatment for infertility at the time of the survey; 49 (16.3%) were seeking hospital treatment, 13 (4.3%) traditional, and 9 (3%) spiritual treatment. Thirty-five (11.7%) were experiencing the following due to infertility: divorce 10 (3.3%), separation 7 (2.3%), bitterness 10 (3.3%), shame 10 (3.3%), and domestic violence 3 (1%). All the 49 seeking treatment for infertility had secondary infertility, having been previously pregnant.

Factors affecting the timing of pregnancy

Overall, respondents who are artisans were found to be more likely to have a pregnancy soon after marriage [Table 3]. Factors such as husband's place of residence, tribe, religion, educational qualification, and marriage type did not significantly affect the marriage to first pregnancy interval.{Table 3}

 Discussion



The age at which a woman gets married and has her first childbirth affects the fertility rate of a country.[4] The earlier the marriage and pregnancy, the higher the TFR. Majority of the women in this present study were aged 23–32 years, which is the most fertile period of a woman's life.[2],[4] The demographics from the present report are similar to the findings of the 2013 National Demographic and Health Survey for Nigeria.[2],[4]

Majority of the respondents got married in early adulthood, followed by teenage years with only a few marrying from 30 years and above. This age is later than that from a Ugandan and Southwest Nigerian study where most of the women got married as teenagers, but earlier than an American study which reported women were likely to get married in their thirties.[6],[7],[8] The implication of this finding is that women in the present North Central Nigeria are likely to have an average family size.

While majority of the respondents were educated to secondary and tertiary levels, a few were civil servants. This may be related to the high level of government unemployment in the country, which has made the women with secondary- and tertiary-level education to settle for self-employment. This is important because the level of education of a woman as well as her employment and income status affect the age of marriage and first pregnancy.[9],[5] Those with higher education and income marry later but tend to get pregnant soon after.

Marriage to first pregnancy interval in the present survey was within the first 1 year in 49.4% of the respondents which is higher than the findings of a Chinese study where only a proportion of women became pregnant within their 1st year of marriage. Unlike the Chinese study where 21% of the first pregnancies were unintended, 72% of the first pregnancies in the present survey were intended and 89.3% were by natural conception.[10] Only 20 (6.7%) women in our report used contraceptives after marriage and only 15.7% delayed their first pregnancy intentionally unlike reports from Iran and India where newly married women routinely used contraceptives to delay their first pregnancy.[11],[12] This behavior may be related to the value placed on pregnancy after marriage in our setting as in most African countries,[5],[13],[14] where a couple is expected to prove their fertility at least 9 months from the wedding date. Failure to do so can result in parental anxiety, with the female partner being the most accused.[15] Studies from other parts of the world have shown that women who marry at later ages are likely to marry by choice and want to prove their fertility soon afterward.

As expected, respondents who resided in the same house with their husbands were likely to have a short marriage to first pregnancy interval. This is important because some husbands and wives stay in different houses or towns after marriage with a possibility of reduced conception rate from inadequate frequency of coitus.[14] Most of the women in our survey had adequate coitus of 2–3 times weekly. Studies from other parts of Africa and the Middle East have shown that girls who have arranged marriages prefer to stay with their parent in-laws to avoid consummating the marriage resulting in a long marriage to first pregnancy interval, whereas those who married in later years and a partner of their choice consummate early.[16],[17]

Our survey has shown that most respondents had 1–4 children with a mean of 3.2 children. Women aged ≥45 years had an average of 4.5 children, which is close to the 5.7 TFR of the region.[6] Most of the respondents had adequate coitus, but the infertility rate is high at 19%, indicating that it would be beneficial to include infertility treatment in primary health care programs.

 Conclusion



The women in this part of North Central Nigeria marry in early adult life and have their first pregnancy soon afterward. Given the high infertility rate and the cultural and social implications of infertility in sub-Saharan Africa, it is recommended that infertility counseling and treatment should be included in primary health care programs in the setting.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Gossett DR, Nayak S, Bhatt S, Bailey SC. What do healthy women know about the consequences of delayed childbearing? J Health Commun 2013;18 Suppl 1:118-28.
2National Population Commission of Nigeria. Nigeria Demographic and Health Survey 1999. National Population Commission and ORC/Macro, Calverton, Maryland; 2000. Available from: https://dhsprogram.com/pubs/pdf/FR115/FR115.pdf. [Last accessed on 2020 Sep 13].
3Nigeria Country Profile. The Department of Making Pregnancy Safer. Regional Highlights 2009. Geneva: World Health Organization; 2009. Available from: https://www.who.int/maternal_child_adolescent/documents/MPSProgressReport09-FINAL.pdf. [Last accessed on 2020 Sep 13].
4Preliminary Report of Nigeria Demographic and Health Survey 2008. National Population Commission, Nigeria and ORC Macro, Calverton, Maryland; 2008. Available from: https://www.dhsprogram.com/pubs/pdf/FR222/FR222.pdf. [Last accessed on 2020 Sep 13].
5Ayiga N, Rampagane V. Determinants of age at first marriage in sub-Saharan Africa: A comparative study of Uganda and South Africa. J Soc Dev Afr 2013;28:9-34.
6Agaba P, Atuhaire LK, Rutaremwa G. Determinants of Age at First Marriage among Women in Western Uganda. Available from: https://pdfs.semanticscholar.org/4295/473eb4c73b4b4afe5fb7ae85941ac8232e8a.pdf. [Last accessed on 2018 Jan 07].
7Payne KK. Median Age at First Marriage, 2010(FP- 12-07) NCF & MR. Available from: http://ncfmr.bgsu.edu/pdf/family_profiles/file 109824.pdf. [Last accessed on 2018 Jan 22].
8Adebowale SA, Fagbamigbe FA, Okareh TO, Lawal GO. Survival analysis of timing of first marriage among women of reproductive age in Nigeria: Regional differences. Afr J Reprod Health 2012;16:95-107.
9Oyefara JL. Age at first birth and fertility differentials among women in Osun state Nigeria. Eur Sci J 2012;8:139-63.
10Che Y, Cleland J. Unintended pregnancy among newly married couples in Shanghai. Int Fam Plan Perspect 2004;30:6-11.
11Abbasi-Shavazi MJ, Morgan SP, Hossein-Chavoshi M, McDonald P. Family change and continuity in Iran: Birth control use before first pregnancy. J Marriage Fam 2009;71:1309-24.
12Pandey A, Singh KK. Contraceptive use before first pregnancy by women in India (2005-2006): Determinants and differentials. BMC Public Health 2015;15:1316.
13Isiugo-Abanihe UC, Ebigbola JA, Adewuyi AA. Urban nuptiality patterns and marital fertility in Nigeria. J Biosoc Sci 1993;25:483-98.
14Begna Z, Assegid S, Kassahun W, Gerbaba M. Determinants of inter birth interval among married women living in rural pastoral communities of Southern Ethiopia: A case control study. BMC Pregnancy Childbirth 2013;13:116.
15Koster-Oyekan W. Infertility among Yoruba women: Perception on causes, treatments, and consequences. Afr J Reprod Health 1999;3:13-6.
16Gurma E, Etana D. Age at first marriage and first birth interval in Ethiopia: Analysis of the roles of social and demographic factors. Afr Popul Stud 2014;28:1332-44.
17MacQuarrie KL. Marriage and Fertility Dynamics: The Influence of Marriage Age on the Timing of First Birth and Birth Spacing. DHS Analytical Studies No. 56. Rockville, Maryland, USA: ICF International; 2016. Available from: https://dhsprogram.com/pubs/pdf/AS56/AS56.pdf. [Last accessed on 2020 Sep 13].