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Research Article

Predictors of age at first child’s birth and contraceptive use among men in Uganda

[version 1; peer review: 1 approved with reservations, 1 not approved]
PUBLISHED 12 Jun 2019
Author details Author details

This article is included in the International Conference on Family Planning gateway.

Abstract

Background: Globally, research on age at first child’s birth among men has been neglected especially in Africa. Consequently, little is known about its impact on male involvement in reproductive health. This paper examined the socio-demographic, economic and proximate predictors of age at first child’s birth among men aged 15-54 years in Uganda.
Methods: We used the 2016 Uganda Demographic and Health Survey (UDHS) on a sample of 3,206 men aged 15-54 years who had a biological child.  The outcome variable was age at first childbirth categorized as: below 17, 18-24 and 25 years and above (25+). Analysis was done using descriptive statistics,  un-adjusted and adjusted multinomial regressions with significance level at 95%.
Results: Median age at first child’s birth was 22 years (IQR = 20-25). The majority of men (62.4%) had fatherhood onset between 18 and 24 years. Only 5.2% had fatherhood onset at 17 years or earlier, increasing to 32.4% at 25+. Respondents whose first sexual encounter was before 18 years was 44.3% and 92.7% by 24+. Few respondents (44.1%) reported use of any contraceptive methods. Anglican religion (RRR=1.62; CI 1.06 – 2.46) or not having attended school (RRR=2.20; CI 1.02-4.71) were predictors of childbirth onset before 17 years.  Age of sex debut at 18 years or higher (RRR= 2.09, CI 1.72 – 2.54) and secondary and above education (RRR = 1.76, CI 1.42-2.18) were predictors of fatherhood onset at 25+.  Contraceptive use among men had no association with age at first child’s birth.
Conclusion: These findings are important for strategic allocation of resources to curb early onset of fatherhood among adolescent and young men under the age of 25 years. They highlight the need for gender-sensitive interventions targeting men for behavioral change, participation in Sexual and Reproductive Health Rights (SRHR) programming and improved access to services delivery.

Keywords

Teenage Fatherhood, First Child Birth, Male Involvement, Reproductive Health, Uganda

Abbreviations

DHS Demographic Health Survey

ICPD International Conference on Population and Development

IPV Intimate Partner Violence

IQR Interquartile Range

SRHR Sexual and Reproductive Health Rights

UBOS Uganda Bureau of Statistics

UDHS Uganda Demographic Health Survey

VIF Variance Inflation Factor

Background

Globally, the role of men in reproductive health was highlighted during the the 1994 International Conference on Population and Development (ICPD) in Cairo as key in improving maternal and adolescent reproductive health indicators, especially in developing countries (Snow et al., 2015). Unfortunately, studies conducted in the sub-Saharan African region to determine the predictors of age at first child’s birth among men are uncommon in spite of advocacy efforts towards male involvement in reproductive health. Literature indicates that there is scarcity of evidence to demonstrate that men have been directly targeted by or are primary beneficiaries from reproductive health programs and activities (Sternberg & Hubley, 2004; Kabagenyi et al., 2014a; Onyango et al., 2010). As a consequence, male fertility in the sub-Sahara African region has remained high – two-fold times higher than female fertility (Ntozi, 1995; Schoumaker, 2017; Snow et al., 2013). The high fertility in these regions could be attributed to the male dominance in sexual relationships and marriage, high desire for large families and polygamy, little or lack of couple discussion on childbearing and disapproval of contraceptive use among men (Berhane et al., 2011; Kabagenyi et al., 2014a; Ntozi, 1995; Schoumaker, 2017; Snow et al., 2013). This paper provides an opportunity to profile the predictors of first child’s birth among men aged 15–54 years in Uganda, with the aim of enhancing knowledge and contributing to an increase in the demand and utilization of reproductive health services among men.

The literature on age at first child’s birth and the associated predictors among men has remained scarce in most developing countries in spite of numerous studies on reproductive health issues and childbearing. Existing evidence shows that most studies on first childbirths and reproductive health matters focus on women rather than men (Kabagenyi et al., 2014a; Macutkiewicz & MacBeth, 2017; Neal et al., 2015). However, a few studies in the literature which focused on men show that age at first child’s birth is not only an important predictor of fertility among men, but also it is central in influencing national and global trends of health indicators (Finer & Philbin, 2014; Martinez et al., 2012). Early age at first childbirth among men increases the risks of suffering from depression, parenting difficulties, psychological conditions such as poor mental health during late adulthood and high mortality odds (Einiö et al., 2015; Grundy & Foverskov, 2016; Grundy & Read, 2015; Grundy & Tomassini, 2006; Mirowsky & Ross, 2002).

Benefits have been associated to delaying the age at first birth among men, and they include: enabling men to complete and attain higher education, prepare for future prospects such as engaging in income generating ventures and pursue better employment or career development during adolescence and young adulthood; reducing the risk of undesired consequences that may arise from unwanted teenage pregnancies, abortions among sexual partners and those associated with teenage fatherhood (Darroch et al., 2016; Kato-Wallace et al., 2016). Lastly, delaying age at first birth among men improves chances for a future healthy start of fatherhood, ensures the smooth transition from adolescence to adulthood, improves the likelihood for better socio-economic status and lowers the risk of reporting adulthood chronic illnesses (Pudrovska & Carr, 2009). Past studies have also demonstrated that education has a strong negative influence on the first child’s birth among men. The literature argues that aspirations for higher education attainment often delay entry into cohabitation, marital unions and fatherhood (Neels et al., 2013).

In Uganda, studies on age at first child’s birth among men are uncommon. The paper seeks to determine the socio-demographic, economic and proximate predictors of age at first child’s birth among men aged 15–54 years in Uganda. Further, the paper sought to generate knowledge to guide strategic resource allocation for family planning and population development programs, with the aim to increase age at first child’s birth. A customized conceptual framework tailored for this study is shown in Figure 1. In this study we propose that the socio-demographic, economic and precursor/precipitating variables indirectly work through the proximate factors (contraceptive use and age at first sex) to influence age at first child’s birth among men as demonstrated in the conceptual framework.

11247572-0c90-4aaa-8c18-afdcaeeecc4b_figure1.gif

Figure 1. Conceptual framework of predictors of men’s age at first child’s birth.

Specifically, the study examined the relationship between contraceptive use, age at first sex, education, financial status, place of residence, occupation, ethnicity and age at first child’s birth. In addition, the following hypotheses were examined: Men with secondary and higher education levels are more likely to have a higher age at first child’s birth than those with no education. Men who experience sexual debut after age 25 years are likely to have a higher age at first child’s birth than those with early sex debut defined as age less than 17 years. Men in rural areas have increased likelihood of having a lower age at first child’s birth than those in urban areas. Men who use contraceptives are more likely to have a higher age at first child’s birth than those who don’t use. This study was conducted in Uganda which has one of the youngest population age structure in the world – half of the population are children below 18 years of age, with a high age dependency ratio (103%) (Uganda Bureau of Statistics (UBOS) Kampala, 2016). Uganda is a developing country in the sub-Saharan African region, specifically in East Africa with a diversity of ethnic groups and socio-cultural heritage.

The findings of this study are crucial in improving male participation in reproductive health by targeting men’s behavior and social norm changes to limit teenage or early fatherhood, and to empower young couples to negotiate family planning decisions for improved contraceptive uptake freely. Second, the findings will enhance building the capacity of skills among healthcare providers in facilities to adequately engage and provide reproductive healthcare services to men. This strategy is anticipated to encourage men to take the lead as users, potential clients, and partners in accessing reproductive healthcare. Lastly, these findings will influence policymakers engaged in reproductive health programming to develop gender-sensitive policies that respond to the needs of the vulnerable young men, so that such men are targeted with efficient and effective interventions for improved male involvement and reproductive health services delivery.

Methods

Study design

This study was based on cross-sectional data to measure the effect of independent factors on age at first child’s birth among men aged 15–54 years. This design was preferred because it facilitates examination of multiple exposures or independent variables at the same time.

Data source

This paper is based on data from a nationally representative Uganda Demographic and Health Survey (UDHS) survey of 5,336 men that was conducted in 2016. The study included all men who had data on age at first child birth. Men who had missing data on age at first childbirth and those who had never had a biological child were excluded from the study. The study focused on analyzing determinants of age at first child’s birth among men aged 15–54 years who responded to the male questionnaire for the three-year demographic health survey period prior to 2016. In terms of geographical scope, the study considered all regions in the entire country. The data source was the Men’s Recode (MR) file of 2016. More details about the sampling procedures and participant selection can be found in the main report (UBOS & Macro International, 2017). Monitoring and Evaluation to Assess and Use Results Demographic and Health Surveys (MEASURE DHS) provided authorization to use this data upon provision of a written request with the description of the intended study.

Sample size

A total of 5,336 records were identified from the men’s individual record (MR) dataset. A total of 3,206 records met the inclusion criteria of men aged 15–54 years and had a biological child were retrieved and considered for analysis, as shown in Figure 2.

11247572-0c90-4aaa-8c18-afdcaeeecc4b_figure2.gif

Figure 2. Derivation of the study sample used in the analysis.

Study variables

The dependent variable for this study was the age at first child’s birth, a variable reported and generated from the men’s questionnaire. During the interview of male respondents and as shown in Figure 3 below, the question on number line 211 was asked: How old were you when your (“first” applies if a respondent has had already more than one child) child was born? The response to this question was recoded numerically in completed years of age.

11247572-0c90-4aaa-8c18-afdcaeeecc4b_figure3.gif

Figure 3. Measure Demographic and Health Survey (DHS) questions asked to men about the age at first childbirth.

The dependent variable data was retrieved as numerical data and recorded in completed years. This data was then categorized into three age groups as follows: “17 years and below” for all men who had their first child’s birth before the 18th birthday, “18 – 24 years” for all men who had their age at first child’s birth 18 to 24 years, and lastly “25+ years” for all men whose age at first child’s birth was after their 25th birthday and above.

The independent variables were grouped into categories as hypothesized to influence the dependent variable. Socio-demographic and economic variables included: religion, ethnicity, education, financial status, occupation, partner-age difference, place of residence, and mass media exposure (including internet use). One of the categories considered for the occupation variable was white-collar jobs, this was defined as occupations that are managerial, technical, clerical or sales based. Proximate variables included: contraceptive use and age at sex debut. Precipitating variables, including previous exposure to parental Intimate Partner Violence (IPV) and forced sex, were included to examine their influence on age at first birth.

Data analysis

Data were weighted and analyzed at three levels: univariate, bivariate and multivariate. Univariate analysis was used to describe the characteristics of men, while unadjusted multinomial regression was performed at a bivariate level to establish the association between the independent variables and the age at first child’s birth. An adjusted multinomial regression model was used to examine the factors associated with age at first child’s birth, using the age group 18–24 years as the reference category. A p-value <0.05 was considered statistically significant at 95% confidence level. Centered and un-centered variance inflation factor (VIF) tests were used to test multicollinearity. The analysis was done using Stata software v15.0.

Results

Description of characteristics for the study population

Table 1 presents the background characteristics and detailed description of the study participants. A weighted total of 3,154 men were analyzed at the univariate level. Mean age at first child’s birth was 23 years, median 22 (IQR=20–25 years). Minimum age at first child’s birth was 14 while the maximum was 50 years. The majority of the respondents were residing in rural areas (76.2%), while more than half (62.4%) aged between 18 and 24 years at the birth of their first child. Regarding education attainment, 94.4% had attained formal education at primary, secondary or higher level all combined, though 37.7% had exclusively attained secondary and higher education level only. The majority of men had access to mass media (91.3%) simultaneously through radio, newspapers, television, and the internet. Nearly half of the respondents were engaged in the agricultural sector (46.4%) as their primary occupation. Most participants affiliated themselves with the Munyankore ethnic group (20.0%), followed by Muganda (16.6%) and Itesot (16.2%). The most common reported religion was Catholic (39.3%) followed by Anglican (35.8%) and Islam (12.9%). Nearly half (44.3%) of the respondents had their sexual debut before 18 years. In total, 3.3% of participants had been exposed to forced sexual acts, while 34.1% had been exposed to parental intimate partner violence. Lastly, more than half of the respondents (55.9%) were not using any method of contraception.

Table 1. Distribution of men by demographic and socioeconomic characteristics.

CharacteristicsPercentage (%)n=3154
Age at first child’s birth
    ≤17 5.2165
    18–24 62.41967
    25+32.41022
Respondents age
    15–190.618
    20–2410.5330
    25–2917.6553
    30–3421.3671
    35–3914.8468
    40–4416.0505
    45–491.0315
    50–549.3293
Place of residence
    Urban23.8751
    Rural76.22402
Education
    No education5.6178
    Primary56.71786
    Secondary+37.71190
Financial status
    Poorest18.3578
    Poorer18.7590
    Middle19.7621
    Richer21.4676
    Richest21.8688
Occupation
    Not working1.134
    White-collar jobs16.8531
    Agriculture46.41463
    Services/domestic8.1255
    Manual labour27.6871
Access to mass media
    No8.7274
    Yes91.32880
Ethnicity
    Acholi9.5301
    Alur6.1191
    Bafumbira6.2195
    Banyoro5.3165
    Banyankore20.0619
    Baganda16.6522
    Bagisu10.7338
    Iteso16.2511
    Basoga7.4232
    Sabinyi2.680
Religion
    No religion and Traditional1.238
    SDA and Orthodox1.445
    Pentecostal and small Christian
sub-groups
9.3295
    Anglican35.81128
    Muslims12.9408
    Catholics39.31240
Exposure to parental IPV
    No65.92079
    Yes34.11075
Exposure to forced sexual acts
    No96.73048
    Yes3.3106
Age at sex debut
     ≤1744.31396
    18+55.71758
Current contraceptive use
    No55.91764
    Yes44.11390

SDA – Seventh Day Adventists, IPV – Intimate Partner Violence.

Association between the independent factors and age at first child’s birth among men

Table 2 presents the unadjusted multinomial results of the associations between the independent factors and the age at first child’s birth. Education, place of residence, ethnicity, age at first sex (sex debut), financial status, religion and occupation were significantly associated with age at first child’s birth (p<0.05).

Table 2. Unadjusted multinomial results of age at first child’s birth and independent variables among respondents.

VariableAge group: 14–17 yearsAge group: 25+ years
Relative Risk RatioConfidence IntervalRelative Risk RatioConfidence Interval
Place of Residence
    Urban0.7990.529 – 1.2060.613***1.360 – 1.913
    Rural^1.000
    Constant0.087***0.073 – 0.1040.460***0.421 – 0.502
Education
    No education1.906**1.149 – 3.1601.1870.836 – 1.686
    Primary^1.000
    Secondary+0.392***0.254 – 0.6062.027***1.733 – 2.370
    Constant0.099***0.082 – 0.1190.384***0.345 – 0.427
Ethnicity
    Acholi1.1090.619 – 1.9890.741**0.551 – 0.997
    Alur0.7130.319 – 1.5960.8610.612 – 1.212
    Bafumbira1.4250.752 – 2.6990.8550.606 – 1.207
    Banyoro1.2520.646 – 2.4270.463***0.308 – 0.696
    Banyankore^1.000
    Baganda0.394**0.203 – 0.7650.748**0.584 – 0.956
    Bagisu0.6890.363 – 1.3060.687**0.516 – 0.914
    Iteso1.1600.700 – 1.9220.8910.696 – 1.141
    Basoga0.9330.479 – 1.8170.711**0.513 – 0.986
    Sabinyi0.8300.293 – 2.3500.574**0.339 – 0.972
    Constant0.092***0.647 – 0.1320.652***0.553 – 0.769
Financial status
    Poorest1.000
    Poorer0.9660.606 – 1.5370.9260.715 – 1.200
    Middle1.0160.640 – 1.6131.1840.922 – 1.520
    Richer0.6310.382 – 1.0411.0720.839 – 1.371
    Richest0.546**0.313 – 0.9511.967***1.552 – 2.493
    Constant0.101***0.072 – 0.1410.427***0.356 – 0.513
Occupation
    Not working2.1140.675 – 6.6271.4510.700 – 3.008
    White-collar jobs0.367**0.187 – 0.7241.918***1.563 – 2.354
    Agriculture^1.000
    Services/domestic1.4550.881 – 2.4021.0980.819 – 1.471
    Manual labour0.8220.564 – 1.1971.0120.842 – 1.217
    Constant0.093***0.074 – 0.1150.453***0.405 – 0.508
Religion
    No religion and Traditional0.3640.038 – 3.4500.5200.232 – 1.165
    SDA & Orthodox1.1150.253 – 4.9131.6380.890 – 3.016
    Pentecostal and other small
Christian sub-groups
1.3830.795 – 2.4051.1540.879 – 1.516
    Anglican1.3830.961 – 1.9931.219**1.025 – 1.449
    Muslims1.1080.661 – 1.8560.9810.769 – 1.253
    Catholics^1.000
    Constant0.071***0.055 – 0.0930.478***0.423 – 0.539
Age at first sex
    ≤ 171.000
    18+0.060***0.032 – 0.1142.189***1.866 – 2.568
    Constant0.164***0.139 – 0.1950.320***0.282 – 0.364
Access to mass media
    No^1.000
    Yes0.9890.569 – 1.7191.0630.812 – 1.390
    Constant0.085***0.050 – 0.1430.491***0.380 – 0.635
Exposure to Parental IPV
    No^1.000
    Yes1.1620.837 – 1.6121.0800.923 – 1.265
    Constant0.079***0.065 – 0.0970.506***0.461 – 0.555
Exposure to forced sexual acts
    No^1.000
    Yes0.5090.156 – 1.6691.0850.722 – 1.630
    Constant0.085***0.073 – 0.1000.518***0.480 – 0.559
Contraceptives Use
    No^ 1.000
    Yes1.1020.804 – 1.5120.9150.786 – 1.064
    Constant0.080***0.065 – 0.0100.540***0.489 – 0.596

Reference Category, Observations: 3,206; *** p<0.01, ** p<0.05, * p<0.1 SDA – Seventh Day Adventists, IPV – Intimate Partner Violence

Precipitating factors such as exposure to mass media, forced sexual acts and exposure to parental intimate partner violence were not significantly associated with age at first childbirth among the participants. Likewise, contraceptive use as a proximate factor was not significantly associated with age at first childbirth among men. All the variables that were significantly associated with age at first childbirth were included in the adjusted multivariate analysis models.

Factors associated with age at first child’s birth among men at multivariate analysis

Adjusted multivariate analysis results (Table 3) showed that men with no education were 2.2 times (RRR=2.2; CI: 1.02 – 4.71) more likely to have first their child by 17 than between 18–24 years compared to those with primary education, other factors remaining constant. On the contrary, men with secondary or higher education were 0.4 times less likely to have their first child (RRR=0.44; CI:0.22-0.89) by the age of 17 than 18–24 compared to those with primary education, holding other factors constant. Men with secondary or higher education were 1.8 times (RRR=1.76; CI: 1.42-2.18) more likely to have their first child by the age of 25 and above than between 18–24 years compared to those with primary education, holding other factors constant. With regards to ones’ ethnicity, Banyoro men were 0.5 times (RRR= 0.48; CI 0.30-0.78) less likely to have their first child by 25 and above than between 18–24 years compared to the Banyankore holding other factors constant. Similarly, among the Baganda men were 0.6 times (RRR=0.61; CI: 0.41-0.81) less likely to have their first child aged 25 and above than between 18–24 years compared to Banyankore holding other factors constant. Regarding religious affiliation, Anglican men were 1.6 times more likely to have their first child by 17 than between 18–24 (RRR=1.61; CI: 1.060 - 2.46) compared to Catholic men. Men were asked about their age at first sexual encounter, this variable was included in the analysis to examine its predictability to the age at which men had their first child. Table 3 shows men whose age at first sexual encounter was 18+ (18 years and above) were 0.1 times less likely (RRR: 0.06; CI:0.03 – 0.11) to have their first child by 17 than between 18–24 years compared to those who had their first sexual encounter when less than 17 years holding other factors constant. Men who had first sex aged 18 years and above were 2.1 times (RRR=2.09; CI 1.72 – 2.54) more likely to have their first child by 25 years and above than between 18–24 years compared to those who had their first sexual encounter when less than 17 years. VIF results for multicollinearity showed that age of a man was strongly correlated with other independent variables. As a consequence, it was excluded at multivariate analysis presented above. Table 4 shows the details of the VIF estimates. In spite of the mean VIF being greater than 1, there was no evidence of significantly detected multicollinearity among either within predictors themselves or any of the predictor with the constant term.

Table 3. Adjusted multinomial regression results of predictors of age at first child’s birth among men aged 15–54 years, using the age group 18–24 years as the base category.

VariableAge group: 14–17 yearsAge group: 25+ years
Relative Risk RatioConfidence IntervalRelative Risk RatioConfidence Interval
Place of Residence
    Urban1.3550.815 - 2.2521.282*0.960 - 1.710
    Rural^1.000
Education
    No education2.196**1.024 - 4.7081.2070.777 - 1.875
    Primary^1.000
    Secondary+0.439**0.218 - 0.8861.757***1.415 - 2.182
Ethnicity
    Acholi1.2690.560 - 2.8770.7890.550 - 1.132
    Alur0.6310.207 - 1.9221.0920.757 - 1.575
    Bafumbira1.1520.456 - 2.9131.0140.656 - 1.567
    Banyoro0.9850.423 - 2.2900.481***0.295 - 0.784
    Banyankore^1.000
    Baganda0.422*0.151 - 1.1750.605**0.411 - 0.891
    Bagisu0.5100.204 - 1.2750.7440.521 - 1.063
    Iteso1.3220.591 - 2.9570.9160.685 - 1.225
    Basoga0.8070.229 - 2.8430.7160.448 - 1.144
    Sabinyi0.6440.128 - 3.2320.619*0.360 - 1.065
Financial status
    Poorest^1.000
    Poorer1.1310.689 - 1.8570.8920.659 - 1.208
    Middle1.2410.658 - 2.3391.1200.780 - 1.609
    Richer0.9540.491 - 1.8540.9150.661 - 1.265
    Richest0.9200.401 - 2.1111.416*0.945 - 2.122
Occupation
    Not working3.273*0.995 - 10.7741.4200.677 - 2.977
    White-collar jobs0.5900.227 - 1.5341.1790.878 - 1.583
    Agriculture^1.000
    Services/domestic1.5450.839 - 2.8440.8770.572 - 1.344
    Manual labour0.9250.560 - 1.5280.8880.702 - 1.124
Religion
    No religion and Traditional0.2040.025 - 1.6620.5860.243 - 1.413
    SDA & Orthodox1.9450.624 - 6.0641.1480.522 - 2.525
    Pentecostal and other small
Christian sub-groups
1.765*0.916 - 3.4011.0400.711 - 1.522
    Anglican1.613**1.060 - 2.4551.1600.948 - 1.419
    Muslims1.7050.763 - 3.8090.9760.693 - 1.377
    Catholics>^1.000
Age at first sex
    ≤ 171.000
    18+0.055***0.028 - 0.1072.089***1.717 - 2.541
    Constant0.147***0.065 - 0.3350.271***0.190 - 0.387

^ Reference Category, Observations: 3,206; *** p<0.01, ** p<0.05, * p<0.

SDA – Seventh Day Adventists

Table 4. Results of the Variance Inflation Factor (VIF) estimates of the independent variables in the model.

VariableCentered VIFUncentered VIF
VIF1/VIFVIF1/VIF
Place of residence
    Urban1.50.671.970.51
Ethnicity
    Acholi1.550.641.710.58
    Alur1.350.741.430.70
    Bafumbira1.260.791.350.74
    Banyoro1.220.821.290.77
    Baganda1.730.582.070.48
    Bagisu1.460.681.640.61
    Iteso1.720.582.050.49
    Basoga1.400.711.510.66
    Sabinyi1.190.841.230.82
Education
    No education1.100.911.170.86
    Secondary+1.340.752.150.47
Financial status
    Poorer1.750.572.160.46
    Middle1.990.502.480.40
    Richer2.210.452.820.35
    Richest3.130.324.000.25
Occupation
    Not working1.050.951.060.94
    White-collar jobs1.560.641.880.53
    Services/domestic1.150.871.260.80
    Manual labour1.380.731.900.53
Religion
    No religion and traditional1.030.971.030.97
    SDA and Orthodox1.060.941.070.93
    Pentecostal and other small Christian sub-groups1.170.861.290.78
    Anglican1.340.752.080.48
    Muslims1.320.761.510.66
    Hindu and others1.040.961.050.95
Age at first sex
    18+1.100.912.140.47
    Intercept16.380.06
Mean VIF1.442.24

SDA – Seventh Day Adventists.

Discussion

Studies on predictors of age at first child’s birth among men in Uganda are uncommon. This paper aimed at examining the socio-demographic, economic and proximate predictors of age at first child’s birth among men aged 15–54 years in Uganda. This study showed that almost three-quarters of the men had their first child as youths, before 25 years. These results are comparable with findings from a study that evaluated trends and characteristics of age at first child’s birth among adolescent girls and young women within the East African countries, which showed that Uganda was one of the countries with the highest proportion of first childbirth among adolescent girls before 20 years of age (Neal et al., 2015). This result may suggest that the determinants of age at first child may be similar between genders. Prior to this research, little has been published focusing on males spite of a high prevalence of low age at first child’s birth among both young men and women, this paper aimed to address this gap. This finding implies that interventions and policy reforms to curb early onset of childbearing among young people should target men younger than 25 years as well.

This study revealed that nearly all men survey had their sexual debut before 25. Both bivariate and multivariate analysis showed that age at first sex was a proximate predictor of age at first child’s birth. This finding are in agreement with another comparative study conducted among the sub-Saharan African countries where more than half of the adolescent men had sexual debut before 25 (Johnson & Gu, 2009). In many African societies behavioral maladjustment disorders, peer perceptions, negative sociocultural sex initiation values and poor parenting are direct determinants of early sex debut among adolescents (Babalola, 2004; Peltzer, 2010). This implies that interventions to ensure safer sexual behaviors have to be implemented and should aim at ensuring universal access to information about the benefits of safer practices and available contraception commodities to decrease the risk of first child’s birth among adolescent men.

This study found no association between exposure to forced sexual acts, parental IPV and age at first child’s birth among men. The findings indicated that fewer men were exposed to forced sexual acts while a third had been exposed to parental IPV. One reason for not finding a significant association could be due to the fact that there was a low sample size of men who are victims of IPV. An earlier study had shown that men who are victims of IPV experience mild-severe consequences but unfortunately, the practice remains ignored in society and as a result, the prevalence and associations of such harmful abuse largely remain undocumented (Hines & Douglas, 2009). The study had hypothesized that men with a history of exposure to parental IPV or forced into sexual acts, especially when they were still young, had a higher risk of being involved in casual sex and early marriages which increases the likelihood for early first child’s birth. The study results, however, were not in agreement with this hypothesis.

Contraceptive use was not found to be a predictor of age at first child’s birth among men. Though contraceptive use is a proximate determinant of childbirth, it is argued in the literature that willingness for contraception uptake increases mainly after the first child’s birth and with subsequent births, especially among young couples for the purposes of child spacing and limiting. Studies in Rwanda and India demonstrated that the propensity for a couple without a child to demand contraception use is often significantly reduced (Jayaraman et al., 2009; Rao & Mathada, 2016). Similar to another study conducted while comparing developing countries, it indicated that less than half of married and unmarried sexually active men used any form contraceptives (Johnson & Gu, 2009). This evidence highly suggests that the low uptake of contraceptives among men is partly the explanation for this result. There are several factors documented in the literature that may explain low contraceptive use levels among men. These include: a high prevalence of negative socio-cultural expectations and values attached to childbirth behavior and practices, misconceptions and fears about modern contraceptives, overreliance on traditional contraceptive methods, prevalence of negative gender attitudes, limited opportunity for male discussion of family planning with health workers, and limited awareness about the role of men in fertility control to mention but a few (Kabagenyi et al., 2014a; Kabagenyi et al., 2014b; Kabagenyi et al., 2016; Johnson & Gu, 2009; MacQuarrie et al., 2015). Thus, the current relationship of contraceptive use and age at first child’s birth in this study may likely be a result of a conflict between the influences of factors that are negatively associated with contraceptive use and its low uptake among men.

The study also showed that education was a positive predictor of late age at first child’s birth. Previous studies conducted in the African region have consistently indicated that lack of or low education is a strong predictor of onset of teenage childbearing, especially among girls (Neal et al., 2015; Peltzer, 2010). This study has also shown similar results among men. Secondary and higher education reduce risks for not working, reverses negative sociocultural values and norms, and other negative attitudes which are associated with early sexual debut and low contraceptive use among men (Johnson & Gu, 2009). Thus, secondary and post-secondary education improves contraceptive use and creates employment opportunities which result in delayed onset of fatherhood. This finding is consistent with the study hypothesis that men with secondary and higher education levels are more likely to have a higher age at first child’s birth than those with no education. This result implies that any interventions and programs that are aimed at curbing teenage fatherhood should prioritize second chance formal education at primary and secondary levels, address barriers of access to universal secondary education and also promote incentives for post-secondary and higher education completion among men.

Ethnicity was found to be a predictor of age at first child’s birth both at the bivariate and multivariate analysis levels. Possibly, cultural values, diversity in norms, and variations in the understanding of sexual roles and childbearing rewards explain the relationship between ethnicity and age at first child’s birth, as these are influenced by socio-economic factors. This finding was consistent with results from studies performed among women (Hirschman & Rindfuss, 1980; Matthews & Hamilton, 2009). However, the determinants for this relationship need to be further studied among men.

Religious affiliation, specifically Anglican denomination was found to be a significant predictor of early onset of fatherhood among the respondents. The relationship between religious affiliations and age at first childbirth has been observed among women in other countries such as Nigeria and Bangladesh (Fagbamigbe & Idemudia, 2016; Sarkar, 2010). However, this relationship among men has not been fully explored and this result provides a basis for further understanding of such dynamics in a Ugandan context. There is a need for more explorative research to study this phenomenological finding.

Study limitations

There were two major limitations to this study. First due to the inherent cross-sectional design weaknesses, such as the inability to establish causal pathways and temporal associations between predictors and the age of first child’s birth among men. The second limitation was related to the source of data which was the Demographic Health Survey, and specifically the inability to study the exhaustive list of predictors to age at first childbirth among men. The list of predictors may not have been exhausted by this study due to the fact that DHS data is standard and hence the possibility that some other predictors were missed in the data collection and analysis was unavoidable.

Conclusion

This paper brings to light important predictors of age at first child’s birth among men in Uganda. The onset of the first child’s birth commonly occurs among young men below the age of 25 years, which may predispose them to increased risks of poor health and human development outcomes during adulthood and older-age. Indirect factors such as education, religion, and ethnicity were strongly associated with age at first child’s birth among men. In addition, age at sex debut was the only direct predictor of age at first child’s birth among men. For policy considerations, reversing secondary and higher-level school/tertiary education drop-out rates among men should be a priority. Universal access to SRHR services (including family planning) and behavioral change and communication messages to address early onset of fatherhood among sexually active young men should be enhanced. Actively engaging men at all levels including the use of cultural and religious institutions in promoting male involvement, through which men are encouraged to take lead in SRHR programming and services delivery should also be strengthened. Lastly, legal efforts and community engagement programs aiming to reduce teenagers’ fatherhood practices should be intensified. For instance, increasing the legal age of marriage among men, preferably to be higher than 18 years which is currently considered to be the cutoff age for minors. These interventions will help in reducing teenage and adolescent first childbirths and associated negative outcomes among men in Uganda. Future research may further explore other possible predictors of age at first child’s birth, causal relationships, and differentials among men.

Ethical considerations

Permission to use the male file dataset was provided by and accessed online from the MEASURE DHS website after providing a brief description of our study. Further details about approval and access to DHS data can be found from DHS website.

Data availability

Source data

The 2016 Ugandan Demographic and Health Survey (UDHS) data used in this study is available from the DHS website: https://dhsprogram.com/data/dataset/Uganda_Standard-DHS_2016.cfm?flag=0 under the ‘Male Recode’ subsection.

Data can be accessed by applying through the DHS website. Please see their data access help page for information.

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Nsobya H, Kabagenyi A and Rusatira JC. Predictors of age at first child’s birth and contraceptive use among men in Uganda [version 1; peer review: 1 approved with reservations, 1 not approved]. Gates Open Res 2019, 3:1492 (https://doi.org/10.12688/gatesopenres.12952.1)
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Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
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