Background

Being a mom is basically a given, even though some women prefer to put off or stay away from getting pregnant and having children. Delayed motherhood refers to women having their first child later in life, a period marked by declining fertility and increased challenges in conceiving [1,2]. In every society, becoming a mother is seen as the most important job that woman can do [3,4]. Age-related infertility in women is particularly vulnerable because aging causes a decrease in the number and quality of egg follicles, which can lead to miscarriages and chromosomal abnormalities [5].

Globally, different articles recognized that a 20-years old healthy woman has a 34% probability of becoming pregnant per cycle [6]. By 30 years of age, this probability is halved to 17% and then falls rapidly to 8% by 37 years of age. At 45 years, the chance of a woman achieving a live birth is as low as 0.5% per cycle [7]. About ten years prior to menopause (the average age for menopause is roughly 51 years), when the menstrual cycle becomes irregular and the biological window for childbearing is quickly closing, conception becomes unlikely [8,9]. Generally, in many nations, the average age of the first birth has outshined 30 years, having risen by 2–4 years over the previous two to three decades [10].

According to fertility trends, the average age at which women give birth to their first child has risen in recent decades. Numerous cultural, societal, and economic settings are contributing to the rise in the number of women giving birth later in life [11,12]. Delaying having children is a complex decision that involves a number of factors, including personal preferences, societal influences, medical concerns, and technological breakthroughs [13]. Existing literature has found that the frequency of postponed pregnancy was consistently linked to women’s educational attainment [14,15], labor market participation, personality traits, attitude [16], and personal preferences; knowledge about fertility [17]; physical and psychological readiness [18]; stable relationships with spouses and other significant individuals; and sociocultural and economic factors [19,20].

In both high-income and low-income countries have recognized that women who are delayed in becoming mothers are more likely to occur a significant risk factor for fetal and perinatal issues [21]. These issues can raise the risk of death and morbidity in the newborn and later years of life. It can also increase the likelihood of health issues for both mothers and children, including higher risks of birth complications and developmental disorders [3,22] like stillbirths, preterm labor, abortion, autism, childhood cancer, and down syndrome, which correlate with advanced maternal and paternal age [23]. Furthermore, the labor market and retirement systems will suffer greatly from low pregnancy rates brought on by postponing childbearing.

The increasing age at which women become pregnant is a universal social issue that has gained prominence in recent decades. Furthermore, scientists contend that postponed maternity is a significant contributing element to lower fertility [24,25]. Several studies have indicated a high prevalence of delayed motherhood. Despite this, there is a scarcity of published articles about delayed motherhood among reproductive age women in Sub Saharan Africa. A thorough analysis of the causes of delayed childbearing can provide researchers, politicians, and healthcare practitioners with important insights into the wider ramifications for people, families, and society [26]. Thus, the purpose of this study was to determine the prevalence and determinant factors of delayed motherhood among reproductive age women in five Sub Saharan Africa.

Methods

Data source, study population and sampling technique

The Demographic Health Survey (DHS) datasets from 2021 to 2023 for the most current East African nations were used for the secondary data analysis. We utilized DHS surveys from in five Sub Saharan, including: Burkina Faso, Ghana, Kenya, Mozambique and Tanzania. In order to determine the magnitude and contributing determinants of delayed to getting pregnant among reproductive age women in Sub Saharan Africa, the data were appended. Different datasets, such as those for men, women, children, births, and households, are included in the survey for each nation. The DHS uses a stratified two-stage cluster design, where the first stage consists of enumeration regions, and the second stage creates a sample of homes from each enumeration area. Delayed to getting pregnant was the outcome variable, which was created by recoding the variable ever used anything or tried to delay getting pregnant (v302a) from the maternal record (IR) data set. The factors associated with delayed to getting pregnant were identified by using a binary logistic regression model; the factors were reported as an adjusted odds ratio (AOR) with a 95% significance level. In the univariate analysis, variables with p-values <0.25 were considered statistically significant, and all variables with p values <0.05 were deliberated to be at 95% confidence intervals. The study had a weighted sample of 49,439 women in total (Table 1).

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Table 1. Determining the Sample Size for Assessing the Prevalence and Determinants of Delayed Motherhood among women of reproductive age in Five Sub-Saharan African Countries.

https://doi.org/10.1371/journal.pone.0326190.t001

Results

Sociodemographic and economic characteristics of women of reproductive age in five Sub-Saharan Africa

Over-all of 47, 439 women with reproductive age were enrolled in the study. The mean age of the study participant was 31.9 years with ± 8.7 standard deviation. More than half (54.54%) of the study respondents were between the age of 20–35 years. Greater than one third (36.13%) of the study participants did not have formal education. Nearly two third (65.14%) of the study respondents were living in urban areas of sub-Saharan Africa countries, whereas little bit more than one third (66.77%) of the study respondents living in sub-Saharan Africa countries where distance to health facilities is not a big problem to get family planning services. About more than half (52.15%) of women living in sub-Saharan African countries have poor community media exposure (Table 2).

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Table 2. Sociodemographic and economic characteristics of women of reproductive age in five Sub-Saharan Africa countries using DHS 2021-2023.

https://doi.org/10.1371/journal.pone.0326190.t002

Random effect ((Measures of variation) and model fitness

A null model was used to identify whether the data supported the decision to assess randomness at the community level. Results from the null model revealed that there were substantial discrepancy in delayed to getting pregnant between communities, with a variance of 0.5163447 and a P value of 0.000. The variance within clusters contributed 86.43% of the variation in delayed to getting pregnant, whereas the variance across clusters was accountable for 13.57% of the variation. In the null model, the odds of a delayed to getting pregnant differed between higher and lower risk clusters by a factor of 1.98 times. The interclass correlation value for Model I indicated that 8.03% of the variation in delayed to getting pregnant accounts for the difference between communities. Then, with the null model, we used community-level variables to generate Model II. Cluster variations were the basis for 5.51% of the differences in delayed to getting pregnant, according to the ICC value from Model II. In the final model (model III), which recognized approximately 77.5% of the variation in the likelihood of delayed to getting pregnant to both individual and community-level variables (Table 3), the likelihood of delayed to getting pregnant varied by 1.38 times across low and high delayed to getting pregnant clusters.

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Table 3. Model comparison and random effect analysis for delayed motherhood among women of reproductive age in five Sub-Saharan Africa countries.

https://doi.org/10.1371/journal.pone.0326190.t003

Association of individual- and community-level factors with delayed motherhood among women of reproductive age in SSA

Finally, the final fitted model of multivariable multilevel logistic regression; maternal occupation, husband occupation, wealth index, distance to health facility, please of residence, community level of illiteracy were significantly associated with delayed to getting pregnant among reproductive age women. (Table 4)

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Table 4. Multivariable multilevel logistic regression analysis of individual- and community-level factors associated with delayed motherhood among women of reproductive age in five Sub-Saharan Africa countries using DHS 2021-2023.

https://doi.org/10.1371/journal.pone.0326190.t004

Women who did not have working were 1.65 times more likely to develop delayed to getting pregnant among reproductive age women as compared to their counterpart (AOR = 1.65, 95% CI: 1.57, 1.73). The odds of delayed to getting pregnant among reproductive age women were 1.55 time more likely to occur women’s whose husband did not have working as compared to their complement (AOR = 1.55, 95% CI: 1.51, 1.78). Delayed to getting pregnant among reproductive age women was 2.62 and 1.85 times more likely to occur among women living in a poor and middle wealth status as compared to women living in a rich wealth index (AOR = 2.62, 95% CI: 1.58,3.66) and (AOR = 1.85, 95% CI: 1.79,2.90) respectively. The odds of delayed to getting pregnant among reproductive age women were 1.04 times more likely to occur among women whose distance to a health facility is not a big problem as compared to women whose distance to a health facility is a big problem (AOR = 1.04, 95% CI: 1.09, 1.39). The odds of delayed to getting pregnant among reproductive age women were 2.48 times more likely to occur among women in urban residences as compared to women living in rural areas (AOR = 2.48, 95% CI: 1.67, 2.09). The odds of delayed to getting pregnant among reproductive age women were 3.24 times more likely to occur women with in a high community illiteracy as compared to women with in a low community illiteracy (AOR = 3.24, 95% CI: 1.55, 5.35).

Discussion

Delayed motherhood represents an important public health concern, especially in Sub-Saharan Africa. This practice carries both benefits and risks; it may lower the chances of complications linked to teenage pregnancies but can also raise the likelihood of health issues such as gestational diabetes and preeclampsia among older mothers [2]. The aim of this study is to reveal the prevalence and its determinants of delayed motherhood among reproductive age women in five Sub Saharan Africa countries” A recent demographic health survey from 2021 to 2023 multilevel analysis. The overall prevalence of delayed motherhood among reproductive age women in five Sub Saharan Africa countries was found to be 61.94% with (95% CI: (61.5, 62.4)). The prevalence of delayed motherhood found in this study was lower than the findings of a study conducted in India; Vancouver 82% [27], United Kingdom 72% [28], Germany 67% [29]. The possible justification for this discrepancy might be due to cultural norms and societal expectations regarding marriage and family formation can vary significantly between countries [2]. In some cultures, early marriage and childbearing may be more strongly encouraged. It could also may be due to lower levels of education can be associated with earlier marriage and childbearing, as education often delays entry into adulthood and provides opportunities for career advancement [30].

On the other hand, the prevalence of delayed motherhood found in this study was higher than the findings of a study conducted in Colombia 26.14% [31] and Spain 37% [32]. The possible rationalization for this difference may be due to the stage of demographic transition a country is can affect fertility rates. Countries in earlier stages of demographic transition often have higher fertility rates. In addition, there are some individuals in Sub-Saharan Africa who are delaying childbearing due to factors like education and career aspirations and gender inequality can limit women’s ability to make decisions about their reproductive health and future or many women in Sub-Saharan Africa are economically dependent on their husbands or partners, which can limit their autonomy and decision-making power regarding family planning [33].

In the multivariable multilevel mixed effect logistic regression analysis, did not have occupation, whose husband did not have occupation, poor wealth status, distance to a health facility, and community-level variables such as urban residence, high community illiteracy, were significantly associated with delayed to getting pregnant among reproductive age women.

This study examines the associated factors of delayed motherhood among reproductive-age women in five Sub-Saharan African countries. Women who did not have occupation were 1.65 times more likely to develop delayed to getting pregnant among reproductive age women as compared to their counterpart. This result was similar to a study conducted in Japan [34], United Kingdom, Australia [35], and Chile [36]. This might be due to unemployed women may be financially dependent on others, limiting their ability to make independent decisions about family planning. They may have less say in decisions about when to try for a baby, as their financial situation might be controlled by others. Their partner or family might prioritize other financial needs over starting a family. Furthermore it might be due to unemployed women may face social stigma and pressure to marry and have children early to avoid being labeled as leftover women [2,37]. Finally, Even if they desire pregnancy, the lack of independent income can raise significant concerns about covering the costs of prenatal care, childbirth, postnatal care, and raising a child. This can lead to a conscious or unconscious delay.

The current study was found to be that, the odds of delayed to getting pregnant among reproductive age women were 1.55 times more likely to occur women’s whose husband did not have working as compared to their complement. The finding of this study is in line with previous study conducted in Iran [38]. This possibility may be due to; in some cultures, there may be societal pressure on men to be can lead the primary breadwinners, leading to delayed marriage and childbearing. This could be due to unemployment to increased stress and anxiety, which may negatively impact reproductive health [20]. Generally, it likely reflects the complex interplay of financial stress, lifestyle changes, and relationship dynamics that can affect reproductive health [39].

According to this study was found to be that, delayed to getting pregnant among reproductive age women was 2.62 and 1.85 times more likely to occur among women living in a poor and middle wealth status as compared to women living in a rich wealth index. This finding was supported by studies conducted in Ethiopia [40]. This might be due to that women in poor households often face significant financial constraints. This can lead to prioritizing economic survival; the immediate need for food, shelter, and daily expenses may take precedence over family planning considerations. Limited access to nutritious food and healthcare can negatively impact a woman’s reproductive health, potentially making it harder to conceive or leading to a conscious decision to delay pregnancy until health improves [41]. Furthermore, it may be due to financial difficulties are able to strain relationships, potentially leading to delayed marriage or divorce, both of which can impact fertility plans. Moreover, women in lower wealth groups may need to prioritize education and employment to improve their economic situation before starting a family. It could also might be due to the cost of healthcare, including prenatal care and childbirth, can be a significant barrier for women in lower wealth groups [42].

The subject of associated factors, the odds of delayed to getting pregnant among reproductive age women were 1.04 times more likely to occur among women whose distance to a health facility is not a big problem as compared to women whose distance to a health facility is a big problem. This finding was in line with other studies conducted in Netherland [43]. the probably justification for this might be due to;While easy access to healthcare can facilitate family planning and reduce unintended pregnancies, it is not the sole determinant of reproductive behavior. A variety of social, cultural, economic, and personal factors influence women’s decisions about when to have children. Moreover, it might be due to women whose distance to a health facility is not a big problem often have better access to family planning services, allowing women to make informed choices about their reproductive health [44].

The odds of delayed to getting pregnant among reproductive age women were 2.48 times more likely to occur among women in urban residences as compared to women living in rural areas. This finding was coherent with previous studies conducted in Swedish [45]. The possible explanation for this may be due to urban areas often have better access to education, leading to higher levels of education among women. Hence, women in urban areas may have more opportunities for economic independence, allowing them to delay childbearing or urban areas offer more job opportunities, which can delay marriage and childbearing [46]. Furthermore, the higher cost of living in urban areas may make it more difficult for young couples to afford housing and other expenses, leading to delayed childbearing [47].

The odds of delayed to getting pregnant among reproductive age women were 3.24 times more likely to occur women with in a high community illiteracy as compared to women with in a low community illiteracy. This is consistent with the findings from previous studies conducted in Iran [48]. The possible rationalization for this similarity might be due to; the fundamental driver is the information asymmetry created by low literacy. Women in high-illiteracy communities are significantly disadvantaged in accessing and understanding crucial reproductive health information, leading to disempowerment and delayed pregnancy [49]. Additionally, in the absence of reliable information, women are more susceptible to harmful cultural myths and misconceptions about fertility which means women is particularly vulnerable for age related infertility because aging causes a decrease in the number and quality of egg follicles [50]. In conclude, illiteracy can undermine women’s confidence in advocating for their reproductive health needs, leading to passive acceptance of unfavorable circumstances.

Conclusion

This study highlights a significance prevalence of delayed pregnancy or motherhood among women of reproductive age in five Sub-Saharan Africa countries, with notable variation across communities. The findings underscore that factors such as unemployment, low household wealth, limited access to health facilities, urban residence, and high community illiteracy are significantly associated with delayed motherhood. These determinants reflect broader socioeconomic and structural challenges that influence women’s reproductive choices and opportunities. To address delayed motherhood effectively, policymakers should prioritize strategies that enhance women’s education, economic empowerment, and access to reproductive health services, while also addressing broader structural inequalities across communities.

Supporting information

Acknowledgments

We are grateful to the DHS programmes for letting us use the relevant DHS data in this study.