In 2022, a survey conducted in Kenya revealed that a share of 16 percent of teenagers (ages 15 to 19 years) who lived in rural areas, had been pregnant. Those who lived in urban areas had a lower prevalence of teenage pregnancy, with a share of 12.3 percent.

Contents:Appendix 1. Sampling.Appendix 2. Baseline survey questionnaire.Appendix 3. Hypothesized models of pathways related to maternal BMI represented on a directed acyclic graph (DAG).Appendix 4. Sample flow chart.Abstract:BackgroundStunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. This study aimed to investigate the relationship between agricultural work during pregnancy, post-natal maternal BMI and LAZ among young infants in rural Pakistan; and explored whether maternal BMI mediated the relationship between agricultural work and infant LAZ.MethodsA cross-sectional survey was conducted from December 2015 to January 2016 in rural Sindh, Pakistan. Mother-infant dyads were recruited via systematic random cluster sampling at 2–12 weeks’ post-partum (n = 1161). Anthropometric measurements (maternal and infant height/length and weight) and questionnaire data were collected. Multivariable linear regression and structural-equation based mediation analyses were used to examine associations of agricultural work during pregnancy with maternal BMI and infant LAZ.ResultsDuring pregnancy, women reported engaging in livestock-related work (57.0%), crop-related work (42.7%), and cotton harvesting (28.4%). All three forms of agricultural work were negatively associated with maternal BMI (β = − 0.67 [− 1.06; − 0.28], β = − 0.97 [− 1.51; − 0.48]; and β = − 0.87 [− 1.33; − 0.45], respectively). Maternal engagement in cotton harvesting alone was negatively associated with infant LAZ after controlling for confounding factors. The total negative effect of cotton harvesting on infant LAZ was − 0.35 [− 0.53; − 0.16]. The indirect effect of maternal BMI on infant LAZ was − 0.06 [− 0.08; − 0.03], revealing that 16% (− 0.06/− 0.35) of the relationship between cotton harvesting and infant LAZ, after adjustment, was mediated via maternal BMI.ConclusionThese results underscore a need to reduce labour-intensive agricultural workload demands during pregnancy, especially in cotton harvesting, to reduce risks of negative maternal energy balance and poor growth outcomes in early infancy.

In 1930, the average woman of childbearing age in Kenya would have had just under seven children over the course of their reproductive years. This rate would steadily increase until the end of the 1960s, peaking at just over eight children per woman in 1970. Following this peak, a combination of strong national and international promotion of family planning in Kenya and an expansion of contraceptive use would lead to a sharp decrease in the fertility rate, resulting in an average of 3.19 children in 2024. Teenage fertility in Kenya In 2022, most teenage pregnancies occurred among 19-year-olds. There is a strong correlation between adolescents who had ever been pregnant and those who had no education. Additionally, those who form part of the highest wealth quintile in the country were less likely to have ever been pregnant. Overall decreasing trends in Kenya’s fertility ratesAlthough fertility rates in Kenya have dropped considerably since 1989, the global fertility rate is significantly lower. Kenyans living in rural areas have a higher total fertility rate compared to those living in urban areas. This is reportedly due to differences in the level of education, the use of contraception, and the desire to live a quality life. Between 1995 and 2000, the decline in fertility rates in Kenya slowed somewhat, partly due to the government prioritizing and reallocating healthcare resources towards combatting the then-emerging HIV/AIDS epidemic. However, resources for contraceptives and family planning commenced once more around 2003, and as a result, the total fertility rate began to fall steadily again.