Determinants of adolescent fertility among ever-married women in Bangladesh: an analysis of the 2022 Bangladesh Demographic and Health Survey

Bangladesh continues to report one of the highest adolescent fertility rates in South Asia, yet most prior national analyses have not fully accounted for the complex survey design of the Demographic and Health Surveys or assessed the robustness of findings to missing data. Using the most recent nationally representative data, this study examined factors associated with adolescent fertility among ever-married adolescent women aged 15-19 years in Bangladesh. We analysed data from the 2022 Bangladesh Demographic and Health Survey. Adolescent fertility was defined as being currently pregnant or having had at least one live birth. Of 2,449 eligible ever-married women aged 15-19 years, 1,601 with complete information on all model variables were included in the primary complete-case analysis. Survey-weighted logistic regression incorporating sampling weights, clustering, and stratification was used to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Multiple imputation by chained equations among all 2,449 respondents was conducted as a sensitivity analysis. Analyses were performed in R version 4.5.1, and a two-sided p < 0.05 was considered significant. Adolescent fertility was strongly associated with age at first cohabitation. Compared with women who first cohabited before age 15 years, the odds were significantly lower among those cohabiting at 15-17 years (AOR = 0.41, 95% CI: 0.31-0.55) and 18-19 years (AOR = 0.15, 95% CI: 0.10-0.22; both p < 0.001). Women whose husbands had higher education had lower odds of adolescent fertility than those whose husbands had no formal education (AOR = 0.46, 95% CI: 0.27-0.77, p = 0.004), whereas a spousal age gap of 11 years or more was associated with higher odds (AOR = 1.63, 95% CI: 1.20-2.20, p = 0.002). Higher household wealth showed a borderline protective association (rich vs poor: AOR = 0.75, 95% CI: 0.56-1.01, p = 0.057). Respondent educational attainment and current working status were not independently associated with adolescent fertility after adjustment. Estimates from the multiply imputed datasets were broadly consistent with the complete-case findings. Adolescent fertility in Bangladesh is shaped by socioeconomic and relational factors, with age at first cohabitation the strongest determinant, alongside partner's education and spousal age gap. Multisectoral strategies that delay early marriage, strengthen child marriage legislation, engage male partners in reproductive health, and address socioeconomic and power inequalities are needed to reduce adolescent fertility and advance progress toward Sustainable Development Goal target 3.7