# Pregnancy loss and its predictors among ever-pregnant women in Sub-Saharan Africa: Multilevel mixed effect negative binomial regression

## TL;DR

This study examines factors associated with pregnancy loss among women in Sub-Saharan Africa using health survey data.

## Contribution

The study identifies predictors of pregnancy loss using multilevel mixed effect negative binomial regression in Sub-Saharan Africa.

## Key findings

- The median number of pregnancy loss is 2.67 among ever-pregnant women in Sub-Saharan Africa.
- Higher maternal age and education levels are linked to increased pregnancy loss.
- Women with multiple under-five children experience lower pregnancy loss rates.

## Abstract

Pregnancy loss is a significant maternal health issue in Sub-Saharan Africa. Africa has the highest rates of stillbirths globally, with an estimated 2.7 million stillbirths occurring each year on the continent. The pregnancy loss data are underreported and inconsistently recorded in Sub-Saharan Africa. Therefore, this study aimed to determine the number of pregnancy loss and its predictors among ever-pregnant women in Sub-Saharan Africa using a recent round of demographic and health survey (DHS) data.

A secondary data analysis was conducted among 235,086 weighted ever-pregnant women in Sub-Saharan Africa using a recent round of DHS data from 2015-2023. Multilevel mixed effect negative binomial regression was conducted. An adjusted incidence rate ratio (AIRR) with a 95% confidence interval (CI) was reported.

The median number of pregnancy loss in Sub-Saharan Africa is 2.67, 95%CI (2.64, 2.69). A one-year increase in maternal age [AIRR= 1.05, 95%CI (1.06, 1.07)], primary educational status of the mother [AIRR = 1.10, 95% CI (1.01, 1.22)], women with a partner who has higher education [AIRR= 1.18, 95% CI (1.04, 1.39)], a higher number of under-five children [AIRR =0.95, 95% CI (0.91,0.99)], women have ever pregnant in Cote’divore [AIRR 1.76, 95% CI (1.6, 2)] are associated with the number of pregnancy loss.

The findings indicate that there are three pregnancy losses among ever-pregnant women in Sub-Saharan Africa. Notably, a one-year increase in maternal age and higher education levels for both mothers and their partners are linked to an increased risk of pregnancy loss. In contrast, mothers with multiple children generally experience lower rates of loss. Therefore, policy interventions should address the heightened risk of pregnancy loss linked to advancing maternal age and higher education levels for both mothers and their partners. This can be achieved by supporting programs that educate prospective parents about the effects of maternal age on pregnancy outcomes. Furthermore, promoting flexible educational pathways and providing career support can encourage healthier timing for pregnancies. Additionally, initiatives that support families and promote larger family sizes may help reduce pregnancy loss rates in Sub-Saharan Africa.