Correlates of high-risk fertility behaviours among married adolescent girls in northern Nigeria: the roles of sexual agency, healthcare accessibility, and participation in self-healthcare decision-making

In this study, we examined whether women’s empowerment indicators, such as sexual agency (SA), healthcare accessibility (HA), and participation in self-healthcare decision-making (PSD), were negatively associated with high-risk fertility behaviours (HRFBs) among married adolescent girls (aged 15-17) in northern Nigeria. The HRFBs were fertility status (FS), pregnancy status (PS), and contraceptive use (CU). From our analyses of the 2008-2023 Nigeria Demographic and Health Surveys (n = 1,690), we found positive associations between SA and CU, HA and CU, and PSD and FS. Women empowerment programmes in northern Nigeria should encourage the use of contraception (especially modern methods) among married adolescent girls with low sexual agency and advocate for easy access to healthcare, while educating married girls who participate in their healthcare decisions (alongside their male partners) on the potential negative health consequences of childbearing before adulthood.