literature review of unemployment in nigeria

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Youth unemployment in Nigeria: nature, causes and solutions

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(University of Ibadan Laboratory for Interdisciplinary Statistical Analysis [UI-LISA], Department of Statistics, University of Ibadan Centre for Econometrics and Applied Research (CEAR))

(Centre for Econometrics and Applied Research (CEAR))

• Olusanya E. Olubusoye
• Afees Adebare Salisu

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Unemployment in Nigeria: Policy Review and Recommendations

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One of the major means of survival in Nigeria (picture by Joshua Oluwagbemiga)

This paper, published in March 2021, is an outcome of an online workshop that was organized by Rethinking The Uploaders (RETU) as part of the project " Solving the Major Economic Problem in Nigeria" (SMEPN), on the topic Unemployment: Policy Review and Recommendations . It explores the various unemployment policies introduced by the Nigerian Government and analyzes how effective they are and suggests some practicable solutions to solving unemployment problems in the country. The project is an output of the Global Pluralist Economics Training (GPET). Do you want to take part in the next one, learn about pluralist economics and also learn how to host your own events? Find more information on Summer Academy for Pluralist Economics here .

UNEMPLOYMENT IN NIGERIA: POLICY REVIEW AND RECOMMENDATION

Author: Abdulkhalid Anda Salihu

Conceptual Clarification

According to the World Bank, unemployment refers to the share of the labor force that is without work but is available and seeking employment. The definition varies based on countries' dynamics and metrics for measurement but generally, the International Labor Organization definition is used. In Nigeria, the Nigeria Bureau of statistics categorizes an unemployed person as one who is part of the labor force who do not work for up to 40 hours per week within the reference week (the preceding week before measurement), another important concept is underemployment which in Nigeria refers to any individual who works for only 20-29 hours per week within the reference week. Unemployment differs in form as it could be structural;  which implies a mismatch between what employers require and what potential employees possess in terms of skill set and education. On the other hand, unemployment can be frictional (that contributes to the natural rate of unemployment) which is the time lag between leaving a job and getting another while cyclical unemployment is driven by fluctuation in the business cycle.

Current State of Unemployment in Nigeria

Nigeria's population is estimated by the UN population department at 200 million people in 2020 which is dominated by youth within the age bracket of 15-34 years, indicating a young population. Nigeria Bureau of Statistics (NBS) second-quarter 2020 reports highlighted the unemployment rate at 27.1% up from the 23.1% recorded in Q3, 2018. With a labor force of about 80 million persons (11.3% lower in Q3'18), the largest portion 29.1% or 23,328,460 falls within the age bracket of 25-34. This means that young people are faced with the challenge of getting full-time employment hence either remain idle otherwise settle with menial, part-time, voluntary jobs which are of course regarded as either unemployment or underemployment based on the bureau benchmark.  Although it is important to note that underemployment showed a gradual decline implying that the economy is actually creating employment but largely in the informal sector where the hours worked are not up to the benchmark for full employment but underemployment which is between 20-29 hour/weeks.  The majority of jobs are created in the informal sector at 54%, the private formal sector accounted for 37%, and the 9% left were generated by the public sector all in 2013 (World Bank 2014).

It seems to be like a paradox that a country blessed with an abundance of crude oil, precious and base metals, fertile lands, favorable weather condition, a young population yet still battles with GDP growth, bags the poverty capital of the world, ranks low in the doing business index which stifles foreign and domestic portfolio and foreign direct investment and of course results in insecurity, banditry, and terrorism we see today.

Some Causes of Unemployment Include

There are various reasons for the persistent rise of unemployment/underemployment in the country. Some of which is due to the structure of the economy and the other due to “not so effective” reforms, policies, and strategies to tackle the problem. Andrew Nelvin, partner and chief economist at Price Water Coopers (PWC), highlighted the country's dependency on crude oil proceeds which restrict diversification, hence shut out employment opportunities in other yielding sectors. Also, the oil sector is industrialized thereby requiring less workforce compared to other sectors. Other reasons include population growth particularly the labor force (15-64 years) compared to low jobs created.  The recent outbreak of coronavirus also contributed to job losses through the cut of global supply chains, the collapse of oil prices which dampened our foreign reserves led to exchange rates hike for a country that is import-dependent for consumables and raw materials making it difficult for firms to meet up, as a result, lay off workers. The deficient school curriculum is another reason; given the continuous changing environment in terms of industrial changes, advancement in technology, corporate technical skills, etc. which have created a skills gap, in other words, a mismatch between the supply side of labor (what employers require) and the demand side of labor (what potential employee possess) in terms of know-how and skill set.  Not forgetting the lack of industries in the country to absorb qualified graduates. Most important to note is that lack of industries is among other reasons due to lack of sufficient infrastructure investment in Nigeria.

Historical Reforms to Curtail Wide Spread of Unemployment

Several reforms, policies, and strategies have been put in place to address the problem of unemployment of which some were focused solely to tackle the problem head-on, a couple of them were indirect through poverty alleviation programs, and others were infused into national development plans. Some of the recent programs include Subsidy Reinvestment Program (SURE P), which was introduced in 2012 towards reinvesting savings accrued from fuel subsidy on critical infrastructure projects and social safety programs. The major objective of this program was to employ graduates through internship programs to reduce social vulnerability. Later in 2013 another initiative called University Entrepreneurship Development Programs (UNEDEP) to tackle graduate unemployment.  It was initiated by the Ministry of Trade and Investment aimed at promoting self-employment among youth before their graduation from higher institutions of learning. Youth Enterprise with Innovation in Nigeria (YOU WIN), initiated in 2011, structured to finance outstanding business plans for young aspiring entrepreneurs in Nigeria. And then, the National Social Investment Program (NSIP) in 2017 is infused in the National Economic Recovery and Growth Plan (ERGP) and the recent trader money and N-power initiative. Despite these reforms, we still witness growing unemployment and underemployment in the country to which I blame largely to lack of a technical framework to achieve these reforms and secondly lack of continuity.

Proposed Solution

Investment in Human Infrastructure in Line with Science Technology Engineering and Mathematics (STEM).   

A critical factor of every economy is the quality of its human capital. If well utilized it will accrue lots of prosperity for the country. Luckily, Nigeria does not only have a large population (Largest in Africa, 7th in the world) but a young population with a median age of 18. Since Science, Technology, Engineering, and Mathematics are drivers of innovation and digitization evidence from the Asian Tigers, If reforms are put in place to foster entrepreneurship within the framework of STEM channeled through the improvement of the educational sector, organizing STEM incubator programs, fellowships, and even scholarships, will help educate, equip and improve the quality of the labor force utilize. It's not enough to train the youth on STEM but further how it can be used to build wealth.

Unlocking the Potentials of the Informal Sector                            

Historically in Nigeria, the informal sector contributes about 41% to GDP and employs 68% of the labor force according to PWC Nigeria. Also, the NBS labor force report highlights a decline in unemployment for an individual with no formal education (22% in 2010, 18% in 2020). This is reflective that if the informal sector (SMEs) have improved access to funding, ease in doing business, not forgetting the role of competition in enhancing efficiency in the market, will thrive and create more jobs. On this basis I recommend reforms that will ensure ease in access to start-up and growth funding, ease in doing business reforms, a system to help mitigate risks these businesses may encounter, also providing non-contributory social safety net programs will help.

Role of the Private Sector                               

Of course, the government can't do it all, in developed nations, the private sector is the driver of employment. Private sector participation is very paramount if the problem of unemployment needs to be addressed. I'll borrow the ideology of Efosa Ojomo and Rich Alton in their paper "Avoiding The Prosperity Paradox". They proposed that developing economies can only grow, create jobs and reduce poverty by fostering prosperity through market-creating innovation by entrepreneurs as they create a market for non-consumers (individuals who cannot afford standard products or services for whom there always exists underlying demand).  If entrepreneurs can break complex (big) products and services into affordable bits to create demand for non-consumers, this will spring up aggregate demand, firms earn more and can employ more hands.

The core role of the government

Economic theory suggests that businesses cannot thrive in an environment with poor infrastructure hence the need for economic, social, and institutional infrastructure in terms of power, good transportation networks, information technology, and strong legal frameworks. Research suggests that favorable infrastructure investment with either deficit or non-deficit financing has the potential to create jobs, directly and indirectly. In response to the current revenue shortage in Nigeria to fund infrastructure projects, the Government can adopt other sources of financing like a public-private partnership, blended finance; a mix of multilateral development institutions, and public sector financing which will then crowd-in private sector financing.  As well as improve domestic resource mobilization.

All in all, as interesting as these policies, reforms, strategies, and frameworks may seem they are susceptible to poor implementation, therefore the need for sustainability, and sincere commitment from all stakeholders towards a better nation for all.

National Bureau of Statistics, "Labor force statistics: Unemployment and underemployment report," Q2 2020

PWC Nigeria, Insight and Publication: "Structural Transformation and Jobless Growth in Nigeria", https://www.pwc.com/ng/publications/structural-transformation-and-jobless-growth-in-nigeria.html

Efosa Ojomo and Rich Alton, "Avoiding The Prosperity Paradox," July 2020

The World Bank, https://databank.worldbank.org/metadataglossary/world-development-indicators/series

Mike I. Obadan & Ayodele F. Odusola, "Productivity and Unemployment in Nigeria".

United Nation Population Division, Worldmeter, https://www.un.org/en/development/desa/populaiton/publications/datatabase/index.asp, https://www.worldmeters.info/world-population/nigeria-population

Rethinking Economics The Uploaders (RETU) webinar on Solving the Major Economic Problem in Nigeria, https://www.retheuploaders.org/programs/SMEPN

Go to: Unemployment in Nigeria: Policy Review and Recommendations

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Impact of Unemployment on Economic Growth in Nigeria from 1990–2020

2022, Asian Journal of Economics, Business and Accounting

This study investigated the impact of unemployment on economic growth in Nigeria from 1990 to 2020. Population rate, unemployment rate and labour force were used as independent variables while Gross domestic product (GDP) as dependent variable. Annual time series data on our targeted variables were obtained from secondary sources including the Central Bank of Nigeria annual statistical bulletin, World Bank development indicators (various years). The Eview9 Statistical Software was employed to analyze the data empirically. The Unit root test shows that Gross domestic product, unemployment rate and labour force variables to be evaluated are all stationary after first deference I(1) while population rate was stationary at level I(0). The data were analyzed using the Autoregressive distributed lag (ARDL). From the results of the ARDL estimates it was revealed that among others, unemployment rate impact negatively on GDP but significant only in the long run. Population rate also impacts ...

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The rate of unemployment has risen in the last decade in most of the sub-Saharan African countries. The situation in Nigeria is rapid population growth with low level of employment rate. The theoretical proposition of the Okun's law is that a negative relationship exists between unemployment rate and economic growth. This study intends to test the validity of Okun's law in Nigeria. In order to examine the relationship between unemployment rate and economic growth, Error Correction Model (ECM) and Johasen cointegration test were employed to determine both the short run and long run relationships among the variables employed in the study. Empirical findings show that there is both the short and the long run relationship between unemployment rate and output growth in Nigeria. Hence, there is need to incorporate fiscal measures and increase the attraction of foreign direct investment (FDI) to reduce the high rate of unemployment in the country. 1. Introduction One of the greatest challenges of the Sub-Saharan African economies today is the high rate of unemployment that has maintained a rising trend over the years. The problem of unemployment has been of great concern to the economists and policy makers in Nigeria since early 1980s. The effect of financial crisis on public and private sectors has led to renew attention on the phenomenon. It is a widely accepted view in economics that the growth rate of the Gross Domestic Product (GDP) of an economy increases employment and reduces unemployment. The three most significant elements for the economy overall are productivity, income distribution and unemployment. This theoretical proposition relating output and unemployment has been proposed by Okun (1962). This relationship is among the most famous in macroeconomics theory and has been found to hold for several countries and regions mainly, in developed countries (Christopoulos, 2004; Daniels and Ejara, 2009). Okun's (1962) postulates a negative relationship between movements of the unemployment rate and the real gross domestic product (GDP) by focussing on the empirical relationship between unemployment and GDP variations. He emphasised that as a result of changes in aggregate demand, industry changes their production pattern which leads to changes in demand for labour which alter the unemployment rates. This empirical relationship is a major part of every traditional macro-model as the aggregate supply curve is derived by combining Okun's law with the Phillips curve. Moreover, this relationship has also important implications for macroeconomic policy. It is simply very interesting to know the growth rate necessary to reduce unemployment (if this is even possible). Furthermore, the effectiveness of disinflation policy depends on the responsiveness of unemployment on the output growth rate (sacrifice ratio). Unemployment problem in Nigeria has different dimensions. There are underemployment cases in which people receive incomes that are inadequate to support their basic needs, in terms of food, clothing and shelter. There are also cases of disguised unemployment where people take up jobs that are below their educational attainment and experience. The worst case of all is that of people seeking for job opportunities but who cannot find any either in the public or the private sector. Some people are willing and ready to set up enterprises themselves and engage in one type of economic activity or the other but are constrained by the prevailing poor macroeconomic environment. All these have contributed significantly to the high level of unemployment and poverty in Africa (Oni, 2006). Another dimension of unemployment problem in Africa is the differentials in its manifestation by sector, sex and educational level. For instance, in Nigeria, available data from National Bureau of Statistics show that as the incidence of poverty is higher in rural than urban area, so also is the rate of unemployment, particularly in the late 1990s and 2000s. The incidence of poverty is higher in Nigeria among those who have little or no education than the other categories. In the same vein, the proportion of employment persons with little or no education is higher than all other categories of people with different levels of education. The objective of this study is to test the validity of Okun's law for Nigeria through. Specifically, the study intends to examine the impact of unemployment on the Nigerian Economic growth and testing the sensitivity of output to change in unemployment rates in both short run and long run.

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Evaluation of High-Quality Development Level of Regional Economy and Exploration of Index Obstacle Degree: A Case Study of Henan Province

• Published: 06 September 2024

Cite this article

• Jun Zhou 1 ,
• Tang-fei Hu 3 ,
• Zhengqi Wei   ORCID: orcid.org/0000-0002-1699-3321 2 &
• Dandan Ji 4  

As China’s economy transitions from a phase of high-speed growth to one of high-quality development, the study of high-quality economic development has become increasingly important. Assessing and analyzing the current level of high-quality economic development can provide guiding recommendations for future economic transformation and high-quality growth. This research constructs an evaluation index system for high-quality economic development based on panel data from Henan Province spanning from 2006 to 2021. The entropy weight method combined with the TOPSIS model is utilized to determine the weights of each indicator and to assess the level of high-quality economic development in Henan Province; a coupling coordination model is employed to analyze the degree of coupling and coordination among its subsystems; and a barrier degree model is applied to identify the main obstacles to high-quality economic development in Henan Province. The study finds that (1) the proportion of technology market turnover has the most significant impact on high-quality economic development, while the revenue sharing level has the least. (2) During the research period, both the level of high-quality economic development in Henan Province and the subsystems of economic structure, innovation drive, regional coordination, and social welfare have shown an upward trend. (3) The coupling coordination degree of the subsystems increases at a rate of approximately 9% per year. (4) The obstacle degree of the economic stability, regional coordination, and infrastructure subsystems is on the rise, while that of the economic structure, opening up level, and social welfare subsystems is decreasing. (5) The inhibitory effects of the urban–rural income coordination level, the coordination level of urban and rural consumption, the community service level, the global unemployment rate, and the global trade level have intensified since 2017. Based on the aforementioned research findings, this paper proposes a series of policy recommendations. The translation ensures logical coherence and enhances the overall quality and readability of the content.

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Predominant approaches to measuring pregnancy-related anxiety in Sub-saharan Africa: a scoping review

• Sophia Dane Fraga 1 ,
• Ibrahim Nawaz Khan 1 ,
• Tanvi A. Sharma 1 &
• Emma R. Lawrence 2  

BMC Public Health volume  24 , Article number:  2425 ( 2024 ) Cite this article

Metrics details

Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregnancy-related anxiety in LMICs have utilized scales developed in high-income countries, despite significant variations in pregnancy-related anxiety due to socioeconomic and cultural contexts. This review surveyed existing literature in order to identify which scales have been used to measure pregnancy-related anxiety in SSA.

A systematic search was conducted in PubMed, Health and Psychosocial Instruments, and APA PsycNet for relevant studies published in the English language up to March 22, 2023. Eligible studies focused on anxiety in pregnant populations within SSA, using validated scales or tools. Screening followed PRIMSA guidelines, with blinded review at the abstract/title level and subsequent full-text review. Data was extracted and analyzed to identify trends and characteristics of the screening tools used.

From 271 articles, 37 met inclusion criteria, identifying 24 different tools used to measure anxiety in pregnant women in SSA. The most common tools were the Generalized Anxiety Disorder 7-item scale (seven uses), State-Trait Anxiety Inventory (five uses), and the Self-Reporting Questionnaire 20 (five uses). Seven tools were pregnancy-specific, with only two designed specifically for SSA: the Risk Factor Assessment (RFA), and the 4-Item Screening Tool. Studies were most frequently conducted in South Africa, followed by Tanzania, Ethiopia, Nigeria, and Ghana.

Conclusions

This scoping review illustrates that only two tools (the RFA and 4-item Screening Tool) were created to assess pregnancy-related anxiety specifically in SSA. This highlights the need for more culturally sensitive tools tailored to the specific contexts of pregnant populations in SSA.

Peer Review reports

Pregnancy-related anxiety is defined as worry associated specifically with maternal or infant outcomes, making it distinct from generalized anxiety disorder (GAD) [ 1 ]. In fact, studies have shown that most women with anxiety in pregnancy had worries not associated with GAD [ 1 ]. A concept analysis broke pregnancy-related anxiety into nine cognitive dimensions: anxiety around fetal health, loss of fetus, childbirth, mother’s wellbeing, body image, parenting and care for child, general health care, financial, and family/social support [ 2 ].

Pregnancy-related anxiety is a pervasive concern that affects pregnant individuals worldwide across income levels and geographic locations. Globally, approximately 15.2% of pregnant women meet criteria for an anxiety disorder [ 3 ]. Untreated maternal anxiety or depression may increase risk for adverse pregnancy outcomes such as gestational diabetes mellitus, fetal growth restriction, preterm birth, or fetal demise by nearly 3.5 times [ 4 ]. Moreover, recent studies have demonstrated a strong association between maternal anxiety and adverse socioemotional, cognitive, motor, and behavioral outcomes in their children. These negative developmental consequences can extend beyond infancy and have enduring effects throughout childhood and adolescence [ 5 ].

In low- and middle-income countries (LMICs), the prevalence of anxiety symptoms during pregnancy is even higher than in high-income countries, with reports suggesting that one in four women experience anxiety symptoms [ 4 ]. In LMICs, pregnancy-related anxiety represents a particularly significant burden due to the numerous challenges faced by pregnant individuals, including limited access to healthcare, poverty, and social disparities [ 6 ]. Sub-Saharan Africa (SSA) notably contains LMICs with the highest rates of maternal morbidity and mortality [ 7 ]. Risk factors for development of maternal mood disorders (poverty, food insecurity, intimate partner violence, and comorbid medical conditions) are common in many countries within SSA [ 8 ]. However, research on prevalence of pregnancy-related anxiety in SSA has been limited [ 8 , 9 ].

Determining the prevalence of pregnancy-related anxiety depends on the adaptation and execution of validated scales to measure anxiety. Most of the existing research conducted in SSA settings has relied on scales and measures developed in high-income countries. However, scales developed in high-income countries may not adequately capture the unique determinants of pregnancy-related anxiety in SSA [ 10 , 11 , 12 ]. Additionally, in applying these scales, users may encounter barriers such as translation errors, administrative challenges in limited-resource settings, or overly complex and inaccessible language [ 10 , 13 ]. Furthermore, the concerns of pregnant women and clinical presentation of pregnancy-related anxiety in SSA may be distinct due to cultural differences [ 10 , 14 , 15 ]. This highlights the need for culturally and contextually sensitive scales that are specifically validated for use in SSA populations. Site-specific validated scales are needed to quantify the overall burden of pregnancy-related anxiety, evaluate individual patients in clinical environments, and accurately assess the efficacy and impact of mental health interventions [ 16 ].

To address these critical gaps, we undertook a scoping review of validated screening tools for detecting pregnancy-related anxiety in SSA, with a focus on identifying scales validated within SSA contexts. Throughout this review, we aimed to (1) describe the use of pregnancy-related anxiety scales evaluated in the literature by type of scale and study setting, and (2) summarize characteristics of the scales, including length and question type, that may impact the practicality of administration in low-resource settings.

This scoping review was conducted following the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) [ 17 ] and adhered to the methodological framework first outlined by Arksey & O’Malley [ 18 ].

The primary aim of this scoping review was to identify and determine the current screening tools utilized to assess pregnancy-related anxiety in SSA. The scope of this project was intentionally limited and not intended to serve as a comprehensive synthesis or systematic review of all relevant literature on pregnancy-related anxiety in SSA. As such, it provides an overview of the tools and methodologies applied in existing studies rather than an exhaustive analysis.

Information sources, search strategy, and eligibility criteria

A comprehensive search strategy was developed by the research team, which consisted of an obstetrician, research assistants, medical students, and an experienced health sciences librarian. The databases PubMed, Health and Psychosocial Instruments (HaPI), and APA PsycNet were searched systematically for relevant studies in the English language that assessed pregnancy-related anxiety in SSA using validated scales. All searches were conducted on March 22, 2023 and included any relevant studies published up to that date. The search terms encompassed concepts related to pregnancy, anxiety, Sub-Saharan Africa, and tool evaluation (Table  1 ). The search strategy adhered to the PRISMA guidelines, with Fig.  1 outlining the search refinement process.

PRISMA flow chart of study selection

The initial database search identified 281 records, from which 12 duplicate articles were removed, yielding 269 unique records. These were exported to Rayyan, a web-based tool designed for reviews. An additional two articles were identified through reference list reviews, bringing the total to 271 articles for screening. Abstracts and titles were reviewed blindly by three independent researchers (SF, TS, IK) using inclusion criteria and exclusion criteria, as detailed below. Blinding limited bias by preventing reviewers from seeing each other’s decisions until all articles had been independently reviewed. Articles were included only if all three readers agreed on inclusion, and discrepancies were resolved via consensus discussions.

From the 271 article abstracts screened for inclusion, 59 met the initial criteria and were subjected to full-text review. Of these, 37 articles were deemed relevant for data extraction, with exclusions made for reasons such as duplicate data, focus on postpartum cohorts, or research conducted outside of SSA, as detailed in the PRISMA diagram (Fig.  1 ).

Eligible studies were required to meet the following criteria: (1) focus on anxiety screening, (2) examination of anxiety specifically among pregnant women, (3) conduct of research in Sub-Saharan Africa, and (4) use of a specific, validated scale or tool for evaluating pregnancy-related anxiety. Studies with a primary focus on other psychological conditions (e.g., depression, psychosis) were included only if they provided data on pregnancy-related anxiety measures.

During the search process, it was noted that many scales utilized were not specific to pregnancy-related anxiety but were originally developed for GAD. Despite the distinct nature and presentation of pregnancy-related anxiety [ 1 ], these generalized scales were included to reflect historical and current practices in the assessment of anxiety during pregnancy. Additionally, studies evaluating peripartum “common mental disorders,” as previously defined by the World Health Organization [ 19 ], were included in the review.

Exclusion criteria included (1) studies that utilized qualitative methods, such as narrative descriptions, (2) studies that utilized focus groups, (3) studies that assessed pregnancy-related anxiety in retrospect, and (4) unpublished studies or studies pending publication.

Data extraction

Data was extracted and reviewed by three authors (SF, IK, TS). Each full text article was examined for the country of study implementation, the number of participants, participant age range, the screening tool(s) used, and the outcome examined (e.g., common mental disorder vs. anxiety) (Table  2 ). In cases where multiple screening tools were used to evaluate different outcomes, only data pertaining to anxiety measurement were extracted; scales that exclusively measured another mental health disorder without components of anxiety (e.g., depression, psychosis) were excluded. An exception was made for three studies that utilized the Edinburgh Postnatal Depression Scale (EPDS) to measure anxiety symptoms in pregnant women [ 20 , 21 , 22 ]. No additional studies were identified for inclusion upon further review of references.

The final stage of data extraction was performed on each full-length pregnancy anxiety screening tool, to examine the characteristics of each tool. Reviewers obtained data on the pregnancy-specificity of each tool, as well as the number of questions, types of questions, and number of answer options (Table  3 ).

Data synthesis

Extracted data were analyzed to identify trends in the use of screening tools across SSA, including country-specific usage patterns. First, data for each pregnancy-related anxiety screening tool was analyzed. Geographic data was compiled, examining the different countries each scale was used in and the number of instances of use in each country. This data was then synthesized along with the data extracted regarding scale characteristics (pregnancy specificity, number of questions, type of scale, number of question options), providing a comprehensive overview of the usage and characteristics of each screening tool (Table  3 ).

Data was then analyzed by country, examining which scales were used in each country, and in how many instances they were used (Table  4 ).

Study selection

The study selection is outlined in the PRISMA diagram (Fig.  1 ). All the included studies assessed pregnancy-related anxiety, with individual studies doing so at different points across all trimesters. Various methods were used to quantify levels of anxiety, with some studies having cut-off scores and others providing ranges to estimate anxiety.

Study characteristics

Thirty-five full-text articles contained studies that used a scale to evaluate mental health in pregnant women [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ] (Table  2 ). The specific outcomes evaluated in the studies varied slightly, but all studies were focused on evaluating forms of anxiety during pregnancy. Of the 35 studies, the most common outcome examined was anxiety (13 studies), followed by common mental disorders (seven studies), anxiety and depression (four studies), psychological distress (three studies), and childbirth fear (two studies) (Table  2 ).

Synthesis of results

Research on pregnancy-related anxiety in SSA was conducted in 10 different countries (Table  4 ; Fig.  2 ). The most frequent locations for the studies were South Africa (11 studies); Tanzania, Ethiopia, and Nigeria (five studies each); and Ghana (four studies) (Table  4 ). Each use of a scale in each study was counted as one data point and extrapolated into a heat map (Fig.  2 ). If a study used multiple scales, it was counted as multiple points on the heat map (i.e., a study that used the Generalized Anxiety Disorder 7-item scale (GAD-7) and the EPDS would count for two points on the heat map).

Frequency of studies on pregnancy-related anxiety by country

The most-used tools to evaluate pregnancy-related mental health in SSA were the GAD-7 (seven uses), State-Trait Anxiety Inventory (STAI; five uses), and Self-Reporting Questionnaire 20 (SRQ-20; five uses) (Table  3 ).

The 35 studies included in this review yielded 24 different tools to evaluate pregnancy-related anxiety in SSA. Nineteen of the 24 tools (79%) used Likert scales for their question type, four (17%) used yes/no questions, and one (4%) used ranking on a number line. Importantly, only seven of the 24 tools were developed to be used specifically in pregnant populations. Only two tools were developed specifically for use in SSA—the 4-item Screening Tool and the Risk Factor Assessment (RFA). These were both developed in South Africa, with the intention of being applied there [ 16 , 17 ]. Three other tools have been adapted for use in SSA: the Pregnancy-related Anxiety Scale (PrAS), the Pregnancy-Related Anxiety Questionnaire (PRAQ), and the Tilburg Pregnancy Distress Scale (TPDS) [ 9 ]. Studies included in this review were published between 1994 and 2022, with 74% (26/35) published in or after 2015, suggesting an increasing focus on pregnancy-related anxiety in SSA in recent years.

Few systematic reviews have described the screening tools used to evaluate pregnancy-related anxiety, and to our knowledge this review is the first to examine the use of these tools specifically in SSA. Three key themes emerged from this review: (1) the use of pregnancy-specific versus general anxiety scales; (2) the cultural relevance of screening tools specifically designed for LMICs—particularly SSA; and (3) the challenges of implementing these tools in these regions.

Regarding themes 1 and 2, of the 24 scales evaluated, only seven were developed specifically for pregnancy-related anxiety. Of these, only five were designed with LMIC contexts in mind: the RFA, the 4-Item Screening Tool, the PRAQ, the PrAS, and the TPDS [ 12 , 21 , 22 ]. Despite the relevance of these tools, the most frequently used tools in SSA were general anxiety scales, such as the GAD-7, the STAI, and the SRQ-20—none of which are pregnancy-specific. The frequent use of these general scales raises questions about their appropriateness in assessing pregnancy-related anxiety due to the significant clinical distinctions between pregnancy-related and general anxiety. Pregnancy introduces a unique set of stressors—financial, social, and health-related—that are not typically assessed by general anxiety scales [ 2 , 12 ]. The GAD-7 has been validated for use in several LMICs, such as Zimbabwe and Ghana, but its lack of pregnancy-specific focus may limit its efficacy in evaluating pregnancy-related anxiety [ 55 ]. Nonetheless, a recent study in Peru did show that the GAD-7 may have promise in evaluating pregnancy-related anxiety; however, this requires further investigation [ 56 ]. The SRQ-20, though developed by the World Health Organization for use in LMICs, similarly lacks a pregnancy-specific focus [ 57 ]. The STAI, despite its widespread use, has limited validation in LMICs, with Malaysia being the sole LMIC in which it is validated [ 58 , 59 ]. These findings underscore the importance of expanding the use and validation of pregnancy-specific scales in LMICs to ensure accurate assessment of pregnancy-related anxiety.

For theme 3, many obstacles remain when applying pregnancy-related anxiety screening tools to SSA contexts, as 19 of the 24 tools evaluated were developed for use in high-income countries. Cultural and economic stressors can be a source of anxiety for pregnant women, and scales developed in high-income countries may not adequately capture these factors and how they relate to pregnancy [ 10 ]. The practical challenges of implementing these tools—such as language barriers, difficulties in translating scales, time and resources needed to validate a screening tool in a new population [ 60 ], and the complexity of Likert scales—pose significant obstacles to their effective use in resource-limited settings.

Strengths and limitations

This study was limited by three main factors. First, the exclusion of non-English language studies may have led to the omission of relevant research, particularly from French- and Portuguese-speaking countries in SSA. This limitation could introduce a bias in our findings, as it may not fully represent the diversity of experiences and practices across SSA. It also prevented the use of databases that may have been relevant to our search such as Africa Wide, limiting the generalizability of our findings. Second, while we included studies that utilized scales validated for use in LMICs, these validations were often limited to specific countries or regions, which may limit their generalizability to other LMIC contexts. Given the diverse cultural and socioeconomic environments within SSA, it is crucial to refrain from characterizing SSA as a monolith, and we must consider that a tool validated in one country or population may not be appropriate for another within SSA. Additionally, external factors such as political shifts or climate change may necessitate the reappraisal and revalidation of these scales over time. Third, our review included a number of studies that utilized general anxiety scales in their aim to evaluate pregnancy-related anxiety. These scales typically included a limited number of questions related to worries of pregnancy and may not fully capture the unique symptomatology and trajectory of anxiety during pregnancy [ 61 ].

This scoping review sheds light on the current state of tools used to evaluate pregnancy-related anxiety in SSA and underscores the critical need for contextually appropriate tools that account for the unique stressors faced by pregnant women in these settings. Future research should prioritize tool development and validation, ensuring their practicality and ease of use in resource-constrained environments. This includes adapting tools to account for language barriers, simplifying scales for varying literacy, and ensuring compatibility with existing healthcare systems. Addressing these gaps may allow for future studies that track the course of pregnancy-related anxiety in SSA longitudinally, providing evidence to inform targeted interventions and policy decisions, and ultimately improving the mental health outcomes of pregnant women in these regions.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Low- or middle-income country

Sub-Saharan Africa

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

Edinburgh Postnatal Depression Scale

Generalized Anxiety Disorder 7

State-Trait Anxiety Inventory

Self-Reporting Questionnaire 20

Pregnancy Related Anxiety Questionnaire

Pregnancy-related Anxiety Scale-revised

Wijma Delivery Expectancy/Experience Questionnaire

Risk Factor Assessment

Tilburg Pregnancy Distress Scale

Zung Self-rating Anxiety Scale

Hospital Anxiety and Depression Scale

World Health Organization Disability Assessment Schedule 2.0

Kessler Psychological Distress Scale

Generalized Anxiety Disorder 2

Brief Symptoms Index

Beck Anxiety Inventory

Perceived Stress Scale

Depression Anxiety Stress Scale-21

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SF contributed substantially to the data acquisition in this manuscript, simultaneously authoring the methods section to document all steps towards data acquisition. SF synthesized all data into the results and discussion components. IK authored the introduction component of this scoping review and served as a blind reviewer in the abstract review phase of data acquisition. IK served as primary editor for the final manuscript. TS served as a blind reviewer in the abstract review phase of data acquisition. TS assisted with data extraction from the identified pregnancy-related anxiety scales, contributing significantly to the results and discussion section. ERL contributed substantially to the conception and design of the work, drawing on her past work in Ghana to determine a research direction for this scoping review. SF, IK, TS, and ERL critically reviewed the manuscript, approved the final version to be published, and agree to be accountable for all aspects of the work ensuring that questions related to integrity are appropriately investigated.

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Fraga, S.D., Khan, I.N., Sharma, T.A. et al. Predominant approaches to measuring pregnancy-related anxiety in Sub-saharan Africa: a scoping review. BMC Public Health 24 , 2425 (2024). https://doi.org/10.1186/s12889-024-19935-3

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Received : 11 April 2024

Accepted : 29 August 2024

Published : 06 September 2024

DOI : https://doi.org/10.1186/s12889-024-19935-3

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