Adolescent fertility in selected countries of Latin America and the Caribbean

Normal 0 14 false false false IT X-NONE X-NONE MicrosoftInternetExplorer4 According to the Millennium Development Goals (MDG) monitoring system, Latin America and the Caribbean is the region that presents the highest adolescent and youth fertility rate (for women aged 15-19), behind only Sub-Saharan Africa. During the 1990’s, several Latin American and Caribbean countries had an increase in this rate. The fertility rates were not only high, but did not decrease and were related to large social inequalities. Besides presenting high level and resistance to the decline, high early fertility concerns due to its large social inequality . This paper aims to offer a detailed and updated description of trends in fertility and motherhood among 15-19 year olds and its socioeconomic inequality in Latin American countries by using the most recent demographic census microdata. Additionally, given the theoretical and policy importance that education plays in adolescent reproduction, this paper aims to determine whether the decreases in fertility rates are due to advances in education. The results show that in last decade, most of the countries have experienced a decline in adolescent fertility and motherhood percentages, most of it due to the increase in enrollments rates in secondary education, as our exercise of direct standardization shows. Regarding the effects of education, the higher the schooling the lower the risk of being a mother during adolescence. However, the protective effect of education is declining insofar as its threshold is increasing. This occurs because, in the past, entering high school (HS), and above all getting a HS diploma implied much lower probabilities of being an adolescent mother than dropping out before HS. Nowadays this difference is narrower. These findings improve the projections of fertility indicators and its inequalities in the region, which in turn are invaluable for promoting public policies based on human and reproductive rights. Jorge RODRIGUEZ VIGNOLI, Research assistant, CELADE-Division de Poblacion de la CEPAL, Chile. E-mail: jorge.rodriguez@cepal.org . Suzana CAVENAGHI, Professor, National School of Statistical Science (ENCE), Brazilian Institute of Geography and Statistics (IBGE), Brazil. E.mai l: suzana_cavenaghi@uol.com.br . /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabella normale"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

Adolescent pregnancy and fertility are often discussed in literature as causes of health concern and as a social problem. Taking these accounts as a starting point, this paper uses the 2011 Uganda Demographic and Health Survey Data explore the factors related to adolescent fertility and pregnancy in Uganda. A total of 2,026 female adolescents are selected for this study. Logistic regression analyses adjusted for socioeconomic and demographic characteristics are estimated to predict the odds of an adolescent having borne a child in the 5 years preceding the survey, being currently pregnant and both having had a child in the 5 years preceding the survey or being currently pregnant at the time of the survey. Marital status is a strong predictor of the likelihood of both having a child in the 5 years preceding the survey and being currently pregnant at the time of the survey. Age equally appears to be an important predictor of the two outcomes, such that an increase in age was associated with increase in the odds of being pregnant and of having born a child. The discourse in this paper shows that adolescent pregnancy and childbearing is a serious policy intervention area that requires redress.

Adolescent health is a major global priority. Yet, as recently described by the World Health Organization (WHO), increased recognition of the importance of adolescent health rarely transforms into action. One challenge is lack of data, particularly on adolescent fertility. Adolescent pregnancy and childbirth are widespread and affect lifetime health and social outcomes of women, men, and families. Other important components of adolescent fertility include abortion, miscarriage, and stillbirth. Access to reliable, consistently-collected data to understand the scope and complexity of adolescent fertility is critical for designing strong research, developing meaningful policies, building effective programs, and evaluating success in these domains. Vital surveillance data can be challenging to obtain in general, and particularly in low- and middle-income countries and other under-resourced settings (including rural and indigenous communities in high-income countries). Definitions also vary, making comparisons over time and across locations challenging. Informed by the Adolescence and Motherhood Research project in Brazil and considering relevance to the Southern Eastern European (SEE) context, this article focuses on challenges in surveillance data for adolescent fertility for middle-income countries. Specifically, we review the literature to: (1) discuss the importance of understanding adolescent fertility generally, and (2) highlight relevant challenges and complexity in collecting adolescent fertility data, then we (3) consider implications of data gaps on this topic for selected middle-income countries in Latin America and SEE, and (4) propose next steps to improve adolescent fertility data for evidence-based health promotion in the middle-income country context.

What Will It Take to Further Reduce Teen Pregnancy in the U.S.?

BackgroundAdolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example.MethodsThis study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS.ResultsThis study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use.ConclusionsIn the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Peer Effects on a Fertility Decision:An Application for Medellín, Colombia Leonardo Fabio Morales (bio) The world’s total fertility rate has fallen substantially in the last fifty years. The Latin American and Caribbean region is not an exception to this rule, as a deep process of demographic transition has swept through the entire region. In the first decade of this century, the region’s total fertility rate (TFR) fell from 2.67 children per woman in 1999 to 2.12 by the end of 2010. The current rate is surprisingly close to the widely accepted replacement rate of 2.1. The evolution of the fertility rate for young populations is especially important because of the negative consequences of teenage childbearing, which is widely associated with low human development and poverty.1 In the last decade, the Latin American and Caribbean region also saw a reduction in the fertility rate for women between fifteen and nineteen years of age (FR15-19), from 83.95 children per 1,000 women in 1999 to 71.68 in 2010. While this reduction in the FR15-19 is substantial, it is smaller than the reduction in the TFR in the same period. Between 1999 and 2010, the TFR dropped 26 percent, while the FR15-19 fell 17 percent. This implies that adolescent fertility has become a more important component of total fertility in most of the countries in the region.2 Relative to adult fertility, adolescent fertility is becoming greater and greater in Latin America. [End Page 119] With some exceptions like Argentina and Peru, the contribution of adolescent fertility to total fertility has increased continuously in almost all Latin American and Caribbean countries. In 1999, adolescent fertility was 15.72 percent of total fertility in developing Latin American and Caribbean countries; by 2010, this ratio had increased to 16.29 percent. There are some remarkable cases, such as Brazil and Ecuador, where the ratio of adolescent fertility to total fertility increased by more than two percentage points between 1999 and 2010. The result of this phenomenon is, on average, an earlier individual onset of childbearing. To explain this interesting phenomenon, it is important to study the factors that determine the age at which a mother decides to have her first child. From an individual’s point of view, it may seem rational to have a child early in life given her education, her household socioeconomic conditions, and the characteristics of her social group. This paper explores the mother’s chosen timing for the onset of childbearing in an urban context in Colombia, emphasizing the role of peer effects and using longitudinal individual information that allows characterizing mothers before or at the time of the pregnancy. Many social researchers in the last three decades have been interested in the phenomenon that takes place when an individual’s behavior is partly explained by the influence of other individuals’ behavior. In economics this has been called social interactions or peer effects. There are several channels through which these effects may take place: for example, individuals may learn from peers’ behavior (social learning), or they may embrace the norms of the community with regard to socially accepted practices (social influence).3 The main purpose of this paper is to test the existence and measure the magnitude of peer effects on a fertility decision. The fertility decision considered is the woman’s age at the onset of childbearing. The study draws on a large sample of poor mothers in the city of Medellín, who had their first child between 2001 and 2010. Social interactions could be a potential explanatory factor in the reduction of the average age of mothers at first birth observed in Latin America and the Caribbean, and they could certainly be a cause for the high incidence of teenage pregnancy in countries such as Colombia. There is evidence on the existence of geographic sorting patterns governing the spatial distribution of several fertility outcomes in Latin American cities.4 For instance, in poor [End Page 120] neighborhoods women have more children and the onset of childbearing is earlier than in other neighborhoods. Nevertheless, the literature on fertility in the region has not explored the...

Little is known about relationship types and processes linked to adolescent pregnancy and childbearing in Sub-Saharan Africa. A greater understanding of the role of relationships could help in the design of interventions to reduce adolescent fertility. Data on 365 romantic and sexual relationships were collected from 298 adolescent female participants of a survey conducted in two towns in southeastern Ghana. Bivariate and multivariate analyses examined associations between adolescent fertility (i.e., pregnancy and childbearing) within a relationship and selected independent variables, such as the age difference between a woman and her partner, the partner's provision of basic and auxiliary financial support, the power disparity within the relationship, and cohabitation or marriage. Adolescent fertility occurred in 17% of relationships. Across model specifications, the strongest predictors of adolescent fertility were the partner's provision of basic financial support, and cohabitation or marriage. Increasing power disparity was associated with greater odds of adolescent fertility in some models. Being in a relationship with a partner five or more years older was associated with adolescent fertility in bivariate, but not multivariate, analyses. Adolescent pregnancy and childbearing in southeastern Ghana may be best understood as an aspect of relationship solidification and family formation along a gendered pathway to adulthood. Interventions that help young women avoid relying on sexual relationships as a source of financial support could be helpful in reducing adolescent fertility.

To meet the needs of female adolescents from low-income urban areas for sexual and reproductive health (SRH) care, vouchers providing free-of-charge access to SRH care at 19 primary care clinics were distributed in Managua, Nicaragua. These vouchers substantially increased the use of services, demonstrating that many adolescents are willing to use such services, if readily accessible. The voucher redemption made it possible to identify the nature of existing, but largely unmet, needs for SRH care. The medical files from 3301 consultations with female adolescents were analysed using descriptive statistical methods and multiple logistic regression. Female adolescents presented SRH problems that merited medical attention. The mean number of problems presented was 1.5 per consultation: 34% of the vouchers were used for contraceptives, 31% for complaints related to sexually transmitted infection (STI) or reproductive tract infection (RTI), 28% for advice/counselling, 28% for antenatal check-up and 18% for pregnancy testing. A new category of health care users emerged: sexually active girls who were neither pregnant nor mothers and who sought contraceptives or STI/RTI treatment. Contraceptive use doubled among the sexually active non-pregnant voucher redeemers. Consultation with a female doctor younger than 36 years was associated with a higher chance of having contraceptives prescribed. Accessible and appropriate SRH care has the potential to make an important contribution to the increased contraceptive use, decreased risk of unwanted teenage pregnancies and decreased prevalence of STIs/RTIs among underserved adolescents. Once adolescents access the services, providers have a crucial role in ensuring current and continuing needs are met.

This study examines the determinants of adolescent sexual behavior and fertility in Nigeria, with a special focus on knowledge, attitudes and behaviors of adolescents aged 10-19 years old in Karu Local Government Authority (LGA), a peri-urban area near the capital city of Abuja. Using the last three waves of Demographic and Health Surveys (2003, 2008, 2013), focus group discussions, stakeholder interviews, and a specialized survey of 643 girls and boys aged 10-19 years old in Karu LGA, the study narrows in on key challenges to and opportunities for improving adolescent sexual and reproductive health outcomes. The national median age at sexual debut for adolescent girls and boys is between 15 and 16 years of age. This is closely emulated in Karu LGA with a median age of 14.8 years for girls and 15.3 years for boys. While data on pregnancies was limited in the Karu sample, DHS data show that for girls, sexual debut is closely associated with marriage or cohabitation, which in turn is a strong predictor of adolescent fertility. Poverty is another strong predictor, with the odds of becoming pregnant being twice as high for adolescents in the lower wealth quintiles compared to their counterparts in the richest quintile in the country. While adolescents’ knowledge of contraception has increased from under 10 percent to over 30 percent, use of health services among adolescents for SRH (and contraception) is limited due to factors such as fear of stigma, embarrassment, and poor access to services, something also emphasized in focus group discussions. Challenges for improving adolescent SRH outcomes relate to: (i) the paucity of data, especially on the 10-14 year olds; (ii) availability and access to youth-friendly services and the Family Life and HIV Education (FLHE); (iii) reaching out-of-school adolescents with SRH information; and (iv) addressing ambiguities and gaps in Federal law and customs on age at marriage, and generating support for the legal age at marriage of at least 18 years old. Addressing these barriers at the State and sub-regional levels is going to be critical in improving adolescent well-being.

A decade after Uruguay legalized abortion at the end of 2012, the adolescent fertility rate dropped to one-third of its previous level. This article aims to establish a causal relationship. To estimate the impact of the abortion reform on adolescent fertility, I use the Synthetic Control Method, comparing trends in Uruguay with Latin American and Caribbean countries with restrictive abortion laws. The results suggest that the adolescent fertility rate declined by 8.3 births per 1,000 girls aged 15–19 between 2013 and 2019, almost 15% relative to the synthetic control unit. This effect is statistically significant and robust. To date, evidence on the impact of Uruguay’s abortion legalization on adolescent fertility that has addressed endogeneity is mixed and based entirely on identification strategies that exploit different sources of exogenous within-country variation that determine exposure to the reform. My contribution here is to exploit cross-country variation to bring new evidence to the ongoing debate, providing critical insights for reproductive health and gender equality in the region.

BackgroundDespite global and regional policies that promote the reduction of adolescent fertility through ending early marriages and reducing early child-bearing, adolescent fertility remains high in most sub-Saharan countries. This study aimed to explore the competing discourses that shape adolescent fertility control in Zambia.MethodsA qualitative case study design was adopted, involving 33 individual interviews and 9 focus group discussions with adolescents and other key-informants such as parents, teachers and policymakers. Thematic and critical discourse analysis were used to analyze the data.ResultsAdolescents’ age significantly reduced their access to Sexual and Reproductive Health, SRH services. Also, adolescent fertility discussions were influenced by marital norms and Christian beliefs, as well as health and rights values. While early marriage or child-bearing was discouraged, married adolescents and adolescents who had given birth before faced fewer challenges when accessing SRH information and services compared to their unmarried or nulliparous counterparts. Besides, the major influencers such as parents, teachers and health workers were also conflicted about how to package SRH information to young people, due to their varying roles in the community.ConclusionThe pluralistic view of adolescent fertility is fueled by “multiple consciousnesses”. This is evidenced by the divergent discourses that shape adolescent fertility control in Zambia, compounded by the disempowered position of adolescents in their communities. We assert that the competing moral worlds, correct in their own right, viewed within the historical and social context unearth significant barriers to the success of interventions targeted towards adolescents’ fertility control in Zambia, thereby propagating the growing problem of high adolescent fertility. This suggests proactive consideration of these discourses when designing and implementing adolescent fertility interventions.

IntroductionDespite the advancement in sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, countries in sub-Saharan Africa (SSA) still experience higher adolescent fertility rates than other low-and middle-income countries. This study examined the disparities in adolescent fertility in 39 countries in SSA, focusing on socioeconomic and residence-based dimensions.MethodsThis study involved a secondary analysis of data obtained from 39 recent Demographic and Health Surveys conducted in SSA. The measures of difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were estimated using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based dimensions.ResultsOut of the 39 countries included in the study, Guinea (D=27.70), Niger (D=27.50), Nigeria (D=23.90), and Côte d’Ivoire (D=23.60) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with the higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the rate of adolescent fertility, with a value of D = -0.80. The burden of adolescent fertility was disproportionately higher among young women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.70), Madagascar (D=41.10), Guinea (D=41.00), and Cameroon (D=40.20). We found significant disparities in educational attainment contributing to unequal inequalities in adolescent fertility, particularly among young women who lack access to formal education. Countries such as Madagascar (D=59.50), Chad (D=55.30), Cameroon (D=54.60), and Zimbabwe (D=50.30) had the most significant absolute disparities.ConclusionThis study revealed that young women residing in rural areas, those in households with low economic status and those with limited educational opportunities experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable sexual and reproductive health services to the populace, particularly for young women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislation pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rates and mitigate the adverse maternal and child outcomes associated with high adolescent fertility in SSA.

Advancing Sexual and Reproductive Health Education—Pursuing the Long Arc of Justice

Afrodescendants are systematically affected by discrimination in the Americas and few multi-country studies addressed ethnic inequalities in health and wellbeing in the region. We aimed to investigate gaps in coverage of key health outcomes and socioeconomic inequalities between Afrodescendants and non-Afrodescendants populations in Latin American and Caribbean countries. Using national household surveys (2011-2019) from ten countries, we analyzed absolute inequalities between Afrodescendants and a comparison group that includes non-Afrodescendants and non-Indigenous individuals (henceforth non-Afrodescendants) across 17 indicators in the continuum of reproductive, maternal, newborn, child, and adolescent health. These include indicators of family planning, antenatal care, delivery assistance, child nutrition, immunization coverage, child protection, access to improved water, sanitation and hygiene, adolescent fertility, and early childhood mortality. Inequalities between country-specific subgroups of Afrodescendants were also explored. The slope index of inequality was used to assess wealth-based inequalities within each ethnic group. Afrodescendants represented from 2·8% (Honduras) to 59·1% (Brazil) of the national samples. Of the 128 combinations of country and indicators with data, Afrodescendants fared worse in 78 (of which 33 were significant) and performed better in 50 (15 significant). More systematic disadvantages for Afrodescendants were found for demand for family planning satisfied, early marriage, and household handwashing and sanitation facilities. In contrast, Afrodescendants tended to present lower c-section rates and lower stunting prevalence. Honduras was the only country where Afrodescendants performed better than non-Afrodescendants in several indicators. Wealth gaps among Afrodescendants were wider than those observed for non-Afrodescendants for most indicators and across all countries. Gaps in health outcomes between Afrodescendants and non-Afrodescendants were observed in most countries, with more frequent disadvantages for the former although, in many cases, the gaps were reversed. Wealth inequalities within Afrodescendants tended to be wider than for non-Afrodescendants. Pan American Health Organization, Bill and Melinda Gates Foundation, and the Wellcome Trust.

Adolescent fertility in low- and middle-income countries presents a severe impediment to development and can lead to school dropout lost productivity and the intergenerational transmission of poverty. However there is debate about whether adolescent pregnancy is a problem in and of itself or merely symptomatic of deeper ingrained disadvantage. To inform policy choices and create a revised research agenda for population and development this paper aggregates recent quantitative evidence on the socioeconomic consequences of and methods to reduce of teenage pregnancy in the developing world. The review finds variable results for all indicator types with the partial exception of knowledge-based indicators which increased in response to almost all evaluating interventions though it is not clear that such interventions necessarily lead to short- or long term-behavior change. The evidence base supporting the effectiveness of conditional cash transfers was relatively strong in comparison to other interventions. Similarly programs that lowered barriers to attending school or increased the opportunity cost of school absence are also supported by the literature. On the basis of these findings the authors argue that donors should adopt a rights-based approach to adolescent fertility and shift their focus from the proximate to distal causes of pregnancy including human rights abuses gender inequality child marriage and socioeconomic marginalization. Further research should be conducted to strengthen the evidence base by 1) establishing causality 2) understanding the differential impacts of adolescent fertility in different contexts and 3) investigating other the impact of adolescent fertility on other socioeconomic outcomes such as labor participation productivity and the intergenerational transmission of poverty.