Abstract
BackgroundDespite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste.MethodsUsing the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance.ResultsWe found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively.ConclusionsThis study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.
Highlights
Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates
While it is assumed that most adolescent pregnancies result from inadequate sex education, lack of access to contraception and reproductive health services [6, 9], recent studies show that there are many complex socio-economic and cultural factors that can increase the likelihood of adolescent pregnancy [10, 11]
The results revealed disproportionately higher Adolescent Fertility Rate (AFR) among the disadvantaged subgroups
Summary
Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. This study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste. Approximately 16 million adolescents aged 15– 19 years become pregnant each year [3]. Though there has been recent global decline in Adolescent Fertility Rate (AFR) [4],defined as the number of births per 1000 women aged 15 to 19 years [5], these rates are either stagnant or increasing in several countries in East Asia and the Pacific [6]. The adolescent pregnancy rates across South East Asia is approximately 94.4 in Lao People’s Democratic Republic, 41.9 in Timor-Leste and 2.7 in Singapore [8]. While it is assumed that most adolescent pregnancies result from inadequate sex education, lack of access to contraception and reproductive health services [6, 9], recent studies show that there are many complex socio-economic and cultural factors that can increase the likelihood of adolescent pregnancy [10, 11]
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