Abstract
Adolescent pregnancy (occurring < age 20) is considered a public health problem that creates and perpetuates inequities, affecting not only women, but societies as a whole globally. The efficacy of current approaches to reduce its prevalence is limited. Most existing interventions focus on outcomes without identifying or addressing upstream social and biological causes. Current rhetoric revolves around the need to change girls’ individual behaviours during adolescence and puberty. Yet, emerging evidence suggests risk for adolescent pregnancy may be influenced by exposures taking place much earlier during development, starting as early as gametogenesis. Furthermore, pregnancy risks are determined by complex interactions between socio-structural and ecological factors including housing and food security, family structure, and gender-based power dynamics. To explore these interactions, we merge three complimentary theoretical frameworks: “Eco-Social”, “Life History” and “Developmental Origins of Health and Disease”. We use our new lens to discuss social and biological determinants of two key developmental milestones associated with age at first birth: age at girls’ first menstrual bleed (menarche) and age at first sexual intercourse (coitarche). Our review of the literature suggests that promoting stable and safe environments starting at conception (including improving economic and social equity, in addition to gender-based power dynamics) is paramount to effectively curbing adolescent pregnancy rates. Adolescent pregnancy exacerbates and perpetuates social inequities within and across generations. As such, reducing it should be considered a key priority for public health and social change agenda.
Highlights
13 million adolescent girls give birth each year worldwide [1]
Eco-Social Theory (EST) provides a conceptual framework to evaluate the relationships among health inequities and power structures, and their transgenerational effects [36,37]
This discourse is at the base of interventions that often revolve around rational decision making by individuals
Summary
13 million adolescent girls (age < 20) give birth each year worldwide [1]. A study conducted in 57 Australian high schools reported that girls enrolled in abstinence programs faced twice the risk of experiencing a pregnancy and an abortion before age 20 compared to those in the control group (8% vs 4%, respectively) [20] Some of these interventions do succeed at reducing adolescent sexual activity, increasing contraceptive use and decreasing adolescent pregnancy in some regions of the world (e.g., Canada [23]; the United States [24]; some European countries [16,25–27]). Focused Intervention (multi-week sexual health education program featuring facilitated conversation between mothers and daughters) To achieve this aim it is necessary to shift the current framing of this public health issue so that we can move from interventions and policies focused on the individual to addressing the social and environmental structures that are at the root cause of adolescent pregnancy. We briefly review three complementary frameworks that we merge to achieve our aim: Eco-Social, Life History, and Developmental Origins of Health and Disease theories
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