Scope of the problem
Every year, an estimated 21 million girls aged 15–19 years in developing regions become pregnant and approximately 12 million of them give birth.1 At least 777,000 births occur to adolescent girls younger than 15 years in developing countries. 2
The estimated global adolescent-specific fertility rate has declined by 11.6% over the past 20 years.5 There are, however, big differences in rates across the regions. The adolescent fertility rate in East Asia, for example, is 7.1 whereas the corresponding rate in Central Africa is 129.5.5
There are also enormous variations within regions. In 2018, the overall adolescent fertility rate in South-East Asia was 33.6 Rates, however, ranged from 0.3 in Democratic People’s Republic of Korea to 83 in Bangladesh.5
And even within countries there are enormous variations. In Ethiopia, for example the total fertility rate ranges from 1.8 in Addis Ababa to 7.2 in the Somali region with the percentage of women aged 15-19 who have begun childbearing ranging from 3% in Addis Ababa to 23% in the Affar region.7
While the estimated global adolescent fertility rate has declined, the actual number of child births to adolescents has not, due to the large – and in some parts of the world, growing – population of young women in the 15–19 age group.8 The largest number of births occur in Eastern Asia (95,153) and Western Africa (70,423).9
Context
Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income countries. Around the world, however, adolescent pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and employment opportunities.10
Several factors contribute to adolescent pregnancies and births. In many societies, girls are under pressure to marry and bear children early.11,12,13 In least developed countries, at least 39% of girls marry before they are 18 years of age and 12% before the age of 15.14 In many places girls choose to become pregnant because they have limited educational and employment prospects. Often, in such societies, motherhood is valued and marriage or union and childbearing may be the best of the limited options available.12
Adolescents who may want to avoid pregnancies may not be able to do so due to knowledge gaps and misconceptions on where to obtain contraceptive methods and how to use them.15 Adolescents face barriers to accessing contraception including restrictive laws and policies regarding provision of contraceptive based on age or marital status, health worker bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and adolescents’ own inability to access contraceptives because of knowledge, transportation, and financial constraints. Additionally, adolescents may lack the agency or autonomy to ensure the correct and consistent use of a contraceptive method. At least 10 million unintended pregnancies occur each year among adolescent girls aged 15-19 years in developing regions.1
An additional cause of unintended pregnancy is sexual violence, which is widespread with more than a third of girls in some countries reporting that their first sexual encounter was coerced.16
Health consequences
Early pregnancies among adolescents have major health consequences for adolescent mothers and their babies. Pregnancy and childbirth complications are the leading cause of death among girls aged 15–19 years globally, with low- and middle-income countries accounting for 99% of global maternal deaths of women aged 15–49 years.3 Adolescent mothers aged 10–19 years face higher risks of eclampsia, puerperal endometritis and systemic infections than women aged 20–24 years. 4 Additionally, some 3.9 million unsafe abortions among girls aged 15–19 years occur each year, contributing to maternal mortality, morbidity and lasting health problems.1
Early childbearing can increase risks for newborns as well as young mothers. Babies born to mothers under 20 years of age face higher risks of low birth weight, preterm delivery and severe neonatal conditions.4 In some settings, rapid repeat pregnancy is a concern for young mothers, as it presents further health risks for both the mother and the child.17
Social and economic consequences
Social consequences for unmarried pregnant adolescents may include stigma, rejection or violence by partners, parents and peers. Girls who become pregnant before the age of 18 years are more likely to experience violence within a marriage or partnership.16 Adolescent pregnancy and childbearing often leads girls to drop out of school, although efforts are underway is some place to enable them to return to school after child birth, this may well jeopardize girls’ future education and employment opportunities.19
WHO response
During the early part of the Millennium Development Goals era, prevention of adolescent pregnancy and related mortality and morbidity and prevention of HIV and HIV related mortality in adolescents and young people were not given sufficient attention due to competing priorities.20 During this period, WHO worked with partners to advocate for attention to adolescents, to build the evidence and epidemiologic base for action such as “WHO’s Guidelines for preventing early pregnancy and poor reproductive outcomes in adolescents in developing countries”,21 to develop and test programme support tools, to build capacity, and to pilot initiatives in the small but growing number of countries that recognised the need to address adolescent health. As the world has transitioned to the Sustainable Development Goals era, adolescents have moved to the centre of the global health and development agenda.21
While WHO continues its work on advocacy, evidence generation, tool development and capacity building, the focus has shifted to strengthening country-level action. WHO works closely with partners within and outside the United Nations system to contribute to the global effort to prevent children becoming wives and mothers. WHO works to strengthen the evidence base for action, and to support the application of the evidence through well-designed and well-executed national and subnational programmes. For example, WHO works closely with the UNICEF, UNFPA and UNWomen on a global programme to accelerate action to end child marriage.22 It also collaborates with Family Planning 2020 ─ a global partnership working to enable 120 million more women and girls access contraceptives by 2020.
Nongovernmental organizations have been at forefront of efforts to prevent adolescent pregnancy in many countries through bold and innovative projects. There is now a small but growing number of successful government-led national programmes e.g. in Chile, Ethiopia and the United Kingdom.23 These countries show what can been achieved with the application of good science combined with strong leadership, management, and perseverance. They challenge and inspire other countries to do what is doable and what urgently needs to be done – now.
ABSTINENCE IS THE BEST CHOICE…….STAY SAFE
References
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(2) UNFPA. Girlhood, not motherhood: Preventing adolescent pregnancy. New York: UNFPA; 2015.
(3) Neal S, Matthews Z, Frost M, et al. Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand 2012;91: 1114–18. Every Woman Every Child. The Global Strategy for Women`s, Children`s and Adolescents` Health (2016-2030). Geneva: Every Woman Every Child, 2015.
(4) WHO. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: WHO; 2016.
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(6) UN DESA, Population Division. World Population Prospects: The 2017 Revision, DVD Edition. New York: UN DESA; 2017.UNDESA, Population Division. World Population Prospects, the 2015 Revision (DVD edition). New York: UNDESA, Population Division, 2015.
(7) UNFPA. Adolescent pregnancy: A review of the evidence. New York: UNFPA, 2013.
(8) UN DESA, Statistics Division. SDG Indicators: Global Database. New York: UN DESA: 2017.
(9) Every Woman Every Child. The Global Strategy for Women`s, Children`s and Adolescents` Health (2016-2030). Geneva: Every Woman Every Child; 2015.
(10) UNICEF. Ending child marriage: Progress and prospects. New York: UNICEF, 2013
(11) WHO. Global and regional estimates on violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: WHO; 2013.
(12) WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2015.Filippi V, Chou D, Ronsmans C, et al. Levels and Causes of Maternal Mortality and Morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 3.
(13) Kozuki N, Lee A, Silveira M, et al. The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health 2013;13(Suppl. 3):S3.
(14) World Bank. Economic impacts of child marriage: Global synthesis report. Washington, DC: World Bank; 2017.
(15) WHO. Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. Geneva: WHO; 2011.
(16) Raj A, Boehmer U. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women 2013;19(4).
(17) WHO. Making health services adolescent friendly: Developing national quality standards for adolescent friendly health services. Geneva: WHO; 2012.
(18) WHO. Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation. Geneva: WHO; 2017.
(19) WHO. Global standards for quality health care services for adolescents. Geneva: WHO; 2015.
(20) WHO. Core competencies in adolescent health and development for primary care providers: including a tool to assess the adolescent health and development component in pre-service education of health-care providers. Geneva: WHO; 2015.
(21) UNESCO. International Technical Guidance on Sexuality Education: An evidence-informed approach for schools, teachers and health educators. Paris: UNESCO; 2009.
(22) UNESCO. Early and Unintended Pregnancy & the Education Sector: Evidence Review and Recommendations. Paris: UNESCO; 2017.
(23) United Nations General Assembly. Resolution adopted by the General Assembly on 25 September 2015: Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.