Adolescent Fertility and Reproductive Health Programmes in Developing Countries

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1 Adolescent Fertility and Reproductive Health Programmes in Developing Countries Ann Biddlecom, PhD Presentation for Panel Discussion, Population Division, Department of Economic and Social Affairs December

2 Overview Current status, trends & context of adolescent fertility Key levers influencing adolescent fertility Programmatic approaches

3 Why care about adolescent fertility? Pregnancies should be Wanted Safe At the right time

4 Why care about adolescent fertility? 1) Lower maternal mortality and morbidity 2) Improve schooling achievement 3) Prevent HIV transmission 4) Raise gender equality 5) Reduce poverty

5 Adolescence is a time when changes in sexual activity happen fast Sex by age South America Sex by age Caribbean/ Central America Eastern/ Southern Africa Sex by age Western/ Central Africa % of year old females who had sex by certain ages

6 And the pace of change is similar for adolescent males Sex by age 15 Sex by age Western/ Central Africa) Eastern/ Southern Africa) Caribbean/ Central America Sex by age South America % of year old males who had sex by certain ages

7 Childbearing begins by age 18 for many girls % of females who had a birth by age Western Asia/Northern Africa South America Caribbean/Central America South-central/Southeastern Asia Eastern/Southern Africa Western/Central Africa NRC & IOM (2005)

8 Adolescent childbearing is less common than among older generations % of females who had a birth by age 18 Age Age Western Asia/Northern Africa South America Caribbean/Central America South-central/Southeastern Asia Eastern/Southern Africa Western/Central Africa NRC & IOM (2005)

9 And this is especially the case for very early childbearing (by age 16) % of females who had a birth by age 16 Age Age Western Asia/Northern Africa South America Caribbean/Central America South-central/Southeastern Asia Eastern/Southern Africa Western/Central Africa NRC & IOM (2005)

10 The majority of births still occur within marriage South-central/Southeastern Asia 97 3 Eastern/Southern Africa Western/Central Africa Caribbean/Central America Western Asia/Northern Africa % 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Within marriage Outside of marriage % distribution of births to mothers age years by marital status

11 But many births to teen mothers are wanted later or not at all Nigeria Burkina Faso Senegal Birth was wanted then Ethiopia Birth was wanted later Uganda Malawi Birth was not wanted at all Ghana South Africa % 20% 40% 60% 80% 100% % distribution of wantedness of births to mothers under age 20

12 Unwanted and mistimed pregnancies are a major problem 7.9 million pregnancies Planned births 53% Miscarriages 16% Abortions 13% Pregnancy outcomes for adolescents aged in Sub-Saharan Africa Unplanned births 18%

13 Key levers influencing adolescent fertility

14 Timing of marriage Beginning of more frequent sex More unprotected sex Pressure to begin childbearing

15 Early marriage declining but still a common experience South-central/Southeastern Asia Western/Middle Africa Eastern/Southern Africa Western Asia/North Africa Caribbean/Central America year olds year olds % of women who were ever married by age 18 NRC & IOM (2005)

16 Schooling School attendance & higher education lower adolescent fertility Rising % of girls attending school after the age of puberty rising % exposed to pregnancy while in school

17 Contraceptive use Challenges for adolescents Provider & general social stigma Location, hours, cost Policy constraints Condom use (HIV & pregnancy prevention)

18 Contraceptive use has risen among sexually-active young women (18 African countries) Single 33 Any method (1993) Any method (2001) 13 Condoms (1993) Married Condoms (2001) % of year old sexually-active women Cleland, Ali & Shah (2006)

19 Programmatic approaches

20 Youth-friendly health services Evaluations show need intervention at facility, provider & community level Modifications at existing health facilities (hours, space, staff training) Stand-alone youth centres

21 School-based programs Family life, sex, or AIDS education Most tested Strong effects on knowledge & attitudes Weaker effects on behavior Not associated with increased risk behaviors

22 At best, only about half of adolescents receive any school-based sex education 100% 80% % 40% 20% % Burkina Faso Ghana Malawi Uganda Received sex education Attended school & did not receive sex education Attended school & sex education not offered Never attended school

23 Other programs specific to RH Peer education Mass media Community mobilization Social marketing

24 Is the program reaching adolescents in need?

25 One in four people reached by peer educators have never been to school (Burkina Faso) None Primary Secondary or higher Level of schooling of those reached by peer educators Females Males Lardoux & Jones (2006)

26 But most adolescents in Burkina Faso have never been to school None Primary Secondary or higher Level of schooling of year olds Females Males Guiella & Woog (2006)

27 Programs that indirectly affect adolescent RH Youth development (addresses wider range of needs; target at-risk subgroups) Micro-credit School retention

28 Adolescent fertility part of achieving larger development goals Lower maternal mortality and morbidity Improve schooling achievement Prevent HIV transmission Raise gender equality Reduce poverty

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