Part of how a girl matures into a healthy adult is ensuring that pregnancy is delayed and intended, especially in contexts where pregnancy can be dangerous. While adolescent pregnancy rates have generally declined over the past decade, approximately 16 million girls between the ages of 15 and 19 give birth each year, with 95 percent of these births taking place in low- and middle-income countries. Poverty and low levels of socio-economic development are a strong predictor of adolescent pregnancy, with the rates in the poorest countries being five times higher than in high-income countries (WHO, 2016). While there is considerable variation across the world, an estimated nine in ten adolescent pregnancies take place within the context of married relationships. In developing countries, approximately one-third of adolescent girls give birth before they are 20 years old and an estimated 2.5 million adolescent girls undergo unsafe abortions each year. Many factors place adolescent girls at a high risk of early or unintended pregnancy, including poverty, residing in rural areas, gender inequality, lack of education, and early marriage. The same factors that increase the likelihood of early or unintended pregnancy among adolescents are further exacerbated by the occurrence of early or unintended pregnancy. For example, girls who become pregnant are more likely to leave school early, have a lower income, and have more children at shorter intervals throughout their lifetime. In contrast, young women who avoid unintended pregnancy are more likely to stay in school, participate in the workforce, and have healthier, more educated children.
Not only does pregnancy during adolescence have negative social impacts, it poses significant risks to the health and lives of young women. Pregnancy is especially dangerous for very young adolescents who are not fully physically developed. Childbirth-related complications are the second-highest cause of death among girls ages 15–19. Pregnancy during adolescence also increases the risk of anemia, postpartum hemorrhage, prolonged obstructed labor, obstetric fistula, malnutrition, and mental health disorders, including depression. In general, adolescents face more birth complications than do older women.
Poor understanding of reproductive health knowledge, limited access to health care and family planning, inability to make health decisions, and incomplete physical development all fuel the disparate rates of negative pregnancy-related health outcomes among adolescents. Compared to older women, female adolescents also are more likely to give birth without a skilled birth attendant.
Strategic investment must be made to curb the multiple vulnerabilities that place girls at risk of unintended pregnancies, pregnancy-related complications, unsafe abortion, and death. Strategies to reduce the number of pregnancies among adolescents include:
- Expanding programs that aim to challenge the root socio-cultural causes of adolescent pregnancy, particularly through empowering girls;
- Expanding access to youth-friendly reproductive health information and services;
- Developing programs that enable girls and their partners to exercise their right to informed choice in methods for delaying and preventing pregnancy;
- Supporting quality comprehensive sexuality and family life education;
- Promoting programs that keep girls in school, including during and after they have been pregnant or had a birth;
- Expanding policies and programs aimed at mitigating the harmful effects of adolescent pregnancy through continuing to provide opportunities for girls who have been pregnant or had a birth;
- Expanding interventions that prevent early marriage;
- Enforcing laws against child marriage;
- Increasing attention to the reproductive health needs of both married and unmarried adolescents;
- Improving girls’ economic opportunities for girls; and
- Targeting gender inequalities.
Comparative Analysis: Policies Affecting Family Planning Access for Young Women in Guatemala, Malawi, and Nepal.
This USAID-funded “comparative analysis report examines the family planning needs of young women ages 15– 19 in Guatemala, Malawi, and Nepal, and how the policy environment shapes their access to services. The analysis drew on national surveys and other secondary data sources to describe the lives of these women and identify, categorize, and analyze policies affecting their access to family planning.” (2017)
Scaling Up Normative Change Interventions for Adolescent and Youth Sexual and Reproductive Health Literature Review Findings and Recommendations
The Passages Project conducted a literature review of published grey and peer-reviewed literature to explore parameters of normative change interventions going to scale that were focused on adolescent and youth reproductive health.(2016)
In this DHS comparative report (#45), authors employ “retrospective data from women and men age 15-24—the most recent cohort that experienced adolescence in the 5 years preceding the survey—to investigate health outcomes during the full range of adolescent years from age 10-19. For 52 countries, this study compiles adolescent sexual and reproductive health indicators in the areas of marriage, sexual activity, contraceptive use, fertility, maternal health, and gender-based violence.” (2017)
This report presents the best and most recent evidence on effective strategies and interventions to reduce the vulnerability of adolescent pregnancy through empowering girls. The report draws on evaluated evidence to provide strategic guidance on how to implement effective programs that work at multiple levels to prevent adolescent pregnancy (2015).
This report reviews global and country trends in adolescent pregnancy, the variations across geographic regions, the interventions used to minimize pregnancy among adolescents, and the evidence for the effectiveness of specific intervention approaches (2013).
Child marriage, Adolescent pregnancy and Family formation in West and Central Africa: Patterns, trends, and drivers of change
This report reviews the drivers of child marriage and adolescent pregnancy in the West and Central Africa region, trends over time in the ages at which key components of family formation (first sexual intercourse, first marriage, and first birth) take place in the region, and suggests directions for future programming and policy in the region (2015).
WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Outcomes Among Adolescents in Developing Countries
This report presents the findings from a systematic review of the evidence on preventing adolescent pregnancy and related poor reproductive outcomes. The report provides recommendations on action and research in these areas, with the goal of providing policy-makers, planners and programmers with information on effective intervention approaches (2011).
This review of the literature on adolescents’ demand for and access to family planning information and services aims to identify the barriers to increasing adolescents’ access to and use of family planning services, programmatic responses to these barriers, and continuing gaps in the evidence that require further research and/or investment (2014).