Nearly one in three women in LMICs become mothers as teenager

While total fertility has fallen around the world, nearly one in three women in low- and middle-income countries are still becoming mothers during their teenage years, the UN's sexual and reproductive health agency highlighted in a new study.

The UNFPA report, entitled Motherhood in Childhood: The Untold Story, also showed that women in these countries who begin childbearing in their teens are having almost five births by the time they reach 40 years of age. The situation is being exacerbated, the authors said, by climate disasters, COVID-19, and conflict, since difficult conditions are potentially forcing millions more vulnerable girls into child marriages and early pregnancies.

The report, which examined global data on childbearing in 110 LMICs between 1960 and 2019, is a stark reminder that gender-based and income inequalities continue to fuel adolescent pregnancies, which keep girls out of school, prevent them from gaining formal employment, and limit their access to both health care and information on safe, consensual sex. The authors also noted that complications from giving birth are a leading cause of death and injury for older adolescent girls, and that being a teen mother can lead to child marriages, intimate partner violence, and mental health issues.

The authors also noted that seven countries – Algeria, Armenia, Bulgaria, Georgia, the Maldives, Tunisia, and Ukraine – were positive outliers, with fewer than 10 percent of its women beginning childbearing in adolescence, and may offer pathways to other countries. The Maldives and Tunisia have seen some of the biggest declines in teen pregnancies, while Central and South Asia have seen the most dramatic declines of any region, with India helping lead the way. On the flip side, Niger, Mozambique, and the Central African Republic currently have the highest proportions of women becoming mothers in their teens.

In advance of International Youth Day, we spoke with the report's primary author Ann Garbett, a researcher at the University of Southampton, and UNFPA project lead Satvika Chalasani, about their findings and recommendations for policymakers, including the need to provide girls with better sexuality education, social support, and health services.

Your report says you’ve uncovered the untold story of more than 50 years of adolescent childbearing in the world’s low- and middle-income countries. What is that story?

Garbett: In my years working in education in the highlands of Chiapas, Mexico, I met a lot of women and girls whose life stories weren't reflected in how adolescent childbearing is talked about in the data or news stories. One of the things that stood out for me was how young many of them were when they started childbearing and how common it was to have multiple births in adolescence, and sometimes within very short spans of each other.

That's where this idea came from, to reflect a little bit better on the more dynamic picture of how adolescent childbearing happens in most lower- and middle-income countries. It's not just a question of whether or not a girl gives birth in adolescence, but if, when, and how many. There's a huge difference between a 13-year-old giving birth to her first child versus a 19-year-old giving her first birth. And a huge difference between a 17-year-old giving birth to her second child and an 18-year-old giving birth to her first child. Timing is really important. Adolescence spans 10 years of really dramatic change.

There's also been increasing recognition [of the need] to help women space out their births to a healthy interval. Generally, the recommendation is about two years in between birth or pregnancy, so we wanted to look at how common these rapid repeat births were. If I sum it up, the untold story comes from using measures that focus on the most vulnerable girls and more dynamic aspects of their childbearing: child mothers, girls with repeat adolescent childbearing, and then births that occur in dangerously quick succession.

Your research examines trends in adolescent childbearing using new measures – could you speak about these measures and why they give a more complete picture?

Garbett: I'll qualify it a little bit because a lot of the measures are actually long-standing demographic techniques, but they've been slightly adapted to really hone in exclusively on adolescents. Demographers really have this down – looking at the different aspects of fertility like timing, spacing, and quantity – but that hasn't been translated into talking about adolescent childbearing. We are talking about things like the proportion of first births in adolescence that are to child mothers, the average number of adolescent births to child mothers, and the proportion of all adolescent births that occur to girls who start childbearing in childhood, among others.

Those who study adolescent childbearing have an almost exclusive focus on the adolescent birth rate. That measure is the number of births per 1,000 adolescents aged 15 to 19. There are a lot of things that, for me, are really inadequate about that measure. First – and probably most important for this report because it's talking about motherhood in childhood – is that it doesn't include any childbearing that happens before the age of 15. Actually, most official statistics don't include childbearing that happens among 14-year-olds and younger. That's why we wanted to focus on bringing that out in the report. Another reason I think that the adolescent birth rate measure is lacking is that it's a rather abstract index. It really helps us to have measures that have more of a real-life analogy, instead of using a number per 1,000, which I think is harder to extrapolate to individual women's lives.

Chalasani: If I can add to that – I think it's much more powerful to say that nearly one third of all women in lower- and middle-income countries begin childbearing in adolescence than saying that each year there are 46 births per 1,000 women between 15 and 19 in less developed regions.

You note there are encouraging signs that levels of motherhood in childhood and adolescence are declining, but that the pace of decline has been “alarmingly slow.” Why do you think that is the case?

Garbett: This is an interesting question because the report actually doesn't directly examine these underlying reasons for the change or lack of change. But what we can say is that there are some regions that have seen really impressive changes and declines and others have not. That said, I think you can separate underlying determinants into more immediate determinants and then secondary determinants. The immediate ones are the things that I would say that we really need to get a better handle on – and one of the most important of those is marriage. A majority of the births that are happening in childhood and adolescence are still occurring within cohabiting unions and marriage. The reason that is so fundamental is because that is driving the frequency of sexual activity. It also has implications for how a girl negotiates contraception with her partner, certain cultural pressures for proving fecundity, the desire for large families, and things like that. There are other aspects that are important and differ across places and have changed over time, like the age of sexual debut and pregnancy intention – the proportion of adolescent births that are intended versus not intended. Then, every place will have differences in induced abortion rates and access to safe abortion. Everything will differ by socioeconomic status as well.

How are gender-based and income inequalities helping fuel teen pregnancies?

Chalasani: I'll start by saying that the story of most sexual and reproductive health issues is a story of inequality. These inequalities include the ones that keep girls out of school and drive child marriages. They limit girls' abilities to have safe and consensual sex – we know a lot of sexual experiences and the subsequent pregnancies and childbirths actually happen within the context of forced sex. Gender inequalities also restrict girls' life aspirations to gender-stereotyped roles where you fulfill your value being a mother and a wife, and not necessarily as an economic agent, even though you’re contributing your unpaid labor. It's a toxic mix of gender inequality and income inequality driving early and rapid repeat childbearing.

Income influences so many different outcomes because of the information and opportunities it brings, so poverty is critical in driving adolescent childbearing.

What recommendations do you have for policymakers to accelerate the rate of decline in levels of motherhood in childhood and adolescence and – perhaps more importantly – what practical advice might you have so they could implement them in LMICs where there is often some resistance to such measures?

Chalasani: If you want to talk about focused policy interventions targeting adolescent pregnancy and childbearing, it has to happen at all levels. You need the political commitment to put in place a basic supportive legal and policy framework that supports girls' rights – we're talking about a rights issue at the end of the day. For example, where there are age or marital status barriers related to accessing contraception, those need to be lifted. You shouldn't have to have the consent of your partner or your parents to access contraception, if you have the capacity to make a decision about it. It also includes raising the minimum age of marriage to 18.

Then, to translate those policies into action, you need a lot of community engagement since the provision of services happens at the community level. Health services, education, social protection, [and] all of those policies need to be tangible and felt by real people, real families, real girls, and that's what creates a supportive community environment. Then, at the level of the family, you're talking about parents, partners, and husbands understanding what it takes to be supportive towards girls' rights.

Perhaps most importantly, at the individual level, it's really about empowering girls to know their rights, to have the right information, to know where to go to seek a service, to know who to go to if she needs help, if she needs a mentor, if she needs social support, if she needs a social network. It's really the entirety of what it means to be an empowered girl. I think all of these are not either/or solutions – it’s what every girl is entitled to.

The good news is that adolescent pregnancy is a tractable problem – we know it's a tractable problem because we've seen countries in which there has been tremendous progress under the right conditions.