Chile, England, Ethiopia, and Jamaica show paths to reducing teen pregnancies

Research has shown that adolescent pregnancies undermine economic growth, slow progress toward global health goals, and have a devastating impact on the health and human rights of women and girls.

The World Health Organization estimates that 12 million girls aged 15 to 19 give birth each year, and more than 777,000 girls aged below 15 give birth annually. Around the world, almost one in six girls gives birth before turning 18, according to UNICEF. For many of these girls, their pregnancy is unplanned and the result of coerced sex, both derailing their education and affecting their social standing in their community. What’s more, pregnancy and childbirth complications are the leading cause of death among girls aged 15 to 19, and children born by them have increased risk of childhood stunting and poor health outcomes.

Over the past 20 years, health leaders have succeeded in reducing the global adolescent fertility rate by 11.6 percent, while a few countries have achieved far higher reductions. A recent webinar highlighted how four countries – Chile, England, Ethiopia, and Jamaica – have achieved dramatic reductions in adolescent pregnancy and childbearing, and reaped benefits ranging from improved educational outcomes and reductions in childhood stunting rates, to increased women’s empowerment.

“Success benefits everyone. It benefits health. It benefits education. It benefits employment. It saves money. And it is achievable," said Alison Hadley, Director of the Teenage Pregnancy Knowledge Exchange at the University of Bedfordshire and Chair of the Sex Education Forum, during the webinar, which was sponsored by the World Health Organization, Medicus Mundi Switzerland, the African Institute for Development Policy, ExpandNet, Exemplars in Global Health, the Geneva Foundation for Medical Education and Research, Human Reproduction Programme, the Women’s Center of Jamaica Foundation, and the IBP network.

From 2000 to 2017, Chile reduced its adolescent fertility rate from 57 births per 1,000 women to 41 births per 1,000 women. The country’s efforts were driven in part by Chile’s adoption of the regional 2007–2013 Andean Plan for the Prevention of Adolescent Pregnancy. The government issued circulars on parental consent requirements, adolescent autonomy, and protecting young people from sexual abuse. The strategy also included improving access to emergency contraception and abortion, and the creation of “friendly spaces” in bars, public gathering places, and squares around the country where adolescents could access sex education, birth control, and speak with health care providers. To help track impact, the government created a monthly statistical register that included data on adolescents, disaggregated by age, sex, and risk factors, and shared this data regularly with journalists to publicize gains.

“These safe spaces allow us to reach girls as young as 10 to 14,” said Fernando Gonzalez, Director of the Department of Prevention and Disease Control with the Chilean Ministry of Health. “We can find solutions through them. By listening to them when they are in a sensitive time of their lives.”

The United Kingdom achieved similar results, halving its adolescent fertility rate from 30 births per 1,000 women to 15 births per 1,000 women, from 1998 to 2015. The UK’s strategy focused on coordinated action at the national and local levels, improved sex education and access to contraception for both girls and boys, a national communications campaign to reach young people and their parents, and coordinated support for young parents.

In Ethiopia, the adolescent fertility rate declined from 118 births per 1,000 women ages 15 to 19 in 1993 to 67 per 1,000 in 2017. Part of this decrease may reflect investments in education. The number of primary schools tripled from 1996 to 2014, and the net enrollment rate in primary education more than quadrupled from only 19 percent in 1994 to 85 percent in 2015. Girls who stay in school longer tend to marry later and have fewer children. Indeed, from 2000 to 2016, Ethiopia saw an 8.8 percentage point decrease in child marriage.

Another driver was Ethiopia's flagship health program, delivered by 35,000 health extension workers trained and deployed beginning in 2004. These village women, trained for one year as community health workers and paid to serve their communities, brought nearly universal basic health care to the country's largely rural population, helping increase demand for services and deliver a wide range of preventive and curative services – including sex education and contraception. From 2000 to 2019, contraceptive use by married adolescent girls aged 15 to 19 increased significantly from three percent to 36.5 percent. And postpartum contraceptive use among the same age group of married adolescent girls increased from 8.5 percent in 2005 to 46.3 percent in 2016.

The government also formulated laws guaranteeing free maternal and newborn health services in public health facilities, and liberalized abortion access, said Lemessa Oljira, Team Leader, Adolescent and Youth Health Research Advisory Council, with Ethiopia's Ministry of Health. To continue the current momentum, Oljira said, "The ministry and government should engage and challenge and change social norms affecting adolescent reproductive rights by engaging religious and community leaders, parents, families, and the adolescent themselves through community dialogue about traditional values that negatively affect adolescents, particularly girls."

Jamaica reduced its adolescent pregnancy rate from 131 births per 1,000 women to 71 births per 1,000 women by focusing on psychosocial and financial support to ensure that pregnant girls stayed in school. With mentorships, scholarships, and other supports, the country sought to reduce the chance of adolescents falling pregnant again and dropping out of school permanently. Ten centers around the country were established to help ensure girls received the health care and contraception they needed to be healthy mothers and continue their educations. Jamaica’s model has now been replicated in other countries, including Grenada, Saint Kitts and Nevis, Botswana, The Gambia, and Kenya.

“[For] these mothers, their place remains in school,” said Zoe Simpson, Executive Director of the Women's Center of Jamaica Foundation. “They have a right to education.”

The success of each of the four countries discussed during the webinar was built on on national political commitments and data-driven pilots that were then scaled across the nations.

The lessons from these exemplars in adolescent pregnancy, said the UK's Hadley, are "finding your moment and the hook to address the issue." In our country, she added "it was addressing inter-generational inequality, which had been passed on to young parents. In other countries, it might be giving girls an education or very high infant mortality or maternal health... finding the hook and then developing the evidence-based strategy that is going to address that... The other thing that is important is having a collective advocacy from all the NGOs and high-profile medical and nursing organizations which government ministers trust, to explain why this is important. And having the nerve to having a longer-term strategy. These things cannot happen over night... and having local implementation and the structures to support it are critical."

“This webinar from the four country examples, in four parts of the world, shows we know what to do. Countries are doing it. Jamaica has been doing it for 43 years,” added Venkatraman Chandra Mouli, Scientist, Department of Sexual and Reproductive Health and Research at the World Health Organization’s Human Reproduction Programme. “These countries show it is doable. It is doable if governments want to get it done … if countries put money on the table, funders will put money on the table … we can’t develop plans and wait for donors to come in and drop their money.”

A full recording of the webinar can be found here: https://www.youtube.com/watch?v=E-h-sCK5Sx0&t=155s