LATIN AMERICA: HIGH ADOLESCENT FERTILITY

AMID DECLINING OVERALL FERTILITY

Jorge Rodríguez VignoliECLAC, Santiago

Expert group meeting on "Adolescence, Youth and Development", New York, 21 and 22 July 2011

CONTENTS

Introduction: Why are we concerned with adolescent fertility?

Levels and comparative trends

Main proximate determinants Menarche Sexual activity (and marriage) Contraception (and abortion)

Reproductive preferences and wishes

Social inequality

Policy implications and research challenges

Introduction: Why are we

concerned with adolescent

fertility?

Disadvantages Infant and mother's health risksLower educational achievementPsychological immaturity for childrearing

Particular policy issuesTrends: slower decline, even increase in some

countries (Latin America)Traditional family planning programs and many RH

programs do not work well with adolescents. They need sensitive and friendly programs

Primary and secondary education have less of a protective effect on teenage motherhood

Affects mostly the poor, and leads to social reproduction of poverty

Obstacles to reproductive rights Sometimes associated to violence and abuse

Adolescent fertility levels:

Latin America and the Caribbean in comparison with other regions of the world

(national levels)

y = 20.535x

R2 = 0.6881

0

10

20

30

40

50

60

70

80

90

100

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

TFR (number of children per woman)

15

-19

ag

e s

pe

cif

ic f

ert

ility

ra

te (

pe

r th

ou

sa

nd

)

AsiaA

North America

Africa

Europe

LAC

Major regions of the world: Adolescent fertility rate and total fertility rate: the Latin American outlier

05101520253035404550

Argen

tina

2001

Belice

200

0

Bolivi

a 200

1

Brasil

200

0

Chile

2002

Colom

bia 2

004/

05

Costa

Rica

200

0

Ecuad

or 2

001

El Sal

vado

r 200

7

Gua

tem

ala

2002

Hondu

ras

2002

Méx

ico 2

00

Nicara

gua

2005

Panam

á 20

00

Peru

2007

Parag

uay 2

002

Rep. D

omini

cana

200

2

Trinid

ad y

Tabago

200

0

Venez

uela

200

1

Urugu

ay 1

995

Countries and census year

Per

cen

tag

eMotherhood during adolescence: still a common experience in Latin America, but with differences across

countries. Percentage of 19 year old women with reproductive experience (censuses = mother; survey = mother or pregnant with first child)

05101520253035404550

Bolivi

a 200

8

Colom

bia 2

010

Domin

ican

Repub

lic 2

007

Ecuad

or 2

004

EL Salv

ador

200

8

Haiti 2

005-2

006

Hondu

ras

2005

-200

6

Jam

aica

2008

Nicara

gua

2006

/07

Parag

uay 2

008

Peru

2009

Countries and survey year

Pe

rce

nta

ge

Adolescent fertility trends in Latin American: - decline, increase or stalemate? - one tendency or different patterns across countries?

A WORRYSOME TREND DURING THE LAST TWO DECADES: ALMOST ALL COUNTRIES INCREASED ADOLESCENT MOTHERHOOD, ACCORDING TO CENSUS DATA. FERTILITY SURVEYS

SHOW LESS SYSTEMATIC TREND (5 INCREASING AMONG 11 COUNTRIES WITH DATA)

-6.0-4.0-2.00.02.04.06.0

COMPARISON BETWEEN CENSUS 1990 AND 2000

Ch

ane

in p

erce

nta

ge

po

ints

SURVEYS (DHS, IRHS)

Recent 2005-2010

(1)

Past1985-1999

(2)Percentage change (1) - (2) (positive means increase)

Bolivia: DHS 2008, DSH 1989 17,9 17,2 0,7Brasil: PNDS 2006, DHS 1986 22,3 13,3 9,8Colombia: DHS 2010, DHS 1986 19,5 13,6 5,9Dominican Republic: DHS 2007, DHS 1996 20,6 22,7 -2,1Ecuador: ENDEMAIN 2004, DHS 1987 19,4 17 2,4El Salvador: FESAL 2008, DHS 1985 22,8 26,6 -3,8Guatemala: DHS 2008 – DHS 1987 21,8 22,8 -1Haiti: DHS 2005-06, DHS 1994-95 14 14,5 -0,5Nicaragua: IRHS 2006, DHS 1998 25,2 27 -1,8Paraguay: IRHS 2008, DHS 1990 11,6 16,8 -5,2Peru, ENDES continua 2009, DHS 1986 13,7 12,7 1

Proximate determinants Menarche is happening earlier (biological and social causes)

Sexual activity is better proximate determinant than marriage because of increasing premarital sex (Stover, 1998)

Indicator: age at first intercourse (there is no reliable data on coital frequency) Post partum abstinence has marginal effect

Contraception ¿Current use or use at first intercourse?....Use at first intercourse is better because many adolescents begin to use AFTER having their first child

Abortion: no available data

Sexual activity during adolescence is becoming more common: 10 out of 11countries have higher % of adolescents sexually initiated by age 18 in the more recent surveys. Marriage and sexual activity among adolescents are more weakly associated: 7 out of 11 countries have a lower % marriages by age 18

Percentage of women aged 20-24 that were married before age 18 and percentage that had first intercourse by age 18

0

10

20

30

40

50

60

70

Boliv

ia 1

989

Boliv

ia 2

008

Bra

zil 

1986

Bra

zil 

2006

Colo

mbia

 1986

Colo

mbia

 2010

Dom

inic

an R

epublic

 1996

Dom

inic

an R

epublic

 2007

Ecuador 

1987

Ecuador 

2004

El S

alv

ador 

1985

El S

alv

ador 

2008

Guate

mala

 1987

Guate

mala

 2002

Haiti 1994/9

5

Haiti 2005-0

6

Hondura

s,

1996

Hondura

s 2

005-0

6

Para

guay 1

990

Para

guay 2

008

Peru

 1986

Peru

 2009

First marriage before 18 First intercourse before 18

Low or very low levels of protected sexual debut (except by Paraguay)

0

10

20

30

40

50

60

70

80

90

Países y años

Por

cent

aje

(tot

al d

e in

icia

das

sexu

alm

ente

)

Women aged 15-24 (some countries with other ages): percentage who used modern contraception at first intercourse

Wanted motherhood and fertility preferences

Until 2000: adolescent fertility was more wanted than at other ages

Very different situation according to more recent surveys: births before the age of 20 are least desired (“wanted at the time”)

Percentage of births “wanted at the time”: births before age 20 and total. Currently this percentage is lower for

births before the age of 20 in almost all countries

0

10

20

30

40

50

60

70

80

90

Country and year

Per

cen

tag

e "w

ante

d t

hen

"

< 20 Total

Social inequality

Fertility differences across socio-economic strata are still sharp, and larger in adolescent motherhood than TFR

Inequality in proximate determinantsAge at first intercourseUse of contraception at first intercourse

Inequality is sharper in adolescent motherhod than in TFR

Ratio of poorest to richest quintile in TFR and percentage of mothers, women aged 15-19

0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0B

OL

IVIA

, 2

00

8

DO

MIN

ICA

N R

EP

UB

LIC

, 2

00

7

HA

ITI

20

04

/05

NIC

AR

AG

UA

, 2

00

6/0

7

low

er/

hig

he

r re

latio

n

Country and Year

TFR Adolescent motherhood

Haití: the only exception

Inequality in age at first intercourse: still very sharp but with some signs of convergence (see negative slope in university-educated women and the slight

age slope of women with primary or no education

14

15

16

17

18

19

20

21

22

23

24

25-29 30-34 35-39 40-44 45-49 25-29 30-34 35-39 40-44 45-49 25-29 30-34 35-39 40-44 45-49 25-29 30-34 35-39 40-44 45-49

No education Primary Secondary University

Age Group and Educational Level

Med

ian

ag

e

Bolivia 2008 Colombia 2010 Dominican Republic 2007 Honduras 2005-06 Peru 2009

Inequality in protected sexual debut

Wealth quintile

El Salvador, 2008

Ecuador, 2004

Chile, 2009

Honduras, 2001

Paraguay, 2008

Lowest 11.5% 6.6% 38.10% 4.2% 55.6%

Second 23.8% 11.1% 50.37% NA NA

Middle 28.8% 11.5% 58.74% 8.6% 75.0%

Fourth 34.7% 17.0% 75.77% NA NA

Highest 48.7% 29.0% 75.61% 17.9% 83.1%

Adolescent fertility in Latin America is higher than expected, and is not falling

We lack of appropriate conceptual framework to understand this fertility

Theories and policies appropriate for young and older adults do not always work with adolescents

Adolescent fertility should be a priority for public policy-making

Design and implementation of specific health and education policies for adolescents are needed

The effect of education on teenage fertility has lessened, but the main risk factor remains not attending to school

School curricula must adapt to new challenges

Policies to reduce adolescent pregnancy should focus on three areas: a) to open access to contraceptivesb) to empower adolescentsc) to offer more and better opportunities for adolescents

Conclusions