LATIN AMERICA: HIGH ADOLESCENT FERTILITY AMID DECLINING OVERALL FERTILITY Jorge Rodríguez Vignoli...
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Transcript of LATIN AMERICA: HIGH ADOLESCENT FERTILITY AMID DECLINING OVERALL FERTILITY Jorge Rodríguez Vignoli...
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