The Social and Educational Consequences of Adolescent Childbearing

February 24, 2022World Bank

More than 12 million adolescent girls between ages 15 and 19 gave birth in 2019. Girls who give birth before adulthood are likely to bear increased health risks, social stigma, and adverse economic impacts for the rest of their lives.

Pregnancy and childbirth are the leading cause of death among adolescent girls aged 15-19. More than half of the abortions that occur among adolescent girls are unsafe. They also face higher health risks than adult mothers aged 20-24, including complications from childbirth contributing to maternal mortality, low baby birthweight, and severe neonatal conditions.

Teenage mothers are less likely to continue going to school, which prevents them from realizing their full potential and finding better economic opportunities, and often results in reduced lifetime earnings. Adolescent pregnancy can also affect future generations, for example daughters of teenage mothers are at a greater risk of teenage pregnancy themselves, perpetuating intergenerational cycles of poverty.

Adolescent pregnancy is generally not a result of deliberate choice, but rather stems from the lack of choices when it comes to marriage and contraceptive use. The level of early childbearing is typically measured by the adolescent fertility rate, defined as the annual number of births per 1,000 adolescent girls aged 15-19.

Global and regional trends in adolescent fertility

The global adolescent fertility rate has halved since 1960 from 86 births per 1,000 adolescents to 42 in 2019.
In most regions, adolescent fertility rates have consistently declined. The decrease in adolescent fertility rate is particularly striking in South Asia and Middle East & North Africa. In 2019, the rate in South Asia was a fifth of its 1960 level (dropping from 114 to 23); and in Middle East & North Africa it was almost a fourth (declining from 137 to 39).
However, despite a decline from 154 births per 1,000 adolescents in 1960 to 100 births in 2019, the adolescent fertility rate in Sub-Saharan Africa remains the highest of all the regions, more than twice as high as the global average of 42 births per 1,000 adolescents. And with a rising population in the region, the total number of adolescent girls giving birth is increasing as well. In 2019, 5.8 million girls aged 15-19 gave birth, up from 1.7 million in 1960.
Within Sub-Saharan Africa there are significant differences across countries. In 1960, adolescent fertility ranged from 55 births per 1,000 adolescents in Somalia to 232 in Cote d’Ivoire.
But by 2019, this range had shifted. The lowest adolescent fertility in the region was 24 births per 1,000 adolescents in Mauritius, and the highest was 180 in Niger.
In Niger, adolescent fertility rate has remained high, while in other countries such as Ghana there has been significant progress in lowering it. The adolescent fertility rate in Ghana steadily fell from 148 in 1960 to 65 in 2019. Ghana also made progress in decreasing rates of child marriage and keeping girls in school, possible contributing factors for decreasing early pregnancies.
In low-income countries, sexual activity for adolescents is often closely related to the prevalence of teenage girls in married couples or in union. As a result, child marriage is a strong indicator for adolescent fertility. In Ghana, where the adolescent fertility rate has fallen steadily, so has the rate of early marriage. In 2018, 19 percent of women aged 20-24 were first married by the age of 18 – a reduction to half in 30 years (rate in 1988 was 41 percent).
In Niger, where the adolescent fertility rate is the highest in the world (180 births per 1,000 adolescents), the rate of early marriage is also the highest, with 3 in every four women aged 20-24 first married by the age of 18.
The costs of child marriage are considerable for adolescent girls, their families, and their communities. Child marriage poses a significant risk to girls' fundamental human rights, including their ability to enjoy the highest attainable standard of physical and mental health, be educated, and own property. Moreover, the risk of experiencing domestic violence is higher among women who marry early.
Similarly, more education is associated with a lower rate of adolescent fertility. Teenage girls who leave school early are more likely to become mothers. In Niger, Mali, and Chad where the adolescent fertility rates are the highest in the world, expected years of schooling typically attained between the ages of 4 and 17 for females are fewer than seven years.
Education prepares girls for jobs and livelihoods and gives them decision-making power. However, early pregnancy jeopardizes educational attainment for girls. Adolescent pregnancy and childbearing can lead girls to drop out of school due to either expulsion from schools or personal circumstances, including having to take care of their children or being stigmatized by family, peers, and communities.
Unlike Sub-Saharan Africa, in many Latin America and the Caribbean countries, girls’ expected years of schooling are higher but teenage pregnancy is also high. For example, in some countries, such as Honduras and Guatemala, girls’ expected years of schooling by the end of upper-secondary level (around 10.5 years) are close to the global average of 12.3 years. But in these countries, adolescent fertility rates (71 and 69 births per 1,000 adolescents) are higher than the global average of 42 births per 1,000 adolescents.
While overall educational attainment is high in Latin America & the Caribbean, girls with lower levels of education (primary or no education) in the region are far likelier to have children by the age of 18 than girls with higher levels of education (more than secondary). For example, in Honduras and Guatemala, while more than 40 percent of women with no or primary levels of education gave birth by the age of 18, less than two percent of women with more than secondary level education gave birth by the age of 18.

Whether school dropout for teenage mothers is a contributing factor for pregnancy or is the result of being pregnant is hard to discern. A qualitative assessment in Ecuador was conducted to understand the behavioral patterns of teenage mothers, and it showed that a lack of agency, limited aspirations for the future and a lack of concrete life goals among adolescents appeared to be one of the key determinants for teenage pregnancy among adolescent girls.

The measure for the share of youth not in education, employment, or training (NEET) furthers our understanding. NEET includes discouraged worker youth and youth outside the labor force for various reasons including engagement in household responsibilities. In a study from 2010, authors estimated that of all the female youth aged 15 to 24 in Latin America & the Caribbean, 7 in every 10 girls were NEET girls, of which 20 percent of them had started their own household with children, in comparison to only 30 percent NEET boys of which only 1 percent had started their own family with children.

From more recent data (2019), we see that the share of female NEET youth has fallen but is still almost double (27 percent) that of male youth (15 percent). Even though we don’t know the share of NEET youth who started their own families with children from 2019, engagement in household care work is a close approximation. 70 percent of NEET girls were responsible for household care work, but only 10 percent of the NEET boys were engaged in unpaid domestic work or caregiving.

Share of female youth population not in education, employment or training

Source: Gender Data Portal (SL.UEM.NEET.ZS)

Efforts to combat adolescent fertility in Latin America & the Caribbean

To reduce adolescent pregnancy, programs to enhance future aspirations and life plans have been implemented in the region. Juventud y Empleo in the Dominican Republic is one such program which provided soft skills training to adolescents. Interventions included improvements in self-esteem, self-efficacy, and enhancement of life plans. The program successfully reduced teenage pregnancy by 20 percent by improving adolescents’ soft skills as well as their aspirations and expectations from life.

Subsidio Educativo was a conditional cash transfer (CCT) program in Colombia where adolescent girls received a subsidy if they attended school, completed their school year, and enrolled in the following year. This program was also effective in reducing pregnancy among adolescents across all grades included in the program.

The success of these programs highlights that ensuring adolescents stay in school, providing them with life skills’ training, and generating awareness about the impact of unintended early childbearing can be effective strategies in preventing teenage pregnancies.

The COVID-19 pandemic brings new challenges

The Sustainable Development Goals (SDGs) recognize the severe consequences of adolescent fertility for individual girls and society and aim to achieve universal access to sexual and reproductive healthcare services. Many countries have made continued efforts and improvements in adolescent girls’ health, social, and economic status. However, with adolescent girls outside the protective environment of schools and therefore at greater risk of early pregnancy, the COVID-19 crisis threatens to reverse this progress.

While the evidence on these impacts is still emerging, media reports suggest more teenage girls have become pregnant. For example, in Gauteng, the most heavily populated province in South Africa, the number of births to adolescent mothers increased by 60 percent since the pandemic started. As outlined in the World Bank's Gender Dimensions of the COVID-19 Pandemic brief, recovery efforts and policies need to ensure continued and expanded investments in the human development of adolescent girls for more inclusive and sustainable growth.