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In traditional societies, the transition from childhood to early adulthood usually occurs rapidly around the time of puberty. For women this almost always means entry into marriage and childbearing. In industrialized societies, however, preparation for the assumption of adult responsibilities requires extensive further education and job training for both men and women. Thus, the modern way of life has led to a period of adolescence, covering roughly the teenage years, during which young people are capable of reproduction but have not yet achieved the economic and social independence necessary to support families of their own. In any given society, childbearing at this stage may be seen as more or less problematical, depending on both the level of development and the particular culture. The topic is now of special importance, because of the surge in the numbers of teenagers worldwide. The focus in this entry is almost entirely on females; although the issue clearly involves males as well, men are less likely on the whole to become fathers while they are still teenagers, the consequences of parenthood are apt to fall less heavily on them, and, most importantly, very little information is available on male fertility.
1.1 Birth Rates For Women Aged 15–19 Years
The most commonly used measure of teenage fertility is the age-speciﬁc birth rate for women 15–19 years old, i.e., the number of births to women in this age group divided by the number of women in the age group. Although some births occur among women below 15 years of age, relatively few of these younger women are exposed to the risk of childbearing, and the usual practice is simply to add these births to the numerator of the rate for women aged 15–19. The implications of childbearing tend to be quite diﬀerent for women aged 15–17 from those aged 18–19 and, ideally, the rates for the two groups should be separated, but the necessary data are not often available.
Table 1 shows age-speciﬁc birth rates per thousand women aged 15–19 in the 1970s and the 1990s for the major regions of the world and their component subregions, as deﬁned by the United Nations. At the regional level, the rates range from a minimum of around 30 for Europe to a maximum that is about four times as high in Africa, where as many as one woman out of eight in this age group gives birth yearly.
There is considerably more variation in the rates for subregions. North America, Australia and New Zealand and the four subregions of Europe comprise the great majority of developed countries. Within this group, the rates for the 1990s are very low in Western and Southern Europe, and are particularly elevated in Northern America (dominated by the USA) and in Eastern Europe (dominated by the former USSR). The underlying national data show that relatively high rates of teenage fertility are common to all of the English-speaking countries. Among less developed areas, the picture in Asia is extremely varied: in the 1990s, Eastern Asia (dominated by China but also including Japan, a highly developed country) exhibits the lowest rate of any subregion, while teenage fertility in South-central Asia (dominated by India, Pakistan and Bangladesh) is higher than anywhere else outside of Africa. Intermediate levels are found in Latin America and the Caribbean and in Other Oceania. The rates are extremely high in sub-Saharan Africa.
In all regions and most subregions, the rates had declined since the 1970s. At the regional level, the steepest drop (24 percent) occurred in Asia. This is due largely to an 86 percent decline in Eastern Asia and took place despite very little downward movement in South-central Asia. The rates rose substantially in two subregions, however: by one-third in Southern Africa (dominated by South Africa) and by one-quarter in Eastern Europe.
1.2 Teenage Fertility Relative To Overall Fertility
In addition to age-speciﬁc fertility rates, it is useful to consider teenage reproductive behavior in the context of that of all women, i.e., to examine the proportion of the total fertility rate (TFR) contributed by women aged 15–19. (The TFR is a hypothetical measure representing the number of children a woman would have if she experienced throughout her reproductive career the actual fertility rates of women in each successive age group at the time and place of observation.) These percentages are also shown in Table 1; in the 1990s, they range from less than one in every 30 births (3 percent) in Western Europe to one birth out of six or seven (16 percent) in Eastern Europe.
Comparison of the percentages between the 1990s and the 1970s reveals that in some cases the trends in teenage childbearing noted above parallel those among older women. In Eastern, Middle and Western Africa and Northern America, the rates for women aged 15–19 represent approximately the same proportion of the total fertility rate in the 1990s as in the 1970s. In many subregions, however, teenage rates changed independently of shifts in overall fertility. Adolescents came to account for a much larger fraction of all births than formerly in Eastern Europe and South-central Asia, and their share also grew throughout Latin America and the Caribbean and in Southern Africa. The opposite is true in other parts of Asia and Europe, especially Eastern Asia and Western Europe and, to a lesser extent, in Northern Africa as well as in Australia and New Zealand.
1.3 The Proximate Determinants Of Fertility
To understand these patterns, it is necessary to examine the behaviors immediately antecedent to childbearing. Variation in teenage fertility can be very largely explained in terms of three factors: sexual activity (marriage), contraception and abortion. These are known as proximate determinants of fertility.
A young woman is at risk of pregnancy and childbirth only after she becomes sexually active. Both age at initiation and frequency of intercourse thereafter are important dimensions of sexual activity. There is evidence that age at menarche is now dropping in developing countries as it did earlier in Western countries, creating the possibility of exposure to risk starting sooner than was previously the case. The proportion married among women of reproductive age was considered originally to be an appropriate indicator of exposure to risk and remains so in most of Asia. Elsewhere, however, this measure has become unsatisfactory because nonmarital childbearing is much more common than it was formerly in many parts of the world and because of greater awareness that in some cultures marriage is not an easily identiﬁable event.
Among sexually active women, the use of contraception can reduce substantially the likelihood that pregnancy will ensue. Contraceptive methods vary, however, in their eﬀectiveness, acceptability and ease of use and thus in their probability of failure. Moreover, young women tend to be less likely than their elders to know about contraception and to have less access to acceptable services, including an adequate choice of methods. In many countries, unmet need for family planning services is concentrated in the early years of reproductive life.
When pregnancy occurs, it does not always lead to a birth. Teenagers are often unready to start childbearing and may seek induced abortion even if the procedure is illegal and unsafe. Because very young women often do not recognize or accept that they are pregnant, however, or because abortion services are not readily accessible, their pregnancies are often relatively advanced before they reach a provider. Reliable data on induced abortion exist for only a few mostly developed countries, making it diﬃcult or impossible to assess its role accurately in many cases.
Diﬀering levels and trends of adolescent fertility are largely a reﬂection of variation in the balance of these three factors. Very high rates, such as those found in sub-Saharan Africa and South-central Asia, necessarily imply a high level of sexual activity, minimal use of contraception and infrequent abortion. In the traditional societies of sub-Saharan Africa, early childbearing has typically been widely accepted if not encouraged and often occurs before ﬁnalization of a marriage. Recently, growing numbers of young women have attempted to postpone marriage and childbearing, but many are nevertheless sexually active, tending to keep fertility high. In South-central Asia, sexual activity is still conﬁned essentially to marriage, but marriage often occurs shortly after puberty, and childbearing starts soon thereafter. Contraception and abortion do not play a signiﬁcant role in either of these subregions.
At the other extreme, low rates of teenage fertility may be due to little exposure to risk, extensive use of contraception, widespread abortion, or any combination of these conditions. Late marriage and social pressure to postpone sexual activity until marriage, backed up by easy access to abortion, accounts in large part for the very low rate in Eastern Asia. Although very few women marry below age 20 in most countries of Northern and Western Europe, a substantial majority become sexually active during their teenage years. Eﬀective, modern means of contraception are widely used; abortion is legal, safe and accessible but not often necessary. The elevated birth rate in the USA appears to be due not to greater exposure to risk but rather to less successful pregnancy prevention; there is a high incidence of abortion as well. The situation has been somewhat diﬀerent in Eastern Europe, where early marriage has been common and abortion the only widely available means of fertility control.
In recent years, increasing attention has been given to the negative consequences of teenage childbearing. There is concern both about health eﬀects and about social and economic eﬀects. Such eﬀects may relate to the individual mother and child, to society at large or, very often, to both. Their impact typically varies with the age and marital status of the mother. Younger adolescents tend to be much more seriously aﬀected than older adolescents. Although issues associated with single parenthood have been most prominent, very young married women may encounter somewhat diﬀerent but equally grave problems.
2.1 Health Eﬀects
Research has shown that teenage mothers and their infants face signiﬁcantly greater health risks than do older women. Some, particularly those resulting from physical immaturity, are a direct function of age. Declining age at menarche enhances the opportunity for conception among women who are still in their early teens. Social factors also play a prominent role, however. The impact of age itself is often exacerbated by poverty, lack of autonomy and, in some situations, speciﬁc cultural customs. Moreover, a high proportion of births to adolescents are ﬁrst births, which are more likely than subsequent births to incur medical complications.
Pregnant teenagers frequently suﬀer from hypertension, iron-deﬁciency anemia and premature labor. Childbirth presents the risk of cephalopelvic disproportion (when the pelvis opening is not wide enough to permit passage of the infant’s head, resulting in prolonged labor and/or obstructed delivery), hemorrhage and infections. Female genital mutilation, a practice that is common in parts of Africa, increases the likelihood of obstructed delivery and other complications of childbirth in addition to its negative eﬀects on women’s general health and sexual functioning. In addition, the infants of very young mothers exhibit higher rates of morbidity and mortality than those of older women, often associated with low birth weight.
Sexual activity in itself carries potential threats to the health of adolescent women. Sexually active teenagers are at high risk of contracting sexually transmitted diseases (STDs) including HIV/AIDS. In some parts of sub-Saharan Africa, STD infection rates are higher among young women than among either young men or older women. Unsafe abortion is a major factor contributing to high maternal mortality in many countries, and teenagers are over-represented among women treated for complications following such procedures.
2.2 Social And Economic Eﬀects
Research in both developed and developing countries indicates that, for most teenagers, childbearing also has lasting unfavorable social and economic consequences. The relationships are nevertheless complex and the causal sequences diﬃcult to disentangle. In addition, the eﬀects are highly variable, and a substantial proportion of women may experience no discernible disadvantage.
Becoming a mother necessarily involves the assumption of certain adult responsibilities. In the traditional societies that still exist in some parts of the world, this is the role expected of females. As long as they are in socially recognized unions, new mothers and their infants take their place in established systems of support that include their partners, other family members, and the community at large. For vulnerable young women, motherhood may oﬀer the only clear path to security and social acceptance. But by the same token, their future options are often limited, while, at the community level, their potential contribution to the growth of human capital and economic output is foregone.
The forces of modernization have nevertheless penetrated even remote corners of the globe. More young women are staying in school beyond the primary years. On the one hand, education delays marriage and childbearing and, on the other, it provides skills, promotes self-reliance and stimulates aspirations for new roles. Unplanned births are likely to arrest this process, however, especially if, as commonly happens, they occur outside of recognized unions and the men involved fail to acknowledge paternity. The mother cannot always count on the support of her family and may be forced to raise the child on her own. In some countries, opportunities for young women to participate in the paid labor force have also opened up with eﬀects that are in some respects similar to those of extended schooling. Moreover, education is an investment that ultimately beneﬁts society at large and employment contributes directly to the economy.
In a few industrialized countries, particularly the USA, the social and economic impact of teenage childbearing has been the subject of considerable investigation. In the USA, the majority of teen pregnancies are unplanned and, relative to other countries, fertility rates are particularly high among women less than 18 years of age. When the issue came to the fore in the 1970s, it soon became clear that early motherhood is linked closely with low education, limited opportunities for employment and poverty later in life. A high proportion of the births occur outside of marriage, and the fathers often provide little or no support. Associations with marital instability, large family size and problems in the children’s behavior and cognitive development have also been documented. Although it was initially assumed that having a child at a young age is in itself largely responsible for such detrimental outcomes, it is now widely acknowledged that the mothers tend to be selected from a subgroup of women who were already at a disadvantage beforehand, and that causation typically runs in both directions. Even when prior factors are taken into account insofar as possible, however, a negative impact remains. Ultimately, poor, young single mothers must often depend on public support, placing a burden on community resources and creating a dependence that tends to perpetuate itself from one generation to the next. In most other Western countries, non-marital childbearing has also become more common among women of all ages, but the mothers are nevertheless likely to be in stable sexual partnerships, and this lifestyle has become widely accepted.
Whether in modern or traditional societies and whether or not the birth occurs in an established union, a considerable age diﬀerence between the young mother and the father of her child is common. In traditional cultures, men must often wait until they have acquired a certain seniority before they marry. In more modern societies, young women may seek the protection of or be exploited by older men. Such relationships are inherently unequal, hindering free communication, preventing the development of mutually supportive partnerships and depriving women of their essential autonomy.
3. Policy Responses
The international community has only relatively recently singled out adolescent childbearing as an independent issue and begun to deal explicitly with it. The Programme of Action adopted at the 1994 International Conference on Population and Development in Cairo urges governments for the ﬁrst time to ‘protect and promote the rights of adolescents to reproductive health education, information and care’ and to ‘greatly reduce the number of adolescent pregnancies.’ It recognizes the rights of young women to privacy and conﬁdentiality and their special needs with regard to sexual behavior and reproduction. The recommendations of the preceding conference held in Mexico City in 1984 concerning adolescents were limited to calls for family life and sex education ‘within the changing socio-cultural framework of each country’ and for an eﬀort to ‘reduce maternal mortality and morbidity’ due to pregnancy and childbearing at young ages. The World Plan of Action adopted in Bucharest in 1974 did not mention adolescents speciﬁcally at all.
3.2 Developing Countries
In some countries, especially in Eastern Asia, age at marriage has risen considerably without undermining the traditional function of marriage as the only acceptable context for sexual activity and childbearing, and there is little call for governmental action. In many other parts of the developing world, however, the eﬀect of rising age at marriage has been oﬀset largely by increases in births among unmarried women. Similarly, in the Caribbean and sub-Saharan Africa, where union formation involves complex processes, births outside of socially sanctioned relationships also occur more frequently than formerly. Single parenthood must compete for governmental attention with a host of acute social and economic needs, however, and there is often great reluctance to enter what is seen as a controversial area. Eﬀorts to address the problem have generally been limited to family-life education programs.
Childbearing within recognized unions among women less than 15 years old, which is still common in sub-Saharan Africa and to a lesser extent in Southcentral Asia, has aroused comparatively little interest. Yet, whether within or outside of marriage, the medical complications of childbearing soon after puberty constitute a public health issue. Many of the risks could be greatly reduced if not eliminated through modern medicine, including better diet, prenatal care, the attendance of trained personnel at the time of delivery and health services for newborns, but the resources to support such interventions are lacking.
A variety of obstacles prevent sexually active adolescent women, especially those who are unmarried, from receiving the support they need to avoid STDs and childbirth. School curriculae rarely include sex education. Existing contraceptive services are frequently restricted to married women. In many countries, abortion is illegal and consequently dangerous. There is much work to be done to provide adolescents with the skills and services necessary for healthy behavior.
3.3 Developed Countries
The great majority of developed countries have gone a considerable way toward meeting the needs of sexually active adolescents. Almost all of these countries have national health systems that provide basic health care, including reproductive health services, to the entire population at low cost to the consumer. Abortion is typically legal and safe. The extension of publicly sponsored contraceptive and abortion services to unmarried minors has often been taken up as a separate and more controversial issue than their provision to adults, but there is widespread agreement that the consequences of unprotected sex are to be avoided.
Scandinavia and a few other countries of northwestern Europe have moved signiﬁcantly farther. Public policy there supports a strong social ethic of sexual responsibility, and there are few unintended pregnancies. Adolescent sexuality is accepted as a normal part of the maturation process. Sexual matters are discussed openly, and related information is readily available. In a number of cases, separate arrangements have been made to meet teenagers’ special need for sensitive, conﬁdential, readily accessible services.
The situation is quite diﬀerent in the USA, though the issue receives considerable public attention. The main thrust of publicly funded teenage pregnancy prevention programs is toward delaying the initiation of sexual activity, although the success of such eﬀorts remains open to question. Sexuality education in schools is typically recommended although not required, and the content may be limited. Family planning clinics serve adolescents as well as older, married women, but their location is often inconvenient for young people and most require some payment. Contraceptive and especially abortion services for young people are highly contentious topics and subject to a constant barrage of legislative proposals and judicial decisions that threaten their eﬀectiveness.
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