- Every year, an estimated 21 million girls aged 15 to 19 years, and 2 million girls aged under 15 years become pregnant in developing regions (1), (2). Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions (2) (3).
- Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally* (4).
- Every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions (1).
- Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years, and babies born to adolescent mothers face higher risks of low birthweight, preterm delivery, and severe neonatal conditions than those born to women aged 20 to 24 years (5).
Scope of the problem
Every year, an estimated 21 million girls aged 15 to 19 years and 2 million girls aged under 15 years become pregnant in developing regions (1) ,(2). Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under age 16 years give birth in developing regions.2,3
The global adolescent birth rate has declined from 65 births per 1000 women in 1990 to 47 births per 1000 women in 2015 (6). Despite this overall progress, because the global population of adolescents continues to grow, projections indicate the number of adolescent pregnancies will increase globally by 2030, with the greatest proportional increases in West and Central Africa and Eastern and Southern Africa (7).
Additionally, regional differences reveal unequal progress: adolescent birth rates range from a high of 115 births per 1000 women in West Africa to 64 births per 1000 women in Latin America and the Caribbean to 45 births per 1000 women in South-Eastern Asia, to a low of 7 births per 1000 women in Eastern Asia (8). There are also up to three times more adolescent pregnancies in rural and indigenous populations than in urban populations (9).
Adolescent pregnancies are a global problem that occurs in high, middle, and low income countries. Around the world, adolescent pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and employment opportunities (2).
For some adolescents, pregnancy and childbirth are planned and wanted. In some contexts, girls may face social pressure to marry and, once married, to have children. Each year, about 15 million girls are married before the age of 18 years, and 90% of births to girls aged 15 to 19 years occur within marriage (2), (10).
For many adolescents, pregnancy and childbirth are neither planned nor wanted. Twenty-three million girls aged 15 to 19 years in developing regions have an unmet need for modern contraception (1). As a result, half of pregnancies among girls aged 15 to 19 years in developing regions are estimated to be unintended (1).
Adolescents face barriers to accessing contraception including restrictive laws and policies regarding provision of contraceptive based on age or marital status, health worker bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and adolescents’ own inability to access contraceptives because of knowledge, transportation, and financial constraints. Additionally, adolescents face barriers that prevent use and/or consistent and correct use of contraception, even when adolescents are able to obtain contraceptives: pressure to have children; stigma surrounding non-marital sexual activity and/or contraceptive use; fear of side effects; lack of knowledge on correct use; and factors contributing to discontinuation (for example, hesitation to go back and seek contraceptives because of negative first experiences with health workers and health systems, changing reproductive needs, changing reproductive intentions).
In some situations, adolescent girls may be unable to refuse unwanted sex or resist coerced sex, which tends to be unprotected. Sexual violence is widespread and particularly affects adolescent girls: about 20% of girls around the world experience sexual abuse as children and adolescents (11). Inequitable gender norms and social norms that condone violence against women put girls at greater risk of unintended pregnancy.
Adolescent pregnancy remains a major contributor to maternal and child mortality, and to intergenerational cycles of ill-health and poverty. Pregnancy and childbirth complications are the leading cause of death among 15 to 19 year-old girls globally, with low and middle-income countries accounting for 99% of global maternal deaths of women ages 15 to 49 years (4), (12).
Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years (5). Additionally, some 3.9 million unsafe abortions among girls aged 15 to 19 years occur each year, contributing to maternal mortality and lasting health problems (1). Furthermore, the emotional, psychological and social needs of pregnant adolescent girls can be greater than those of other women.
Early childbearing can increase risks for newborns, as well as young mothers. In low- and middle-income countries, babies born to mothers under 20 years of age face higher risks of low birthweight, preterm delivery, and severe neonatal conditions (5). Newborns born to adolescent mothers are also at greater risk of having low birth weight, with long-term potential effects.5 In some settings, rapid repeat pregnancy is a concern for young mothers, which presents further risks for both the mother and child (13)
Economic and social consequences
Adolescent pregnancy can also have negative social and economic effects on girls, their families and communities. Unmarried pregnant adolescents may face stigma or rejection by parents and peers and threats of violence. Similarly, girls who become pregnant before age 18 are more likely to experience violence within marriage or a partnership.7 With regards to education, school-leaving can be a choice when a girl perceives pregnancy to be a better option in her circumstances than continuing education, or can be a direct cause of pregnancy or early marriage. An estimated 5% to 33% of girls ages 15 to 24 years who drop out of school in some countries do so because of early pregnancy or marriage (14).
Based on their subsequent lower education attainment, may have fewer skills and opportunities for employment, often perpetuating cycles of poverty: child marriage reduces future earnings of girls by an estimated 9% (14). Nationally, this can also have an economic cost, with countries losing out on the annual income that young women would have earned over their lifetimes, if they had not had early pregnancies.
WHO published guidelines in 2011 with the UN Population Fund (UNFPA) on preventing early pregnancies and reducing poor reproductive outcomes (15). These made recommendations for action that countries could take, with 6 main objectives:
- Reducing marriage before the age of 18 years. Estimates suggest a 10% reduction in child marriage could contribute to a 70% reduction in a country`s maternal mortality rate (16).
- Creating understanding and support to reduce pregnancy before the age of 20 years.
- Increasing the use of contraception by adolescents at risk of unintended pregnancy. If this need was to be met, 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths could be averted each year (1).
- Reducing coerced sex among adolescents.
- Reducing unsafe abortion among adolescents.
- Increasing use of skilled antenatal, childbirth and postnatal care among adolescents.
WHO also published documents facilitating implementation and prioritization of adolescent pregnancy prevention in adolescent health, including global standards for adolescent friendly health services and the Accelerated Action for Adolescent Health Guidance (18).
To address the health sector response to adolescents, WHO produced Global Standards for Quality Health-Care Services for Adolescents (19) and Core Competencies in Adolescent Health and Development for Primary Care Providers (20).
WHO provided support to UNESCO to develop the International Technical Guidance on Sexuality Education (21) and Early and Unintended Pregnancy & the Education Sector: Evidence Review and Recommendations (22).
Currently, WHO is synthesizing its recommendations on adolescent sexual and reproductive health into a Compilation Tool. Additionally, WHO is committed to reaching the Sustainable Development Goals targets 3.1 and 3.7 associated with adolescent pregnancy and maternal mortality (23). WHO is also invested in the United Nations Secretary-General's Global Strategy for Women’s, Children’s, and Adolescents' Health (9), and is working in collaboration with partners to fulfil its objectives.
* Note that special tabulations were done, as source does not provide information for ages 15-19 years.
(1) Darroch J, Woog V, Bankole A, Ashford LS. Adding it up: Costs and benefits of meeting the contraceptive needs of adolescents. New York: Guttmacher Institute; 2016.
(2) UNFPA. Girlhood, not motherhood: Preventing adolescent pregnancy. New York: UNFPA; 2015.
(3) Neal S, Matthews Z, Frost M, et al. Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand 2012;91: 1114–18. Every Woman Every Child. The Global Strategy for Women`s, Children`s and Adolescents` Health (2016-2030). Geneva: Every Woman Every Child, 2015.
(4) WHO. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: WHO; 2016.
(5) Ganchimeg T, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. Bjog. 2014;121(S Suppl 1):40-8.
(6) UN DESA, Population Division. World Population Prospects: The 2017 Revision, DVD Edition. New York: UN DESA; 2017.UNDESA, Population Division. World Population Prospects, the 2015 Revision (DVD edition). New York: UNDESA, Population Division, 2015.
(7) UNFPA. Adolescent pregnancy: A review of the evidence. New York: UNFPA, 2013.
(8) UN DESA, Statistics Division. SDG Indicators: Global Database. New York: UN DESA: 2017.
(9) Every Woman Every Child. The Global Strategy for Women`s, Children`s and Adolescents` Health (2016-2030). Geneva: Every Woman Every Child; 2015.
(10) UNICEF. Ending child marriage: Progress and prospects. New York: UNICEF, 2013
(11) WHO. Global and regional estimates on violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: WHO; 2013.
(12) WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Trends in maternal mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: WHO; 2015.Filippi V, Chou D, Ronsmans C, et al. Levels and Causes of Maternal Mortality and Morbidity. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 3.
(13) Kozuki N, Lee A, Silveira M, et al. The associations of birth intervals with small-for-gestational-age, preterm, and neonatal and infant mortality: A meta-analysis. BMC Public Health 2013;13(Suppl. 3):S3.
(14) World Bank. Economic impacts of child marriage: Global synthesis report. Washington, DC: World Bank; 2017.
(15) WHO. Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. Geneva: WHO; 2011.
(16) Raj A, Boehmer U. Girl child marriage and its association with national rates of HIV, maternal health, and infant mortality across 97 countries. Violence Against Women 2013;19(4).
(17) WHO. Making health services adolescent friendly: Developing national quality standards for adolescent friendly health services. Geneva: WHO; 2012.
(18) WHO. Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to support country implementation. Geneva: WHO; 2017.
(19) WHO. Global standards for quality health care services for adolescents. Geneva: WHO; 2015.
(20) WHO. Core competencies in adolescent health and development for primary care providers: including a tool to assess the adolescent health and development component in pre-service education of health-care providers. Geneva: WHO; 2015.
(21) UNESCO. International Technical Guidance on Sexuality Education: An evidence-informed approach for schools, teachers and health educators. Paris: UNESCO; 2009.
(22) UNESCO. Early and Unintended Pregnancy & the Education Sector: Evidence Review and Recommendations. Paris: UNESCO; 2017.
(23) United Nations General Assembly. Resolution adopted by the General Assembly on 25 September 2015: Transforming our world: the 2030 Agenda for Sustainable Development. New York: United Nations; 2015.