UN/POP/EGM-AYD/2011/01
21 July 2011
ENGLISH
UNITED NATIONS EXPERT GROUP MEETING ON ADOLESCENTS, YOUTH
AND DEVELOPMENT
Population Division
Department of Economic and Social Affairs
United Nations Secretariat
New York
21-22 July 2011
HIGH ADOLESCENT FERTILITY IN THE CONTEXT OF
DECLINING FERTILITY IN LATIN AMERICA 1
Jorge Rodríguez 
1
The opinions expressed in this paper are those of the author and do not necessarily reflect those of the
United Nations or its Member States. This paper is reproduced as submitted by the author.

The United Nations Economic Commission for Latin America and the Caribbean (ECLAC)
HIGH ADOLESCENT FERTILITY IN THE CONTEXT OF DECLINING
FERTILITY IN LATIN AMERICA
Jorge Rodríguez, Latin American and Caribbean Demographic Centre (CELADE) Population Division of ECLAC
A. INTRODUCTION
Adolescent fertility is both a relevant and an emergent issue in Latin America for several
reasons. i First, adolescent pregnancy implies greater health risks for both mother and baby. Second,
early motherhood and fatherhood typically results in disadvantages as lower educational achievement,
including early school dropout and weaker performance in the labour market. Third, adolescent
mothers are more likely to suffer gender bias, experience cultural stigma or find themselves confined
to traditional women’s activities. Fourth, adolescent mothers are less mature and therefore less able to
cope with the challenges of childrearing. Fifth, adolescent mothers find it more difficult to consolidate
a family. Sixth, poor adolescents have higher fertility rates. The combination of disadvantages and
poverty bias means that adolescent fertility is one of the components of the poverty reproduction
cycle. Seventh, adolescents tend to be more vulnerable to sexual violence, peer pressure and risky
behaviour. Eighth, social, cultural and familial acceptance and tolerance of premarital sexual activity
among adolescents is a sensitive issue; in fact, in the region, unmarried adolescents who are sexually
active often face societal disapproval and condemnation. And ninth, while reproductive and health
policies and programmes have successfully reduced fertility among young and adult women
(especially married adult women), they have not had the same effect on adolescent fertility. Thus, in
many countries of the region the total fertility rate has fallen rapidly in the past 40 years but the agespecific rate for the 15-19 age group remains virtually unchanged.
In light of these considerations, there is now clear political consensus both in the region and
worldwide ii to: (a) regard early parenthood as a relevant issue to be incorporated in public policies;
and (b) take steps to prevent adolescent pregnancy and fertility. This consensus provides a firm basis
for governments to carry out campaigns to highlight and aware adolescents on the disadvantages of
early parenthood. Moreover, it justifies active reproductive health policies to: (i) empower adolescents
to take preventive steps, including delaying first intercourse; (ii) provide them with an appropriate
sexual education; and (iii) offer them contraceptive services in accordance with their particular needs
and wishes. Moreover, the number of unwanted pregnancies among this age group is in fact growing,
providing stronger grounds for public policies and programmes designed to improve adolescent
access to sexual and reproductive health services, including the provision of sexual education and
contraception. Despite this political consensus, however, policy interventions on adolescent
pregnancy cannot be imposed against the will of adolescents.
This paper focuses on adolescent fertility in Latin America. First, comparative trends—
between regions of the world and between countries of Latin America—in two indicators: (a) the
fertility rate of adolescents aged between 15 and 19 years; and (b) the percentage of mothers in the
15-19 age group, are presented using the most recent sources, including projections by the United
Nations Population Division, international demographic surveys, vital statistics and censuses. Second,
trends relating to key proximate determinants –as sexual activity, timing of the union, iii and use of
contraception- are shown and discussed. Third, trends and patterns of unwanted fertility among
adolescents and the total population are explained and compared. Fourth, the historical social
inequality of adolescent motherhood is re-examined using the most recent data and taking into
account changes in educational structure in the region. The final section discusses the policy
implications of the findings.
B. COMPARATIVE REGIONAL AND NATIONAL TRENDS
1. Latin America: An outlier with high adolescent fertility
Figure 1showsthat Latin America has the second highest adolescent fertility rate in the world
behind Africa and is moving away from the stylized link between the fertility at early ages and the
total fertility rate. In fact, the age-specific adolescent fertility rate for the 15-19 group is much higher
than might be expected based on its total fertility rate. Figure 2 gives the same data broken down by
country in the region and shows that nearly every country stands out as having an adolescent fertility
rate that is considerably higher than might be expected based on its total fertility rates. These findings
suggest that the structural socio-economic changes, cultural transformations and public programmes
that encouraged the rapid, sustained decline in total fertility rates in Latin America have not had the
same effect on adolescent fertility.
Figure 1
100
90
15-19 age-specific fertility rate (per thousand
Africa
80
70
LAC
60
50
40
Asia
y = 20.535x
2
R = 0.6881
30
North
America
20
Europe
10
0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
TFR
Figure 2
250
y = 21.139x + 10.361
R2 = 0.5514
15-19 age-specific fertility rate (per thousand)
200
150
Bangladesh
HON
100
NIC
GUA
DR
BR
BOL
ELS
COL
JAMAICA
HAITÍ
PERU
PY
50
0
0
1
2
3
4
5
TFR (average number of children per woman)
6
7
8
2. Latin America: An anomaly in long-run projections
The persistently high levels of adolescent fertility in Latin America undermine the optimistic
hypothesis that adolescent fertility will decline inexorably purely because it has done so in other
regions of the world. The United Nations Population Division appears to have taken this into account
in its latest projections, shown in figure 3, by predicting that adolescent fertility rates in Latin
America will be the highest in the world by far and virtually stable for the period 2020-2100. These
projections are not without grounds: they are based on regional adolescent fertility trends over the past
30 years.
Figure 3
140
120
100
Per thousand
80
60
40
20
0
1995- 2000- 2005- 2010- 2015- 2020- 2025- 2030- 2035- 2040- 2045- 2050- 2055- 2060- 2065- 2070- 2075- 2080- 2085- 2090- 20952000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050 2055 2060 2065 2070 2075 2080 2085 2090 2095 2100
Africa
Asia
Europa
Five
period
Latinyears
America
and the Caribbean
North America
The assumption that such a peculiar trend will persist throughout the twenty-first century is
nonetheless a bold one. Moreover, this paper provides new background on the non-desirability of
procreation in adolescence, the link between union and fertility in adolescence and the use of
contraception by adolescents indicating a change in some of the determinants of high adolescent
fertility, which could be becoming more responsive to the policies and programmes designed to
reduce it.
3. National trends according to specialized surveys
Although adolescent fertility has traditionally been measured by the specific fertility rate for
the 15-19 age group, the proportion of women in that group reporting to have had one or more live
births is also very useful because this figure: (a) is simple and straightforward to calculate and
interpret; (b) can be obtained directly from both censuses and surveys; (c) is not affected by
cumulative fertility iv in adolescence; and (d) is more relevant for policy purposes, since it quantifies
the adolescent mother and enables an estimate of that population in the future assuming that current
conditions remain unchanged. As a result, this indicator or something similar (percentage of mothers
or first-time expectant mothers among women aged between 15 and 19 years, which can be obtained
only from surveys) is the main indicator used in this paper.
Table 1 shows the percentage of adolescent mothers or pregnant for first time recorded in
surveys carried out in the 1980s or 1990s and in or after 2000, and therefore portrays trends in
adolescent motherhood. Although the findings vary—in six countries adolescent fertility has declined
while in five it has risen—they certainly suggest that adolescent fertility behaves differently to the
total fertility rate, which has been falling consistently in all countries in the region.
4. National trends according to vital statistics
Four of the region’s countries without international specialized surveys—Argentina, Chile,
Costa Rica and Uruguay—have relatively reliable vital statistics allowing adolescent fertility trends to
be tracked. These countries are special cases since they have undergone the most socio-economic
development in the region, according to the Human Development Index (HDI), and Uruguay and
Argentina in particular have led the sustained decline in fertility in the region (ECLAC, 2005).
As shown in figure 4, adolescent fertility in Uruguay and Argentina is currently higher than it
was in the 1960s, a trend that contrasts with total fertility (not shown in the figure), which fell in both
countries during the reference period. In Chile, however, adolescent fertility is now lower than in
1960, but the fluctuations in its trajectory contrast with the steady decline in total fertility. Moreover,
while adolescent fertility currently stands at 80% of the 1960 rate, total fertility stands at just 40% of
that rate. Only in Costa Rica has adolescent fertility declined consistently and considerably, although
it has still fallen less than total fertility (32% and 57%, respectively).
Figure 4
120
100
Per thousand
80
60
40
20
Argentina
Chile
Years
Costa Rica
20
08
20
04
20
06
20
00
20
02
19
98
19
94
19
96
19
90
19
92
19
86
19
88
19
84
19
82
19
78
19
80
19
74
19
76
19
72
19
70
19
68
19
64
19
66
19
60
19
62
0
Uruguay
In short, trends in these four countries reflect the resistance of adolescent fertility to
downward change and in two cases the rate has risen in the past 50 years despite the decline in total
fertility and social changes that should have triggered a drop in adolescent fertility, such as increased
school enrolment (Grant and Furstenberg, 2007).
5. Censuses
The question on the number of live-born children included in nearly all censuses in the region
was used to calculate the percentage of women aged between 15 and 19 years who are mothers. The
traditionally high rate of omission in this question was corrected by imputing zero children to girls
who left it blank (Rodríguez, 2005 and 2009). Figure 5 shows the differences in the two percentages
obtained from censuses carried out in the 1980s or 1990s and in or after 2000. In most cases the
percentage has risen during the period of reference. It remains for the censuses conducted in the 2010
decade to update the overall pattern in adolescent fertility trends. In the meantime, 2010 surveys
carried out in Panama and Mexico show varying trends: a slight increase between 2000 and 2010 in
Mexico contrasting with a fall in Panama v in the same period.
Figure 5
6.0
2.0
Uruguay, 1985-1995
Venezuela, 1990-2001
Trinidad y Tabago,
1990-2000
Paraguay, 1992-2002
Peru, 1993-2007
Panamá, 1990-2010
Nicaragua, 1995-2005
México, 1990-2010
Honduras, 1988-2001
Guatemala, 1994-2002
El Salvador, 1992-2007
Ecuador, 1990-2001
Costa Rica, 1984-2000
Colombia, 19932004/05
Chile, 1992-2002
Brasil, 1991-2000
Bolivia, 1992-2001
-2.0
Belice, 1990-2000
0.0
Argentina, 1991-2001
Cambio (en puntos percentuales)
4.0
-4.0
-6.0
Pais y período
C. PROXIMATE DETERMINANTS
1. Introduction: Proximate determinants of adolescent fertility
The pioneering work of Davis and Blake on the direct and indirect determinants of fertility
(1956), followed by Bongaarts’ formalization of the proximate determinants and their impact on
natural fertility (1978 and 1982) and the subsequent revision of his model by Stover (1998) have been
very valuable in the social research on human fertility. The conceptual framework of proximate
determinants is also useful for analysing adolescent fertility, but it is more difficult to formalize and
requires more sophisticated methodology than with other age groups. The proximate determinants of
fertility are essentially the start of menstruation (age of menarche), exposure to sexual activity, the use
of contraception and abortion.
There is consensus that menstruation is starting at an earlier age in most of the region’s
countries (Gómez, Molina and Zamberlin, 2011; Rodríguez, 2009), increasing the risk of adolescent
fertility. But given that menarche was around age 14 in the past, its earlier onset would have only
minimal direct effects on the fertility of the 15-19 age group studied in this paper.
With regard to sexual activity, a key change made by Stover to Bongaarts’ model concerns
the use of sexual activity rather than marriage to indicate exposure to pregnancy (Stover, 1998). This
is important because premarital sexual activity tends to be more frequent, increasing the likelihood of
early reproduction without prior union vi (Alí and Cleland, 2005; Bozon, 2003). This does not point to
pregnancies or births resulting from casual sexual relations, however. On the contrary, the sexual
activity of Latin American adolescents overwhelmingly begins in the context of romantic
relationships, but a higher proportion of these do not constitute consensual unions or marriages.
Certainly, once sexual initiation has taken place the opportunities for—and therefore the frequency
of—casual sexual relations increase but it is generally rare for these to result in adolescent
motherhood.
As a proximate determinant, sexual activity can be broken down into the age of sexual
initiation, crucial in the case of the adolescent group, and frequency. vii Age of initiation can be
determined by a simple question in a specialized survey (although bias may affect the responses).
Frequency, however, is more difficult to assess because specialized surveys do not provide for a
record of sexual activity. viii That said, a question on sexual activity during a given, recent period can
give a broad indication of the frequency of sexual activity and a method has been developed to
convert the data from this question into estimates of annual coital frequency, although there are
doubts as to the quality of these estimates (Alí and Cleland, 2005). Accordingly, this paper uses age of
sexual initiation as an indicator.
With regard to the use of contraception, the current models of intermediary variables and their
impact on fertility use current prevalence as an indicator. But even if Stover’s ix refined concept is used,
current prevalence is fundamentally flawed in the case of adolescents since it assumes that all girls
currently using contraception are protected against the risk of pregnancy when in fact this does not apply
to those who are already mothers. Moreover, cross-sectional multivariate models (typically logistic
regression) using the current use of contraception as a variable determining the likelihood of a girl
becoming an adolescent mother tend to find that women who use contraception are more likely to
become mothers (Rodríguez, 2009; Di Cesare and Rodríguez, 2006), as confirmed by data from recent
surveys. For illustrative purposes only, the first two columns of table 2 show the findings for the
Plurinational State of Bolivia based on that variable, namely that girls already sexually initiated and not
using contraception are just over half (54.9%) as likely to become a mother than those currently using
contraception. Of course this does not mean that contraception use increases the probability of becoming
an adolescent mother. What happens—as confirmed by a wealth of evidence (Rodríguez, 2009)—is that,
in Latin America at least, it is common for adolescent girls to start using contraception after the birth of
their first child, because the fact that they are already mothers breaks down the barriers to accessing
contraception. Consequently, and in the absence of synthetic indicators of contraception trends, the
indicator measuring contraceptive protection used in this paper is the use of contraception in the first
sexual intercourse. Although this approach has evident weaknesses inasmuch as the use of
contraception x in the first sexual intercourse is no guarantee of protection in future sexual relations, the
evidence available shows that this is a good indicator xi of future preventive behaviour (Di Cesare and
Rodríguez, 2006).
Lastly, with regard to abortion, what little evidence there is for the region is fragmented, since
abortion is illegal in most Latin American countries. Only recently have international surveys
(Demographic and Health Surveys; and International Reproductive Health Surveys) included
questions on induced abortions but their findings are pending technical validation. Official statistics
from Cuba, where abortion is legal, suggest that it has a significant impact on adolescent fertility
levels but that early motherhood is nonetheless more common than might be expected based on the
country’s low fertility rate. In Chile, the Sixth National Youth Survey carried out in 2009 showed that
6% of the adolescent who have had unplanned pregnancies have undergone at least one abortion
(male responses—which nevertheless tend to be less reliable or consistent on these matters—place the
percentage much higher). Despite its importance, the lack of information means that this proximate
determinant has to be excluded from the analysis below.
2. Childbearing and marriage among Latin American adolescents: A complex relationship
In several of the region’s countries, vital statistics show that most adolescent mothers are unmarried,
especially in Chile, xii where 39,902 births were recorded in 2008 to mothers aged between 15 and 19
years, of whom 38,132 were unmarried. However, a large proportion of these seemingly single
mothers have been or are in a relationship, probably with the child’s father. This can be inferred from
figure 6, based on census data, which shows that, with the exception of Argentina in 2001, Chile in
1992 and 2002 and Paraguay in 2002, less than 40% of mothers report being single. All the same,
figure 6 also highlights the rise in single xiii adolescent motherhood, a trend that is deeply worrying
given that on top of the difficulties inherent in raising a child before 20 years of age, adolescent
mothers in this position have to contend with lack of support from a partner. Here, support often
comes from the families of adolescent mothers and the baby is raised by both its mother and
grandmother (Oliveira and Vieira, 2010; Tobío 2003), thereby involving a third generation in the
daily care of babies and children.
Figure 6
60.0
50.0
only 3 exceptions among 16 countries
40.0
30.0
20.0
10.0
ARGEN
BOLIVIA
BRAZIL
CHILE
COLOMBIA
C. RICA
ECUADOR
EL SAL. GUATEMALAHONDURAS MEXICO
NICAR
PANAMÁ
PARAGUAY
PERU
2001
1990
2007
1993
2002
1992
2010
2000
1990
2005
1995
2000
1990
2001
1988
2002
1994
2007
1992
2001
1990
2000
1984
2005
1993
2002
1992
2000
1991
2002
1992
2001
1991
0.0
VENEZ
3. Sexuality and marriage among Latin American adolescents: A weakening link
Prevailing social theories on sexual initiation trends predict that: (i) it will take place at an earlier age;
(ii) it will increasingly occur before union (whether formal or consensual); and (iii) the gap between
the respective ages of sexual initiation of men and women and of adolescents in the various socioeconomic strata will gradually narrow (Bozon, 2003). The cultural transformations driving these
trends are the secularization of sexuality and the increasing autonomy of adolescents in decisionmaking and value formation, both taking place in Western developed countries (Grant and
Furstenberg, 2007). These trends could spread to Latin America given that ideas and behavioural
patterns in developed countries tend to influence the region (Alí and Cleland, xiv 2005). While it was
less clear based on data from the 1990s (Guzmán and others, 2001), data from the 2000s show that
sexual initiation is taking place at an earlier age, increasing the risk of adolescent motherhood (see
table 3).
With regard to marriage, both modernization theory and the second demographic transition
theory predict that young people will increasingly delay getting married (Castro and others, 2010;
Grant and Furstenberg, 2007). Moreover, adolescent marriage is generally predicted to virtually
disappear as young people concentrate on their education and on gaining personal and professional
experience, both of which are almost incompatible with raising a child. However, according to recent
studies (Castro and others, 2010; Esteve and others, 2010; Fussel and Palloni, 2004), Latin America
diverges from this pattern since, despite the socio-economic and demographic changes that have taken
place in the region, its decades-old marriage pattern remains unchanged. The above conclusions are
essentially logical in view of the evidence gathered up to the end of the twentieth century, but they
should be clarified. First, while civil registers show that the average age at first marriage is indeed
rising significantly, there has been no change in the pattern relating to the age of informal union.
Second, the average could disguise divergent trends among socio-economic groups and, far from
being a stable pattern, it appears to be a polarized one. Third, specialized surveys conducted in the
2000s suggest a decline in adolescent unions, xv but only a slight one and with national specificities
(see table 3).
In summary, although young people are becoming sexually active at an earlier age, they are
not forming consensual unions any earlier, resulting in a growing gap between the two and an
increased risk of adolescent motherhood outside a consensual union, as reflected in the rise in single
mothers. xvi
4. Contraception
Both the menarche and first intercourse are occurring at an earlier age, and if this is not to bring about
an increase in adolescent motherhood, more adolescents must use contraception. The figures available
suggest that contraceptive use has indeed risen over the past two decades, largely because AIDS
prevention programmes have led to greater use of condoms (Rodríguez, 2009). Nevertheless,
contraceptive use remains very low and is clearly insufficient to address the high and rising levels of
unwanted fertility recorded in the region, which will be analysed in depth in the next section.
Table 4 illustrates ones of the reasons behind the apparent contradiction between
increased contraceptive use and a growing unmet need for contraception among adolescents. In
all countries, the proportion of adolescent girls having been at some stage in a union who have
never used contraception is falling sharply. In principle, this suggests greater protection from
unwanted fertility. However, the protective impact is lower, because in most countries there has
been a corresponding increase (although more moderate) in the proportion of adolescent girls
who are or have been in a union who began to use contraception after having their first child.
This finding illustrates the drawbacks mentioned earlier of taking current contraceptive use as a
factor protecting adolescents against unwanted pregnancy since their sexual initiation. A more
relevant indicator, which also concerns all sexually initiated teenage girls, rather than only those
who have been in a union, is examined below.
This is the “Use of contraception at first intercourse” indicator, which is systematically
captured and published by International Reproductive Health Surveys for the 15-24 age group. xvii
Here again, taking all contraceptive methods into consideration, there is a trend towards using
contraception during first intercourse. Paraguay in particular stands out: contraceptive use increased
from 23.6% in 1995/96 to 70.5% in 2008 (National Demographic and Sexual and Reproductive
Health Survey (ENDSSR), CEPEP, 2008). Over a similar period of time (1998-2008) it rose from
9.5% to 28.2% in El Salvador (National Family Health Survey (FESAL), ADS, 2008). In Ecuador it
climbed from 4.8% in 1994 to 13.5% in 2004 (Demographic and Mother-and-Child Health Survey
(ENDEMAIN), CEPAR, 2004).
However, with the exception of Paraguay—where not by chance there has also been a sharp
decline in adolescent fertility over the past 20 years and levels are currently among the lowest in the
region—those who use contraception during first intercourse are still in a minority. When only
modern methods are considered (pills, condoms xviii and injections), Paraguay is the only country with
a figure of over 50%, which is still far below the almost 90% recorded in Spain in 1995 (see figure 7).
In fact, contraceptive use right from the start is the fundamental reason why the adolescent fertility
rate in Spain is around 10 per 1000, or a seventh of the region’s, despite having a similar age for first
intercourse as Latin America. xix
Figure 7
90
80
70
Percentage
60
50
40
30
20
10
España, 1995 (18-19
años)
Paraguay 2004 (1524)
Paraguay 2008 (1524)
Honduras 1996 (1524)
Honduras, 2001 (1524)
Guatemala, 2002
(15-24)
El Salvador, 2008
(15-24)
El Salvador, 2002/03
(15-24)
Ecuador 1994 (1524)
Ecuador, 2004 (1524)
Costa Rica, 2000
(18-19 años)
Brazil , 1996 (15-19)
0
Coutries and years
The reasons for failing to use contraception during first intercourse are relevant to sexual and
reproductive health policies and programmes aimed at adolescents. If an explicit desire to have
children were responsible for lack of contraceptive use, policies should focus on addressing these
expectations, since programmes designed to provide better access to contraceptive methods would not
be successful while they persisted. However, the data does not appear to indicate that this is the case
since the reasons given for not using contraception during first intercourse have little to do with a
desire for children; rather, they are far more strongly associated with insufficient prevention and poor
access to contraception. Insufficient prevention is the reason behind responses such as “Did not expect
to have sex” (32.2%, El Salvador 2008, ADS, 2008), “Carelessness” (44.1%, Paraguay 2008, CEPEP,
2008) and “Was irresponsibly” (28.1%, Chile, 2009, special processing of the data from the Sixth
National Youth Survey (ENAJU), INJUV, 2009). xx Lack of access is reflected in responses such as
“Did not know what methods were available”, (15.2% in Paraguay and 15% in El Salvador), “Partner
didn’t want to” (8.2% in El Salvador), “Could not get any” (Chile, 9.3% among women and 16%
among men). With regard to the desire to have children as justification, this ranged from 12.2% in El
Salvador, to 4.6% in Paraguay and to 5.7% in Chile. For Paraguay, El Salvador and Ecuador a
distinction is made between first intercourse within a union and first intercourse outside a union, xxi
since the reasons for not using contraception vary significantly in each case: in couples who are
married or in a union, the desire to have children is stronger—in fact, it is the main reason cited in El
Salvador in 2008.
This data reinforces the complex interaction between sexual activity, union and pregnancy in
adolescence. On the one hand, sexual activity prior to union is increasing, which in principle limits the
relevance of union as an explanation for teenage fertility. On the other hand, a not insignificant
proportion of Latin American girls form a union at an early age, in particular impoverished girls, as
will be seen later. Many of them have explicit expectations of early reproduction, and the beginning
of the union continues to be a sign that pregnancy will follow soon after. This is particularly true of
early unions that are the product of cultural norms, as in many indigenous communities. But it also
seems to apply to some poor urban teenage girls, who view forming a union and having a family as a
way to acquire an identity, a home and a sense of purpose in an environment that offers few
alternatives. xxii
D. UNWANTED FERTILITY AND SEXUAL AND REPRODUCTIVE RIGHTS: A CRITICAL ISSUE
Studies and researchers in Latin America have traditionally suggested that adolescents want
to have children and, in particular, that they want to do so more than at other ages. xxiii The arguments
underpinning this proposal range from demographics—that is, birth order, because first order births
are more desired and most births to teenage mothers are first order births—to anthropology—cultural
norms that prize early reproduction—to sociology—early motherhood as an option that provides
meaning and a life plan—particularly in contexts with few or no alternatives (Oliveira and Vieira,
2010; Binstock and Pantelides, 2006; UNFPA, 2005; Stern, 1997).
These arguments are not supported by the current evidence. Figure 8 is unequivocal in this
respect. It shows how the desirability of children born in the five years prior to each survey has
changed over time among adolescents and among all women between the ages of 15 and 49. Surveys
conducted during the 1980s and 1990s do bear out the greater desirability hypothesis. In all countries,
the percentage of births described as “wanted then” was higher for births before the age of 20.
Surveys carried out during the first decade of the twenty-first century, however, point to (i) a
systematic and considerable drop in some countries in the desirability of children conceived during
adolescence; (ii) lower levels of desirability for births during adolescence compared to all births in
most countries.
Figure 8
90
80
Percentage wanted then
70
60
50
40
30
20
15-19
Country and year
Peru 1996
Paraguay 2008
Nicaragua 1998
Honduras 2005-06
Haiti 1994-95
Guatemala 2008
El Salvador 2002
Dominican Republic 2007
Colombia 1990
Bolivia 1994
0
Brazil 2006
10
Total
These findings are highly relevant for policy decisions, since they signal a greater need for
sexual and reproductive health services, in particular access to contraception, and suggest that there is
considerable scope for programmes promoting preventive behaviour in regard to teenage pregnancy.
In the 1960s, the high levels of unwanted fertility detected by the surveys on fertility in Latin America
(PECFAL) among women from a number of Latin American cities (CELADE/CFSC, 1972) served as
a justification for establishing family planning programmes in the region. The evidence regarding the
decline in planned births among teenage mothers is an incentive and powerful argument for stepping
up reproductive and sexual health public policies and programmes for this group.
E. EARLY MOTHERHOOD IN LATIN AMERICA: AN EXPRESSION OF LONG-STANDING, SHARP SOCIAL
INEQUALITIES
In Latin America, national averages hide sharp social inequalities. This is undoubtedly the
case for adolescent fertility, because it is highly correlated with educational level and social standing.
In fact, the most recent results from specialized surveys in the region suggest that this relationship
persists, given that girls with low levels of education continue to have much higher probabilities of
becoming mothers during adolescence. Furthermore, in most countries, the differences between
educational groups with regard to adolescent motherhood are much greater than the disparity recorded
in the total fertility rate. The region’s success in tackling disparities in the number of children women
have is marred by the persistent disparity in reproductive timing, as women in disadvantaged groups
continue to start their reproductive life much earlier (Jimenez and Rodríguez, 2009; ECLAC, 2005).
The close correlation between education and adolescent motherhood has raised expectations
that the predicted expansion in access to secondary and university education in the region will be
accompanied by a sustained decline in adolescent fertility. Simply because of a statistical composition
effect, more schooling does in fact tend to reduce aggregated levels of teenage fertility and
motherhood (Rodríguez, 2009). Figure 5 illustrates this effect and draws on new data from the 2010
Panama census. The census shows that 15.5% of girls aged between 15 and 19 were mothers in 2010,
less than the 17.2% recorded in 2000 and the 16% in 1990 (an overall decline between 1990 and
2010). However, when this percentage is disaggregated by educational level, an increase in all
categories is observed, with the exception of “No education” (see figure 9). The composition effect is
the reason behind these contradictory trends. If it were not for the expansion in schooling between
1990 and 2010—during which the percentage of adolescents with low levels of education, in other
words below secondary, fell from 34% to 17%—the adolescent motherhood rate would have been
20.8% in 2010, far higher than the 15.5% recorded that year and the 16% recorded in 1990.
Figure 9
45
40
35
Percentage
30
25
20
15
10
5
0
No education
Primary incomplete
Primary complete
1990
Secondary incomplete Secondary complete
Entered higher
education/university
Educational level 2010
Panama’s experience is not unique. Figure 10 illustrates how, when the data is separated by
educational group, adolescent motherhood has risen almost across the board in most countries of the
region. While the trend observed in the national percentage for teenage motherhood is less clear-cut
(as seen in table 1 and figure 5), this is due to the composition effect, which arises from the declining
proportion of adolescents with low levels of education, who, as has been explained and demonstrated,
continue to experience far higher levels of adolescent motherhood than highly educated adolescents.
Figure 10
40
35
30
Change (porcentual points)
25
20
15
10
5
Peru 1986 -2009
Paraguay 1990-2008
Nicaragua 1998 -2006
Honduras 2001-2005/06
RHS (10)
Haiti 1994/95-2005/06
Guatemala 1987-2008
El Salvador 1985-2008
Ecuador 1987-2004
Dominican Republic 19962007
-15
Colombia 1986-2010
-10
Brazil 1986-1996
-5
Bolivia 1989-2008
0
Countries and period
No Educacion
Primary
Secondary and more
Figure 9 sounds an alarm bell for Latin America. Without a doubt education continues to be a
factor protecting against teenage motherhood, but its ability to prevent has declined and, above all, the
educational threshold needed to provide a close-to-zero probability of adolescent motherhood has
risen from secondary school to university. This is much more marked in countries where secondary
education is widely available, since socio-economic disparities in these countries are increasingly
expressed as a distinction between adolescents who enter higher education and those who do not. In
countries where only a minority of adolescents have access to secondary education, attaining this level
still prompts a sudden drop in the likelihood of becoming a teenage mother.
Given that progress towards providing universal secondary education in Latin America has
not been accompanied by improvements in the job market and social inequality persists (ECLAC,
2010), a not insignificant proportion of the educated teenage population has low expectations
regarding the benefits and opportunities that these extra years of study will bring. They find it difficult
to imagine themselves in good jobs, they see going to university as complicated or financially
unfeasible, and alternatives paths to personal fulfilment based on economic and domestic
emancipation seem out of reach. All of these factors ensure that the losses and costs associated with
early motherhood are less keenly felt by a section of Latin American youth. As such, structural
change in the form of a more equal society that offers adolescents and young people more
opportunities should clearly foster a decline in the region’s high teenage fertility rate.
In addition, school, to which there is now mass access, has become the main place for
socialization during adolescence (rather than simply a place to receive education). Teenagers meet
their peers at school and are influenced by them. This is where they learn how to relate to the opposite
sex. In this context, they make their first romantic and sexual forays. However, neither society nor the
school itself has adapted to this new reality. Both the family and the health sector continue to deny
that teenagers are sexual beings and place barriers in the way of access to contraception. Even sex
education, which should be a fundamental part of the education provided by a modern school, remains
firmly attached to “biological” approaches, which do little to help teenagers develop preventive
behaviour.
Schools in Latin America are therefore presented with great challenges. These must be faced
on the basis that merely imparting knowledge and rules to students is not enough if they are to be able
to act in a healthy, safe, well prepared and self-determined way.
Finally, inequality is also observed in the case of the proximate determinants. For first
intercourse, figure 11 confirms the familiar pattern: the most disadvantaged groups report an early
first sexual experience, largely because they form a union earlier. However, figure 11 also illustrates a
theory that had not been borne out in the region until now: the trend towards social convergence of
first intercourse. As is clearly shown, there has been a sharp fall in the age at first intercourse among
women with university or higher education, but much less so in the case of girls with a low level of
education. What may happen therefore in the medium term is that the social disparity for first
intercourse will become less acute and less important as a determinant of social inequality in
adolescent motherhood (as is already happening in countries such as Chile, according to the Sixth
National Youth Survey of 2009). In any case, the importance of first intercourse does not depend
solely on the age at which it occurs but also on whether or not it occurs within a union. Accordingly,
if the age of first intercourse among poor girls continues to be linked to union, there is a high
probability that it will continue to result in pregnancy.
Figure 11
24
23
22
21
Median Age
20
19
18
17
16
15
14
2529
3034
3539
4044
4549
2529
No education
Bolivia 2008
3034
3539
4044
Primary
Colombia 2010
4549
2529
3034
3539
4044
4549
Secondary
Dominican
Republic
2007 level
Age
group and
educational
2529
3034
3539
4044
4549
Universitary
Honduras 2005-06
Peru 2009
The other key proximate determinant is contraception. According to the latest surveys
available, even if all methods are included (that is, even traditional methods, which are far less
effective and far more common among underprivileged groups), the disparity continues to be great
(see table 5). Thus, sexual and reproductive health policies and programmes face a dual challenge. On
the one hand, they must facilitate access to contraception for all adolescents who need it when they
become sexually active, since the overall figures for protected first intercourse are low and unwanted
teenage fertility is on the increase. On the other hand, they must pay particular attention to the poorest
groups in the population, which in many countries demonstrate levels of protected first intercourse
that are close to zero.
F. POLICY IMPLICATIONS AND RESEARCH CHALLENGES
In the absence of a sustained and solid increase in contraceptive protection during
adolescence, teenage fertility in Latin America will remain stubbornly high, since the increasingly
early age of the menarche and first intercourse appear to be trends that are difficult to reverse.
Moreover, unwanted fertility will continue to rise among adolescents, both because the desire to have
children during adolescence is declining and because a growing percentage of sexual activity is
beginning and continuing outside union, making reproductive intentions less likely.
As a result, public policies and programmes are needed that aim to provide adolescents with
universal access to comprehensive sex education and relevant and specialized sexual and reproductive
health services. The first important decision concerns first intercourse, and comprehensive sex
education should strengthen adolescents’ ability to make a careful, considered decision. In addition,
merely distributing contraception is ineffective because adolescents need more: the require
instruction, advice and empowerment if they are to use contraception regularly.
In terms of research, several subjects are still outstanding, to the extent that they have not
even been mentioned in this paper. These include the specificities of indigenous communities, teenage
parents, and the behaviour of men in the context of adolescent motherhood. Although some work has
recently been done in the region and worldwide (Olavarría and Madrid, 2010; Del Popolo, López and
Acuña, 2009; Rodríguez, 2009; Guzmán and others, 2001; Greene and Biddlecom, 2000), this has
only scratched the surface. Abortion is also notable by its absence, but sources of data on this remain
scarce.
At least three of the subjects analysed in this paper require in-depth research in the future. The
first is the inequality that persists in both reproduction and the intermediate variables. The second is
the fact that some adolescents form a union early, which is directly linked to inequality (the poor and
indigenous are much more likely to form such unions) and this is a crucial point for policymakers on
account of the reproductive preferences these girls tend to exhibit. Finally, there is the matter of social
institutions such as the family, the health sector, the media and schools, whose actions and omissions
have a direct impact on adolescent behaviour (Rodríguez, 2009).
This paper attributes more importance to education and schools because it was deemed
necessary to underline the existing contradiction between what they offer and the new risk factors for
adolescent motherhood which adolescents face and which increasingly operate at school. The message
of this paper aims to highlight a school's ability to protect. This requires schools, in particular
secondary schools, to adapt to the new reality of mass access to education and to respond to the needs
and concerns of its students, including those relating to comprehensive sex education, impulse control
and affective development. Without a doubt the deep-rooted inequalities that persist in the region,
including educational and labour segmentation, conspire against the equalizing role of education. Yet
school remains the key institution for education. Future generations in Latin America depend on its
ability to modernize and to offer a good-quality, comprehensive education to all.
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NOTES
i
ii
iii
iv
v
vi
vii
viii
ix
x
xi
xii
xiii
xiv
xv
These reasons are not universally accepted. Some researchers argue that adolescent fertility does not involve
greater health risks, except for pregnancy at a very early age (under 15). Experts also highlight the socioeconomic and cultural roots of teenage fertility in developing countries. Other scholars using data from the
1980s and 1990s argue that wanted fertility is higher among adolescents. Finally, some specialists reject the
link between adolescent fertility and poverty reproduction, arguing that other factors (such as economic,
educational and political inequalities) are the key drivers of poverty reproduction (Oliveira and Vieira, 2010;
Binstock and Pantelides, 2005; Guzmán and others, 2001; Stern, 1997; Furstenbers Jr. 1998).
Indeed, the adolescent fertility rate (i.e. for women aged 15 to 19) has become one of the indicators for
Millennium Goal 5.B: “Achieve, by 2015, universal access to reproductive health” (Jimenez and Rodríguez,
2009), despite an appeal not to set quantitative fertility targets expressed in the Programme of Action of the
International Conference on Population and Development (Cairo, 1994) (United Nations, 1994).
The term union is used in this paper to refer to consensual union or formal marriage, or both, whereas the
term marriage refers only to formal marriage.
This is particularly important when the number of births above first order among adolescents decreases, but
not first order births, which is exactly what is happening in many Latin American countries (Rodríguez,
2009).
The percentage of mothers in 2010 is even slightly lower than that recorded in 1990. A standardization
exercise to control changes in the single age structure between the 1990 and 2010 censuses does not alter this
relationship; in other words, the decrease is not due to age composition.
Teenage union continues to be closely associated with adolescent motherhood, since the desire to start a
family is often stronger once an adolescent begins to live with their partner. However, the reverse is not
uncommon, where a pregnancy arising within the context of a romantic relationship that has not been
formalized and the partners do not live together prompts union, usually consisting of cohabitation without
marriage.
And possibly its relationship to the likelihood of pregnancy.
In fact, a study that makes rigorous use of the information provided by the Demographic Health Surveys
states that “The calendar contains no information about frequency of sexual intercourse or number of sexual
partners, which is a major limitation. We therefore have no alternative but to consider time after loss of
virginity as sexually active.” (Ali and Cleland, 2005, p. 1177).
“Contraceptive prevalence should be defined as the proportion of sexually active, fecund women using
contraceptives that does not overlap with the proportion experiencing postpartum amenorrhea.” (Stover, 1998, p.
262).
This will in fact be condom use at first intercourse. The databases available already contained this indicator,
and condoms have become by far the most common form of contraception used during first intercourse in
recent years, owing it would seem to AIDS prevention campaigns promoting its use.
The best indicator would of course be the “Percentage of sexually active time protected by contraception”
indicator, calculated by Ali and Cleland (2005) using data from Demographic and Health Surveys complete
contraceptive histories. However, this is a difficult indicator to calculate and can only be obtained from
countries with Demographic Health Surveys. Moreover, even with this sophisticated indicator, a distinction
would have to be made between time protected before and after having the first child.
National Institute of Statistics (INE), Estadísticasvitales.Informeanual 2008, table 1.2.2.1-04, Santiago
[online]
www.ine.cl/canales/menu/publicaciones/calendario_de_publicaciones/pdf/21_12_10/vit_08211210.pdf,
2010, pp. 84-85.
Census data captures the following categories: married, single and in a consensual union. This ensures that
single girls are not merged with girls in an informal union (as tends to happen in the case of vital statistics).
In any event, the declaration by a girl of “single” in a census does not necessarily imply that the baby’s
father is absent, as she may be in a romantic relationship but not live with the father, or the father and mother
may be separated but the father be present. However, it is highly likely that a teenage mother who declares
she is single is neither in a relationship with nor supported by the father of her child.
“To the extent that attitudes among young people in Latin America are influenced by mass media messages
emanating from North America and Western Europe, where levels of premarital sexual activity are much
higher, the trend may be irreversible.” (Ali and Cleland, 2005, p. 1183)
This is a more meaningful indicator of the risk of becoming a mother during adolescence than median age at
first union or the singulate mean age at marriage (SMAM) indicator, both of which are used in most studies
on marriage trends in Latin America (Castro and others, 2010).
xvi
“Because of pervasive declines in the protective effect of virginity, conception rates among single women in
Latin America are rising. Contraceptive uptake, particularly of condoms, is increasing but not sufficiently to
offset the decline in virginity.” (Ali and Cleland, 2005, p.1175).
xvii
National surveys also capture this data. In Chile, the Sixth National Youth Survey (ENAJU) in 2009
recorded a figure of 58.8% for protected first intercourse among girls aged 15 to 19.
xviii
Demographic Health Surveys ask about condom use during first intercourse. The most recent results for
women aged 15 to 19 are: Bolivia, 2008: 16.5% (Ministry of Health and Sports, EncuestaNacional de
Demografía y Salud (ENDSA) 2008. Informe preliminar, 2008, table 13.5, La Paz, p. 291); Brazil, 2006:
20.3% (Ministry of Health of Brazil, Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher
(PNDS) 2006. Relatório, table 17, Brasilia, 2008, p. 186); Colombia, 2010: 55.4% Association for Family
Welfare (Profamilia), Informe de la Encuesta Nacional de Demografía y Salud (ENDS) 2010, table 12.16,
Bogota, 2011, weighted data, p. 348; Dominican Republic, 2007: 28.6% (Centre for Social and
Demographic Studies (CESDEM), República Dominicana. Encuesta demográfica y de salud 2007. Informe
preliminar, table 12.20, November 2007, p. 257); Honduras, 2006: 10.9% (NationalInstitute of Statistics
(INE), Informe de la Encuesta Nacional de Demografía y Salud (ENDESA) 2005-2006, table 13.12,
Tegucigalpa, December 2006, p. 241).
xix
United Nations official estimates [online] http://esa.un.org/unpd/wpp/unpp/p2k0data.asp [date of reference:
9 June 2011].
xx
In the case of Chile 2009 (ENAJU), up to three reasons could be submitted. Percentages may therefore total
more than 100%.
xxi
This does not mean casual sex. In the case of El Salvador 2008, for example, 91.4% of girls aged 15 to 24
who became sexually active before marriage declared their sexual partner to have been a boyfriend and only
1.5% to have been a casual encounter (ADS, 2009, table 7.7).
xxii
Of course, early union and reproduction do not always provide an identity, a home or a life plan. Rather, the
evidence available tends to suggest the opposite. As has been seen, the proportion of single teenage mothers
increases, as does the proportion of teenage mothers living with their parents rather than making their own
home.
xxiii
Guzmán and others, 2001: “….with few exceptions, the highest percentage of wanted, even planned,
children are born to mothers in the 15-19 age group.” (p.43; free translation).