Largest Generation Of Adolescents Faces Reproductive Health Risks

June 23, 1998

NEW YORK -- What are the consequences of early sexual activity and childbearing and what can be done to help adolescents in developing countries make a healthy transition to adulthood? Although adolescence is one of the most crucial times of life, little attention has been devoted to the reproductive health of young men and women in developing countries, even as the largest generation of adolescents comes of age. The June 1998 issue of Studies in Family Planning -- a special edition devoted to adolescents -- explores the social, economic, biological, and demographic events that affect adolescents in the developing world. Nine of the ten articles, written by demographers, sociologists, economists, and public health specialists, stem from a March 1997 workshop sponsored by the Committee on Population of the National Academy of Sciences.

"The quality of future adult life depends largely on the extent to which adolescents take advantage of opportunities for personal growth by going to school and being employed while avoiding potentially problematic outcomes of sexual relations, such as early dropout from school, unplanned pregnancy, or adverse health effects," note demographers John Bongaarts and Barney Cohen in the issue's introduction.

Key findings from the studies in this issue include:The Largest Generation Comes of Age

In the developing world as a whole, the population of adolescents aged 10-19 was estimated at 914 million in 1995, about one-fifth of the population of all ages, making it the largest generation in history. As these adolescents enter their childbearing years, the decisions they make about sexuality and childbearing will have life-long significance.

Today more young women in the developing world are attending school and delaying marriage than ever before, and concerns about rising premarital fertility have increased in recent years. With marriage postponed, young people are exposed to the risks of premarital intercourse for longer periods of time, and are at greater risk of unintended pregnancies, induced abortions, and STDs. Of particular concern to many policymakers has been the increase in pregnancy-related school dropouts. In most cases, schoolgirls who become pregnant have to resort to illegal (often unsafe) abortions or face expulsion from school. Girls who drop out of school as a result of pregnancy rarely return to complete their education, and their opportunities for socioeconomic advancement in later life are considerably reduced.

In many traditional rural societies however, the vast majority of women marry and start childbearing at very young ages. Because of their physiological and social immaturity, the health risks associated with childbearing among these young women are more pronounced than are those among older women, regardless of whether or not they are married. In many cases, these health risks are exacerbated by a lack of appropriate prenatal care. Nevertheless, public attention tends not to focus on the potential dangers of immediate postpubertal childbearing among young, married women, not because the dangers are not known, but because there are strong cultural, political, and religious barriers to acknowledging them openly and, above all, to addressing their root causes.

The articles in this special issue of Studies in Family Planning analyze the causes and consequences of reproductive behavior among adolescents in the developing world and offer policy options to address the urgent needs of adolescents as they make the transition to adulthood.

Sexual Behavior and Contraceptive Knowledge and Use Among Adolescents in Developing Countries

Many teens are exposed to the risk of pregnancy the first time they have intercourse, conclude Ann K. Blanc and Ann A. Way in an article about contraceptive knowledge and use among adolescent women in Africa, Asia, the Near East, and Latin America and the Caribbean. The authors draw on data from recent rounds of the Demographic and Health Surveys to demonstrate that both age at first intercourse and age at first marriage are generally rising, but that age at first marriage typically has risen substantially faster so that the length of time between first intercourse and first marriage has increased, exposing young women to a greater risk of premarital pregnancy.

Ann K. Blanc is Principal Demographic Expert and Ann A. Way is Deputy Director for Operations, Macro International, Inc., Calverton, MD

Adolescent Childbearing in Developing Countries: A Global Review

An article by Susheela Singh reveals that as the number of years that young women spend unmarried increases, the possibility of premarital sexual activity and pregnancy rises. As a consequence, in several countries, particularly in sub-Saharan Africa (for example, in Botswana, Kenya, Liberia, Madagascar, Namibia, and Zambia), the proportion of adolescent births to unmarried women is increasing and may continue to do so if contraceptive use among sexually active unmarried young women does not increase substantially.

Susheela Singh is Director of Research, The Alan Guttmacher Institute, New York, NY

The Construction of Adolescence in a Changing World: Implications for Sexuality, Reproduction, and Marriage

An article by John C. Caldwell and his colleagues shows how the period now known as adolescence came into being and how it has been shaped by international economic, institutional, and social influences. Drawing on their own extensive research programs in Nigeria, Sri Lanka, India, and Bangladesh, the authors contend that in matters of sexuality, reproduction, and marriage, the most important forces shaping modern-day adolescence are still each society's different cultural values and institutions.

John C. Caldwell is Coordinator and Pat Caldwell is Centre Visitor, Health Transition Centre, Australian National University, Canberra, Australia. At the time this article was written, Bruce K. Caldwell was Population Council Postdoctoral Fellow, ICDDR,B Extension Project (Rural), Dhaka, and Indrani Pieris was Coordinator, Joint ICDDR,B Extension Project (Rural) Australian National University Project

Sexual Activity and Contraceptive Use: The Components of the Decisionmaking Process

Power disparities based on economics, age, and gender make adolescent girls more vulnerable than adult women to exploitative and coercive sexual relationships, notes Anastasia J. Gage in an article about sexual and reproductive decisionmaking. Although some adolescents appear to weigh the pros and cons of engaging in certain behaviors, not all decisions are made rationally. For example, decisions to engage in unprotected sexual intercourse may be based on insufficient knowledge or on distorted judgments concerning the risks of pregnancy or STDs.

Anastasia J. Gage is Senior Technical Advisor, Population Leadership Program, Western Consortium for Public Health, Washington DC

Gender Differences in the Schooling Experiences of Adolescents in Low-Income Countries: The Case of Kenya

Barbara S. Mensch and Cynthia B. Lloyd find that in Kenya, teachers perpetuate traditional assumptions about gender roles. Teachers exhibit a double standard regarding sexual activities, and they have lower expectations for adolescent girls than for boys. Although they are treated poorly, girls have much to gain from doing well in school, the authors conclude. Those who score well enough on primary-school exams to go on to secondary school typically have better job and marriage prospects than those who do not.

Barbara S. Mensch is Associate, and Cynthia B. Lloyd is Senior Associate and Director of Social Research, Policy Research Division, Population Council, New York, NY

Transition to Adulthood of Female Garment-factory Workers in Bangladesh

By working outside of the home and by generating their own income, young women factory workers in Bangladesh experience a radically different transition to adulthood than their counterparts who are socialized for a traditional pattern of early marriage and childbearing. According to Sajeda Amin and her colleagues, young women in the garment industry increasingly delay marriage and childbearing because of the high opportunity costs that women associate with leaving the work force.

Sajeda Amin is Associate, Policy Research Division, Population Council, New York, NY; Ian Diamond is Dean of Social Sciences, University of Southampton, Ruchira T. Naved is Senior Fellow, Population Council, Dhaka and Research Coordinator, Save-the-Children (USA). Margaret Newby is Research Student, University of Southampton

The Costs of Adolescent Childbearing: Evidence from Chile, Barbados, Guatemala, and Mexico

For women in several Latin American and Caribbean countries, early childbearing reinforces poverty, concludes Mayra Buvinic. In an analysis of women in Chile, Barbados, Guatemala, and Mexico, Buvinic finds that poor adolescent mothers work more and earn less than do other mothers, and the timing of their childbearing is directly related to their children's nutritional status.

Mayra Buvinic is Chief, Social Development Division, Inter-American Development Bank, Washington DC

The Health Consequences of Adolescent Sexual and Fertility Behavior in Sub-Saharan Africa

The health consequences of early sexual activity and childbearing can be dire, say Laurie Schwab Zabin and Karungari Kiragu, two public health specialists who draw on literature from sub-Saharan Africa. Because of adolescents' physiological and social immaturity and the lack of adequate prenatal care available to them in most countries, their early childbearing poses significant health risks, such as pregnancy-induced high blood pressure, anemia and hemorrhage, obstructed and prolonged labor, and postpartum infection. Although these ailments can occur at any age, they are often more pronounced and more dangerous in very young adolescents.

Laurie Schwab Zabin is Professor, Department of Population Dynamics, and Karungari Kiragu is Senior Program Officer, Center for Communication Programs, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD

Improving the Fit: Adolescents' Needs and Future Programs for Sexual and Reproductive Health in Developing Countries

Current health programs fall short of helping young people acquire the knowledge, skills, and behaviors they need, argue Jane Hughes and Ann P. McCauley. After reviewing intervention programs around the world, the authors identify a set of good practices for implementing successful sexual and reproductive health programs for young people.

Jane Hughes is Associate Director, Population Services, The Rockefeller Foundation, New York, NY; Ann P. McCauley is Public Health Analyst, International Center for Research on Women, formerly with the FOCUS on Young Adults Program

When Will Teenage Childbearing Become a Problem: The Implications of Western Experience for Developing Countries

In the United States, the combined approach of encouraging postponement of sexual activity while promoting contraceptive use for those who intend to engage in sex is a formula for failure, maintains Frank F. Furstenberg, Jr. His article asks what, if anything, can the Western experience teach developing countries about the causes and consequences of teenage childbearing? Furstenberg argues that in the United States a combination of demographic, economic, cultural, and political factors are to blame for establishing teenage childbearing as a social problem. Developing countries should not use the U.S. as a model, he suggests.

Frank F. Furtenberg, Jr. is Zellerbach Family Professor of Sociology, University of Pennsylvania, Philadelphia, PA

This special issue of Studies in Family Planning, vol.29, no. 2, "Adolescent Reproductive Behavior in the Developing World," was edited by John Bongaarts, Vice President, Policy Research Division, Population Council, New York, NY and Barney Cohen, Director, Committee on Population, National Research Council, National Academy of Science, Washington, DC.

For subscription information on Studies in Family Planning, call 212-339-0514 or fax 212-755-6052. For further information, contact Christina Horzepa, 212-339-0520 or Sandra Waldman, 212-339-0525.

The Population Council is an international, nonprofit, nongovernmental institution that seeks to improve the wellbeing and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices.

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