Schooling and Adolescent Reproductive Behavior in Developing Countries Cynthia B. Lloyd Population Council Many tables and charts are derived from DHS data prepared for forthcoming NAS panel report, Growing Up Global: Transitions to Adulthood in Developing Countries

Outline Schooling among adolescents Adolescent reproductive health and behavior Adolescent reproductive health by schooling status School girl pregnancy Implications

Percent Ever Attended School, by Cohort 100 80 60 40 20 20 40 60 80 100 Girls Boys Africa Latin America Asia 40-44 yrs old 10-14 yrs old

Percent Completed 6 or More Years of School, by Cohort 100 80 60 40 20 20 40 60 80 100 Girls Boys Africa Latin America Asia 40-44 yrs old 20-24 yrs old

Percent Currently Enrolled (15 year olds) 20 40 60 80 100 Africa Latin America Asia

Percent Currently Enrolled, 9 Latin American Countries (median, quartiles, range) Boys Girls 12 15 18 Age

Percent Currently Enrolled, 13 Asian Countries (median, quartiles, range) Boys Girls 12 15 18 Age

Percent Currently Enrolled, 28 African Countries (median, quartiles, range) Boys Girls 12 15 18 Age

Percent of Students Aged 12-14 Enrolled in Primary vs Percent of Students Aged 12-14 Enrolled in Primary vs. Secondary and Above

Percent of Students Aged 15-17 Enrolled in Secondary and Above vs Percent of Students Aged 15-17 Enrolled in Secondary and Above vs. Primary

Percent of Students Aged 15-17 Currently Enrolled, by Socio-Economic Status Kenya Tanzania Latin America (7) Asia (12) Africa (28)

Conclusions: Schooling among adolescents Rapid growth in attendance and attainment Recent growth rates more rapid for girls Majority of 15 year-olds are students In many countries, majority of adolescent students attend primary school Poverty compromises school attendance

Outline Schooling among adolescents Adolescent reproductive health and behavior Adolescent reproductive health by schooling status School girl pregnancy Implications

Percent Distribution of Deaths in Developing Countries at Ages 15-29 by Cause, According to Sex and Region Source: WHO (2001) Females Males World 0 25 50 75 100

Percent of Women Giving Birth by Age 18, by Cohort 20 40 60 80 100 20% 40% 60% 80% 100% Africa (28) Latin America (9) Asia (13)

Recent trends in percent marrying, having premarital sex, and having sex by 18 Direction of Change Marriage Premarital Sex Sex ASIA Kazakhstan Philippines LATIN AMERICA Bolivia Colombia Dom. Republic Guatemala Haiti Nicaragua Peru Source: Mensch, Grant, Blanc, forthcoming

Recent trends in percent marrying, having premarital sex, and having sex by 18 AFRICA Direction of Change Marriage Premarital Sex Sex Benin Burkina Faso Cameroon Cote d’Ivoire Kenya Madagascar Mali Niger Nigeria Rwanda Senegal Tanzania Uganda Zambia Zimbabwe

Percent Aged 15-17 Sexually Active, by Socio-Economic Status Latin America Asia Africa Note: Not age standardized

Conclusions: Reproductive health and behavior among adolescents HIV/AIDS is the leading cause of mortality and morbidity in Sub-Saharan Africa Death rates due to HIV/AIDS in Sub-Saharan Africa are highest among young women Overall, roughly 15 percent of deaths among young women are due to maternal causes

Conclusions: Reproductive health and behavior among adolescents (continued) Child marriage remains prevalent in many countries In most countries during the 1990s, percent having sex before 18 has not risen but the context is changing Poor adolescent girls are more likely to be sexually active than their better off peers

Outline Schooling among adolescents Adolescent reproductive health and behavior Adolescent reproductive health by schooling status School girl pregnancy Implications

Possible pathways of association: School attendance and adolescent reproductive behavior Sex Risky sexual behaviors (unprotected sex, multiple partners, sex in exchange for money or favors, coercive sex) Contraceptive (in particular condom) use among sexually active Abortion among those experiencing unwanted pregnancy Early marriage leading to early childbearing

Percent Ever Had Sex, Aged 15-17, by Enrollment Status Latin America Asia Africa Note: Boys not age standardized, Girls age standardized

Aged 15-17 (Not in school/In school) Proportion who ever had sex Ratio of Proportion of Unmarried Women Aged 15-17 Who Ever Had Sex Among Those Not Currently Enrolled vs. Enrolled, by Overall Proportion in School Source: DHS Surveys, 1995-2001 Aged 15-17 (Not in school/In school) Proportion who ever had sex Guatemala Zimbabwe Bolivia Proportion in school Latin America Africa Note: Age standardized

Sex among unmarried adolescents aged 15-17 by school status For unmarried girls, 25% of students or less have ever had sex; percent having had sex is lower among students For unmarried boys, levels of sexual activity vary much more widely; in majority of cases, levels of sex are lower among students Among unmarried girls, ratio of percent having sex among non-enrolled relative to the enrolled exceeds one in almost all countries and does not vary by enrollment level

Percent Aged 15-17 Using Any Contraception, by Enrollment Status Latin America Africa Note: Not age standardized

Percent Using Condoms Among Those Aged 15-17 Who Ever Had Sex, by Enrollment Status Latin America Africa Note: Not age standardized

Contraceptive (condom) use among unmarried sexually active adolescents by school status Relatively few unmarried 15-17 year olds have ever had sex; often sample sizes are too small to estimate rates Where rates can be calculated, contraceptive use is notably higher among students Association between school enrollment and contraceptive use appears stronger for girls Patterns are similar for condom use

School exit and marriage timing A mechanistic relationship? Unlikely A causal relationship? A weaker cross-country association between inter-cohort change in educational attainment and the inter-cohort change in rates of early marriage (below 18) than might be expected (R = -0.46) Source: Mensch, Casterline, Singh (forthcoming)

Outline Schooling among adolescents Adolescent reproductive health and behavior Adolescent reproductive health by schooling status School girl pregnancy Implications

Percent reporting pregnancy as reason for dropout (women 20-24 who ever attended school) Asia Latin America Africa Percent

School Girl Pregnancy Rise in percent of girls attending school after puberty leads to a rise in percent of girls exposed to risk of pregnancy as students Whether pregnancy leads to dropout depends on whether or not a student chooses to continue with pregnancy; studies show that girls often express their desire to stay in school as a reason for seeking abortion

School Girl Pregnancy Percent reporting pregnancy as a reason for dropout are a selective sample of those who become pregnant while students; in many cases pregnancy may be an ex post rationalization for dropout rather than the underlying cause In only few countries with data do the percent of young women who ever attended school report rates of dropout due to pregnancy exceeding 10 percent. In half the countries, reported rates of dropout due to pregnancy are less than 5 percent.

Conclusions Sexual maturation is increasingly likely to occur while in school Being in school as an adolescent is likely to have important implications for adolescent reproductive health Expansion of opportunities for secondary schooling could represent one of the most significant reproductive health interventions for youth

Unanswered Questions What features of primary, secondary schools are most likely to: Encourage delays in sexual initiation Reduce incidence of risky sexual behaviors Encourage contraception and protection among the sexually active Delay marriage and childbearing among young women