Motherhood in Childhood Facing the Challenge of Adolescent Pregnancy 30 October 2013 India Theme for the State of World Population Report 2013State of World Population Report 2013

Up A head  UNFPA, Rights and Adolescent Pregnancy  Global Statistics  The Challenges Worldwide  The Underlying Causes  Pressures from Many Directions & Levels  Ecological Model  India: Factsheet  Foundations for Progress  Eight Ways to Get There  The Benefits  Research Needs  Voices

“From a human rights perspective, a girl who becomes pregnant- regardless of the circumstances or reasons - is one whose rights are undermined.” —Dr. Babatunde Osotimehin Executive Director, United Nations Population Fund Under-Secretary-General of the United Nations.

UNFPA is guided by the Programme of Action of the International Conference on Population and Development (ICPD), respecting protecting and fulfilling adolescents human rights including their right to sexual and reproductive health and reproductive health. UNFPA, Rights and Adolescent Pregnancy

Countries with 20% or more of women ages reporting a birth before age 18

Per cent of adolescent girls in marriages and adolescent birth rates Developing RegionsGirls, ages Currently Married (%)Adolescent Birth Rate Arab States1250 Asia and Pacific1580 East Asia and Pacific550 South Asia2588 Eastern Europe and Central Asia931 Latin America and Caribbean1284 Sub-Saharan Africa24120 East and Southern Africa19112 West and Central Africa28129 Developing Countries1685

Lifetime cost of adolescent pregnancy of the current cohort of girls 15 to 19 years old, as share of annual GDP

Pregnancy Desires and Contraceptive Use The proportion of married adolescents who are or wish to become pregnant varies widely by region Want to avoid pregnancy, using no method Want to avoid pregnancy, using a traditional method Want to avoid pregnancy, using a modern method Want pregnancy or are intentionally pregnant Sub-Saharan Africa South Central & Southeast Asia Latin America & Caribbean

 20,000 girls giving birth every day  Missed educational and other opportunities  70,000 adolescent deaths annually from complications from pregnancy, childbirth  3.2 million unsafe abortions among adolescents each year  Perpetuation of poverty and exclusion  Basic human rights denied  Girls’ potential unfulfilled The Challenges Worldwide

 Child Marriage  Gender inequality  Obstacles to human rights  Poverty  Sexual violence and coercion  National policies restricting access to contraception, age- appropriate sexuality education  Lack of access to education and reproductive health services  Underinvestment in adolescent girls’ human capital The Underlying Causes

An ‘ecological’ approach to adolescent pregnancy is one that takes account the full range of complex drivers (individual, family, school/peers, community, national) of adolescent pregnancy and the interplay of these forces Pressures from Many Directions & Levels For more details on the ‘ecological’ approach please refer to Page 33, State of World Population Report 2013

Ecological Model

India: Factsheet IndicatorsValue Percentage of women aged married before age 18 (NFHS-3)47.4 Percentage of women aged married before age 15 (NFHS-3)18.2 Percentage of women aged who had already given birth by 18 years of age (NFHS-3) 21.7 Percentage of women aged who had already given birth by 15 years of age (NFHS-3) 3.4

India: Percentage of women age married before age 18 Source: DLHS- 3

Median age at first marriage and first birth among women aged by educational attainment Source: NFHS -3 Refer to notes below

India: Factsheet (Cont.) IndicatorsValue Percentage of married adolescent girls years who are currently using a modern method of contraception (NFHS-3) 6.9 Percentage of married adolescent girls years who have an unmet need for family planning (NFHS-3) 27.1 Percentage of ever married women aged who have ever experienced spousal physical violence (NFHS-3) 25.3 Percntage of ever married women aged who have ever experienced spousal sexual violence (NFHS-3) 13.1 Refer to notes below

 Empower Girls: Building girls’ agency, enabling them to make decisions  Rectify gender inequality: Put girls and boys on equal footing  Respect human rights for all: Upholding rights can eliminate conditions that contribute to adolescent pregnancy  Reduce poverty: In developing and developed countries, poverty drives adolescent pregnancy Foundations for Progress

“What is needed is a new way of thinking about the challenge of adolescent pregnancy. Instead of viewing the girl as the problem and changing her behaviour as the solution, governments, communities, families and schools should see poverty, gender inequality, discrimination, lack of access to services, and negative views about girls and women as the real challenges, and the pursuit of social justice, equitable development and the empowerment of girls as the true pathway to fewer adolescent pregnancies.” —Dr. Babatunde Osotimehin Executive Director, United Nations Population Fund Under-Secretary-General of the United Nations. The Way Ahead... Refer to notes below

1.Girls 10 to 14: Preventive interventions for young adolescents 2.Child marriage: Stop marriage under 18, prevent sexual violence and coercion 3.Multilevel approaches: Build girls’ assets across the board; keep girls on healthy, safe life trajectories 4.Human rights: Protect rights to health, education, security and freedom from poverty 5.Education: Get girls in school and enable them to stay enrolled longer 6.Engage men and boys: Help them be part of the solution 7.Sexuality education and access to services: Expand age-appropriate information, provide health services used by adolescents 8.Equitable development: Build a post-MDG framework based on human rights, equality, sustainability Eight Ways to Get There

... And The Benefits  Better Maternal and Child Health: Later pregnancies reduce health risks to girls and to their children  More Girls Completing their Education: This reduces the likelihood of child marriage and delays child bearing leading eventually to healthier birth outcomes. Also builds skills, raises girls’ status  Equal Rights and Opportunity: Preventing pregnancy helps ensure girls enjoy all basic human rights  Increased Economic Productivity and Employment: Investments that empower girls improve income-earning prospects  Adolescent Girls’ Potential Fully Realized: Prospects are brighter for a girl who is healthy, educated and able to enjoy rights

Research Needs  Data on needs and experiences of young adolescents years  Data about pregnancies or births outside of marriage  Data and insights about the men and boys who father the children of adolescent girls  More in-depth data and contextual information on patterns, trends, and the circumstances of pregnancy among girls under 18  Need for periodic survey on extent and types of violence experienced by adolescents

Voices from across the world

“I knew about condoms, but could not ask my husband to use one. I was only 16 when I got married and felt he would get angry, as I was less educated than him.” Pinki, 19, India

“I am always imagining what my life would be like if I had met someone before I was pregnant, someone who taught me to be assertive, someone who talked to me about relationships, the advantages and disadvantages of engaging in sex so young. Maybe I would not be in this situation” Swinton, 20, pregnant at 15, Zimbabwe

“I was given to my husband when I was little and I don’t even remember when I was given because I was so little. It’s my husband who brought me up” Kanas, 18, Ethiopia

“Pregnancy is not like going to a party and then it is over. Before you even think about having sexual relationships, you should always think about the consequences.” Valeria, 15, Nicaragua

“I was going out with my boyfriend for a year and he used to give me money and clothes. I got pregnant when I was 13… He promised he would take care of me. After that, he left. ” Ilda, 15, Mozambique

“As I look back... I remember many goals I wanted for myself but could not achieve” Jessica, 39, pregnant at 18, USA

“I was 16 and never missed a day of school. Then one day I was told that I had to leave it all, as my parents bartered me for a girl my elder brother was to marry. I pleaded with my mother, but my father had made up his mind ” Komal, 18, India

“When we devote attention and resources to the education, health and well being of adolescent girls, they will become an even greater force for positive change in society that will have an impact for generations to come.” - United Nations Secretary- General Ban Ki-moon Refer to notes below

Delivering a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled