1. LATIN AMERICA: HIGH ADOLESCENT FERTILITY AMID DECLINING OVERALL FERTILITY Jorge Rodríguez Vignoli ECLAC, Santiago Expert group meeting on "Adolescence, Youth and Development", New York, 21 and 22 July 2011

2. CONTENTS Introduction: Why are we concerned with adolescent fertility? Levels and comparative trends Main proximate determinants  Menarche  Sexual activity (and marriage)  Contraception (and abortion) Reproductive preferences and wishes Social inequality Policy implications and research challenges

3. Introduction: Why are we concerned with adolescent fertility?

4. Disadvantages  Infant and mother's health risks  Lower educational achievement  Psychological immaturity for childrearing Particular policy issues  Trends: slower decline, even increase in some countries (Latin America)  Traditional family planning programs and many RH programs do not work well with adolescents. They need sensitive and friendly programs  Primary and secondary education have less of a protective effect on teenage motherhood  Affects mostly the poor, and leads to social reproduction of poverty  Obstacles to reproductive rights  Sometimes associated to violence and abuse

5. Adolescent fertility levels: Latin America and the Caribbean in comparison with other regions of the world (national levels)

6. Major regions of the world: Adolescent fertility rate and total fertility rate: the Latin American outlier

7. Motherhood during adolescence: still a common experience in Latin America, but with differences across countries. Percentage of 19 year old women with reproductive experience (censuses = mother; survey = mother or pregnant with first child)

8. Adolescent fertility trends in Latin American: - decline, increase or stalemate? - one tendency or different patterns across countries?

9. A WORRYSOME TREND DURING THE LAST TWO DECADES: ALMOST ALL COUNTRIES INCREASED ADOLESCENT MOTHERHOOD, ACCORDING TO CENSUS DATA. FERTILITY SURVEYS SHOW LESS SYSTEMATIC TREND (5 INCREASING AMONG 11 COUNTRIES WITH DATA) SURVEYS (DHS, IRHS) Recent 2005-2010 (1) Past 1985-1999 (2) Percentage change (1) - (2) (positive means increase) Bolivia: DHS 2008, DSH 198917,917,20,7 Brasil: PNDS 2006, DHS 198622,313,39,8 Colombia: DHS 2010, DHS 198619,513,65,9 Dominican Republic: DHS 2007, DHS 199620,622,7-2,1 Ecuador: ENDEMAIN 2004, DHS 198719,4172,4 El Salvador: FESAL 2008, DHS 198522,826,6-3,8 Guatemala: DHS 2008 – DHS 198721,822,8 Haiti: DHS 2005-06, DHS 1994-951414,5-0,5 Nicaragua: IRHS 2006, DHS 199825,227-1,8 Paraguay: IRHS 2008, DHS 199011,616,8-5,2 Peru, ENDES continua 2009, DHS 198613,712,71

10. Proximate determinants Menarche is happening earlier (biological and social causes) Sexual activity is better proximate determinant than marriage because of increasing premarital sex (Stover, 1998)  Indicator: age at first intercourse (there is no reliable data on coital frequency)  Post partum abstinence has marginal effect Contraception  ¿Current use or use at first intercourse?....Use at first intercourse is better because many adolescents begin to use AFTER having their first child Abortion: no available data

11. Sexual activity during adolescence is becoming more common: 10 out of 11countries have higher % of adolescents sexually initiated by age 18 in the more recent surveys. Marriage and sexual activity among adolescents are more weakly associated: 7 out of 11 countries have a lower % marriages by age 18 Percentage of women aged 20-24 that were married before age 18 and percentage that had first intercourse by age 18

12. Low or very low levels of protected sexual debut (except by Paraguay) Women aged 15-24 (some countries with other ages): percentage who used modern contraception at first intercourse

13. Wanted motherhood and fertility preferences Until 2000: adolescent fertility was more wanted than at other ages Very different situation according to more recent surveys: births before the age of 20 are least desired (“wanted at the time”)

14. Percentage of births “wanted at the time”: births before age 20 and total. Currently this percentage is lower for births before the age of 20 in almost all countries

15. Social inequality Fertility differences across socio- economic strata are still sharp, and larger in adolescent motherhood than TFR Inequality in proximate determinants  Age at first intercourse  Use of contraception at first intercourse

16. Inequality is sharper in adolescent motherhod than in TFR Ratio of poorest to richest quintile in TFR and percentage of mothers, women aged 15-19 Haití: the only exception

17. Inequality in age at first intercourse: still very sharp but with some signs of convergence (see negative slope in university-educated women and the slight age slope of women with primary or no education

18. Inequality in protected sexual debut Wealth quintile El Salvador, 2008 Ecuador, 2004 Chile, 2009 Honduras, 2001 Paraguay, 2008 Lowest11.5%6.6%38.10%4.2%55.6% Second23.8%11.1%50.37%NA Middle28.8%11.5%58.74%8.6%75.0% Fourth34.7%17.0%75.77%NA Highest48.7%29.0%75.61%17.9%83.1%

19. Adolescent fertility in Latin America is higher than expected, and is not falling We lack of appropriate conceptual framework to understand this fertility Theories and policies appropriate for young and older adults do not always work with adolescents Adolescent fertility should be a priority for public policy-making Design and implementation of specific health and education policies for adolescents are needed The effect of education on teenage fertility has lessened, but the main risk factor remains not attending to school School curricula must adapt to new challenges Policies to reduce adolescent pregnancy should focus on three areas: a) to open access to contraceptives b) to empower adolescents c) to offer more and better opportunities for adolescents Conclusions