Academic journal article International Perspectives on Sexual and Reproductive Health

Adolescent Childbearing in Nicaragua: A Quantitative Assessment of Associated Factors

Academic journal article International Perspectives on Sexual and Reproductive Health

Adolescent Childbearing in Nicaragua: A Quantitative Assessment of Associated Factors

Article excerpt

CONTEXT: Nicaragua has one of the highest adolescent fertility rates in the world, but little is known about why approximately half of Nicaraguan women give birth before age 20.

METHODS: Data from the 2001 Nicaragua Demographic and Health Survey were used to examine the sexual and reproductive behavior of 3,142 females aged 15-19. Age at sexual debut and age at first birth were assessed using life table analysis, and the impacts of various factors on these measures were then examined in Cox proportional hazard models. Among sexually active females, current use of modern contraceptives was examined using logistic regression analysis.

RESULTS: In Cox models, rural residence, rising levels of education and greater wealth were associated with older age at sexual debut (hazard ratios, 0.8, 0.5 and 0.9, respectively). When these factors were accounted for in multivariate analysis, age at first birth was positively associated with age at first sex: Having had first sex before age 15 was associated with an increased risk of having an earlier first birth (1.7-2.4), whereas having first had sex at age 16 or later was associated with a decreased risk (0.2-0.7). Among sexually active females, current use of a modern method was positively associated with being married or in a stable union and with having given birth (5.8 and 4.5, respectively), and negatively associated with lacking health care autonomy and wanting a baby within two years (0.4 and 0.6, respectively).

CONCLUSIONS: Interventions that improve young women's education and economic opportunities might help them delay both sexual debut and childbearing, and efforts are also needed to facilitate their access to contraceptives, particularly for unmarried women.

International Perspectives on Sexual and Reproductive Health, 2009,35(2):91-96

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Every year, 13 million babies are born to adolescent mothers between the ages of 15 and 19, representing more than 10% of total births worldwide. (1) The consequences of adolescent childbearing are well established in the literature, and include higher risks of pregnancy complications and maternal mortality, increased rates of infant mortality and malnutrition, higher overall parity and more closely spaced births. (2), (3) Adolescent mothers are also at elevated risk of poverty, downward social mobility, and divorce or separation. (1), (4)

Total fertility rates decreased by 19% between 1990 and 2000 in Latin America, but adolescent fertility rates have not declined proportionately. (1), (5) In Nicaragua, the contrast between the rates is particularly striking: Between 1990 and 2005, the country's total fertility rate dropped by 26%, from 5.1 to 3.8 lifetime births per woman aged 15-49,2 but over the same period, the adolescent fertility rate declined by only 11%, from 152 to 135 births per 1,000 females aged 15-19. (1) Moreover, Nicaragua's adolescent fertility rate is the highest in the world outside of Africa, and is higher than the rate for Sub-Saharan Africa as a whole (127 births per 1,000), (1), (6) Approximately half of young women in Nicaragua give birth before they reach age 20, and nearly a quarter of all births in the country are to adolescent women. (7)

BACKGROUND

Nicaragua has a unique social and political climate that likely contributes to its high adolescent fertility rate. It is the second poorest country in the Western Hemisphere, with 48% of the population living below the national poverty line. (8), (9) The Catholic Church continues to wield powerful influence in the country: Abortion is illegal, without any exception for the life of the mother; premarital sex is widely considered to be a sin; there is no formal sex education in Nicaraguan schools; and pregnant girls can be summarily expelled from school. (10) The national health plan developed by the Nicaraguan Ministry of Health acknowledges that adolescent pregnancy is a substantial problem, but it does not address solutions. …

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