Preventing early pregnancy through appropriate legal, social and economic measures
Early pregnancy in adolescence – within or outside marriage – is determined by a web of factors in the immediate and wider environment.
Understanding the determinants of early pregnancy and identifying effective and feasible legal, social and economic measures of preventing it.
What is the relevance of this area to ASRH* ?
As estimated 1 million adolescent girls aged 10-14 give birth every year, and an estimated 16 million aged 15-19 do so. Most of these pregnancies occur in developing countries, affecting primarily the poorest families and communities.
Why do these early pregnancies occur? Some girls/women get pregnant because they are unable to refuse unwanted sex or to resist forced or coerced sex. Others do so because they do not know how to avoid a pregnancy or are unable to obtain contraceptives, including emergency contraception. Still others get pregnant because their pregnancy is wanted – by themselves or by influential people around them. As the Centre for Global Development noted in a recent report: "Adolescent pregnancies may not be caused by lack of knowledge of sexual or reproductive health, but rather by the desire or social pressure to become pregnant that is not mitigated by outside incentives to delay fertility." (i)
Early pregnancy contributes to poor health in mothers and babies. It also results in social and economic costs to young mothers, their families and communities.
What is WHO's reading of the need in this area ?
Early pregnancy in adolescence – within or outside marriage – is determined by a web of micro- and macro-level factors. Individuals make choices to engage in specific behaviours. Family and community norms, traditions and economic circumstances influence these choices. Policy and regulatory frameworks facilitate or hinder choices. The recently published WHO guidelines on adolescent pregnancy (ii) recommend actions at the policy level, at the health system level, at the family and community level and at the individual level to address these determinants of adolescent pregnancy. Alongside these actions, they underscore the importance of building a more sound understanding of the determinants of early pregnancy, and of identifying more effective legal, social, cultural and economic measures to address them.
How is WHO responding to this need ?
There are many different actors working in this area. They include other United Nations agencies, international and indigenous NGOs and government bodies. Some of them are working to strengthen epidemiology and to carry out research on determinants of early pregnancy and effective approaches to address it. Others are involved in advocacy and country support at different levels – formulating and applying laws and policies to prevent early marriage, keep girls in school and protect them from coerced sex; using economic incentives and livelihood programmes to keep girls in school and to delay early marriage; and informing and empowering girls, and mobilizing their families and communities to support girls to grow and develop into women before becoming mothers.
The Department of Reproductive Health and Research (RHR) is disseminating the adolescent pregnancy guidelines and supporting member states to implement them. In terms of research RHR is consulting with the various actors referred to above to identify how best it can contribute to our collective understanding of the determinants of early pregnancy in adolescents and the evidence base on effective approaches to prevent it.
(i) Centre for Global Development. Adolescent Fertility in Low and Middle Income Countries: Effects & Solutions – Working Paper 295. Centre for Global Development. Washington. 2012.
(ii) WHO. Guidelines on preventing pregnancy and poor reproductive outcomes in adolescents in developing countries. WHO. Geneva. 2011.
* Adolescent Sexual and Reproductive Health