Municipal contraceptive services, socioeconomic status and teenage pregnancy in Finland: a longitudinal study

ObjectivesDeclining teenage pregnancy rates have been linked to improved access to youth-friendly contraceptive services, but information on the combined association of these services and socioeconomic factors with teenage pregnancy is lacking.Design and settingThis retrospective longitudinal register-based study covers the annual teenage childbirth and induced abortion rates in the 100 largest municipalities in Finland in 2000–2018. We investigated the combined association of regional, socioeconomic (ie, education level and need for social assistance) and adolescent contraceptive service variables (ie, free-of-charge contraception, an adolescent-only clinic and availability of over-the-counter emergency contraception (OTC EC)) with teenage childbirth and induced abortion rates at the municipality level by using Poisson mixed-effects model.Primary outcome measuresAnnual teenage childbirth and induced abortion rates as numbers per 1000 teenage girls aged 15–19 years old in the 100 largest municipalities in Finland from 2000 to 2018.ResultsThe following variables were significantly associated with both lower teenage childbirth and induced abortion rates when adjusted for all the other variables used in the model: providing free-of-charge contraception (rate ratio (RR) 0.82 (95% CI 0.73 to 0.92) and RR 0.87 (95% CI 0.79 to 0.96), respectively), availability of OTC EC without age limit (RR 0.70 (95% CI 0.67 to 0.75) and RR 0.74 (95% CI 0.71 to 0.78), respectively), and high education level of the municipality (RR 0.94 (95% CI 0.94 to 0.95) and RR 0.94 (95% CI 0.93 to 0.94), respectively).ConclusionProviding free-of-charge contraception and availability of OTC EC without age limit are associated with lower teenage pregnancy rates. These services combined with proper counselling are thus important contents of youth-friendly contraceptive services that should be provided equally for all teenagers in order to further reduce teenage pregnancy rates.

Early adolescent childbearing in Colombia: time-trends and consequences

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

Education and teenage childbirth in Uganda

Purpose The role of increased schooling on teenage childbirth has been expansively studied especially in developed countries. However, caveats remain in the case of low-income countries especially Sub-Saharan Africa. The purpose of this paper is to ascertain the impact of increased schooling on the probability of first childbirth at 15 years or younger, 16-17, 18-19, and 20 years or older, in the important context of Uganda – a country with one of the highest adolescent fertility rates in Africa. Design/methodology/approach The empirical analysis uses recent data from the nationally representative Demographic and Health Survey for Uganda conducted in 2011. The authors then adopt a fuzzy regression discontinuity design, estimated using instrumental variables techniques that exploit the exogenous change in schooling impelled by the universal primary education policy enacted in 1997 in Uganda. The empirical approach compares the fertility outcomes for women born in 1984-1992 (i.e. exposed to the policy) to those born in 1973-1981 (i.e. non-exposed). Findings The authors find that a one-year increase in schooling lowers the probability of first childbirth at age the age of 15 years or younger, 16-17, 18-19, and 20 years or older by nearly 8.2, 9.2, 9.4, and 9.5 percentage points, respectively. Also, pathways through which education impacts teenage motherhood included information access through the media, increased literacy, prenatal care utilization, marital status, and unhealthy sexual behavior. Originality/value The paper uses nationally representative survey data to scrutinize the causal influence of schooling on the probability of first childbirth using the 1997 universal primary education in Uganda as a natural experiment to identify the impact of schooling. The study recommends that expanding primary schooling opportunities for girls may be an effective strategy toward accelerated reductions in teenage fertility in Uganda.