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Using three indicators to understand the parity-specific contribution of adolescent childbearing to all births
  1. Lenka Benova1,
  2. Sarah Neal2,
  3. Emma G Radovich1,
  4. David A Ross3,
  5. Manahil Siddiqi4,
  6. Venkatraman Chandra-Mouli4
  1. 1 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Department of Social Statistics and Demography, University of Southampton, Southampton, UK
  3. 3 Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, London, UK
  4. 4 Department of Reproductive Health and Research/Human Reproduction Program, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Lenka Benova; lenka.benova{at}


Introduction A strong focus on sexual and reproductive health of female adolescents is a key to achieving sustainable development goals, due to the large size of the current cohort in low-income and middle-income countries (LMICs) and adolescents’ biological and social vulnerability. Several indicators of fertility among adolescents are in wide use, but the contribution of adolescent births to all births is poorly understood. We propose and calculate a package of three indicators capturing the contribution of adolescent births to all births, stratified by parity (first and second/higher).

Methods We used Demographic and Health Survey data for 30 LMICs and vital registration for two high-income countries (to calculate levels and trends across a range of countries) for three time periods: 1990–1999, 2000–2009 and 2010–2015. The three indicators were calculated overall and by age thresholds (<16, <18  and <20  years) and exact ages, for each country and time point. Patterns of changes in indicators for the three cumulative thresholds over time are described.

Results In the 30 LMICs, the percentage of all live births occurring to adolescents varied across countries, with a median of 18% for adolescents <20  years. Three countries (Jordan, Indonesia and Rwanda) had levels below 10%; Bangladesh had the highest at 33%. The contribution of adolescent first-order births to all first-order births was high; a median of 49%. Even among second-order and higher-order births, the contribution of adolescent childbearing was appreciable (median of 6%). Over the period under examination, the proportion of adolescent births among all live births declined in the majority of the LMICs.

Conclusion These three indicators add to our understanding of the scale of adolescent childbearing and can be used in conjunction with population estimates to assess the absolute need for age-appropriate and parity-appropriate reproductive, maternal and newborn healthcare and to monitor progress in improving young people’s health.

  • health
  • medical demography
  • health policies and all other topics
  • cross-sectional survey
  • vital registration
  • adolescent fertility

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  • Handling editor Seye Abimbola

  • Contributors DAR, LB, SN, ER: designed the analyses. LB, SN: conducted the data analysis. LB, SN, ER: drafted tables and figures. All authors participated on interpreting the results, drafting and commenting on the paper.

  • Funding LB and ER were partly funded by a research grant from Merck Sharp and Dohme (MSD) through its MSD for Mothers programme.

  • Disclaimer The content of this article is solely the responsibility of the authors and does not represent the official views of MSD and also does not necessarily represent the official views of the institutions to which the authors are affiliated.

  • Competing interests LB and ER report receiving a research grant from Merck Sharp and Dohme (MSD) through its MSD for Mothers programme. Funding was used for general financial support, including staff salaries, travel and overheads. MSD for Mothers is an initiative of Merck & Co, Inc, Kenilworth, NJ, USA.

  • Patient consent Not required.

  • Ethics approval The Research Ethics Committee of the London School of Hygiene and Tropical Medicine approved our analyses.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.