There has been a decline in birth rates among girls since 1990, but about 11% of all births worldwide are still in girls aged 15 to 19. Most of these births (95%) occur in low- and middle-income countries.
World Health Statistics 2014 shows that the average global birth rate between 15 to 19 years is 49 per 1,000 girls. Country rates range from 1 to 299 births per 1000 girls, with the highest rate in sub-Saharan Africa.
Teenage pregnancy remains a major contributor to maternal and child mortality, and the cycle of health and poverty.
For some teenagers, pregnancy and childbirth are planned and desired, but for the most part they are not. Teenage pregnancies are more likely to occur in poor, uneducated and rural communities. In some countries, getting pregnant out of wedlock is not uncommon. Conversely, some girls may face social pressure to marry and, once married, have children. More than 30% of girls in low- and middle-income countries married before the age of 18; about 14% before they were 15 years old.
Some girls do not know how to avoid getting pregnant: sex education is less common in many countries. They may feel too stunted or embarrassed to seek contraceptive services; contraception may be too expensive or not widely available or legal. Even when contraceptives are widely available, sexually active teens tend not to use them more than adults. Girls may not be able to resist unwanted sex or refuse sex by force, which tends to be unprotected.
Complications of pregnancy and childbirth are the second leading cause of death between 15 and 19 years globally. However, there has been a significant decline in the number of deaths in all regions since 2000, especially in Southeast Asia where the death toll dropped from 21 to 9 per 100,000 girls. About 3 million unsafe abortions among girls aged 15 to 19 years occur each year, contributing to maternal deaths and ongoing health problems.
Early childhood increases the risk for both mother and baby. In low- and middle-income countries, infants born to mothers under the age of 20 face a 50% higher risk of being still born or dying in the first few weeks than those born to mothers aged 20-29. The younger the mother, the greater the risks for the baby. Newborns born to teenage mothers also tend to have low birth weight, with the risk of long-term effects.
Economic and social consequences
Teenage pregnancies can also have negative social and economic effects on their daughters, families and communities. Many girls who are pregnant should drop out of school. A girl with little or no education has little skills and opportunities to find a job. It could also have economic costs with a country that loses the annual income that a young woman would gain in her entire life, if she was not pregnant from the start.
WHO publishes guidelines in 2011 with the UN Population Fund (UNFPA) to prevent early pregnancy and reduce poor reproductive outcomes. It makes recommendations for actions that countries can take, with 6 main objectives:
reducing marriage before age 18;
creating understanding and support to reduce pregnancy before age 20;
increase the use of contraception by adolescents at risk of unwanted pregnancies;
reduce forced sex among adolescents;
reducing unsafe abortion among adolescents;
improve the use of antenatal, delivery and postnatal services among adolescents.
WHO is also involved in joint efforts with related institutions and programs, such as the “H4 +” initiative that includes UNAIDS, UNFPA, UNICEF, UN Women and the World Bank. H4 + aims to accelerate progress towards achieving Millennium Development Goals 4 and 5 (improving maternal health) by 2015. It addresses the root causes of maternal deaths, morbidity, and death, newborns and children among whom gender inequality, child marriage and limited access to education for girls. H4 + is closely aligned with the national health plan and provides some financial and technical support to the government.