This is the third in a series of excerpts from the 2013 State of World Population report released recently by the United Nations Population Fund.

ADOLESCENT pregnancies do not occur in a vacuum but are the consequence of inter-locking factors, such as widespread poverty, communities’ and families’ acceptance of child marriage and inadequate efforts to keep girls in school.

The observation is made in the 2013 State of the World Population report, which takes an in-depth look at adolescent pregnancy.

The report, which is titled ‘Motherhood in Childhood: Facing the challenge of adolescent pregnancy’, was recently released by the United Nations Population Fund. The report puts forward the view that there is need for an “ecological approach” to adolescent pregnancy “that takes into account the full range of complex drivers that conspire against the adolescent girl to increase the likelihood of her pregnancy”.

The model spans national, community, school/peers, family, and individual determinants. Below are some excerpts:

National-level determinants

“National laws and policies, the level of government commitment to meeting obligations under human rights instruments and treaties, the extent of poverty or deprivation, and political stability can all influence whether a girl becomes pregnant. These determinants are beyond an adolescent’s, or any individual’s, control, yet they can have a tremendous impact on how much power a girl has to shape her own future and realise her potential.

“For example, if they are enforced, national laws that ban child marriage can help eliminate one of girls’ main vulnerabilities to pregnancy.

At the national level, adolescents’ access to contraception may be blocked because of laws that prohibit anyone under age 18 from accessing sexual and reproductive health services, including family planning, without parental or spousal consent, thereby preventing sexually active girls and their partners from obtaining and using contraception. Many countries also ban emergency contraception or forbid adolescents’ access to it.

In some countries, there is a disconnect between age of consent to sexual activity and the minimum age to access sexual and reproductive health services, including contraception and information. As a result, adolescents may be constrained by requirements for parental consent to access services or they may have to rely on health providers to deem them capable or eligible for services. Health care providers may be reluctant to grant access in fear of reprisals from parents or guardians who may not want their children to obtain contraception or other sexual and reproductive health services.

The major national-level determinant of adolescent pregnancy is an overall under-investment in girls’ human capital development, especially education and health, including sexual and reproductive health. Less than two cents of every dollar spent on inter- national development is directed specifically toward adolescent girls (International Planned Parenthood Federation).

Community-level determinants

Each community has its own norms, beliefs and attitudes that determine how much autonomy and mobility a girl has, how easily she is able to enjoy and exercise her rights, whether she is safe from violence, whether she is forced into marriage, how likely she is to become pregnant, or whether she can resume her education after having had a child.

School, peers, partners

The longer girls stay in school, the more likely they are to use contraception and prevent pregnancy and the less likely they are to marry young (Lloyd, 2006; UNICEF, 2006; Lloyd and Young, 2009). Girls who are not in school are more likely to get pregnant than those remaining in school, whether or not they are married.

Peers can influence how adolescents view becoming pregnant, as well as their attitudes towards preventing pregnancy, dropping out of school or staying enrolled until graduation. Peer pressure can thus discourage early sexual debut and marriage, or it can reinforce the likelihood of early and unprotected sexual activity (Chandra-Mouli et al, 2013).

Research on the early sexual activity of adolescent males shows that unhealthy perceptions about sex, including seeing women as sexual objects, viewing sex as performance-oriented and using pressure or force to obtain sex, begin in adolescence and may continue into adulthood. Perceptions of masculinity among young men and adolescent boys are a driving force for male risk-taking behaviour, including unsafe sexual practices.

Unless a girl lives in a child-headed household or is homeless, she is going to be influenced by her family or guardian. Family-level determinants include the stability and cohesiveness of the family; the degree to which there is conflict or violence in the home; the extent of household poverty or wealth; the presence of role models; and the reproductive history of parents, especially whether the mother and father married as children or whether the mother became pregnant as an adolescent.

Individual-level determinants

“Adolescence is a critical developmental transition between childhood and young adulthood, a period in which important individual, behavioural and health trajectories are established — and a period in which problematic or harmful patterns can also be prevented or ameliorated, and positive patterns enhanced.

“A pivotal moment in adolescence is puberty. On average, girls enter puberty 18 to 24 months before boys, whose physical development is slower and can continue through late adolescence. For girls, many of the developmental changes associated with adult reproductive capabilities are often complete before intellectual and decision-making capacities fully mature. Puberty is a time when specific gender roles and expectations are reinforced.”