Trends and inequities in adolescent childbearing in Latin American and Caribbean countries across generations and over time: a population-based study

Background Latin America and the Caribbean present the second highest adolescent fertility rate in the world, only after sub-Saharan Africa, and have reached the third position globally in the incidence of motherhood in adolescence. We aimed to explore trends and inequities in adolescent childbearing in the region. Methods We used nationally representative household surveys from Latin American and Caribbean countries to address trends in early childbearing (proportion of women having their first livebirth before age 18 years) over generations and in adolescent fertility rates (AFRs; livebirths per 1000 women aged 15-19 years) over time. For early childbearing, we analysed the most recent survey conducted since 2010 from 21 countries (2010-20); for AFR, we analysed nine countries with two or more surveys, with the most recent being conducted from 2010 onwards. For both indicators, variance-weighted least-square regression was used to estimate the average absolute changes (AACs) at the national level and by wealth (bottom 40% vs top 60%), urban versus rural residence, and ethnicity. Findings Among 21 countries studied, we noted a decrease in early childbearing along generations in 13 of them, with declines varying from -0 center dot 6 percentage points (95% CI -1 center dot 1 to -0 center dot 1) in Haiti to -2 center dot 7 percentage points (-4 center dot 0 to -1 center dot 4) in Saint Lucia. We observed increases over generations in Colombia (1 center dot 2 percentage points [0 center dot 8 to 1 center dot 5]) and Mexico (1 center dot 3 percentage points [0 center dot 5 to 2 center dot 0]) and no changes in Bolivia and Honduras. The fastest early childbearing decline occurred among rural women, whereas no clear pattern was observed for wealth groups. Decreasing estimates from oldest to youngest generations were found among Afro-descendants and non-Afro-descendant and non-indigenous groups, but results were mixed for indigenous people. All nine countries with data for AFR presented reductions over time (-0 center dot 7 to -6 center dot 5 births per 1000 women per year), with the steepest declines observed in Ecuador, Guyana, Guatemala, and the Dominican Republic. In general, adolescents in rural areas and the poorest adolescents had the largest reductions in AFR. If current trends persist, by 2030 most countries will present AFR values ranging between 45 and 89 births per 1000 women, with notable wealth-related inequalities. Interpretation Our results indicate a reduction in AFR in Latin American and Caribbean countries that was not necessarily accompanied by a decrease in early childbearing overall. Large inequalities both between countries and within countries were observed, with no clear reduction over time. Understanding trends in adolescent childbearing and its determinants is essential for planning and designing programmes to ensure the desired reductions in rates and gaps across population subgroups. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Automated summary

Latin America and the Caribbean have the second highest adolescent fertility rate in the world, with a high incidence of motherhood in adolescence. The study aimed to examine trends and inequalities in adolescent childbearing in the region.