Department of Medicine, University of California San Diego, La Jolla, California, USA.
Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
J Glob Health. 2020 Jun;10(1):010706. doi: 10.7189/jogh.10.010706.
Adolescent pregnancy and childbirth are common throughout Central America. While gendered beliefs promoting motherhood are a known risk factor, their association with adolescent childbirth within the social networks of Central American communities is unknown.
This was a cross-sectional study looking at adolescent childbirth amongst women ages 15-20 years (N = 2990) in rural Honduras, using reproductive health data on all individuals ≥15 years of age (N = 24 937 of 31 300 population) including social network contacts, all of whom were interviewed as part of the study. The outcome, adolescent childbirth, was defined as having had a child < age 20 years. Predictors included whether a woman's social contact had an adolescent childbirth and the social contact's reported perception of community support for adolescent childbirth.
While girls who identified a father in the village as a social contact had a lower likelihood of adolescent childbirth regardless of whether or not they reported being in a partnership, this finding did not hold for girls who identified mothers. There was an association between a social contact's report of norms supporting adolescent childbirth and a girl's risk of adolescent childbirth; however, village-level aggregate norms attenuated that relationship. Independent significant associations were found between a girl's risk of adolescent childbirth and both a social contact's adolescent childbirth and the village proportion of women who had had an adolescent childbirth. The association between social contacts' adolescent childbirth and a girl's risk of adolescent childbirth across relationships was more robust for stronger relationships and when the social contact was closer in age to the girl.
If, as this evidence suggests, a strong driver of adolescent childbirth is the frequency of the occurrence of adolescent childbirth both within the greater community and within a girl's proximal social network, the challenge for intervention strategies is to encourage norms that prevent adolescent childbirth without stigmatising those who have had an adolescent childbirth. Programmatic efforts to counter prevailing norms that limit a woman's role to motherhood, and that support and encourage strong norms for girls' education may play an important role in addressing this situation.
中美洲各地普遍存在青少年怀孕和生育的情况。虽然促进生育的性别观念是已知的风险因素，但它们与中美洲社区社会网络中青少年生育的关联尚不清楚。
这是一项横断面研究，调查了洪都拉斯农村地区 15-20 岁（N=2990）的青少年生育情况，使用了所有≥15 岁人群的生殖健康数据（N=24937/31300 人口），包括社会网络联系人，所有这些人都作为研究的一部分接受了访谈。因变量为青少年生育，定义为生育年龄<20 岁的女性。预测因素包括女性社会接触者是否有青少年生育以及社会接触者对社区支持青少年生育的看法。
尽管与村庄中作为社会接触者的父亲身份认同的女孩，无论是否处于伴侣关系中，都不太可能出现青少年生育，但这种情况并不适用于认同母亲的女孩。社会接触者报告的支持青少年生育的规范与女孩青少年生育的风险之间存在关联；然而，村庄层面的总体规范减弱了这种关系。女孩青少年生育的风险与社会接触者的青少年生育以及村庄中曾有青少年生育的女性比例都存在独立的显著关联。在不同关系中，社会接触者的青少年生育与女孩青少年生育的风险之间存在关联，这种关联在关系更紧密和社会接触者年龄更接近女孩时更为显著。
如果正如这一证据表明的那样，青少年生育的一个主要驱动因素是在更大的社区内以及女孩的近邻社会网络内青少年生育的发生频率，那么干预策略的挑战是鼓励防止青少年生育的规范，而不会污名化那些已经有青少年生育的人。反对限制妇女角色为母亲的普遍规范，并支持和鼓励女孩教育的强烈规范的方案努力可能在解决这一情况方面发挥重要作用。
