Pan-American Health Organization, Washington, DC, USA.
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
Lancet Child Adolesc Health. 2023 Jun;7(6):392-404. doi: 10.1016/S2352-4642(23)00077-9.
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.
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.
Among 21 countries studied, we noted a decrease in early childbearing along generations in 13 of them, with declines varying from -0·6 percentage points (95% CI -1·1 to -0·1) in Haiti to -2·7 percentage points (-4·0 to -1·4) in Saint Lucia. We observed increases over generations in Colombia (1·2 percentage points [0·8 to 1·5]) and Mexico (1·3 percentage points [0·5 to 2·0]) 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 (-0·7 to -6·5 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.
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.
PAHO, Bill & Melinda Gates Foundation, and Wellcome Trust.
For the Spanish and Portuguese translations of the abstract see Supplementary Materials section.
拉丁美洲和加勒比地区是世界上青少年生育率第二高的地区，仅次于撒哈拉以南非洲地区，在青少年生育方面已位居全球第三。我们旨在探索该地区青少年生育的趋势和不平等现象。
我们使用拉丁美洲和加勒比国家的全国代表性家庭调查来研究早育（18 岁前首次活产的妇女比例）的代际趋势和青少年生育率（每千名 15-19 岁妇女的活产数）的时间趋势。对于早育，我们分析了自 2010 年以来 21 个国家（2010-20 年）进行的最新调查；对于青少年生育率，我们分析了 9 个有两个或更多调查的国家，其中最近的调查是在 2010 年及以后进行的。对于这两个指标，我们使用方差加权最小二乘回归来估计国家层面和财富（40%最低与 60%最高）、城乡居住和种族之间的平均绝对变化（AAC）。
在所研究的 21 个国家中，我们注意到 13 个国家的早育率随代际下降，海地的降幅最大，为-2.7 个百分点（-4.0 至-1.4），圣卢西亚的降幅最小，为-0.6 个百分点（-1.1 至-0.1）。哥伦比亚（1.2 个百分点[0.8 至 1.5]）和墨西哥（1.3 个百分点[0.5 至 2.0]）的早育率随代际增加，玻利维亚和洪都拉斯则没有变化。农村妇女的早育率下降最快，而财富群体则没有明显的模式。在非裔和非非裔原住民群体中，从最年长到最年轻的几代人，早育率的估计值都在下降，但原住民的结果则各不相同。所有有青少年生育率数据的 9 个国家都呈现出随时间下降的趋势（每年每千名妇女减少 0.7 至 6.5 个活产），厄瓜多尔、圭亚那、危地马拉和多米尼加共和国的降幅最大。一般来说，农村地区和最贫困的青少年的青少年生育率降幅最大。如果目前的趋势持续下去，到 2030 年，大多数国家的青少年生育率将在每千名妇女 45 至 89 个活产之间，存在显著的与财富相关的不平等。
我们的研究结果表明，拉丁美洲和加勒比国家的青少年生育率有所下降，但总体而言，早育率并没有随之下降。国家之间和国家内部都存在着很大的不平等，而且没有随着时间的推移而明显减少。了解青少年生育的趋势及其决定因素对于规划和设计方案以确保在人口亚群中实现所需的率和差距的减少至关重要。
泛美卫生组织、比尔及梅琳达·盖茨基金会和惠康信托基金会。
