Reducing adolescent pregnancy: evidence from randomized evaluations

Summary:

In 2018, 21 million girls and young women aged 15 to 19 in developing regions were expected to become pregnant. Pregnant adolescents face a higher risk of maternal mortality than women in their twenties, and their babies are more often born prematurely, weigh less, and are more susceptible to neonatal and infant death. As governments, NGOs, and other stakeholders prioritize gender equity, reducing adolescent pregnancy is essential. However, early marriage and childbearing can be brought on by multiple factors, including limited knowledge of sexual health, constrained bargaining power within the household, and/or few educational or labor market prospects. This presentation will review eight randomized evaluations in eight low- and middle-income countries of educational or economic interventions to reduce adolescent pregnancy. Importantly, this evidence synthesis allows for cross-national, cross-sectoral learning from innovators in the SBCC community. The studies have evaluated the success of adolescent programs that aim to change behavior through empowerment, information, incentives, skills development, or a combination of these approaches. Informed by this research, we will also present a conceptual model that highlights key sexual health decision points across the lifecycle, the demand-side factors that influence pregnancy, and specific levers for behavior change. By consolidating findings from these programs, the presentation will outline the mechanisms through which interventions did or did not achieve significant impacts, identify key contextual factors to consider in programming, and share policy insights that apply to decision-makers around the world.

Background/Objectives:

Adolescents who become pregnant are more likely to experience lower educational attainment, social isolation, high-risk pregnancies, STIs, and intimate partner violence. Pregnancy complications are the leading cause of death among girls aged 15-19. As governments, NGOs, and other stakeholders prioritize gender equity, reducing adolescent pregnancy is essential. However, early marriage and childbearing can be brought on by multiple factors, including limited knowledge of sexual health, constrained bargaining power within the household, and/or few educational or labor market prospects. This presentation analyzes findings from rigorous impact evaluations targeting these factors and highlights how these interventions shifted girls sexual behavior.

Description of Intervention and/or Methods/Design:

Eight randomized evaluations in eight low- and middle-income countries across Africa, Asia, and Latin America form the basis of these policy recommendations. The studies have evaluated the success of adolescent programs that aim to change behavior through empowerment, information, incentives, skills development, or a combination of these approaches. All, however, are an economic or educational intervention that aim to improve adolescent girls' access to education or labor market opportunities, or shape their perceptions of said opportunities. Informed by this research, we will present a conceptual model that highlights key sexual health decision points across the lifecycle, the demand-side factors that influence pregnancy, and specific levers for behavior change. By consolidating findings from these programs, the presentation will outline the mechanisms through which interventions did or did not achieve significant impacts, as well as policy recommendations that apply to decision-makers around the world.

Results/Lessons Learned:

Interventions that changed the cost/benefit calculus of unprotected sexual activity and childbirth delayed pregnancy among adolescents. Some programs directly altered costs and benefits, while others shifted perceptions of them. Encouraging participation in activities that develop human capital (e.g., job training or schooling) can help adolescents delay pregnancy. Interventions implemented outside of educational institutions may more effectively reach the most vulnerable adolescents. Empowerment programs that aim to develop girls and young womens agency over their lives and bodies through training, information, and access to resources have not demonstrated consistent impacts on adolescent pregnancy. Finally, parental decisions around their daughters educational and economic opportunities can be important determinants of pregnancy outcomes. Under some circumstances, parental decisions could be significant barriers to reducing adolescent pregnancy or otherwise improving gender equity. However, when programs take considerations of these decision-makers into account, parents can also be catalysts of change.

Discussion/Implications for the Field:

Policymakers interested in supporting adolescents delay childbirth should improve access to education and training programs that build girls capacity to pursue opportunities, or invest in information programs that amplify their perceptions of available opportunities. More research is needed to understand how to structure empowerment curricula to change behavior. More broadly, by carefully analyzing theories of change and rigorous evidence across contexts, we can uncover key insights into individual decision-making and ways of promoting healthy behavior. This strategy is critical for learning from the progress of the SBCC community and improving the well-being of girls.

Abstract submitted by:

Caroline Tangoren - Abdul Latif Jameel Poverty Action Lab (J-PAL)