PPD Policy Brief on ‘Adolescent Pregnancy: Status, Socio-Economic Cost, Policy and Program Options for 25 Member Countries of PPD’



‘Adolescent pregnancy’ is the theme for the World Population Day this year.  Partners in Population and Development (PPD) is taking this opportunity to highlight the status of adolescent pregnancy in its member countries and discuss relevant policy and program options for them.

PPD is a southern-led, southern-run Inter-governmental organization of 25 developing countries across Africa, Asia, the Middle-east and Latin America, promoting South-South Cooperation in Reproductive Health, Population and Development (http://www.partners-popdev.org/).

The adolescents aged 10-19 years stood about 1.2 billion in 2011 constituting 18% of the total world population. About 90% of the adolescents live in developing countries and nearly 62% in 25 PPD member countries.  In the member countries of PPD, the proportion of adolescents ranged from highest 25% in Ethiopia, Yemen and Zimbabwe to lowest 15% in China and Thailand in 2011 (Table 1).

Early Marriage and Adolescent Pregnancy

While adolescent marriage is a human rights abuse, it also presents a formidable threat to adolescent girls’ lives, health and future prospects. According to WHO and UNFPA reports, 2012, over 30% of adolescent girls in developing countries were married before 18 years of age and about 14% before the age of 15 years. The prevalence of adolescent marriage before 18 years among women aged 20-24 years ranged widely among the member countries of PPD, with the highest 66% in Bangladesh and the lowest 6% in South Africa (Table 1).

Early marriage can lead adolescent girls to complications related to pregnancy and childbirth, and expose them to sexually transmitted infections including HIV. In developing countries, complications of pregnancy and childbirth are the leading causes of death among adolescent aged 15-19 years and accounts for about 50,000 deaths each year. Adolescents who give birth carry a much higher risk of dying from maternal causes compared to women who are in their twenties and thirties. The risk increases exponentially as maternal age decreases, adolescents under 15 years carry five times more risk of dying during childbirth compared to women in their twenties.  The adverse effects of adolescent pregnancy also impact the health of their newborns. Still births and newborn deaths in the first week of birth are 50% higher among babies born to adolescent mothers than among babies born to mothers aged 20-29 years.

Adolescent Pregnancy in PPD Member Countries

Among the 25 member countries of PPD, pregnancy among adolescents aged 15-19 years was highest in Egypt (9.6%) and lowest in Tunisia (0.9%). Among the member countries of PPD in Asia-pacific region, the rate was highest in Bangladesh (6.1%) and lowest in Vietnam (1.6%). In Sub-Saharan Africa, Mali (5.4%), Uganda (5.7%) and Zimbabwe (5.5%) had similar high rates of adolescent pregnancy. The lowest rate of adolescent pregnancy was in South Africa (2.3%). In the MENA region, the highest prevalence of adolescent pregnancy was in Egypt (9.6%) and the lowest was in Tunisia (0.9%).  The prevalence of adolescent pregnancy was 4.3% in Colombia and 3.9% in Mexico.

According to WHO, 2012, about 16 million adolescents aged 15-19 years and 2 million adolescents under the age of 15 years give birth every year. About 95% of these births occur in developing countries. The prevalence of women aged 20-24 years who gave birth before 18 years, ranged widely in PPD member countries, from the highest 46% in Mali to the lowest 3% in Vietnam (Table 1). A considerable proportion of adolescent pregnancies are either unplanned or unwanted and 30% to 60% of these pregnancies among adolescents end in abortion.

According to the Guttmacher Institute and UNFPA, 2009, around 44% of married adolescents aged 15–19 years in the developing countries wanted to avoid pregnancy of which only 33% used a modern contraceptive method. The prevalence of contraceptive use (modern methods) ranged widely in 25 member countries of PPD. The prevalence was highest in Thailand (67%) followed by Colombia (55%), South Africa (48%), Indonesia (45%), Bangladesh (37.6%), Morocco (36%) and Zimbabwe (36%). The lowest prevalence was in Nigeria (2.4%).

Among adolescents who wanted to avoid pregnancy in PPD member countries, the prevalence of unmet need of contraceptive was highest in Ghana (62%) followed by Mali (35%), Ethiopia (33%), Senegal (31%), India (27%), Benin and South Africa (26%), Bangladesh and Pakistan (20%), Nigeria (19%), Zimbabwe (17%), Uganda (11%), Kenya (9%), Colombia (8%) and Morocco (1%).

PPD has been actively advocating for repositioning family planning in the international development agenda and working with its member countries to realize the commitments made by the governments at the London FP Summit 2012 to address the unmet need.

Currently, PPD is working with a research consortium of 6 partners (Population Council, ICDDR,B, London School of Hygiene and Tropical Medicine, Marie Stops International, African Population and Health Research Centre and PPD) on the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) project to generate policy-relevant research to promote an evidence based approach for improving access to family planning and safe abortion. The evidence will inform programs to address the unmet need and unintended pregnancies of adolescents. As one of the partners of this international consortium, PPD is involved in increasing the research evidence uptake, capacity building as well as creating partnership and networking in five focus countries (Bangladesh, India, Kenya, Ghana and Senegal).

Socio- Economic Cost of Adolescent Pregnancy

While adolescent pregnancy and child birth presents serious threats to adolescent girls’ health and lives, it also results in substantial social and economic costs.  While there is information gap in developing countries, reviews in developed countries reported substantial social and economic costs linked to adolescent pregnancy and child birth. According to the Centre for Disease Control (CDC), 2008, in the United States, adolescent pregnancy and child birth accounted for nearly USD 11 billion each year.  An economic evaluation of a comprehensive adolescent pregnancy prevention program in the United Kingdom, 2011, reported that the cost savings from averted births were nearly USD 1,599 per adolescent per year.  Adolescent pregnancy and childbearing also have significant long term social consequences for the adolescents, their children, families and communities. Reviews showed that adolescent pregnancies led them to less educational attainment, poor health and poverty. Children born to adolescent mothers also experience poor health outcomes, low level of cognitive development, have behavioral problems and less educational attainment.

Policy and Program Options

PPD is urging the governments of its member countries to take immediate steps to end early marriage and adolescent pregnancy. It can be achieved through formulating policies and programs for empowering girls, changing social and cultural norms, undertaking legal reform and reinforcement, designing and implementing programs ensuring universal access to reproductive health.

Proven strategies include keeping adolescent girls in schools using economic incentives and livelihood programs, protect them from coerced sex, offering life skills, informing families and communities on adverse effects of adolescent pregnancy, and mobilize them to support girls to grow and develop into women before becoming mothers.

The programs need to include Sexual and Reproductive Health and Rights (SRHR) information, skills building and services for adolescents e.g. a) informing adolescents about their rights to have access to health care services b) providing accurate knowledge on sexual and reproductive health c) increasing the use of contraception by adolescents at risk of unintended pregnancy d) addressing unmet need for Family Planning e) increasing access to adolescent friendly services f) reducing unsafe abortion among adolescents and to ensure post abortion care g) increasing the use of skilled antenatal, childbirth and postnatal care h) increasing community awareness and participation i) addressing gender equity and equality j) promoting youth-adult partnerships, and k) ensuring male participation in all SRHR programs for adolescents.

PPD is also urging its member countries to share their lessons learned with each other from existing SRHR programs for adolescents to prevent early marriage, adolescent pregnancy, and improve over-all adolescent health. PPD is willing to facilitate the exchanges as a part of promoting South-South Cooperation among its member countries in Reproductive Health, Population and Development.




















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Trends of Human Development Index (HDI) in Partners in Population and Development (PPD) Member Countries, 1990-2012

The UNDP’s Human Development Report 2013: The Rise of the South: Human Progress in a Diverse World indicates Global South Shows Major Gains. But still Least Developed. South- South Collaboration for improving HDI needs to be explored.

Human Development Index (HDI) is a composite estimate of national development that includes indicators along three dimensions; life expectancy, educational attainment and command over the resources needed for a decent living.

The 2013 Report identifies four specific areas of focus for sustaining development momentum: enhancing equity, including on the gender dimension; enabling greater voice and participation of citizens, including youth; confronting environmental pressures; and managing demographic change.

In 2012, the global average of HDI value was 0.694. Among the developing regions, Europe and Central Asia had the highest HDI value (0.771) followed by Latin America and the Caribbean (0.741). The average HDI value was lowest for Sub-Saharan Africa (0.475) followed by South Asia (0.558).

Among the member countries of PPD in Asia-pacific region, in 2012; (Table 1. Trends of Human Development Index (HDI) in PPD Member Countries, 1990-2012)  the HDI value was highest for China (0.699) and lowest for Bangladesh and Pakistan (0.515). During the period from 1990 to 2000, the average annual HDI growth ranged from highest 1.98% in Viet Nam to lowest 0.89% in Pakistan. During 2000 to 2012, the average annual HDI growth ranged from 1.74% in Pakistan to 0.82% in Thailand.

Among the member countries of PPD in Sub-Saharan Africa, in 2012; the HDI value was highest for South Africa (0.629) and was lowest for Mali (0.344). During the period from 1990 to 2000, Mali and Uganda achieved over 2% average annual HDI growth (2.86% and 2.06%, respectively). During 2000 to 2012, Ethiopia achieved highest annual HDI growth (3.09%) followed by Mali (2.04%).

In the member countries of PPD in MENA region, the HDI value was highest for Tunisia (0.712) followed by Jordan (0.700), Egypt (0.662), Morocco (0.591) and Yemen (0.458) in 2012. During the period between 1990 to 2000; the average annual HDI growth ranged from 2.78% in Yemen to 0.95% in Jordan. During 2000-2012, the average annual growth was highest in Yemen (1.66%) and was lowest in Jordan (0.62%).

Compare to other regional member countries, Colombia and Mexico, the two member countries of PPD in LA and Caribbean had better HDI values (0.719 and 0.775, respectively) in 2012. The average annual HDI growth was 0.93% for Colombia and 1% for Mexico during the period from 1990 to 2000. During 2000-2012, the average annual HDI growths were 0.75% and 0.59%, respectively.

The Report also suggests that as global development challenges become more complex and transboundary in nature, coordinated action on the most pressing challenges of our era, whether they be poverty eradication, climate change, or peace and security, is essential. As countries are increasingly interconnected through trade, migration, and information and communications technologies, it is no surprise that policy decisions in one place have substantial impacts elsewhere. The crises of recent years—food, financial, climate— which have blighted the lives of so many point to this, and to the importance of working to reduce people’s vulnerability to shocks and disasters.

Health is increasingly becoming the core concern of development. The findings of the report is an indication that in the coming years, the practice of  health diplomacy may need to develop additional body of knowledge and become a mature discipline.

Table 1. Trends of Human Development Index (HDI) in PPD Member Countries, 1990-2012











Average annual HDI growth



Average annual HDI growth




Ranking of PPD MCs in 2012











































Viet Nam







Sub-Saharan Africa


















































South Africa
























































LA and Caribbean














Human Development Report 2013, The Rise of the South: Human Progress in a Diverse World, http://hdr.undp.org/en/media/HDR_2013_EN_complete.pdf

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Gaining Momentum: Women Empowerment and Health

IntWomensDay2013Luckily enough, women’s rights have improved a great extent deal over past centuries. Once, women were just expected to look after their household and rear children, but overtime women have become more involved in careers and excelled in those. Globally, countless women have achieved superior positions in politics, as great professors, writers, doctors and or even in just their respective workplaces.

However, it is not the case everywhere. In many countries, many nations still women are subjugated in various forms. It’s not that unusual anymore to flip pages of the newspaper to find cases of rapes, domestic violence, suicides due to eve teasing, sexual harassments and what not. Just within last year in Asia there have been major incidents such a girl being raped by a teacher in, several gang rapes, girls being harassed, beaten or even shot to death just for voicing their opinion; to name just a few. Similar stories occur all over the world, somewhere, everyday, only it does not get publicized. Although, the laws and government do put in a lot of effort to address these and other issues related to gender inequality, women continue to lag behind men in almost all aspects. Except for a calculable number of countries, children still take their father’s surnames, which is probably the he most common and simple example of the existing patriarchy. Men are still the head of the family, the higher income holder and thus with the strongest voice. Resultantly, women automatically become the weaker one in the family and eventually in the society also affecting maternal health in the process.

Not only just after marriages, discrimination of women due to this “insecured” society where it is unsafe for women to travel alone at night, leads to young girls are pushed into bearing the burden of marriage at a very early age, i.e. adolescent marriage. Young girls at the age of 10-19 gets separated from education are therefore unaware of their rights related to reproduction and sexuality which includes topics such as family planning, delayed childbearing, uses of contraception, treatment of fertility, interruption of unwanted pregnancies, breastfeeding etc. Consequently, she falls prey to complications in child-birth arises causing both the lives of the young mothers and infants to be threatened.  Thousands of women continue to lose their lives in pregnancy and childbirth; while many suffer pain, ill health and permanent disability as a result of pregnancy related problems.  Besides, an estimated 215 million of them lack access to modern contraception. Also up to 20 million unsafe abortions are performed on women, of whom 70,000 die every year. Not only just that, in case of planned pregnancies even, every single women carrying the children in their wombs deserve their husband’s attention, support, care and concern. After all, the father’s duty begins from the very second the baby is conceived. Just because the baby is inside the mother, it does not mean that he does not have any responsibility. In fact it is his duty to ensure his wife is taking nutritious meals, medications on time and routine check-ups to the doctor.  In addition, every man should also respect their wives decision in family making and has no authority to force them to take children unless she is willing to.

It is astounding; despite playing the versatile roles of a daughter, a wife, a mother, a home maker and also a sincere employee at work, women are discriminated. With the motto of not just counting people, rather making every people count The 1994 International Conference on Population and Development (ICPD) in Cairo was a milestone in the history of population and development, as well as in the history of women’s rights. With the aim of providing universal access to family planning and sexual and reproductive health services and reproductive rights, delivering gender equality, empowerment of women and equal access to education for girls, addressing the individual, social and economic impact of urbanization and migration and supporting sustainable development along with addressing environmental issues associated with population changes, a total of 179 countries have achieved remarkable success.

Nonetheless, to guarantee that no mother dies due to deficient of proper treatment, there is still a long way to go. Women need to be educated and made aware of their rights so that they can raise their voices when necessary, so that they do not lose their lives due to their husbands’ blatant ignorance or the obnoxious behavior by the men domineering in the society. Dear women, nobody will wrap your rights in a box and give it to you; you have to be bold and seek it for yourselves. Till the day you consider yourself a minority, you are going to be marginalized. Be bold, be brave and voice your rights. Gift a little independence to yourselves. PPD wishes you all a very happy and sovereign women’s day!

Rakshinda Huq, PPD

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Bangladesh Immunization Program received International Recognition

news2012_0712_1_1GAVI Alliance Partners Forum held a mega event of the child health and immunization in Dar es Salaam, the capital city of Tanzania from December 4 to 7, 2012. More than 700 participants from over hundred countries of the world participated in the forum. The forum was attended by Ministers of Health from over fifty countries. The main theme of this year’s partners forum was “Rising to the challenge” with regard to immunization.

H.E. Prof. AFM Ruhal Haque MP, Board Member of Partners in Population and Development (PPD), Honorable Minister of Health and Family Welfare of Bangladesh, and member of the Board of GAVI Alliance represented Bangladesh in the partners forum. In a grand ceremony, Bangladesh was awarded the best prize for extraordinary success in routine immunization program and sustaining high coverage overcoming many challenges. The Honorable Health Minister received the prize on behalf of the Bangladesh Government from GAVI alliance. The ceremony was attended by the First Lady of Tanzania, Health Ministers, top officials of UNICEF, WHO, UNFPA, and the leading development agencies of the world.

The Bangladesh Health Minister, delivered a key note on “Country Driven Immunization Program: Reflections from Bangladesh.” Bangladesh Health Minister had a bilateral meeting with the Health and Social Services Minister of Tanzania, Dr. Hussain Ali Mwiney. The Social Services Minister of Tanzania expressed interest to receive doctors and other health workers from Bangladesh to support their health service. The Bangladesh Health Minister emphasized exploring Pharmaceutical import from Bangladesh to Tanzania during the meeting.

Experience sharing, sharing of resources (Human, financial and technology) is one of the prime PPD South-South Cooperation strategies. Therefore, PPD will work with the PPD Board Member of Bangladesh and the Republic of Tanzania to actualize experience sharing in the Expanded program of immunization (EPI).

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Free HIV/AIDS drugs from December

Under a new plan beginning in December, the government will supply free drugs to people living with HIV/AIDS in Bangladesh in a major relief.

Officials say they have already bought those ‘expensive’ doses worth over Tk 40 million needed for a year to suppress the virus and stop the progression of the disease to nearly 1,000 HIV positives currently on treatment in Bangladesh.

“The drugs will be made available at five big hospitals initially,” Dr Md Abdul Waheed, Line Director of National AIDS/STD Programme (NASP), told bdnews24.com.

People with HIV/AIDS now get the antiretroviral therapy (ART), a combination of antiretroviral drugs, free under the project of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) which will be exhausted on Nov 30.

The patients receive the drugs from the organisations that work for them. But there are apprehensions that they might not get the free drugs after the project ends.

“We appreciate the move,” said Habiba Akhter, Executive Director of Ashar Alo Society from where around 500 people with HIV/AIDS receive the therapy.

“It would be sustainable now. They (people with HIV) can live worry-free now,” she told bdnews24.com. “Once government started the supply, they will never stop.”

According to NASP, Tk 450 million has been kept in the budget for the ongoing five-year Health, Population and Nutrition Sector Development Programme (HPNSDP) for the treatment of HIV/AIDS patients.

Akhter, however, said only distributing drugs would not suffice.

“They (people with HIV/AIDS) need additional support like counselling, CD-4 cell counting to see progress and training of family and caregivers so that they can adhere to drugs until death,” Akhter, also an HIV-positive who lives a healthy life with drugs, said.

“The government facilities are not ready for that,” she said and suggested supply of the drugs also to those centres from where they are currently receiving until the government prepares hospitals.

The NASP Line Director also acknowledged it.

“We are planning to supply the drugs to them (organisations from where HIV positives get drugs now) also,” he said, “Process is underway to finalise it.”

“But, when we are fully prepared, we will stop that supply,” he said.

The latest official figures released in last year’s World Aids Day, December 1, put the number of HIV positives at 2,533 and AIDS patients at 1,101 in Bangladesh where 325 died of AIDS since the first case was detected in 1989.

The United Nations AIDS programme (UNAIDS) says more people now than ever are living with the AIDS virus but this is largely due to better access to drugs that keep HIV patients alive and well for many years.

In a report it says the number of people dying of the disease fell to 1.8 million in 2010, down from a peak of 2.2 million in the mid-2000s.

Doctors say the antiretroviral drugs help decrease viral load in patients to non-detectable levels, giving them better immunity against others infections.

They need to take the drugs all their life and it even lowers the chance of transmission.

Studies in Sub-Saharan Africa, an HIV epidemic region, suggest patients may fail to adhere to the medication because of socioeconomic factors.

The Ashar Alo Society’s Executive Director said the drugs cost even Tk 15,000 a month for many which is beyond the means of many middle-class patients.

According to the ninth HIV surveillance 2011 report, HIV prevalence is still less than 1 percent among the high-risk – sex workers, injecting drug users, gays and transgender people – in Bangladesh.

But experts always keep Bangladesh on HIV-alert as it shares a large porous border with India, home to more than 1.5 million people with HIV.

Nurul Islam Hasib
Source : http://bdnews24.com/details.php?cid=13&id=236597

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PPD’s Statement on International Day of the Girl Child

The UN General Assembly adopted Resolution 66/170 on 19 December 2011 to declare “Eleven October” as the International Day of the Girl Child. For the first time this year on 11 October 2012, the world will celebrate the International Day for the Girl Child in an effort to improve the childs well before. Observing a day devoted to the girl child will promote their rights, equal opportunities, access to basic social services, empowerment, social dignity and freedom from violence and abuse.

The theme for the girl childs day this year 2012 is “Ending Child Marriage”. Child marriage is a social immorality, violates the girl childs fundamental human rights, interrupts their education, puts their health at risk, limits their future opportunities for education and socio-economic development and mostly, it negatively impacts all aspects of their life.

According to a study (Bruce and Clark, 2004) an estimated 10 million girls aged under 18 years are married worldwide annually. One in seven girls are married before their 15th birthday in the developing world. Forty six percent of girls in South Asia, 38% in Sub-Saharan Africa and 29% in Latin America and the Caribbean are married before they reach 18 year of age (UNICEF 2011). These married girls are at greater risk of experiencing complications in pregnancy and during child birth, becoming infected with HIV/AIDS and suffering from domestic violence. At current trends, 100 million girls below 18 years of age will be married in the next decade, who are unlikely to continue their education or meet their full potential (The United Nations Interagency Task Force on Adolescent Girls, Fact Sheet 2009).

Observance of the International Day of the Girl Child each October 11, is a unique opportunity to raise public awareness of the different types of discrimination and abuse that many girls around the world suffer from. This year people around the world will organize different events and will talk to the public about the causes and consequences of the child marriage.

Considering the importance of the day and the magnitude if girls whose sexual reproductive health rights are violated, Partners in Population and Development (an inter-Governmental alliance of a group of 25 developing countries mandated to promote south-south cooperation in the area of RH population and development) urges community, faith based and cultural leaders, development practitioners, policy makers and right based groups to join hands and initiate efforts to stop child marriage, offer them opportunities through active support and engagement for their empowerment, improving their access to quality education and economic incentives and ensuring enabling laws and policies for the girl child.

Globally, the majority of the school going adolescent population is girl children. If the authorities of the schools worldwide could pay special attention to the observance of this day, it would have far reaching impact in raising the voices of the urgent need to address and to stop child marriage.

Your assistance to observe this important day will be much appreciated.

Joe Thomas, PhD
Executive Director, PPD

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UN Commission on Life-Saving Commodities for Women and Children – Commissioners’ Report

The UN Secretary-General’s Global Strategy for Women’s and Children’s Health (2010) called on the global community to work together to save 16 million lives by 2015. This challenge was taken up by the UN Commission on Life-Saving Commodities for Women and Children, which identified and endorsed an initial list of 13 overlooked life-saving commodities that if more widely accessed and properly used, could save the lives of more than 6 million women and children.

The Commission also identified key, interrelated barriers that prevent access to and use of the 13 commodities and recommended 10 time-bound actions to address them. These focus on the need for improved global and local markets for life-saving commodities, innovative financing, quality strengthening, regulatory efficiency, improved national delivery of commodities and better integration of private sector and consumer needs.

The Commission estimated that an ambitious scaling up of these 13 commodities over five years would cost less than $2.6 billion and would cumulatively save over 6 million lives including 230,000 maternal deaths averted through increased access to family planning. The estimated costs per lives saved are low and represent excellent global development investments. Thus, the scaling up of these commodities is not solely a moral obligation but one of the most effective ways of getting more health for the money invested. It would make a significant contribution to putting maternal and child health on a trajectory to end these preventable and tragic deaths.


Source: UNFPA

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