Fertility Patterns of Adolescent and Older Women in Pacific Island Countries: Programming Implications*

1 August 1999

Introduction

Patterns of Adolescent Fertility in the Pacific Island Countries

    Alternative measures

Childbearing by Older Women – A Forgotten Issue?

    Older women: a special target group?

Conclusions

References

Table 1: Age-Specific Fertility Rates (ASFRs) for 15-19 Year Old Women by Country, for Selected Years.

Table 2: Age Specific Fertility Rates of 15-19 Year Olds for South Pacific Countries and Selected Countries from other Regions (Restricted to data for the 1990s)

Table 3: Percent of 20-24 Year Olds Who Have Borne a Child Before Age 20

Table 4: Absolute Number of Births, and Share of Total Number of Births, Attributable to Adolescents Aged 15-19 in Selected Pacific Island Countries and the World Over Time

Table 5: Age-Specific Fertility Rates for Women Aged 35 and Over

Table 6: Age-Specific Fertility Rates of 15-19, 35-39 and 40-44 Year Olds in Selected Pacific Island Countries and World Regions in the 1990s

Table 7: Absolute Number of Births and Share of Total Number of Births Attributable to Women Aged 35+ in Selected Pacific Island Countries and the World Over Time

Following the International Conference on Population and Development (ICPD) in Cairo in 1994, much concern has been expressed about the importance of the life-cycle stage of adolescence, the powerfully formative time of transition to adulthood. What happens to the individual during this period shapes how they will live their adult lives, in the reproductive arena as well as in the social and economic realm. The ICPD was especially concerned over the vulnerable reproductive health status of adolescents, particularly girls between the ages of 15 and 19 years, partly due to their changing demographic and sexual behaviour. Indications are that, while the mean age at menarche has been falling, both the mean age at first marriage and age at first intercourse have been rising, but the increase in age at marriage is greater, resulting in an extended period of possible exposure to adolescent pregnancy (Bongaarts and Cohen, 1998). Adolescents, especially those aged 15 to 19 years, are believed to engage in high levels of unprotected sexual activity both within and outside marriage, leaving them exposed to the risk of unplanned and unwanted pregnancy, contracting sexually transmitted diseases (STDs) and the transmission of HIV and AIDS. Such behaviour, often resulting in early out-of-wedlock pregnancy, constitutes a major threat to the health of these young women, as well as retarding their potential educational, career and economic development.

Recently, organizations in many countries have created a wide range of programmes to respond to the reproductive health needs of adolescents, although it is fully recognized that existing programmes are too few and too limited to meet the global need. This need is reflected in the approximately 1 billion persons who are adolescents, 85% of whom live in developing countries. Very many adolescents are sexually active and at risk of numerous reproductive health dangers, such as unsafe abortion, sexually transmitted diseases and, in particular, HIV, whereby 40% of all new infections occur among 15-24 year olds.

Clearly, adolescents are a sizeable vulnerable group and the world community, and UNFPA in particular, is justified in highlighting their specific problems. They often lack basic reproductive health information, skills in negotiating sexual relationships, and access to affordable, confidential reproductive health services. Concerns about privacy or the ability to pay, and real or perceived disapproval by service providers further limit access to services where they exist, as do legal barriers to information and services in some countries. Many adolescents lack strong stable relationships with parents or other adults with whom they can talk about their reproductive health concerns.

This increased concern for the health and welfare of young people is to be welcomed and it has been echoed repeatedly in recent years in the Pacific Island countries (PICs). Indeed, much of the rationale for UNFPA’s current programme in the region is premised on the belief that adolescents are increasingly sexually active, often exposed to early pregnancy and infections from sexually transmitted diseases, and frequently by-passed by the institutions and personnel responsible for the provision of reproductive health services, including family planning.

The adverse social and economic consequences for an adolescent girl who becomes pregnant and delivers a baby will depend on her particular marital, cultural, familial, and community situation. However, the physical and health consequences for the mother and her child are universally recognised as problematic (Singh, 1998). From the societal and familial viewpoint, the consequences of adolescent pregnancy and childbirth, especially that of very young adolescents, are profound. In less developed countries, where health conditions are poor and anemia and malnutrition are common, and where access to health care is inadequate, adolescent pregnancy can bring forth very high risks to the immediate and long-term health status of the mother and child.

No doubt, the adverse social, economic and personal repercussions of adolescent childbearing are inversely related to the age of the teenage mother. The young mother will invariably drop out of school and any opportunities for further education will be curtailed; she is very likely to be unmarried and to become overly dependent on her family for economic support. Her lifetime opportunities for self-advancement will have been seriously damaged by the act of early motherhood.

While accepting, unequivocally, that adolescent reproductive health, particularly the deleterious consequences for the subjects of unprotected sexual activity and teenage pregnancy, should be a prime concern of UNFPA and other development agencies, the purpose of this short paper is to bring an element of circumspection to the often seemingly alarmist popular perceptions about trends in adolescent sexual behaviour which are widely portrayed in the local media¹. We wish to investigate whether adolescent birth rates are high and rising over time in the Pacific Island countries, as is widely believed, and whether they are high relative to past years and to other developing regions in the world. We conclude by examining the merits of also focussing financial and technical assistance on another vulnerable group of women, those exposed to pregnancy over the age of 35 years, whose claims for special treatment seem to have been subordinated by the perception of rising rates of teenage pregnancy in the region in recent years.

No doubt, the societal consequences of an early age at initial childbearing are profound and can be especially adverse if the woman is unmarried. They will vary according to the timing of childbirth during the adolescent years as well as the proportion of women who start childbearing at different ages. The level of, and changes over time in, adolescent childbearing are examined here, to the extent possible, using various measures. The overall rate is best captured by the age-specific fertility rate (ASFR), particularly for girls aged 15-19 years. Another indicator is the proportion of all births in a year attributable to adolescents, or more definitively, to those aged 15-19. On the other hand the timing of childbearing is better measured by the proportion who have had a child by selected ages within the period of adolescence, say by the age of 20.

The ASFR measures the annual number of live births per 1,000 women in each of seven age groups (15-19, 20-24….40-44, 45-49) and is a valuable measure of current childbearing performance by these cohorts. Very few Demographic and Health Surveys (DHS) have been conducted in the PICs and the development of a registration system of vital events (births, deaths and marriages) remains in its infancy in the great majority of Pacific Island countries. Reliance on registered births from incomplete hospital records would produce very misleading results as coverage rates vary from year to year. Therefore, in most cases, we must rely on the decennial Census of Population for information on childbearing to trace the evolution of changing patterns of adolescent fertility.

These data are taken from the demographic analyses of past censuses. While we cannot vouch for the reliability of the data, they are likely to be the best available. It is also likely that, over time, their reliability has improved as national statistical offices have gained experience and built national capacity, often through the support of donor organisations. For the PICs, how high is current adolescent fertility and what has been happening to the ASFR of adolescents over time? The only available source and most reliable evidence comes from national censuses which is portrayed in table 1 which reports the annual number of births per 1000 women aged 15-19 at various times over the last 30-40 years in the PICs and major regions of the world.

While the longevity of the data series differs across countries, what can we conclude about general patterns of change in childbearing of adolescents from Table 1? With a few exceptions (PNG, Marshall Islands and Tuvalu) it can be concluded that adolescent fertility has fallen over the years in the PICs at a time when overall fertility was generally declining for all women. The lowest rates of adolescent fertility are found in Polynesia (Tonga 28; Samoa 22) with some of the highest in Micronesia (Marshall Islands 162 in 1988) and Melanesia (PNG, 77 in 1996 and Solomon Islands, 101 in 1984-86). The apparent increase in adolescent fertility in PNG and Tuvalu seems implausibly high, underlining the difficulty of monitoring demographic trends in small island populations².

Table 1: Age-Specific Fertility Rates (ASFRs) for 15-19 Year Old Women
by Country, for Selected Years.