Transcript Dropout rates by age (15-19 year olds in school at age 12

Schooling and Adolescent
Reproductive Behavior in
Developing Countries
Cynthia B. Lloyd
Population Council
Many tables and charts are derived from DHS data prepared for
forthcoming NAS panel report, Growing Up Global: Transitions
to Adulthood in Developing Countries
Outline
• Schooling among adolescents
• Adolescent reproductive health and
behavior
• Adolescent reproductive health by
schooling status
• School girl pregnancy
• Implications
Percent Ever Attended School, by Cohort
100
-100%
80
-80%
60
-60%
40
-40%
20
-20%
0% 0%
20
20%
40
40%
60
60%
80
80%
Boys
Girls
Africa
Latin
America
Asia
40-44 yrs old
10-14 yrs old
100
100%
Percent Completed 6 or More Years of School, by Cohort
100
-100%
80
-80%
60
-60%
40
-40%
20
-20%
0% 0%
20
20%
40
40%
Boys
Girls
Africa
Latin
America
Asia
40-44 yrs old
60
60%
20-24 yrs old
80
80%
100
100%
Percent Currently Enrolled (15 year olds)
20
40
60
Africa
Latin
America
Asia
Boys
Girls
80
100
Percent Currently Enrolled, 9 Latin American Countries
(median, quartiles, range)
Boys
100
Girls
80
60
40
20
0
12
15
Age
18
Percent Currently Enrolled, 13 Asian Countries
(median, quartiles, range)
Boys
100
Girls
80
60
40
20
0
12
15
Age
18
Percent Currently Enrolled, 28 African Countries
(median, quartiles, range)
Boys
100
Girls
80
60
40
20
0
12
15
Age
18
Percent of Students Aged 12-14 Enrolled in Primary
vs. Secondary and Above
100
Boys
75
Latin America (9)
Asia (13)
Africa (28)
50
25
0
0
25
50
Girls
75
100
Percent of Students Aged 15-17 Enrolled in
Secondary and Above vs. Primary
100
Boys
75
Latin America (9)
Asia (13)
Africa (28)
50
25
0
0
25
50
Girls
75
100
Percent of Students Aged 15-17 Currently Enrolled,
by Socio-Economic Status
BOYS
GIRLS
100
100
Kenya
75
LOW
LOW
75
Tanzania
50
50
25
25
0
0
0
25
50
75
100
0
HIGH
Latin America (7)
25
50
HIGH
Asia (12)
Africa (28)
75
100
Conclusions:
Schooling among adolescents
•
•
•
•
Rapid growth in attendance and attainment
Recent growth rates more rapid for girls
Majority of 15 year-olds are students
In many countries, majority of adolescent
students attend primary school
• Poverty compromises school attendance
Outline
• Schooling among adolescents
• Adolescent reproductive health and
behavior
• Adolescent reproductive health by
schooling status
• School girl pregnancy
• Implications
Percent Distribution of Deaths in Developing Countries
at Ages 15-29 by Cause, According to Sex and Region
Source: WHO (2001)
Females
East Asia
Latin America
North Africa and Middle East
Southeast/southwest Asia
Sub-Saharan Africa
Males
East Asia
Latin America
North Africa and Middle East
Southeast/southwest Asia
Sub-Saharan Africa
World
Female
Male
00%
Maternal
Noncommunicable
25%
50%
25
50
HIV
Unintentional Injuries
75%
100%
75
100
Communicable
Intentional injuries
Percent of Women Giving Birth by Age 18, by Cohort
20
20%
40
40%
60
60%
80
80%
Africa (28)
Latin
America (9)
Asia (13)
40-44 yrs old
20-24 yrs old
100
100%
Recent trends in percent marrying, having
premarital sex, and having sex by 18
Direction of Change
Marriage
Premarital Sex
ASIA
Kazakhstan
Philippines
LATIN AMERICA
Bolivia
Colombia
Dom. Republic
Guatemala
Haiti
Nicaragua
Peru
Source: Mensch, Grant, Blanc, forthcoming
Sex
Recent trends in percent marrying, having
premarital sex, and having sex by 18
AFRICA
Benin
Burkina Faso
Cameroon
Cote d’Ivoire
Kenya
Madagascar
Mali
Niger
Nigeria
Rwanda
Senegal
Tanzania
Uganda
Zambia
Zimbabwe
Direction of Change
Premarital Sex
Marriage
Sex
Percent Aged 15-17 Sexually Active,
by Socio-Economic Status
GIRLS (39 countries)
100
100
75
75
LOW
LOW
BOYS (30 countries)
50
50
25
25
0
0
0
25
50
75
100
0
HIGH
Latin America
Note: Not age standardized
25
50
HIGH
Asia
Africa
75
100
Conclusions: Reproductive health
and behavior among adolescents
• HIV/AIDS is the leading cause of mortality
and morbidity in Sub-Saharan Africa
• Death rates due to HIV/AIDS in SubSaharan Africa are highest among young
women
• Overall, roughly 15 percent of deaths
among young women are due to maternal
causes
Conclusions: Reproductive health
and behavior among adolescents
(continued)
• Child marriage remains prevalent in many
countries
• In most countries during the 1990s, percent
having sex before 18 has not risen but the
context is changing
• Poor adolescent girls are more likely to be
sexually active than their better off peers
Outline
• Schooling among adolescents
• Adolescent reproductive health and
behavior
• Adolescent reproductive health by
schooling status
• School girl pregnancy
• Implications
Possible pathways of association:
School attendance and adolescent
reproductive behavior
• Sex
• Risky sexual behaviors (unprotected sex, multiple
partners, sex in exchange for money or favors,
coercive sex)
• Contraceptive (in particular condom) use among
sexually active
• Abortion among those experiencing unwanted
pregnancy
• Early marriage leading to early childbearing
Percent Ever Had Sex, Aged 15-17,
by Enrollment Status
GIRLS (32 countries)
100
100
75
75
Not in School
Not in School
BOYS (29 countries)
50
25
50
25
0
0
0
25
50
75
100
0
Note: Boys not age standardized, Girls age standardized
50
In School
In School
Latin America
25
Asia
Africa
75
100
Ratio of Proportion of Unmarried Women Aged 15-17 Who Ever
Had Sex Among Those Not Currently Enrolled vs. Enrolled,
by Overall Proportion in School
Source: DHS Surveys, 1995-2001
9
8
Guatemala
Zimbabwe
7
6
5
Bolivia
4
3
2
1
0
0
0.2
0.4
0.6
Proportion in school
Note: Age standardized
Latin America
Africa
0.8
Sex among unmarried adolescents aged
15-17 by school status
• For unmarried girls, 25% of students or less
have ever had sex; percent having had sex is
lower among students
• For unmarried boys, levels of sexual activity
vary much more widely; in majority of cases,
levels of sex are lower among students
• Among unmarried girls, ratio of percent having
sex among non-enrolled relative to the enrolled
exceeds one in almost all countries and does not
vary by enrollment level
Percent Aged 15-17 Using Any Contraception,
by Enrollment Status
GIRLS (18 countries)
100
100
75
75
Not In School
Not In School
BOYS (12 countries)
50
25
0
50
25
0
0
25
50
75
100
In School
Latin America
Note: Not age standardized
0
25
50
In School
Africa
75
100
Percent Using Condoms Among Those Aged 1517 Who Ever Had Sex, by Enrollment Status
GIRLS (18 countries)
100
100
75
75
Not In School
Not In School
BOYS (12 countries)
50
25
0
50
25
0
0
25
50
75
100
In School
Latin America
Note: Not age standardized
0
25
50
In School
Africa
75
100
Contraceptive (condom) use among
unmarried sexually active
adolescents by school status
• Relatively few unmarried 15-17 year olds have
ever had sex; often sample sizes are too small
to estimate rates
• Where rates can be calculated, contraceptive
use is notably higher among students
• Association between school enrollment and
contraceptive use appears stronger for girls
• Patterns are similar for condom use
School exit and marriage timing
• A mechanistic relationship? Unlikely
• A causal relationship? A weaker crosscountry association between inter-cohort
change in educational attainment and the
inter-cohort change in rates of early
marriage (below 18) than might be
expected (R = -0.46)
Source: Mensch, Casterline, Singh (forthcoming)
Outline
• Schooling among adolescents
• Adolescent reproductive health and
behavior
• Adolescent reproductive health by
schooling status
• School girl pregnancy
• Implications
Proportion of 15-19 year olds
who dropped out of school due
to pregnancy, of those who have
had a birth
School Enrollment and School Dropout
due to Pregnancy, 15-19 year olds
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
0
0.2
0.4
0.6
0.8
1
Proportion 15-19 year olds currently enrolled in school
Percent reporting pregnancy as
reason for dropout
(women 20-24 who ever attended school)
Asia
Latin
America
Africa
0
10
20
Percent
30
40
50
School Girl Pregnancy
• Rise in percent of girls attending school after
puberty leads to a rise in percent of girls
exposed to risk of pregnancy as students
• Whether pregnancy leads to dropout depends on
whether or not a student chooses to continue
with pregnancy; studies show that girls often
express their desire to stay in school as a reason
for seeking abortion
School Girl Pregnancy
• Percent reporting pregnancy as a reason for
dropout are a selective sample of those who
become pregnant while students; in many cases
pregnancy may be an ex post rationalization for
dropout rather than the underlying cause
• In only few countries with data do the percent of
young women who ever attended school report
rates of dropout due to pregnancy exceeding 10
percent. In half the countries, reported rates of
dropout due to pregnancy are less than 5
percent.
Conclusions
• Sexual maturation is increasingly likely to
occur while in school
• Being in school as an adolescent is likely to
have important implications for adolescent
reproductive health
• Expansion of opportunities for secondary
schooling could represent one of the most
significant reproductive health interventions
for youth
Unanswered Questions
What features of primary, secondary schools are
most likely to:
• Encourage delays in sexual initiation
• Reduce incidence of risky sexual behaviors
• Encourage contraception and protection among
the sexually active
• Delay marriage and childbearing among young
women