At a glance

• 16 million adolescent girls between 15

and 19 become mothers every year

• Adolescent pregnancies are most

common among poor and less educated
girls and those living in rural areas

• Despite progress, adolescent pregnancy

continues to increase in some regions of
the developing world
OMS
Consequences

Adolescent pregnancy and childbirth is associated

with greater health risks for the mother:
Complications of pregnancy and childbirth are the
leading cause of death in adolescent girls aged 15-19
years in developing countries.

Adolescent pregnancy is harmful to the health

of infants: Babies of adolescent mothers are more
likely to die, to have low birth weight, and to have
long time ill effects.

Adolescent pregnancy reinforces the vicious cycle of

poverty and ill health: Adolescent mothers in many
places leave or are made to leave school, and are less
likely than their peers to develop vocational skills.

OMS
WHO Guidelines on preventing early pregnancy and poor
reproductive outcomes in adolescents in developing countries

Based on
• Thorough review of the evidence
• Practical experience of policy makers, programme managers,
and front-line workers from countries around the world

Developed in a systematic and transparent manner

In partnership with
• Guttmacher Institute
• International Center for Research on Women
• FHI360
• Population Council
• Centro Rosarino de Estudios Perinatales (Argentina)

Supported financially by
• United Nations Population Fund
• United States Agency for International Development
• International Planned Parenthood Federation

UN
 Levels of Early Pregnancy Determinants

Early pregnancy and poor reproductive

outcomes among adolescents are
determined by a web of micro- and macro-
level factors:
• Individuals make choices to engage in specific
behaviours
• Family and community norms, traditions, and
economic circumstances influence these choices
• Policy and regulatory frameworks facilitate or
hinder choices

Actions are needed at each of these levels

by different sectors.
Adolescents too have key roles to play.
ONU O’LOUGHLIN
JOEY
 OUTCOME 1

Reduce marriage before age 18

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Prohibit
Prohibit early
early marriage
marriage

INDIVIDUAL,
INDIVIDUAL, FAMILY
FAMILY &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
•• Inform
Inform and
and empower
empower girls
girls
•• Keep
Keep girls
girls in
in school
school
•• Influence
Influence cultural
cultural norms
norms that
that support
support early
early
marriage
marriage
UNFPA
 OUTCOME 1

Reduce marriage before age 18

EVIDENCE
EVIDENCE
•• 21
21 ungraded
ungraded reports
reports or
or studies,
studies, and
and the
the expert
expert
panel’s
panel’s recommendations
recommendations
•• Evidence
Evidence from
from Afghanistan,
Afghanistan, Bangladesh,
Bangladesh, Egypt,
Egypt,
Ethiopia,
Ethiopia, India,
India, Kenya,
Kenya, Nepal,
Nepal, Senegal
Senegal && Yemen
Yemen
•• Interventions
Interventions included
included communicating
communicating targeting
targeting
adolescents,
adolescents, community
community members,
members, andand other
other
political
political decisions
decisions
UNFPA
 OUTCOME 2
Create understanding and support to reduce
pregnancy before the age of 20 years

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Support
Support pregnancy
pregnancy prevention
prevention programmes
programmes among
among
adolescents
adolescents

INDIVIDUAL,
INDIVIDUAL, FAMILY
FAMILY &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
JOEY O’LOUGHLIN

•• Educate
Educate girls
girls and
and boys
boys about
about sexuality
sexuality
•• Build
Build community
community support
support for
for preventing
preventing early
early pregnancy
pregnancy
 OUTCOME 2
Create understanding and support to reduce
pregnancy before the age of 20 years

EVIDENCE
EVIDENCE
•• 22 graded
graded systematic
systematic reviews,
reviews, 33 ungraded
ungraded studies,
studies, and
and the
the expert
expert panel's
panel's
recommendations
recommendations
•• Evidence
Evidence from
from Mexico,
Mexico, Nigeria,
Nigeria, and
and poor
poor socioeconomic
socioeconomic segments
segments of
of
developed
developed countries
countries
JOEY O’LOUGHLIN

•• Interventions
Interventions included
included sexuality
sexuality education,
education, cash
cash transfer
transfer schemes,
schemes, early
early
childhood
childhood education
education && youth
youth development
development andand life
life skills
skills building
building
 OUTCOME 3

Increase use of contraception

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Legislate
Legislate access
access to
to contraceptive
contraceptive information
information and
and services
services
•• Reduce
Reduce the
the cost
cost of
of contraceptives
contraceptives to
to adolescents
adolescents
(conditional
(conditional recommendation)
recommendation)

INDIVIDUAL,
INDIVIDUAL, FAMILY
FAMILY &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
•• Educate
Educate adolescents
adolescents about
about contraceptive
contraceptive use
use
•• Build
Build community
community support
support for
for contraceptive
contraceptive provision
provision to
to
adolescents
adolescents
•• Enable
Enable adolescents
adolescents to
to obtain
obtain contraceptive
contraceptive services
services
WHO
 OUTCOME 3

Increase use of contraception

EVIDENCE
EVIDENCE
•• 77 graded
graded studies
studies or
or systematic
systematic reviews,
reviews, 2626 ungraded
ungraded studies,
studies,
and
and the
the expert
expert panel’s
panel’s recommendations
recommendations
•• Evidence
Evidence from
from Bahamas,
Bahamas, Belize,
Belize, Brazil,
Brazil, Cameroon,
Cameroon, Chile,
Chile, China,
China,
India,
India, Kenya,
Kenya, Madagascar,
Madagascar, Mali,
Mali, Mexico,
Mexico, Nepal,
Nepal, Nicaragua,
Nicaragua,
Rwanda,
Rwanda, Sierra
Sierra Leone,
Leone, South
South Africa,
Africa, United
United Republic
Republic of
of Tanzania
Tanzania
&& Thailand
Thailand
•• Interventions
Interventions included
included health
health system
system improvements,
improvements, andand
community
community and and stakeholder
stakeholder engagement.
engagement.
WHO
OUTCOME 4

Reduce coerced sex

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Prohibit
Prohibit coerced
coerced sex
sex

INDIVIDUAL,
INDIVIDUAL, FAMILY
FAMILY &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
•• Empower
Empower girls
girls to
to resist
resist coerced
coerced sexsex
•• Influence
Influence social
social norms
norms that
that condone
condone coerced
coerced sex
sex
•• Engage
Engage men
men and
and boys
boys to
to critically
critically assess
assess gender
gender norms
norms

UN
OUTCOME 4

Reduce coerced sex

EVIDENCE
EVIDENCE
•• 22 graded
graded studies,
studies, 66 ungraded
ungraded studies
studies or
or reports
reports & & expert
expert
panel’s
panel’s recommendations
recommendations
•• Evidence
Evidence from
from Botswana,
Botswana, India,
India, Kenya,
Kenya, South
South Africa,
Africa,
Tanzania,
Tanzania, && Zimbabwe
Zimbabwe
•• Interventions
Interventions included
included communication
communication directed
directed atat girls,
girls,
boys
boys and
and men
men && the
the community
community members
members to to influence
influence
knowledge,
knowledge, understanding
understanding && attitudes
attitudes on
on coerced
coerced sexsex

UN
 OUTCOME 5

Reduce unsafe abortion

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Enable
Enable access
access to
to safe
safe abortion
abortion and
and post-abortion
post-abortion
services
services for
for adolescents
adolescents

INDIVIDUAL,
INDIVIDUAL, FAMILY,
FAMILY, &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
•• Inform
Inform adolescents
adolescents about
about dangers
dangers of
of unsafe
unsafe abortion
abortion
•• Inform
Inform adolescents
adolescents about
about where
where they
they can
can obtain
obtain safe
safe
abortion
abortion services,
services, where
where legal
legal
•• Increase
Increase community
community awareness
awareness ofof the
the dangers
dangers of
of
unsafe
unsafe abortion
abortion

HEALTH
HEALTH SYSTEM-LEVEL
SYSTEM-LEVEL ACTIONS
ACTIONS
•• Identify
Identify and
and remove
remove barriers
barriers to
to safe
safe abortion
abortion services
services
UN
 OUTCOME 5

Reduce unsafe abortion

EVIDENCE
EVIDENCE
•• No
No available
available studies
studies
•• Expert
Expert panel
panel relied
relied on
on its
its experience
experience and
and
judgment
judgment toto inform
inform the
the recommendations
recommendations
UN
OUTCOME 6
Increase use of skilled antenatal,
childbirth, and postpartum care

POLICY-LEVEL
POLICY-LEVEL ACTIONS
ACTIONS
•• Expand
Expand access
access to
to skilled
skilled antenatal,
antenatal, childbirth,
childbirth, and
and
postnatal
postnatal care
care
•• Expand
Expand access
access to
to Basic
Basic and
and Comprehensive
Comprehensive Emergency
Emergency
Obstetric
Obstetric Care
Care

INDIVIDUAL,
INDIVIDUAL, FAMILY,
FAMILY, &
& COMMUNITY-LEVEL
COMMUNITY-LEVEL ACTIONS
ACTIONS
•• Inform
Inform adolescents
adolescents and
and community
community members
members about
about
the
the importance
importance of
of skilled
skilled antenatal
antenatal and
and childbirth
childbirth care
care

HEALTH
HEALTH SYSTEM-LEVEL
SYSTEM-LEVEL ACTIONS
ACTIONS
•• Ensure
Ensure that
that adolescents,
adolescents, families,
families, and
and communities
communities are
are
well
well prepared
prepared for
for birth
birth and
and birth-related
birth-related emergencies
emergencies
•• Be
Be sensitive
sensitive and
and responsive
responsive to
to the
the needs
needs of
of young
young
mothers
mothers and
and mothers-to-be
mothers-to-be

WHO
OUTCOME 6
Increase use of skilled antenatal,
childbirth, and postpartum care

EVIDENCE
EVIDENCE
•• 11 graded
graded study,
study, 11 ungraded
ungraded study,
study, existing
existing WHO
WHO
guidelines
guidelines & & expert
expert panel’s
panel’s recommendations
recommendations
•• Studies
Studies from
from Chile
Chile and
and India
India
•• Interventions
Interventions included
included home
home visits
visits to
to adolescent
adolescent
mothers
mothers and
and aa cash
cash transfer
transfer scheme
scheme contingent
contingent
upon
upon health
health facility
facility births
births

WHO
 “Educated and empowered women and girls can make
informed decisions about their own health.”
— DR. MARGARET CHAN, DIRECTOR-GENERAL, WHO

“When girls are educated, healthy and can avoid child

marriage, unintended pregnancy and HIV, they can contribute
fully to their societies’ battles against poverty.”
— DR. BABATUNDE OSOTIMEHIN, EXECUTIVE DIRECTOR, UNFPA