Executive Summary
This report stems from concerns that adolescent childbearing in sub-Saharan Africa (hereafter, Africa) may be increasing. High fertility among adolescent women in this part of the world is nothing new. A large percentage of all African births have long been those to adolescents, and most adolescent childbearing in Africa is perceived to be not only quite normal but highly desired.
Yet, in parts of Africa, the social context of early childbearing is changing dramatically. In the past, young women tended to move directly from childhood to adult responsibilities. Now, according to some evidence, the once brief interlude between childhood and adulthood is lengthening. Menarche may be declining in a few areas, while schooling and other forms of training are delaying marriage. In particular, where girls find opportunities for education they seek to prolong their school careers, a goal that most national policies as well as family elders declare incompatible with motherhood.
The most significant change in sub-Saharan Africa is not a rise in overall rates of adolescent fertility but in childbearing among women who do not appear to be married. The report builds on the fact that many of the problems that are associated with adolescent fertility in Africa—problems such as school dropout and abortion—appear to stem not from adolescent childbearing itself, but from condemnation of childbearing under conditions society disapproves.
Ambiguities in young women's marital status have important bearing
on how society perceives a pregnancy. Yet there are many problems in taking premarital childbearing as the indicator of illegitimacy. The age at first marriage is only tenuously linked to the onset of childbearing in Africa, in part because diverse and ambiguous marriage practices have weakened the link. But dramatic new changes in economic opportunities, law, religion, and education are compounding the difficulty in defining the exact date of entry into marriage, which, in Africa, has long been recognized as a highly fluid institution.
The socioeconomic and cultural contexts of fertility in Africa suggest why adolescent pregnancy can have such different outcomes and why women might begin childbearing early or try to delay it. Adolescence is a key period of transition in life. During their adolescent years, women are likely to terminate their training; leave home; and begin conjugal life, childbearing, and adult work. Although fertility is highly valued, elders try to ensure that it occurs within sanctioned states in which (1) the parents have had adequate ritual or training preparation for the responsibilities of adulthood, and (2) the child has a recognized father, which implies access to a supportive paternal family. Hence, girls encounter strong social pressures against childbearing before they have had adequate preparation for adult responsibilities, and when no responsible father is in view.
Ages at first birth are strongly correlated with the educational attainment of women, especially secondary education, and most African countries have successfully raised their levels of education within the past two or three decades. Causation may operate either way: Young women who acquire more education may limit their childbearing; or social strictures that discourage young women from returning to school after marriage or a pregnancy encourage them to remain unmarried or restrict their childbearing (whether through abstinence, contraception, or abortion) so that they may continue their educations.
Yet focusing solely on the relationship between education and fertility is problematic because few girls in Africa go far in their schooling. Alternative avenues for training older girls, such as trade apprenticeships, domestic service, or ritual initiation, engage far more girls than the small group who go on to secondary school. These other forms of training also require large time investments and may, like formal education, be associated with delayed marriage and entry into childbearing.
In order to assess the risks and consequences of early childbearing, we identify two distinct configurations of adolescent fertility. The first configuration involves married adolescents, quite frequently those in rural areas, who marry and give birth when they are very young. Childbearing for these young women commences with the approval, if not the insistence, of their families, for reasons of economic necessity or commitment to societal or religious norms that confer value on a woman through childbearing.
Problems, when they do arise among these very young women, stem primarily from physical immaturity: medical complications that a mother or her children suffer when her body is not mature enough to effectively nurture a fetus and give birth to a baby.
The second configuration, one of increasing prevalence in the subcontinent, involves social disapproval of adolescent childbearing under nonlegitimate conditions. The closest indicator of this problem that we have in survey data is premarital childbearing. Whereas childbearing in the past occurred largely within what was considered marriage, we now see increases in births to adolescents who report themselves as unmarried. Many adolescents are still attending school when they become pregnant. One consequence is that young women in such circumstances attempt dangerous abortions or suffer damage in the birth process that renders them infertile or endangers their lives. Again, the social context of childbearing is extremely important. Many prenatal clinics and family planning programs serve only married women, leaving unmarried teens to forgo these services or acquire them through informal channels or local medical practitioners.
These two configurations, of course, should be seen as the ends of a very long continuum. But, more importantly, we urge strong caution about accepting at face value even these apparently clear-cut consequences of adolescent fertility. It is virtually impossible to separate the effects of young age per se on health risks from the social effects produced by the father's refusal to recognize a child or the forsaking of a school career. In settings where fertility is expected to begin very early, by contrast, we know little about the consequences of not bearing children as an adolescent. We conclude that the social context of adolescent childbearing has an effect on the outcome for the mother and the child that is as important as the physiological maturity of the mother.
An increase in adolescent fertility outside of marriage is only one of many changes that affect the lives of African women. Other important trends include rises in formal education, informal training, urbanization, and the use of contraception. These changes, however, are part and parcel of an unfolding social context that, while it creates new opportunities for young women, also sharpens public antipathies toward adolescent fertility outside an approved relationship. In such situations, adolescent fertility per se may be changing less than the social context that condemns it.
