How can we reduce adolescent pregnancies in low- and middle-income countries?

Many young girls in low- and middle-income countries become pregnant early, which can be dangerous for them and for their babies. Studies show that girls who stay in school are less likely to get pregnant at a young age. Financial support can encourage girls to stay in school and delay pregnancy and marriage in some settings. However, a new large study from Zambia found that two years of financial support combined with comprehensive sexuality education and community dialogue meetings, moderately reduced births during the support period, but not after the financial support ended. As a result, the overall effect on births before age 18 was limited over the 4.5 years study period even though more girls completed junior secondary school. Longer-term efforts to make high school more affordable are likely to be important to keep girls in school and more clearly reduce adolescent pregnancies in low- and middle-income countries.

The study, to be published in eClinicalmedicine on 14^th November, randomized 157 rural Zambian schools into three groups: one received economic support, another received economic support plus sexuality education and community dialogue, and the third served as a control group. The study included 5000 girls about to finish primary school (average age 14). Researchers from the University of Zambia, University of Bergen, Chr. Michelsen Institute, and the Norwegian School of Economics conducted the trial.

Previous research shows that poverty is a major reason why girls drop out of school and get pregnant early. Other reasons include social pressure to have children, and lack of knowledge about and access to birth control. The limited effects of the studied support package probably reflect that the support period was too short and many families could not afford school fees after the financial support ended. Most participants were around 16 and still at risk of early pregnancy. If the support had continued until they finished secondary school or turned 18, fewer girls may have gotten pregnant before 18. Also, better access to health services and contraceptives for young people is probably needed to reduce teenage pregnancies more effectively.

According to Professor Ingvild Sandøy, at the University of Bergen in Norway, the study is in line with previous research indicating that short-term poverty-reducing measures such as cash transfers should be combined with other initiatives to achieve substantial reductions in teenage pregnancies in low- and middle-income countries. Professor Patrick Musonda from the University of Zambia adds that Zambia’s recent removal of secondary school fees is a good initiative. It will likely keep children in school longer and help prevent many young girls from getting pregnant.

The funding for the study came from the Research Council of Norway, and the Swedish International Development Agency (through the Swedish Embassy in Zambia).