NEW YORK (16 December 1998)--Though adolescent sexual initiation and fertility are significant events -- both from demographic and health perspectives -- they result from social pressures deeply rooted in family systems, peer relations, and the social construction of gender. Without an understanding of the factors that shape it, therefore, adolescent reproductive behavior, particularly in developing countries, cannot be understood and modified.
"The Uncharted Passage: Girls' Adolescence in the Developing World," a new monograph from the Population Council, approaches adolescence from an angle that is absent from most previous research: the societal and familial forces that pressure girls into involuntary and unprotected sexual relations and early childbearing. Authors Barbara S. Mensch, Judith Bruce, and Margaret E. Greene explore how young females are treated in their families, schools, peer groups, and communities, probing for evidence of exclusion from (or integration into) the social and economic mainstream. They aim to provide researchers and policymakers with a broad, flexible framework for understanding girls' experience and to inspire additional substantive research and innovative programs that will improve their lives.
"Gender issues have been greatly neglected," Bruce says. "Girls disappear as policy subjects after receiving their last childhood immunization, and do not reappear until they are past puberty, pregnant, and most often married. Adolescence as we know it -- a period in which children attain physical maturity but are not burdened with adult roles and responsibilities -- does not exist for many girls in developing countries." Bruce notes that "During adolescence, the world expands for boys and contracts for girls. Boys enjoy new privileges reserved for men; girls endure new restrictions reserved for women. Boys gain autonomy, mobility, opportunity, and power; girls are systematically deprived of these assets."
"Both the strengths and weaknesses in information on developing-country adolescents," Mensch says, "reflect the agenda of the population and family planning field, which has sponsored much of the research in this area and has defined the field of inquiry." From fragments of available information, Mensch observes, "we reconstructed as best as possible what it means to grow up female in the developing world." The monograph draws on data from Demographic and Health Surveys (DHS) conducted since 1990 in 39 countries as well as data from other research studies to obtain a broad picture of girls' lives. However, conventional fertility surveys are of limited value in this context, because of their focus on reproductive and health behavior and because they include girls in such a broad age span.
A focus on adolescents could yield substantial dividends, the authors say, because the planet is now populated by the largest generation of youth in human history; roughly 900 million 10-19 year olds and by 2005 their numbers will exceed one billion.
Girls' Adolescence: Home, School, and Work
The driving forces behind early marriage and childbearing, Mensch, Bruce, and Greene say, are girls' social and economic disadvantages. In many settings, these include girls' living arrangements, domestic responsibilities, and restrictions on their mobility. Girls' domestic duties are expected to prepare them for a lifelong role as wife and mother and include activities such as child care, food preparation, fetching of water and fuel, cleaning, and agricultural work, while boys are encouraged to develop some degree of autonomy and independence from the family. Even when in school, girls (in Guinea and Kenya, for example) are expected to perform menial chores, such as preparing and serving food or cleaning the classroom. Adolescents do not always live under parental supervision and a substantial proportion of both girls and boys live in households without a father, which may increase the work burden of girls especially. Many girls in sub-Saharan Africa are "fostered out" to other households, where they may be exploited in domestic service.
Adolescent girls' movements outside the home are highly constrained in many countries. This affects girls' social contacts and education. As a general pattern, girls' school enrollment lags behind boys' in many developing countries, and the gap is much higher for secondary than for primary school. In sub-Saharan Africa and South Asia, the majority of school-going adolescents are found to be in primary school, as a result of late school-entry and grade repetition. Girls' school enrollment declines steeply during adolescence because of a combination of factors: rising school fees, distances girls must travel from home to school, and fear for girls' reputations as well as their safety. Parents who recognize the economic benefits of educating a daughter may, nevertheless, believe that the families the girls marry into, rather than their own parents, will realize these gains.
Some adolescents work and earn income -- the International Labour Organization estimates that number at a minimum of 73 million 10- to 14-year-olds or 13 percent of children in developing countries. But most adolescent girls, including the substantial number in domestic service, work outside the modern sector without clear remuneration; as a result their levels of productive employment often are underestimated. The most egregious form of exploitative child labor (both girls and boys) is in commercial sex work.
Concerns about child labor and exploitation have generated negative attitudes toward girls' work and have even inadvertently created some bad outcomes for girls. Inspections of work environments in free-trade zones have often revealed disgraceful conditions. Yet, the authors say, for many adolescent girls, wage-earning work (under the right circumstances) could represent a step up in the working world. Moreover, girls' increasing participation in wage-earning work appears to be inevitable, as economic modernization reduces some of the demands on their time. Girls may endure onerous work conditions, but they also experience pride in earnings, maintain a higher standard of dress than their unemployed counterparts, and, most significantly, develop an identity apart from being a child or wife.
Adolescent Reproductive Health, Marriage, and Childbearing
Although menarche is but one part of the maturation process, it is often culturally defined as the indicator of girls' maturity and readiness for marriage and sexual activity. Margaret Greene notes that, at the onset of menstruation, girls' lives change abruptly: in some domains, their activity may be restricted, and they may be kept from food preparation and consumption, socializing, religious practice, bathing mobility, school attendance, and sexual activity.
Researchers have devoted the bulk of their attention to premarital sex. Thus, there is a striking dearth of information about the sexual and reproductive knowledge of soon-to-be married partners; the transition to marriage; the experience of young, married couples; and their negotiations regarding the intervals between marriage and sexual intercourse and between marriage and first birth. Although data on trends in sexual activity prior to marriage are not reliable enough to support firm conclusions about changes over time, researchers believe that sexual activity among unmarried youth is increasing in many regions.
Data also suggest that unmarried girls' sexual partners, as well as husbands of adolescents, are likely to be considerably older, and that some of this sexual experience is not consensual. The age gap between sexual partners has become a salient concern in those developing countries where the incidence of STDs, including HIV infection, is greater among adolescent girls than among adolescent boys. Wherever adolescents' knowledge of reproductive biology and health has been studied, data indicate that young people -- married and unmarried -- have a minimal grasp of this biology and a limited understanding of how to prevent pregnancy and reproductive health problems.
Despite their limited knowledge of reproductive biology and health, young people generally know of at least one modern contraceptive method, and how to obtain it, but the level of contraceptive use among adolescents is low. Why sexually active unmarried adolescents do not use contraception is unclear: some may want pregnancy and the status it brings them; some have limited power to negotiate use of contraception; and some might use contraceptive services if they were accessible and nonjudgmental.
A study of 19 countries where there has been at least a half-year rise in women's average age at marriage shows that there has not been a parallel increase in the time elapsed between marriage and first birth. The urgency to marry and have children early is related to the precariousness of girls' status, rather than to fertility goals. Childbearing is believed to have serious health consequences for the youngest mothers and their children, but the broader life consequences and the links with poverty of early childbearing in developing countries have been largely neglected as both a research and policy subject.
An Agenda for Policy, Programs, and Research
Adolescent policies sensitive to the different needs of girls and boys must be built virtually from the ground up, the authors say, because there is no cultural consensus that adolescence exists as a distinct and important developmental stage for all 10 to 19-year-old girls and boys.
Public policies, the authors say, "must set an agenda for adolescent girls that is organized around the distinctive features of their lives: their risk of exploitative living arrangements; confinement to domestic roles and responsibilities; restricted mobility; inadequate school experience; unacknowledged work needs and compromising work situations; pressure to marry and begin childbearing early; and limited control over, and knowledge about, their reproductive health and fertility, even (perhaps especially) in the case of married girls."
The authors set out four main policy challenges:
- Create a safe, supported passage for girls from ages 10 to 19, recognizing
that the second decade of their lives is a period of critical capability
building and heightened vulnerability, which does not end with marriage and
childbearing;
- Acknowledge that adolescent girls' lives are often governed by harmful,
culturally sanctioned gender rules imposed by males, parents, and other elders
and perpetuated at times by girls themselves;
- Expand girls' social participation, schooling, and economic opportunities,
understanding that these are basic entitlements and that they frame girls'
reproductive behavior;
- Recognize that a large proportion of adolescent girls are already wives and mothers, who need support and investment as least as much as do their unmarried female peers.
"We must move adolescent policy beyond reproductive health," the authors say. They issue a call for development of a multisectoral adolescent policy, "with diverse initiatives that improve the conditions of girls' lives, not only in the realm of reproductive health, but also in the areas of work, sports, and schooling. This will require advocacy and budgetary resources for social and economic investments outside the health sector. Ministries of education, employment, labor, youth, community development, and sports must all contribute to a broadly cast program."
Expanding girls' economic options should be a priority: girls need access to microenterprise, savings, and credit programs; they also need opportunities for wage-earning work outside the home in the formal sector. Education is arguably the most influential investment, because it has the potential simultaneously to contribute to girls future social and economic independence and raise the age of childbearing, reduce desired family size, and empower females with the knowledge and social authority to space and limit childbearing and to invest in their children.