Introduction

Family planning is a set of actions that are put at the disposal of human beings to use the fundamental human right to have the number of children they desire and establish the intergenesic intervals between them and the timing of their birth in the course of their reproductive life. This concept implies informed and aware decisions on the part of the couples that make up a family or are forming a family in accordance with the culture in which they live and develop.

These concepts, which are very well known and have been extensively analysed, are decontextualised when it comes to adolescents, with the exception of those societies in which precocious marriage is part of their culture. A more adequate term would be adolescent contraception to prevent a first pregnancy and repeat pregnancies.

By definition, adolescent pregnancy is pregnancy in females between the ages of 10 and 19, as this is the age group defined as adolescence. Nonetheless, bio-demographic information expresses adolescent fecundity as occurring between the ages of 15 and 19 years. Pregnancy in females under 15 years of age is extremely severe in every aspect and requires very complex and long-term solutions.

The term precocious primigravida, which was so popular in the world of obstetrics up to the 1980s in the past century, was replaced by the concept of pregnant adolescent as a consequence of evidence of negative maternal and perinatal results and the deficiencies in prenatal care and treatment for females under 19 years of age. The two most important periods in human growth and development are the foetal period and adolescence. From this point of view, antenatal and prenatal care of pregnant adolescents should be provided by comprehensive and preferential attention programmes.

The most severe effects of adolescent pregnancies are the social impacts that affect education, work and the social organisation of the family, which are a factor of poverty.

Adolescent contraception and pregnancy are mainly treated as a female issue. Nonetheless, an indispensable consideration of the concept of sexual and reproductive health in adolescence is the permanent inclusion of both genders. This consideration is indispensable in the application of strategies for the prevention of adolescent pregnancy, of which adolescent contraception is a single aspect of these strategies.

Magnitude of the problem and analysis of the international situation

On the basis of information provided by UNFPA in a study that compared 1995 with 2008, fecundity rates between the ages of 15 and 19 have fallen in the last 13 years. Reduction rates are higher in the less developed countries. Adolescent Fecundity rates have fallen in all the Regions, with higher proportions in North America and Europe. Latin America and the Caribbean is the region with lower reduction rates as can be seen in Figures 1 and 2

Births per 1,000 women aged 15–19.

Adolescent fecundity rates 1995–2008 per 1000 women aged 15–19 years by regions.

Table 1 compares adolesent fecundity and avaliablity of contraceptives.

The information is analysed according to regions, owing to their different cultural realities. The 10 countries with the higher fecundity rates between 15 and 19 years of age have been recorded, as have those with the lower rates. A summary is given of the average use of contraceptives in each five-country subgroup. In regions with less than 20 countries, each country in the region is tabulated, as shown in Table 1 .

In Africa, the countries with the lower adolescent fecundity rates have a higher prevalence of use of contraceptives (4 and 5 times more). Similarly, the five countries with the lower fecundity rates have a difference of more than 10 points with their counterparts that have fecundity rates of over 39 per 1000.

The Latin American and Caribbean region has a somewhat similar profile, with the exception of the five countries with lower adolescent fecundity rates, evincing a lower frequency in use of contraceptives. This can be influenced by the fact that the region has a concentration of countries with very similar rates of fecundity and others with exceptionally low contraceptive use rates such as Haiti and Trinidad and Tobago. It is also a fact that clandestine abortions in these two countries is a factor that is very difficult to weigh in terms of adolescent fecundity.

In Asia, there is a very close relationship between lower adolescent fecundity rates and greater use of contraceptives, with the exception of the five countries with lower rates ranging from 42 to 71 per 1000.

Europe has the lowest rates of adolescent fecundity and the highest prevalence of contraceptive use. In this region, the influence of legalised abortion is an important factor in adolescent fecundity.

North America gives similar rates of contraceptive use but very different fecundity rates. It is probable that this has been affected by political and structural factors in the area of attention to adolescents, sex education at school and co-ordination with the health sector.

In Oceania, the relationships between both variables are extremely clear in the four countries analysed.

The region of former USSR countries shows that the countries with fecundity rates below 29 have only 6 more points in terms of prevalence of use. It is quite possible that the legalisation of abortion in this region explains the low fecundity rates among adolescents.

Finally, the highest rate of adolescent fecundity (222 per 1000) is seen in the Democratic Republic of the Congo in Africa, with 21% of prevalence of use; the lowest is seen in the Democratic People’s Republic of Korea (1 per 1000), with 69% of prevalence of the use of contraceptives.

Until a decade ago, infant mortality was an excellent health indicator that reflected the levels of poverty or development of countries. Nonetheless, the introduction of better health care, immunisations, modern medicine with a wider scope of action and the improvement of nutrition patterns in various developing countries have had a very important impact on infant mortality.

Adolescent fecundity has become the most exact bio-demographic and health indicator of development levels in many countries. On comparing five countries of the Latin American and Caribbean region with the six developed countries with lower Infant Mortality rates in 2008 and their evolution since 1995, there is a 10-point difference between Sweden and Uruguay, a 2-point difference with Cuba and 4 points with Chile. These differences do not reflect differences in development. Nonetheless, when comparing the adolescent fecundity rates between Sweden and Uruguay, there is a difference of 56 points, 42 with Cuba and 55 with Chile. This can be seen in Figures 3 and 4 .

Infant Mortality Rates in Selected Countries Fecundity Rates of 15–19 years old in 1995 and 2008(*).

Fecundity Rates of 15–19 years old in 1995 and 2008(*) Selected Countries 1995–2008(*).

Adolescent fecundity gives an almost unequivocal reflection of the differences between developed and developing countries. This reflection also means that the solution is not circumscribed to contraception in adolescents, but that there are many actions to be taken that affect adolescent fecundity apart from poverty and underdevelopment.

Magnitude of the problem and analysis of the international situation

On the basis of information provided by UNFPA in a study that compared 1995 with 2008, fecundity rates between the ages of 15 and 19 have fallen in the last 13 years. Reduction rates are higher in the less developed countries. Adolescent Fecundity rates have fallen in all the Regions, with higher proportions in North America and Europe. Latin America and the Caribbean is the region with lower reduction rates as can be seen in Figures 1 and 2

Births per 1,000 women aged 15–19.

Adolescent fecundity rates 1995–2008 per 1000 women aged 15–19 years by regions.

Table 1 compares adolesent fecundity and avaliablity of contraceptives.

Table 1

Higher and Lower adolescent fecundity and prevalence of contraceptive use by Regions and Countries.

Reg/Count	Higher Adoles.Fecund.Rate		Reg/Count	Lower Adoles.Fecund.Rate
	Fecundity Rate	Contr.Use Prevalence		Fecundity Rate	Contr.Use Prevalence
Africa			Africa
Congo R.D	222	21	Burundi	55	20
Liberia	219	6	Botswana	52	44
Niger	196	11 11.2	Mauritius	41	76 43.2
Guinea-Bissau	189	10	Rwanda	40	17
Mali	179	8	Egypt	39	59
Chad	164	3	Swaziland	33	46
Sierra Leone	160	5	Morocco	19	63
Uganda	152	24 11.6	Tunisia	7	63 55.6
Guinea	149	9	Algeria	7	61
Mozambique	149	17	Libyan Arab Jamahiriya	3	45
Latin America & Caribbean			Latin America & Caribbean
Nicaragua	113	72	Costa Rica	71	80
Dominican Republic	108	61	Colombia	65	78
Guatemala	107	43 62.2	Mexico	65	71 74.0
Honduras	93	65	Uruguay	61	77
Venezuela	90	70	Chile	60	64
Brazil	89	77	Peru	60	71
Panama	83	—	Argentina	57	65
El Salvador	81	67 71.5	Cuba	47	73 55.8
Ecuador	83	73	Haiti	46	32
Jamaica	78	69	Trinidad &Tobago	35	38
Asia			Asia
Bangladesh	125	58	Israel	14	68
Nepal	115	48	Malaysia	13	55
Afghanistan	113	19 42.6	Kuwait	13	52 57.2
Lao People’s D.R.	72	32	Oman	10	24
India	62	56	China	8	87
Palestinian occupied Territory	79	50	Singapore	5	62
Yemen	71	23	Hong Kong	5	84
Timor-Leste R.D.	54	10 34.8	Corea Rep of	4	81 70.0
Philippines	47	51	Japan	3	54
Cambodia	42	40	Corea Dem. Rep.	1	69
Europa			Europe
Bulgaria	40	42	Finland	9	77
Romania	32	70	Spain	9	66
Serbia	25	41 61.4	Greece	9	76 72.6
United Kingdom	24	84	Germany	9	70
Estonia	21	70	Norway	8	74
Macedonia	21	14	Slovenia	7	74
Slovakia	20	24	Belgium	7	78
Bosnia& Herzegovina	20	36 39.6	France	7	71 72.2
Hungary	19	77	Denmark	6	78
Lithuania	19	47	Italy	6	60

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