John S Santelli1, Xiaoyu Song2, Samantha Garbers2, Vinit Sharma3, Russell M Viner4. 1. Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: js2637@columbia.edu. 2. Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York. 3. UNFPA, Regional Office for Asia and Pacific Region, Bangkok, Thailand. 4. UCL Institute of Child Health, University College London, London, United Kingdom.
Abstract
PURPOSE: National wealth, income inequalities, and expenditures on education can profoundly influence the health of a nation's women, children, and adolescents. We explored the association of trends in national socioeconomic status (SES) indicators with trends in adolescent birth rates (ABRs), by nation and region. METHODS: An ecologic research design was employed using national-level data from the World Bank on birth rates per 1,000 women aged 15-19 years, national wealth (per capita gross domestic product or GDP), income inequality (Gini index), and expenditures on education as a percentage of GDP (EduExp). Data were available for 142 countries and seven regions for 1990-2012. Multiple linear regression for repeated measures with generalized estimating equations was used to examine independent associations. RESULTS: ABRs in 2012 varied >200-fold-with the highest rates in Sub-Saharan Africa and lowest rates in the Western Europe/Central Asia region. The median national ABR fell 40% from 72.4/1,000 in 1990 to 43.6/1,000 in 2012. The largest regional declines in ABR occurred in South Asia (70%), Europe/Central Asia (63%), and the Middle East/North Africa (53%)-regions with lower income inequality. In multivariable analyses considering change over time, ABRs were negatively associated with GDP and EduExp and positively associated with greater income inequality. CONCLUSIONS: ABRs have declined globally since 1990. Declines closely followed rising socioeconomic status and were greater where income inequalities were lower in 1990. Reducing poverty and income inequalities and increasing investments in education should be essential components of national policies to prevent adolescent childbearing.
PURPOSE: National wealth, income inequalities, and expenditures on education can profoundly influence the health of a nation's women, children, and adolescents. We explored the association of trends in national socioeconomic status (SES) indicators with trends in adolescent birth rates (ABRs), by nation and region. METHODS: An ecologic research design was employed using national-level data from the World Bank on birth rates per 1,000 women aged 15-19 years, national wealth (per capita gross domestic product or GDP), income inequality (Gini index), and expenditures on education as a percentage of GDP (EduExp). Data were available for 142 countries and seven regions for 1990-2012. Multiple linear regression for repeated measures with generalized estimating equations was used to examine independent associations. RESULTS: ABRs in 2012 varied >200-fold-with the highest rates in Sub-Saharan Africa and lowest rates in the Western Europe/Central Asia region. The median national ABR fell 40% from 72.4/1,000 in 1990 to 43.6/1,000 in 2012. The largest regional declines in ABR occurred in South Asia (70%), Europe/Central Asia (63%), and the Middle East/North Africa (53%)-regions with lower income inequality. In multivariable analyses considering change over time, ABRs were negatively associated with GDP and EduExp and positively associated with greater income inequality. CONCLUSIONS: ABRs have declined globally since 1990. Declines closely followed rising socioeconomic status and were greater where income inequalities were lower in 1990. Reducing poverty and income inequalities and increasing investments in education should be essential components of national policies to prevent adolescent childbearing.
Authors: Tetine Sentell; Saionara Maria Aires da Câmara; Alban Ylli; Maria P Velez; Marlos R Domingues; Diego G Bassani; Mary Guo; Catherine M Pirkle Journal: South East Eur J Public Health Date: 2019-04-30
Authors: Elia Diez; Maria J Lopez; Gloria Perez; Irene Garcia-Subirats; Laia Nebot; Ramon Carreras; Joan R Villalbi Journal: BMC Public Health Date: 2020-01-08 Impact factor: 3.295