title: Global Trends in Adolescent Fertility, 1990-2012, in Relation to National Wealth, Income Inequalities, and Educational Expenditures.
abstract: OBJECTIVE
  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.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: js2637@columbia.edu.
authors.forename: John S
authors.initials: JS
authors.lastname: Santelli
authors.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Song
authors.affiliation: Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Samantha
authors.initials: S
authors.lastname: Garbers
authors.affiliation: UNFPA, Regional Office for Asia and Pacific Region, Bangkok, Thailand.
authors.forename: Vinit
authors.initials: V
authors.lastname: Sharma
authors.affiliation: UCL Institute of Child Health, University College London, London, United Kingdom.
authors.forename: Russell M
authors.initials: RM
authors.lastname: Viner
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health / Q000639:trends*; D001723:Birth Rate / Q000639:trends*; D005260:Female; D005298:Fertility; D014943:Global Health / Q000639:trends*; D006801:Humans; D016014:Linear Models; D011159:Population Surveillance; D011203:Poverty; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Adolescent birth rate; Adolescent fertility; Gini index; Income inequalities; Socioeconomic status