title: Early adolescent childbearing in low- and middle-income countries: associations with income inequity, human development and gender equality.
abstract: Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods.
  
  
  
  Among women ages 18–24, prevalence estimates for early birth (<16 years) were calculated by nation, and weighted linear regressions evaluated associations between national indicators and early childbearing. To examine temporal trends, analyses were stratified by year groupings.
  
  
  
  Early adolescent childbearing declined over time, with the greatest change observed in Bangladesh (31.49% in 1996/7 to 19.69% in 2011). In adjusted models, GDI was negatively associated with early childbearing, i.e. early childbearing prevalence decreased as GDI increased. In the most recent time period, relative to the lowest GDI group, the average prevalence of early childbearing was significantly lower in the middle (-12.40, P < 0.00) and upper (-10.96, P = 0.03) tertiles after adjustment for the other indicators. These other indicators showed no consistent association with early childbearing.
  
  
  
  As national-level GDI increased, early adolescent childbearing declined. The GDI, which reflects human development adjusted for gender disparities in educational and economic prospects, was more consistently related to early adolescent childbearing than the absolute development prospects as given by the HDI. While creating gender equality is an important goal in and of itself, the findings emphasize the potential for improved national-level gender equitable development as a means to improve adolescents’ sexual and reproductive health.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Population Family & Reproductive Health, Baltimore, MD, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Population Family & Reproductive Health, Baltimore, MD, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Kalamar
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Hindin
mesh_terms: D000293:Adolescent; D001723:Birth Rate / Q000639:trends*; D003906:Developing Countries; D005260:Female; D059066:Gross Domestic Product / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D063507:Sexism; D012959:Socioeconomic Factors; D055815:Young Adult