The strongest predictors of adolescent women’s experiencing pregnancy and childbearing in southeastern Ghana are provision of basic financial support by their partner and cohabitation, according to "The Relationship Context of Adolescent Fertility in Southeastern Ghana," by Jeffrey B. Bingenheimer of the Milken Institute School of Public Health at George Washington University and Kirsten Stoebenau of American University. The study suggests that adolescent fertility can best be understood as a family formation process that presents a pathway to adulthood in settings where alternative pathways—such as completing secondary education and securing stable employment in the formal sector—are scarce for young women.

The study, published in International Perspectives on Sexual and Reproductive Health and now available online, examines how relationship types are linked to adolescent fertility—defined as a live birth or current pregnancy before age 20. The researchers collected data on more than 350 romantic and sexual relationships among almost 300 adolescent women in two towns in southeastern Ghana. In this sample, adolescent fertility occurred in 17% of relationships.

Reducing adolescent pregnancy and childbearing in Sub-Saharan Africa is a public health and development priority, given the associated health risks for mother and child as well as the associated social consequences, including lower levels of educational attainment. While early marriage is common and acts as the primary driver of adolescent fertility in some parts of Sub-Saharan Africa, this is not the case in Ghana. In the West African nation, adolescent pregnancy and childbearing most often occur outside of marriage. Therefore, identifying the specific relationship contexts in which these events happen can lead to a better understanding of the drivers of adolescent fertility and thus to the design of more effective interventions.

The study finds the relationship factors most strongly associated with adolescent pregnancy and childbearing are the partner’s provision of basic financial support and cohabitation or marriage. There is also some evidence that power disparity and a partner who is five or more years older are associated with adolescent fertility.

The researchers urge that their findings be viewed through the perspective of the broader gender system within a patriarchal society. In this system, men are expected to provide for their partners and children and hold authority over their households. In Ghana, this expectation also applies in premarital relationships.

It is important to take into consideration alternative pathways open to adolescent women in Ghana. A majority of young women will not complete secondary school, and employment opportunities in the formal sector for those without a secondary education are extremely limited. For many adolescent women, the prospect of adulthood involves low-paying jobs in the informal sector. In such circumstances, starting a family early with a partner who can provide basic financial support can be an appealing alternative.

The findings of this study suggest that effective interventions to reduce adolescent fertility in Ghana must include expanding educational and employment opportunities for young women. This requires a long-term approach to improve the labor market and invest in the educational system. In the short term, incentive-based programs that help young women to complete secondary school and establish a livelihood may provide them with more options and improve their health, social and economic well-being.

"The Relationship Context of Adolescent Fertility in Southeastern Ghana," by Jeffrey B. Bingenheimer and Kirsten Stoebenau, appears in International Perspectives on Sexual and Reproductive Health and is currently available online.

Also in this issue of International Perspectives on Sexual and Reproductive Health:

"Understanding Female Condom Use and Negotiation Among Young Women in Cape Town, South Africa," by Julia Martin, Patsy de Lora, Roger Rochat and Karen L. Andes

"Place, Time and Experience: Barriers to Universalization of Institutional Child Delivery in Rural Mozambique," by Victor Agadjanian, Jing Yao and Sarah R. Hayford

"Global Trends in Family Planning Programs, 1999–2014," by Bernice Kuang and Isabel Brodsky
 

Comment

"Understanding Early Marriage and Transactional Sex in the Context of Armed Conflict: Protection at a Price," by Aisha Hutchinson, Philippa Waterhouse, Jane March-McDonald, Sarah Neal and Roger Ingham

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