T Senescyt 00569

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Do young adolescents matter? An analysis of young adolescence pregnancy

in Ecuador and its socio-cultural impacts
London School of Economics and Political Science
SA499 Dissertation
MSc Population and Development
Date of Submission: 2nd of September, 2013
Candidate Number: 70348
Contents
Chapter 1: Introduction ........................................................................................................................ 2
1.1 Background: ............................................................................................................................... 2
1.2 ICPD impact in Ecuador ............................................................................................................ 3
1.3 Research focus ........................................................................................................................... 4
1.4 Overall research aim and individual research objectives ........................................................... 7
1.5 Research worth ........................................................................................................................... 8
Chapter 2: Issues and review of related literature .......................................................................... 8
2.1 Why is adolescent pregnancy a development problem? ....................................................... 8
a) Cairo, paradigms shift for adolescents? ....................................................................................... 8
b) Adolescent a complex target: why are they more vulnerable than others? ................................ 11
2.2 Adolescent pregnancy a socio-cultural problematic ........................................................... 13
a) Adolescent fertility in Latin America and Ecuador.................................................................... 13
b) Education and fertility in adolescents in Ecuador...................................................................... 17
c) Adolescent pregnancy: a gender-based issue in Ecuador .......................................................... 20
2.3 Literature review conclusion ................................................................................................. 24
Chapter 3: Research methods ......................................................................................................... 25
3.1 Introduction: ............................................................................................................................. 25
3.2 Research Strategy ..................................................................................................................... 26
3.3 Data collection ......................................................................................................................... 28
3.4 Framework for data analysis .................................................................................................... 30
3.5 Limitations ............................................................................................................................... 30
Chapter 4: Findings and Conclusions ................................................................................................ 30
4.1 Findings and discussion ........................................................................................................... 31
4.2 Conclusions .............................................................................................................................. 40
4.3 Potential further research ......................................................................................................... 41
References ...................................................................................................................................... 41
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Chapter 1: Introduction
1.1 Background:
In Ecuador about 2,080 out of the total 346,700 females of ages 10 to 14 years in 2010 had already
experienced motherhood (INEC, 2010). Beyond improving adolescent and young people lives,
investing in adolescent sexual and reproductive health will contribute to broader development goals
in the future (UNFPA, 2013; Bearinger et al., 2007; Institute Guttmacher, 2010).
Currently 56% of the world population are youth, the largest number it has ever been in the history
(Juarez, 2005). There are 600 million girls and more than half a billion live in developing countries
(UNFPA, 2013). For these reasons, the skills that this population group will acquire during their
adolescence will return in their adulthood turning them into active and empowered citizens and
human beings. Reducing pregnancies will help break the poverty cycle but also return the
investment on further education, political stability, and higher access to labour market in the future.
(Bearinger et al, 2007).
According to UNICEF, WHO and UNFPA ‘‘Pregnancy and childbirth-related deaths are the
number one killers of 15 - 19 year old girls worldwide. Each year, nearly 70,000 die. At least 2
million more are left with chronic illness or disabilities that may bring them life-long suffering,
shame, and abandonment''1. Consequently, UNFPA has decided to assign World Population Day
2013 teen pregnancy as a global priority. It emphasizes the importance of promoting actions
towards teen pregnancy prevention with the objective of giving adolescents and young people
enough opportunities and capabilities to replicate the patterns in their future lives.
It was only one decade and a half ago that adolescents were brought into the national agendas and
the focus was placed on the importance of promoting actions with adolescents. By emphasizing on
1 Sources: UNICEF 2002; WHO, UNICEF, and UNFPA 2004; Safe Motherhood Inter-Agency Group 2002; Olukoya
et al. 2001; Bale, Stoll, and Adetokunbo 2003; Wagstaff and Claeson 2004
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their sexual and reproductive rights, some of the root causes for pregnancy will break at this age
group such as poverty, gender disparities, violence and lack of education. It was in 1994 in the
International Conference of Population and Development (ICPD) in Cairo that 179 countries
embraced the concept and practice of sexual and reproductive rights as a necessary factor for
poverty reduction as well as for the reduction of high fertility and mortality rate and HIV and AIDS
prevalence (McIntosh and Finkle, 1995).
When analysing sexual and reproductive health we are discussing the sexual behaviour of
individuals and couples, which must be seen as complex socio-cultural settings. Understanding
these complex environments is essential for the development of effective strategies and
interventions (Desmond et al., 2005).
Many efforts have been made in the world after ICPD but including sexual and reproductive rights
in the political agendas is not enough. There have to be an ensemble of elements that must be joint
together in a set of policies and actions as well as education and information. Furthermore, good
quality of sexual and reproductive health services must be available in order for adolescents to take
risk-free choices and healthy decisions when related to their sexual life. ICPD has impacted
positively in many of the signatories countries and they have adapted the Program of Action
depending on their geopolitical and socio-cultural environments. The following section will analyse
its impact in Ecuador.
1.2 ICPD impact in Ecuador
The International Conference of Population and Development Program of Action had echoed
worldwide and Ecuador was not an exception. From 1994 until now Ecuador has reached
significant progress in terms of sexual and reproductive health of men and women (ENDEMAIN
1987; 2004).
Ecuador has successfully ratified several international agreements within which the current policies
are set such as the Convention of Belem do Pará 1994, the Committee on the Elimination of
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Discrimination against Women (CEDAW) 1996, and the Population and Development Action of
Plan Cairo 1994, the Millennium Development Declaration 2000, Ecuador right based Constitution
2008, the International Convention of Children Rights 1990, and Childhood and Adolescents Code
2003. All these agreements are favouring public health and social issues related to reproductive
health from child to adulthood. The promotion of the adolescents´ sexual and reproductive rights
has flourished in the past years with the leadership of the Ministry of Health. However, the UN
Committee for the Rights of Children has expressed concern regarding the high prevalence of
adolescent pregnancy due to lack of access to health and education services (Goicolea et al. et al,
2010). For this reason, Ecuador and 6 other Andean countries signed in 2007 the 5-year Andean
Plan for Adolescent Pregnancy Prevention. This is the key to understanding where the country
stands currently in terms of social policies.
One of the greatest inputs of the current administration of Rafael Correa 2 government was the 2008
Constitution which recognizes and guarantees sexual and reproductive rights related to a dignified
life as well as the access to health care and a life free of violence. It also recognizes the right to take
free, informed, responsible and voluntary decisions related to sexuality, life and sexual orientation.
Based on this statement, is that the National Strategy for the Family Planning and Teenage
Pregnancy Prevention, (ENIPLA for its acronym in Spanish) was launched successfully in 2010.
And finally, in 2013 with a Ministerial agreement on access and availability of contraception
methods in the health care system, it guarantees the access for every person despite their age,
ethnicity, sex, and gender to free acquisition of any contraception methods and information related
to the given family planning program (Ministerial Agreement 2490, 2013).
1.3 Research focus
As it was mentioned above, education has long been a crucial factor at the moment of determining
2 Rafael Correa is the President of Ecuador. He was first elected in 2006. In the 2013 general election Correa
was elected President for a third time with 57% of the vote. Correa was a close ally of the late President Hugo Chavez
of Venezuela and is firmly in South America's leftist bloc.
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the influence of women's childbearing trends. Education has been assigned as a sustainable
determinant for fertility reduction as it is an indicator of socio economic development when
explaining the demographic and the fertility transition (Castro Martín and Juarez, 1995). Amartya
Sen as well has reminded us that strengthening human capabilities is the essential element to protect
population from poverty, and reach a more equitable access to the world benefits as well as
exercising humans´ freedom. Furthermore, he has defined that is not only necessary to have access
to education to reach freedom, but it is also necessary that humans´ environment is appropriate in
order for their capabilities to be potentiated (Sen, 1999).
Adolescence marks an important phase in human beings development. During this stage all the
physical, physiological and emotional changes are happening, as well as t the sexual interests and
arousal emerge as the body also faces its most drastic changes. It is consider a moment where
adolescents are building their personalities and their new gendered sexual relationships with others
(Dixon-Muller, 2007). Consequently, as adolescents are going through a process of transformation,
they face various risks as well. First, because their reproductive and immune systems are
biologically immature and therefore more vulnerable for STIs 3 and HIV transmission; in case a
pregnancy happens, their bodies are exposed to more problems than adult women. Moreover, there
are social factors such as relations of power that can influence girls and adolescents to become
sexually active without knowing the risks or even become victims of sexual abuse or submission.
For this reason, it has been placed in evidence that sex education programmes are considered a
cornerstone when promoting sexual health and decreasing adolescent risk behaviour. (Bearinger et
al, 2007).
In Latin America the educational gap has narrowed down since the 1970's and women's educational
attainment has increased rapidly. This means that the amount of educated women has raised and
consequently has affected positively the decline of fertility in this region (Weinberger et al., 1989).
In the case of Ecuador, the education gap has narrowed specially in the urban area, however there
3 Sexual Transmitted Infection

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are still some data that worries: for example the percentage of population from 10 to 17 years of age
that are currently not studying or with high schooling dropout rate (Ministry of Health of Ecuador,
2007). Moreover, unemployment and sub employment affects directly the adolescents and young
people who are normally not well paid, have no social security and could interact in less safe
environments.
Early marriage and teenage pregnancy are the two most common causes for adolescents´ school
dropout in Ecuador. Women who have not finished their education have less opportunities of future
labour and less income compared to educated women. A teenage pregnancy means in average 2.5
years less of schooling that a woman has (González, Rosada, Martín 2010). The increasing trend
rate of teenage pregnancy in women younger than 15 years has in the last decade been around 74%
whereas women older than 15 years of age are only 9%. In Ecuador according to the Census 2010, 2
out of 3 uneducated adolescents from 15 to 19 years old are already mothers or are pregnant for the
1st time. According to the Demographic Maternal and Child Health Survey 2004 (ENDEMAIN)
45% of the adolescents who got pregnant, had not studied nor worked before the pregnancy.
One could say that the data from the ENDEMAIN 2004 4 which includes women in their fertile and
reproductive age from 15 to 49 years old gives a somewhat clear view of the fertility trends that
occur in Ecuador. However, ENIPLA has identified that there is a high prevalence of girl’s
between10-14 years of age who are having early pregnancies and who are close to invisible in the
policy decision making. Moreover, very few academic analysis have been made related to the socio
economic and socio cultural factors that determine a trend in fertility in the age group from 10 to 14
years of age (UNFPA Ecuador, 2013). According to the 2010 population census, 4 out of 1000
women younger than 15 years old had had a first live birth. Taking into account that adolescents
who during the survey were 15-19 years old and reported a live birth in the previous 5 years, was
4 ENDEMAIN is the Demographic Maternal and Child Health Survey, for its acronym in Spanish, which is
based on the DHS questionnaire. The last ENDEMAIN Ecuador participated was in 2004.
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3.75% lower than the girls from 12 to14 years of age who reported a live birth at the moment of the
survey. 5
The focus of this research is to analyse the socio cultural factors that contribute to teenage
pregnancy in the age group of girls from 10 to 14 years old which has been invisible and why this is
considered a development problem in Ecuador.
1.4 Overall research aim and individual research objectives
The overall aim of this research is to advance in the understanding of the socio-cultural impact that
teenage pregnancy has in developing countries, but specially in Ecuador. It is important to analyse
how the social and gender structures affect sexual behaviours in young adolescents in rural and
urban areas and in education or non-educational environments. To comprehend these issues,
structural trends will help to understand why it is that despite fertility has decreased in the last
decades in Latin America, fertility in adolescents has not gone the same pace and has even
increased in some countries (CEPAL, 2007).
Furthermore, this research will assess what is the percentage of adolescents who have had a live
birth during their 10-14 years old using the data collected in the ENDEMAIN 2004, as this age
group was not considered as part of the survey. Lastly, two main research paths will be developed to
facilitate this paper: an in-depth review of the socio-cultural and socio-economic arguments
concerning the factors that affect adolescents in Latin America and in Ecuador and the analysis of
the empirical data. The section entitled Research Methods contains the details of both research
strategy and the data analysis. The objectives of this research are to:
1. Identify the factors that constitute adolescent pregnancy a development problem in Latin
America and its effects in Ecuador.
2. Evaluate critically theories and frameworks that justify adolescent pregnancy as a socio-
5 Ecuador's population Census 2010 takes only in account girls from 12 years old onwards to report live births.
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cultural problem.
3. Calculate based on the ENDEMAIN Survey the percentage of girls who have had a live
birth in the age group 10 to 14 years in 2004.
4. Elaborate recommendations for further policies on education and health highlighting the
importance of including young adolescent’s sexual and reproductive needs.
1.5 Research worth

This research will add value to this academic field firstly, because there have very few previous
studies relating socio-cultural factors of teenage pregnancy but in the 10-14 age group. Secondly, it
this experimental study will use the Mean Age at Childbearing formula using the ENDEMAIN
2004 data and not only using the census data to calculate the fertility rate in the age group (10-14
years old) which is not considered within the survey information.
Chapter 2: Issues and review of related literature
This literature review will examine the main issues concerning adolescent pregnancy in Latin
America and Ecuador. This review will focus on the research objectives 1 and 2. Whereas
objectives 3 and 4 will be analysed in chapter 3 y 4.
2.1 Why is adolescent pregnancy a development problem?
a) Cairo, paradigms shift for adolescents?

The International Conference of Population and Development held in Cairo was a cornerstone for
sexual and reproductive rights6. It was the first time that they were incorporated as part of the right
of health at international level (McIntosh and Frinkle, 1995). It was an important shift in the way
6 ICPD definition of Reproductive health: is a state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity??, in all matters relating to the reproductive system and to its functions and
processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that
they have the capability to reproduce and the freedom to decide if, when and how often to do so ”.(Glaiser et al., 2006)
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reproductive health was grasped and it left behind the notion of thinking health as a group of
separate policies. Health now had a different approach and moved toward the promotion of
individuals´ capabilities to make informed decisions of their bodies and sexuality. (Goicolea et al. et
al, 2010). As well as including the sexual and reproductive rights concept as an integrated recipe
that incorporated family planning, maternal health, prevention of STIs and HIV, violence against
women and sexual violence. Thus, this right means placing the individual as the main decision
maker regarding the social determinants of reproductive and sexual health (Goicolea et al. et al,
2010).
The main input of Cairo was a Programme of Action for the next 20 years which also referred to
adolescents and their sexual and reproductive health needs that have to be met, for example
unwanted pregnancies, unsafe abortion, STI and HIV prevention. In Cairo, governments designated
adolescents as a priority group, mainly because in developing countries the youth group comprises
the majority of the population (M Haslegrave, 2004). Reducing adolescent pregnancy not only
implies a reduction in population growth, but it will also undoubtedly break the poverty cycle.
Consequently the efforts in improving adolescents´ healthy life will be considered an investment on
further education and greater access to labour market in the future (Bearinger et al, 2007).
Progress has been made after Cairo by including in health and education policies the need for access
of services but also by including sex education programmes as part of the curricula (Kirby, 2002,
Guttmacher Institute, 2013). However, the process of advancing on giving adolescents the right of
decision over their sexual behaviour has been hampered by conservative elements intrinsic to the
social and cultural context (M Haslegrave, 2004). Consequently the access for adolescents to
pertinent services and counselling have been blocked or denied. Despite the big advances gained in
Cairo as one of FFP7 head officers stated “we have succeeded beyond our wildest dreams”, some
aspects such as abortion were reiterated as non-family planning methods. Unsafe abortion is most
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prevalent in developing countries and is common among young women; 41% of unsafe abortions
occur among women aged 15–24 (Guttmacher Institute, 2012). Moreover, evidence shows that
unsafe abortion and unintended pregnancies, especially in adolescent women, are related to violence
and sexual abuse. Showing as well that of “145 developing countries, abortion was not permitted
for rape or incest in 101 countries, for fetal impairment in 108, and for economic or social reasons
in 118 countries” (Goodwin et al., 2000).
A common mistake that policy makers do when dealing with adolescent matters, is to categorize
them as a homogeneous group. WHO has divided different age groups due to their needs, interests
and behaviours may vary widely in between this ages: Young adolescents: 10–14 years old;
Adolescents: 10–19 years old ; Young people: 10–24 years old; Youth: 15–24 years old; Young
adults: 20–24 years old,. Successful programmes are the ones that manage to integrate sexual and
reproductive health care into primary health services as a mainstream program and not as a separate
component (Haslegrave, 2004), and by taking into consideration the differences and demands of
this complex group.
Cairo is considered a paradigm shift, not only because it seeks and ensures the sexual and
reproductive health needs for girls and women of all ages during their life and reproductive cycles,
regardless their marital status, sexual behaviour and the purposes of their sexual interactions
(Germain et al, 1994), but also because unlike previous population conferences, it reflected the
“growing awareness that population, poverty, health, education, patterns of production and
consumption, and the environment are all inextricably linked” (Glaise et al., 2006). However, there
do exist incoherence in the UN speech between ICPD and the Millennium Development Goals
(MDGs) due to the fact that there is not a specific goal related to neither sexual and reproductive
health nor teen pregnancy prevention. (Glaiser, 2006). It would have been a key element for
ensuring the achievement of the MDGs as for mobilizing resources and political will. Unfortunately
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sexual and reproductive rights (SRH) have been adhered to other MDGs such as the HIV/AIDS
prevention as a subcomponent (Bearinger et al., 2007).
b) Adolescent a complex target: why are they more vulnerable than others?
Etymologically the word adolescence comes from the latin adolescere which means to grow.
Misguidedly adolescence has been socially constructed as a problematic stage in life, which
requires control and surveillance from adults and thus, limits the dialogue and mutual understanding
between adults and young people. By seeing adolescence as a problem will only increase the
stigmatization of the risks they face when they lack information and appropriate sex education
(Hopenhayn, 2006).
Adolescence has long been thought as problematic stage, where problematic behaviours occur. And
this socially incorrect behaviour is the one that opens up to risks such as STIs and unintended
pregnancies accompanied by other factors such as substance consumption and delinquency (CT
Tucker Halpern, 2010). Besides the psychological changes there are the physical changes that make
adolescents more vulnerable. It all starts out wrong when thinking that the first menstruation is a
signal for women to be prepared for sexual intercourse or even pregnancy. But also because “[a]
girl's skeletal and muscular growth is still incomplete, and gains in height and weight, the full
development of the pelvis, breasts, and uterus, and the maturation and lubrication of the cervix and
vagina occur mostly after menstruation begins” (Dixon-Muller, 2007). That is why they are more
vulnerable of maternal health during pregnancy, and “adolescent sexuality has always been seen as
a problem especially because its undesirability is primarily a function of age and assumed
immaturity, rather than intrinsic and inevitable health risk” (Tucker Halpern, 2010).
Conceptualizing adolescence as a biosocial development of a human being could be limiting.
Despite the various changes adolescents face during this stage, it is fundamental to understand that
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the body is the space where the identity is built from an individual perspective but influenced by
territorial and socio-cultural externalities. That is why the body is a space of identity construction
which starts in the adolescence. Bodies become “the most immediate and delicate scale of politics
and markers of gender and national identity” (Hyndman and De Alwis 2004). Bodies seen from this
perspective represent adolescent’s everyday life and therefore their behaviour universe. Thus, by
approaching the adolescence needs, it is imperative to understand their demands and listen to their
voices.
As it was previously mentioned when analysing sexual and reproductive rights, we are inevitably
talking about sexual behaviour which is determined by a specific context (Desmond et al., 2005).
Thus, given that many adolescents start their sexual live during this stage of life, it is crucial to
deliver comprehensive and pertinent information about sexuality, family planning methods,
relationships and physical changes, ideally before age 15 (Guttmacher Institute, 2012) when the
questioning starts. Evidence has demonstrated the existence of high level of unplanned births
among adolescents especially in developing countries which stresses the urgent need of
contraception. Studies have shown that adolescents have an unmet need for the access to quality
services for contraception and family planning methods. Approaching to adolescents with
appropriate information should not limit only to accessing contraception, it also does not ensure that
they will use or use it properly.
According to UNFPA (2007), the lack of education is a key factor predisposing adolescents to
pregnancy. Recent research shows that girl adolescents who are enrolled in school are less likely to
ever have had sex. Moreover, female students are more likely to use contraception if they are in-
school than students with no education who are more likely to become pregnant (Lloyd, 2006;
Westoff, 2003). As Kirby (2002) concludes that even though youth have gained the knowledge and
skills regarding contraception, this might not be enough motivation to avoid pregnancy. Others may
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lack the knowledge and skills but will have connections with adults or will have a belief in the
future and thus avoid pregnancy. Kirby states that it is necessary to first determine the reasons for
their sexual risk-taking behaviour and then create an appropriate educational program. This as a
whole will support adolescents to make autonomous and healthy decisions regarding their well-
being and promote more equitable relationships.
2.2 Adolescent pregnancy a socio-cultural problematic
a) Adolescent fertility in Latin America and Ecuador

During the 1970s, the fertility rate in Latin America and Caribbean decreased strongly (CEPAL,
2007). There were various factors that affected this phenomenon: socioeconomic factors such as
industrialization, urbanization, modernization; cultural factors such as the secularization of values,
individual life projects, new family live styles, gender advances, labour insertion and social
visibility, as well as technological progress, especially when talking about contraception. In certain
countries this process has been supported by several policies and campaigns in favour of family
planning. It has also contributed to spreading the ideas of reproductive health improvement,
especially for women.
Within this context, the fertility rate has decreased. This occurred particularly in generations where
the fertility rate had been high, and this trend continued with a drastic drop down until the late
1980s. However, the fertility rate in groups below the age of 20 has advanced in a different pace.
First it was influenced by the regional decrease but once it reached a low point in the 90s, it has
started to go up again (CEPAL, 2007). In all the Latin American and Caribbean countries the
adolescent fertility rate has declined between 2000 and 2010. Yet the decreases differed
substantially from one country to the next. Markedly, the four countries with the highest adolescent
fertility rate (Nicaragua, the Dominican Republic, Guatemala and Honduras) reported the same in
2000 and in 2010. Colombia, Haiti, Costa Rica, El Salvador and Peru have a higher reduction in the
adolescent fertility rate. Whereas, the Dominican Republic, Ecuador and Venezuela still are
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considered by having the highest rate of adolescent pregnancy in the whole region (CEPAL, 2007).
Graph 1:
As it is shown in the preceding table (Graph 1), all the countries in the region have increased
adolescent pregnancy rates (except Belize, Guatemala, Nicaragua and Paraguay). Comparing the
data from the census 1999 and 2001, Ecuador has decreased adolescent pregnancies only in the 15
age group but increased in the rest of 16-19 age group (CEPAL, 2007).
This shows a barrier to the fertility decrease in adolescents, which has positioned the Latin
American region as a particular and unique case. On one hand, Latin America presents a globally
low fertility average rate compared to some developed countries. On the other hand, it shows
adolescent fertility trends that exceed the global average, and which are only are lower compared to
Africa. (CEPAL, 2007) This imply both political and cultural implications such as earlier sexual
initiation for adolescents and young people, the lack of sexual education in the education system as
well as weak policies concerning sexual and reproductive health for adolescents and adult women.
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Graph 1: Selected Countries from Latin America and the Caribbean: evolution of the proportion of women 15-19 years
old who have had live births by individual age. Retrieved from: CEPAL, 2007
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In addition to these factors, the increase of women population aged 15-19 has affected the fertility
rate from 8,5% 60 years ago to 18,5% nowadays. High fertility is also a consequence of poverty,
thus, adolescents and young people will adapt to enter at early stages in their lives to the workforce
instead of attending school (Villa and Gon le , 2004). On the contrary, fertility in above age
groups (20-24 year olds) has decreased due to the impact of contraceptive use, more access to
education, a women’s access to the labour market and the cultural pattern changes which have an
influence over personal decisions (CEPAL, 2007).
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As it is shown in the graph on the left CEPAL (2007) concludes arguing that the fertility rate in the
Latin American region will continue to decrease due to the effects of the demographic transition. By
2040 there will be less people younger than 15 years old and more who are older than 65 years, and
this will modify the population pyramids. However, due to the historically high fertility rate in Latin
America as well as acknowledging that the vast majority of the population are young (16,5% of
the total population is young); the population will
grow in the next years, and consequently, teenage
pregnancy will stall or increase in certain countries
where the youth population is higher. These
projections should be addressed with increasing
policies of sexual and reproductive rights policies for
the most vulnerable groups in the region.
According to Fl re and N e (2001) the raise in teenage pregnancy varies across the different age
groups. In the report it is observed that fertility in the region has decline in the mid-1990s onwards;
however teenage pregnancy has not gone the same pace as the general fertility rates. Therefore in
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Graph 2 : TFR in Latin America by age of mother in selected years. Retrieved from CEPAL, 2007.
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some countries “... it has stayed practically constant, while in others it has declined, though less
than fertility among older women. In other countries, fertility may have increased.” (Flore and
Nunez, 2001, pp.8). According to the last 2010 Census in Ecuador, 1% of the girls in the 10-14 age
groups had a live birth in 2010. This indicates that about 2,080 girls out of the total adolescent
population (346,700) had already become mothers. Notably, teenage fertility rate in young
adolescents has increased in the last 10 years. The total prevalence of the adolescent fertility rate in
2010 in Ecuador has reached 17.2% compared to 16.5% in 2004 (World Bank, 2012; ENDEMAIN,
2004).
This preoccupying situation has called the attention of the Ecuadorean government and the civil
society. Based on this evidence, the Ministry of Health, Education and Economic and Social
Inclusion (MIES) joined the Social Sector Coordinating Ministry and the Secretariat for
Immigration Affairs in order to create the National Strategy for Family Planning and Adolescent
Pregnancy (ENIPLA - for its acronym in Spanish).
The fertility rates in Ecuador have decreased in the last decades; however going into greater detail,
these trends vary depending on the socio-economic, cultural background and education access of
the different groups. Ecuador has a fairly high fertility rate in adolescents (81.45 births per 1,000
women age 15-19, Census 2010). A persistent problem is the high teenage pregnancy fertility
despite the improvements in education and health services. Total fertility rates in Ecuador have
decreased from 4.2 in 1987 to 2.2 in 2010 (DHS data, Stat compiler 10). Based on this opposed
trends, that is the total fertility rate (TFR) decreasing versus persistent high teenage pregnancy, the
World Bank concludes that fertility is moving towards younger age groups. Similarly to CEPALs
(2007) argument stating that the amount of population aged 15-19 is high due to historical high
fertility adolescent pregnancy, and has not declined at the same pace as the regional fertility rates. In
Ecuador this is clearly shown that teenage pregnancy has amounted from 14% in 1987 to 16.5% in
10
The MEASURE DHS STAT compiler allows users to make custom tables based on hundreds of demographic and
health indicators across more than 70 countries. Customize tables to view indicators by background characteristics,
over time, and across countries. Retrieved from: http://www.statcompiler.com/
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2004 and 17.2% in 2010 (ENDEMAIN, 2004; INEC, 2010).
The decrease in the fertility rate in Ecuador as mentioned is to be linked to the number of preferred
children a woman wants. This is indicated at all levels of education and it is attributed the crisis
that countries in Latin America faced in the 70s and 80s. Consequently, the cost of life as well as the
costs and returns of having children increased, and thus, the amount of desired children declined.
Because of the economic factor, the decline in educational differentials plays a minor role when
showing the overall shift towards a decrease in the fertility rate (Weinberger et al., 1989). So these 2
components: economic stagnation and narrowing of educational differentials have both affected in a
positive way to a rapid decline in the Latin American total fertility rate.
b) Education and fertility in adolescents in Ecuador
Markedly there are still differences among the socio-economic context, the ethnicity and the
educational attainment indicators, and they continuously influence the fertility trends in Latin
America (CEPAL, 2007). As it was mentioned previously in this study, according to Castro Martin
and Juarez (1995), the educational impact has not been automatically included as a demographic
indicator, or as a reproductive behaviour cornerstone. At the macro-social level, education is used as
an indicator of socio economic development, which has also been used to measure demographic and
fertility transition structural changes. An effect of the transition is the reduction of fertility at a
regional level in Latin America based on the evidence shown in the ENDEMAIN 1987 and 2004.
This is related to the increasing education attainment in Latin America, and especially in Ecuador,
where the years of schooling indicator has increased approximately 2 years between the 2 surveys
from1987 to 2004. This shows an intrinsically education-fertility relationship which is common
throughout the region, and has also impacted positively on the Ecuadorean TFR from 4.2 in 1987
to 2.2 in 2010 (World Bank, 2012).
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Latin America is a highly polarized region, and so is Ecuador. Here diverse social groups present
very different reproductive patterns, and poorly educated women have high fertility levels, whereas
more educated women will have 2 or 3 children (similar to more developed countries). However,
when analysing the desired family size, the data reveals that despite the years of schooling a woman
has the results of reproductive desire do not differ much. Fertility norms are similar and are usually
following a similar pattern, yet poorly educated woman are less successful in achieving smaller
families (Castro Martin and Juarez, 1995). In Ecuador, meanwhile fertility started to decline in the
1970s and 1980s as a result of narrowing down the gap between educated and uneducated women,
it also showed that women with more than 7 years of education were to marrying later, having less
children and the years of childbearing were fewer as well. Improvements in education alone would
explain 40-67 per cent of the fertility decline if there had been no change in behaviour within the
education groups (Weinberger et al., 1989).
The education experiences have shown that it has a long term impact on women's lives as a path to
knowledge and future labour opportunities and thus, will strengthen their economic and social
aspirations. Moreover it will shape women's role in society, their attitudes and personal choices.
Hence, having an appropriate sexual education not only depends on the contents taught but also
includes, as it has been called by theorists, a “hidden curricula” (i.e.: teaching methods, evaluation
criteria and social relationship). This is what influences adolescents and youth to take appropriate
decisions towards their sexuality, although having the knowledge does not necessarily means that
they will have the motivation to avoid a pregnancy (Kirk, 2002).
“If access to education is not truly universal, schools may be merely legitimizing the existing social
status quo instead of promoting individual advancement and societal change” (Castro Martin and
Juarez, 1995, pp.57). The role of education would be socially transformative that would encourage a
deep social change and therefore changes in individual behaviour. It will have a positive effect on
human sexuality and consequently; the current 43% of women adolescents with low education level
in Ecuador, who are pregnant for the first time, would be much lower nowadays (ENDEMAIN,
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2004).
Another counter argument is held by the World Bank Report about teenage pregnancy in Latin
America (2012): it states that in both developed and developing countries, evidence shows a
negative association related to the education and fertility relationship due to the slight variation of
reproductive patterns according to the education attainment of women. This could also be
associated with the belief of adolescents concerning their education: it may not change their future
so they take short term decisions, such as early motherhood. Data collected from DHS for Bolivia,
Colombia, the Dominican Republic, Haiti and Peru showed that the fertility rate increased at the
end of primary or secondary education periods. This has two interpretations: either adolescents are
planning to become pregnant when succeeding a schooling period or it is staying that when
attending school, it reduces the chances of early childbearing (World Bank, 2012).
N slund-Hadley and Binstock (2010) argue similarly after a study that was conducted in Peru and
Paraguay on a group of adolescent mothers. One of the results was that the women believed that
education was never a factor they thought could improve their opportunities in the future. They
would have dropped out of school anyways despite the fact they were pregnant or not. So the
opportunity cost of childbearing for this group of people is still low and as the authors alleged that
low levels of schooling in girls makes pregnancy not a coincidence, but a ration choice. Similarly to
Naslund-Hadly and Binstock, Ishida et al. (2009) argue that education has only made small
differences in current fertility trends in Ecuador. They came to the conclusion that education has not
been a determinant factor for fertility decreasing in Ecuador: the only significant decline in TFR
was for those who had 0–5 years of schooling (from 5.7 births in 1994 to 4.9 births in 2004).
Women with higher education showed almost no decline throughout their schooling period: The
fertility level stabilized at 4.0 births for women with 6 years of schooling, at 3.0 births for those
with 7 up to 11 years of education and 2.4 births for those women with 12 onwards years of
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education (Ishida et al., 2009). However, this clearly shows that from 2.4 births to 4.0 there is a
marked difference influences by the access to education.
c) Adolescent pregnancy: a gender-based issue in Ecuador
It is inevitable not to talk about sexual behaviour when analysing sexual and reproductive rights
based on a specific context (Desmond et al., 2005). The sexual behaviour and fertility decisions that
adolescents make are affected by different factors as gender which is “[...] produced and
reproduced by individuals through social relations, and at the institutional and macro social level.
Gender is not a fixed concept, but is always under construction through action and practice”
(Goicolea et al. et al, 2010, pp.54).
Poverty is another high risk factor of adolescent pregnancy in Ecuador since social and economic
factors are beyond their control. It is a proof of how social and political factors affect young
adolescents sexual and reproductive lives. Adolescents who have lived in poor contexts, are more
likely to have less opportunities for future attainment both educational and in the labour market
(Guijarro et al., 1999; Goicolea et al. et al, 2009).
These above mentioned factors (gender and poverty) are the main drivers when adolescents take
decisions related to their sexuality. When talking about decision making, we are also referring to the
HBM (Health Belief Model), which arises from the work of the health system in the US in 1950.
The HBM has been included in theories concerning the analysis of socio-cognitive factors related to
health, as well as being applied in safe sex practices. In this sense, it is not appropriate only to focus
on the decision of the person to prevent risks, it is also crucial to take into account the complexity of
the all the aspects that involve change in habits, and specifically; the decision of having safe sex
(Juarez and Gayet, 2005).
There are some elements that affect the decision-making process of an adolescent when starting an
active sexual life such as: the rational decision related to fertility itself, the behavioural issues that
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promote a specific rational setting (I.e.: self-control, information), and the social relationships (peer
pressure). The interaction of these three elements will affect the final decision related to sexual
reproductive behaviour. All these factors will also be influenced by the macro context: the socio
cultural and socio economic context which will determine the outcome of an adolescent long term
plans (World Bank, 2012). These factors will promote young adolescent girls to have the possibility
of agency which means that are able to make their own decisions. However this is influenced by
gender structures of the environment and the time in which they have to make their decisions. These
gender structures are normally operated by institutions such as the family or school, which mostly
determine the gender norms and order (Connell, 1987). Family is one of the most influential
institutions in the lives of human being especially for adolescents as they are building their lives and
personalities. Guijarro et al. (1999) shows that early separation of parents and parents initiating
relationships with new partners cause early sexual activity, unwanted pregnancy, and a more
liberal sexual behaviour of teenagers in Ecuador. The risk increases when both parents are absent in
the family and will drive the young adolescent to encounter a parental figure by becoming a parent
at early age themselves. Adolescents need a protective figure more than they need an actual
traditional family structure (mother, father and children). When a parent figure is absent in their
lives the risk of early pregnancy increases for the same reason stated before. Without question,
family is considered as a structural unit in the Ecuadorean society and its appropriate function (this
does not necessarily refer to the traditionally family structure) promotes the well-being and healthy
development of all its members (Guijarro et al., 1999).
For this reason, the freedom of choice a young adolescent girl has over having safe and protected
sex will depend of her family environment, the power she has to decide the partner, whether she
chooses to have sex with as well as the capability to negotiate a contraceptive method, which is also
determined by the family environment she lives in. Taking into account that many cases of abuse
happen within the same household, implies a potential imbalance of abuse of power and age, and in
some contexts has been categorized as a socially accepted event. But at the same time, it is
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something that is not talked about or mentioned openly and thus, it is not denounced to authorities
as a violent abuse.
Goicolea et al. et al. (2010) conducted a study in the Amazon basin in Ecuador, which analysed the
“interpretative repertoires”11. This analysis was done with the purpose to discover what were the
speeches related to sexuality, which can be variable and inconsistent affected by the everyday
discourses. Very interesting results came out of this study that took place in the amazon basin in
Ecuador: 1) The “sex is not fun repertoire”: this is relating to the discourse that sexual intercourse is
dangerous because of the use adolescents can make of it, if its openly discussed, adolescents can
misuse it or overuse it (sex). This is contradictory since the Ecuadorean government is currently
trying to transform sexual and reproductive health with access for everyone despite their ethnic,
gender or age condition. This “sex is not fun” speech is also contradictory regarding contraceptive
use and the counselling to adolescents related to the sexual and reproductive needs when it is trying
to implement abstinence-only education and prevention throughout fear. This implicates biased
information which is counterproductive, and leads to the second finding: 2) The “gendered -
sexuality and parenthood” which reduces girls´ and adolescents´ freedom to have e safe sex and
instead promotes submissive, dependent and obedient attitudes. These behavioural norms are a
result of the machismo-marianismo system commonly seen in Latin America which encapsulates
women as sexually uninterested and responsible mothers, whereas men are constructed as sexually
driven and unreliable (Goicolea et al. et al, 2010). All these factors intertwine at the moment when
adolescent women decide “freely” over their sexual and reproductive needs.
Making the wrong decision could end in a possible unsafe abortion as a result of the stigma of being
pregnant without a partner or because pregnancy is the result of an abusive sexual relationship. In
Ecuador abortion is only legal, according to the Penal Code, when the life and health of the mother
are at risk, and when pregnancy is due to rape of mentally disabled women. This disables
11
Interpretative repertoires: refer to the meanings that people use to construct their arguments to any action they take
which in other words are blocks for manufacturing versions of actions based on individual and social structures.
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adolescents´ and adult women´s freedom and right to choose upon continuing or terminating an
unwanted pregnancy, and simultaneously “addressing motherhood as women's natural and
responsibility” (Goicolea et al. et al, 2010 pp. 9).
Graph 3:
12
When referring to sexual behaviour as it can be seen in the Graph 3 the decision making is a process
determined by a context (Desmond et al.,2005) the point of interest is not the individual decision
making but the interaction in itself. Since individuals become part of interactive situation with
expectations, plans, stories and desires, these factors have to be taken into account when analysing
the causes of the behaviours and decision making related to people´s sexual and reproductive lives.
The result is what is going to matter since it refers to the real action of making safe sex decisions
such as condom negotiation, relationship wishes and desires, and the context (Juarez and Gayet,
2005). When the first sexual intercourse is before age 15, and the couple is not using any type of
contraception, the risk of getting pregnant is very high, and thus, the need for having appropriate
health service focusing on the adolescents´ needs and information on the the different
contraceptive methods is imperative. Consequently, adolescents will have the freedom to choose
from a variety of methods but will also have the tools to negotiate with their partners the use and
future effectiveness of any contraceptive methods (Goicolea et al. et al, 2009). This will make a
12
Graph 3: Adolescent Fertility: a complex decision making process. Retrieved from: World Bank, 2012.
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significant impact on reducing pregnancy at early ages and ensures the right-based approach of the
public health services to access and use any contraceptive method for young adolescents.
On the other hand, there is also the emotional factor that highly determines early pregnancy cases:
that pregnancy sometimes is a way to demonstrate compromise to the partner in the relationship or
what is called prueba de amor (sign of love) and trust, which in other studies have shown as the
reason why adolescents the lack of use of contraception (SmithBattle, 2003).
Finally, it seems important to redefine teenage motherhood not only as a woman’s goal in life, but
as a conscious decision accompanied with appropriate information, sexual education, access to
health services, method information availability without discrimination or stigma. This will
encourage an open debate regarding reproductive and sexual rights but also abortion for young
adolescents as well as guarantee the importance of the state and local government to ensure that
girls and adolescents can manage early motherhood without having to give up their rights such as
education, freedom, leisure and future labour opportunities.
2.3 Literature review conclusion
The review of the literature identified when and why adolescents became part of the international
agenda, and the sociocultural factors that stress teenage pregnancy as a development problem in
Latin America and in Ecuador (UNFPA, 2012). It also addressed the reasons why fertility has
declined in Latin America due to an increase in educational attainment and higher access to
contraception, however fertility in adolescents has slightly decreased in some countries and in other
cases, such is the case of Ecuador, it has increased in the past decades. Since the 1970s, Ecuador has
experienced an increment in access to education at all levels, and this has had an impact in general
on the fertility reduction. On the other hand, teenage fertility has increased due to the historically
high fertility rates in Ecuador and in Latin America; as a result of the amount of youth population
has grown larger.
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Moreover, the machismo-marianismo norms as a gender structure and system, have determined
women as sexually uninterested and child bearers, whereas men have been constructed as sexually
driven and the decision makers for women’s sexuality, and thus addressing an unequal relationship
between men and women. Adolescents’ women have been victims of power abuse by older men and
have had to proof their love by not taking appropriate decisions over contraceptive use in the first
sexual encounter which puts them in higher risk of an early pregnancy or STI infection.
Additionally to these findings, it is evident to the literature review analysis, that the majority of the
studies on the topic do not focus on young adolescents´ pregnancies or health risks related to their
sexual and reproductive needs. This is related to the third research objective of this study:
[c]alculate, based on the ENDEMAIN Survey, the percentage of girls who have had a live birth in
the age group 10 to 14 years 2004 in Ecuador. This will be analysed in greater detail in the next
chapter on Research Methods, which will attempt to find out, how many young adolescents from
the 10-14 age group had a live birth in Ecuador had based on the information collected in the
ENDEMAIN survey 2004 by using the MACB (Mean Age at Child Bearing formula). With these
results, more accurate data will assist to make visible their current underestimated needs, which
now appear mostly invisible.
Chapter 3: Research methods
3.1 Introduction:
This research study has four inter-connected objectives within the context of adolescent pregnancy
in Ecuador. An important aspect to this research study relates to the objective 3: to calculate the
current mean age of adolescent mothers at birth of their children, and to determine the percentage
of mothers who correspond to the age group 10 to 14 years. Furthermore, it is analysed how
proximate determinants (Bongaarts, 1978) affect adolescent pregnancies in Ecuador based on the
information from the ENDEMAIN 2004.
Chapter 2 identified the socio cultural factors that affect teenage pregnancy and its effects in terms
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of education and gender structures. Another finding from the Literature Review was the gap of
information related to young adolescents (10 – 14 years old). Data is commonly analysed starting
from the following age group (15-19 years old), since fertility trends are analysed primarily on
women in their reproductive live from 15-49 years of age.
A central contribution to this research work will be the analysis of the ENDEMAIN 2004 data on
how to calculate the Mean Age at Childbearing using SPSS13 for the age group 10 – 14 years.
Thus, this research is moving one step forward when taking into account the analysis of secondary
data from ENDEMAIN 2004 developed by CEPAR14, which is the last complete population survey
taken place in Ecuador based on the DHS questionnaires. The survey was performed in 10,814
households in Ecuador, and 24,696 women who were in the reproductive stage within those
households.
This section – Research Methods – will provide the details of the analysis taken into account when
calculating the Mean Age at Childbearing (MACB), which will provide accurate data in order to
know: how many girls in the age of 10 to14 year have already had their first live birth (based on the
Age Specific Fertility Rate15 of 2004). After defining the MACB, it will combine certain variables
used within the data collection from the ENDEMAIN data set.
3.2 Research Strategy

The overall research strategy of this study is an experimental analysis based on a demographic
survey. The survey used is the latest ENDEMAIN (Demographic Maternal and Child Health
Survey) developed in Ecuador in 2004. It was used an individual questionnaire for women in their
fertile stage who is identified in each household.16 The main objective of this demographic survey is
13 Statistical Package for Social Sciences

14 Centre of Studies of Population and Social Development.
15 The number of births occurring during a given year or reference period per 1,000 women of reproductive age
classified in single-or five-year age groups.
16 ENDEMAIN 2004 interviewees were selected from 19 provinces 10 from the Sierra and 5 from the Coastal part and
the main cities Quito and Guayaquil. The areas were selected based on the census from 2001 stratification. For the
individual women questionnaire analyses: reproductive background, health during childhood, maternal health services,
family planning, reproductive preferences, nuptuality, violence against women, sexual transmitted diseases, HIV/AIDS,
maternal mortality, educational attainment and anthropometry.
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to obtain updated and disaggregated information related to the demographic dynamic and the state
of health of mothers and children. This will be used to diagnose the current situation of policies and
programmes related to population and sexual and reproductive health. Moreover, it analyses in
depth the levels, trends and differentials of fertility, infant and maternal mortality, as well as sexual
and reproductive health of women in Ecuador in a determined moment in time. ENDEMAIN based
on the Demographic and Household Survey collects information usually every 5 years, which gives
a periodical update of data from sexual reproductive health (SRH) on topics such as: child health,
domestic violence, education, and family planning, fertility and fertility preferences, HIV/AIDS
among others.
The purpose of using ENDEMAIN 2004 is first of all because it is the latest survey specifically
dedicated to sexual and reproductive health issues and demography. Secondly, because it has a
disaggregated data base focused on all women from the households interviewed, who are in their
reproductive age 15-49 (since data below 15 years of age is not included in the demographic
surveys). Finally, this survey has its information based on 5 age groups, which facilitates the
calculation of Age Specific Fertility Rate (ASFR). The ASFR calculates the number of births
occurring during a given year or reference period per 1,000 women in the reproductive age
classified in single or five-year age groups. (MEASURE17) is one of the components of the formula
to calculate the Mean Age at Childbearing:
MACB= ∑xi * ASFRi

∑ASFRi
Explanation of the MACB formula:
The use of xi is the mid-point for each year interval, and it is used since it takes into account 5 age
groups where it is assumed that the fertility rate is distributed equally. It is necessary to make this
assumption since the survey does not provide data for individual single year ages. .The Age Specific
17 Retrieved from: http://www.measuredhs.com/What-We-Do/Survey-Types/DHS.cfm

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Fertility Rate (ASFR) is used to calculate the fertility rate in the same country over a certain time,
but also as to calculate in between countries. The ASFR is used for women, whose age corresponds
to an age group of which xi is the mid-point. In this case, it is used to compare ASFR between
different age groups, which will include the ASFR of the age group 10-14 years. This is not
included in the ENDEMAIN data or in the Stat Compiler. So this study will include ASFR from the
age group 10-14 years instead of starting with the 15-19 year old group, which is normally used to
calculate MACB. The total sum of the numerator (∑ xi * ASFRi) will be divided by the
denominator, and will be the sum of ASFR for each of the age groups, who are in their reproductive
age stage (including the adolescent age groups 10-14). The result of this calculation will be the
mean age of mothers at the birth of their children if these women were subject of analysis during
their lives to the ASFR, and observed in a specific year (UN data18)
It is also important to explain the calculation for the ASFR since this one is not included in the
analysis of the survey ENDEMAIN 2004 for the young adolescents group. To define ASFR (10-14),
it is necessary to identify all the women who, when participated in the survey in 2004, had already a
live birth 5 years before, meaning: when they were in the young adolescent age group. By using this
information, it will be defined how many births they had, when they were before than 15 years of
age , and then divided by the females aged x at mid-year then multiply by 1,00019.
ASFR formula:
ASFR= Bx
Fx
In the next sub section of this Chapter 3, it will be explained how the data was collected to elaborate
this analysis.
3.3 Data collection

This research is divided into 2 parts related to teenage pregnancy: first, it focuses on a theoretical
framework showing the socio cultural factors, which affect early pregnancies as a development
18 Retrieved from: http://www.un.org/esa/population/publications/WFD%202008/Metadata/MACB.html

19 All rates are multiply by 1,000 to calculate how many out of 1,000 people have that specific characteristic.
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problem; secondly, it will estimate the mean age at childbearing for young adolescents of whom,
there is a lack of analysis referring to early childbearing in Ecuador and its social implications. In
this section, it will be discussed how the data was collected to analyse the second/quantitative part
of this study.
Qualitative data will be mainly obtained from a secondary source which is the ENDEMAIN survey
2004, and the following aspects will be identified from it:
5. From the second section of the survey (which is focused on analysing the fertility trends of
all the women within their reproductive life) by using SPSS, cases will only be selected that
fit the following conditions:
being a woman aged 15 up to 19 years , who have had a live birth until the moment of
the survey
and
have had the first live birth between 1999 and 2004
2. It will be computed this target population to the following variables within the survey:
 highest education level  marital status
 currently studying  children currently alive
 live in rural/urban area  currently pregnant
 births before 1999  ever studied
The data collected, after extracting these cases, was 382 adolescents from 15 up to 19 years old. Of
these, 43 had had at least one live birth from 1999 to 2004, and 22 out of these 43 girls had more
than one birth before 1999. The rest of the variables combination will be analysed in the subsequent
Chapter 4, when discussing the results.

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To calculate the ASFR and MACB for the adolescent group, it will be necessary to compare and
contrast with the ASFR for the rest of the age groups until women who are 49 years old, and also
how MACB for the young adolescents group will affect the MACB when analysing only using data
from 15 to 49 years of age . To carry out this comparative analysis, the data will be collected from
Stat compiler, which is a tool that shows and combines the different variables from the DHS
questionnaires. For the rest of the data, it will be analysed and calculated using the data set from
ENDEMAIN 2004.
3.4 Framework for data analysis

To help focus on the adolescent group this research, the findings collected within ENDEMAIN
2004 will be connected with the literature review. For this purpose, the findings section will be
structured based on the 2nd research objective of this study: Evaluate critically theories and
frameworks that justify adolescent pregnancy as a socio cultural problem.
It will be structured by a) Fertility trends in young adolescent group; and b) Socio-cultural
factors of teenage pregnancy. Within this framework, the analysis will combine and contrast the
qualitative data to the quantitative information to strengthen the findings.
3.5 Limitations
Some limitations can be found while performing the calculations. When calculating the ASFR and
MACB using survey data concerning age misreporting, birth omissions, misreporting of the date of
birth of the child.
Chapter 4: Findings and Conclusions
This Chapter will start by revealing the results of the quantitative analysis described in the previous
Chapter Research Methods. The research will be concentrated on the young adolescent group who
was identified after using as a secondary data; the information was based on the ENDEMAIN
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survey 200420, where only the following e information on adolescent women was extracted: who
had had a live birth 5 years preceding the survey (meaning they had been in the 10 to 14 years old
age group when giving birth). Subsequently, this information was combined with other variables
such as education level and marital status to identify some of the socio cultural factors for
adolescent pregnancy as discussed in Chapter 2.
4.1 Findings and discussion

The analysis is structured in the following way: a) fertility trends in the young adolescent group;
and b) socio cultural factors of teenage pregnancy; each section will describe the results, analyse the
findings and perform an empirical discussion based on the Literature Review.
a) Fertility trends in the young adolescent group
1. Total fertility rate and Age Specific Fertility Rate in the adolescent group (15 – 19 years
of age) from 1987 to 2004
Results and discussion:
This part of the study refers to how fertility trends have changed from 1987 to 2004 in Ecuador.
Based on the ENDEMAIN 2004 data, the ASFR of young adolescents (10-14 years old) is 109.612
out of 1,000 women and thus higher than the 15- 19 years old adolescents. As it is shown in Graph
1 below, the trend starts slightly higher in the 10-14 years old, then decreases in among the 15-19
years old and then markedly increases in the higher age groups until it starts constantly to decline at
the older age groups.
Graph 1:
20
ENDEMAIN 2004 data is used since is the latest Demographic and Household Survey available in Ecuador
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Latin America is a special case when referring to the fertility trend, while the General Fertility Rate
(GFR) has decreased starting in the 1970s and 1980s, the youth age groups have now either stalled
or increased (CEPAL, 2007). The highest Total Fertility Rate (TFR) in Latin America are found in
Ecuador along with Dominican Republic and Venezuela. According to the Census 2010, Ecuador's
fertility rate among adolescents reached 17.2% (INEC, 2010) compared to 16.5% in 2004. This
shows an increase in the fertility rate among adolescents in less than a decade.
The graph indicates two important issues: 1) the noticeable gap in the age groups when using any
type of contraception method in the sexual relationships, much related to the limited access to
sexual and reproductive health services for young adolescents (Goicolea et al. et al, 2009); 2)
childbearing mostly happens in the age groups where marriage or being in a relationship are more
normal factors in women’s lives (age 20-34). Thus, in order to elaborate more appropriate policies
directed towards needs of the youth, the finding in Graph 1 shows that the youth group should be
divided into 10-14 years and 15-19 years, as the two groups differ in behaviour. The ASFR
calculation for the young adolescents group helped to evaluate the MACB21 for adolescents (10-19
year olds) and for the women in the fertile age (10-49 year olds), who participated in the 2004
survey that will be discussed further on this study.
21
Mean Age at Childbearing
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2. Mean Age at Childbearing in young adolescents
The MACB calculation including 10-14 year old girls gave interesting results to complement the
TFR in 2004.
Graph 2:
Once calculated the number of adolescents who gave live birth at least one time 5 years prior to the
survey (n=43), the number of girls who had more than one live birth until the moment of the survey
before 1999 (n=22) was included. Calculating the MACB only for the adolescents group resulted in
the mean age of mothers at the birth of their children, by using the age specific fertility rate of
adolescents in 2004, being 14 years old. When including the ASFR for young adolescents, it varied
the total MACB of the population and changed from 27 years to 25 years. This rate compared with
countries in the European Union countries, the MACB differed with 4.2 years in 2004. (EU
Statistics, 2013) 22. This result indicates that the majority of women, who had at least one child in
2004, were 25 years old.
3. Young adolescents currently pregnant (in 2004) and age of mothers at first birth
The following data is based on the cases selected in SPSS: the percentage of women who had their
first live birth in the 10 to 14 year old group. As it is shown in Graph 3 17% of all the adolescents
who participated in the survey had a live birth before the age of 15.
22 Retrieved from:
http://epp.eurostat.ec.europa.eu/tgm/table.dotab=table&init=1&plugin=1&language=en&pcode=tps00017
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Graph 3:
As well based on the same data analysis it could be identified how many women aged between 15
to 19 years old in 2004 were currently pregnant during the. As it is shown in Graph 4, 7% of the 15
to 19 year olds were currently pregnant at the moment of the survey. In order to carry out an age
group comparison in the reproductive trend of the 20-24 year olds, it shows a slight difference (9%),
exposing that women tend to get pregnant mostly in their 20s onwards due to giving birth during
marriage or in a relationship. However, if there was also included women with the same
characteristics but who as well had at least one live birth between 1999 and 2004 (n=3), it would
show that 0.8% of the total population analysed, were pregnant at the time of the survey. This
identifies that the possibilities of having more children than one t child before the age of 15 is not
high. One of the possible reasons for this, could be that it was not a decision to start an active
sexual live at earlier ages, and also that it was an “only-once” situation (abusive or not). Another
reason could be that these girls having given birth the first time before 15 years of age, are not
longer in a relationship (if they ever had any), or that they after the first birth decided to use a
contraceptive method to avoid pregnancy. Graph 4:
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At this point it is important to stress that the age of the first pregnancy influences future
reproductive patterns in terms of spacing future births or limiting the number of births in the future.
By using the identified data from the survey, as revealed in Graph 5, it is demonstrated that the
majority of the girls, who had at least one child as young adolescents, were 14 years old, which is
also shown with the MACB calculation. Moreover, out of these young adolescent mothers, 39% had
more than one live birth before the age of 14 years (Graph 5). This clearly shows a lack of
knowledge of the situations of risk and vulnerability of young girls, when having a birth so early in
life.
Graph 5:
b) Socio cultural factors of teenage pregnancy
4. Teenage pregnancy and ethnicity
As a result of the data analysis, it is evident that there is a lack of answers: for example whether
they live in a rural or urban area. There is a 96% of “missing information” in this question for the
adolescent group; from the total amount of young adolescents who were identified in the survey
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(n=65), only 2 of them answered this question. However, analysing in a broader way excluding the
missing answers, 2,3% live in rural areas and 1.5% live in urban areas. This puts into evidence two
things: 1) the majority of adolescent mothers live in rural areas and 2) this question has to be
reformulated for further surveys to ensure to have a more accurate answer and analysis.
However, based on the Census 2010, 63,5% of Ecuador's population live in rural areas, where there
is identified the highest percentage of ethnic minorities (Rural and poverty portal, 201323), this
being afro-descendants and indigenous communities. This indicates the vast majority of these
adolescents who had early live births, are either indigenous or afro-descendant adolescents. Since a
higher fertility rate in adolescent is a factor of poverty, it also limits the access to education and
labour market insertion in the future (Villa and Gonzales, 2004; Bearinger et al., 2007). Thus, the
poverty cycle has not been reduced in the last years in Ecuador since the amount of young
adolescents and adolescents having early pregnancies have increased (World Bank, 2012). Once the
capabilities of the youth population have been strengthened, it will protect them from poverty (Sen,
1999). On the next section, the impact of education on youth capabilities and its impact on teenage
pregnancies will be discussed.
5. Adolescents and young adolescents´ education level
Higher fertility rate for adolescents is also a factor of poverty, which increases the chances of
entering prematurely to the workforce in exchange of educational attainment (Villa and Gonzalez,
2004). This has already been shown in the results of how the ASFR, when calculating live births 5
years before for the adolescent group of 15-19 years, has increased in the last decades in Ecuador
(ASFR 15-19: 91 in 1987 and 100 in 2004). It also shows the direct relationship of teen pregnancy
and the never ending cycle of poverty (Bearinger et al., 2007). Education is well known as a
sustainable determinant for fertility reduction as an indicator of socio economic development
23 Retrieved from: http://www.ruralpovertyportal.org/country/home/tags/ecuador

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explained by the demographic and fertility transition (Juarez, 1995) in Latin America and in
Ecuador. It is clearly shown how TFR has decreased from 4.2 in 1987 to 2.4 in 2010 (INEC, 2010).
The decrease of TFR is also related to the increased attainment in education in Latin America since
the 1970s and 1980s (Weinberg et al., 1989). However, the quality of the contents taught (hidden
curricula) will affect directly the adolescents´ final decisions towards their sexuality. Despite
having the knowledge of how to avoid a pregnancy, it is the motivation to avoid it which matters the
most (Kirk, 2002).
Graph 6: Graph 7:
In the following graphs (Graph 6 and Graph 7), it is exposed the percentage of young mothers,
who have never studied and what has been their highest level of schooling at the moment of the
survey. They demonstrate how the very low education attainment in young ages will increase in the
future.
This also shows that once girls, who have become pregnant at early ages, will be more likely to end
education at a primary level. Poor schooling can lead pregnancy as a consequence of a rational
choice (Naslund-Hadley and Binstock, 2010), which will also lead to take short term decisions, if
they have already achieved a goal of finishing a level of education that being either primary or
secondary. This indicates how education attainment is related to the fertility rate decline.
Even though the educational gap has narrowed, it has not made greater changes in terms of fertility
reduction, since reproductive desires have not changed as much. The difference is in the use of
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contraception between the two groups: the educated women and the poorly or non-educated. This is
what will show a difference in the fertility patterns, because the more educated women will have
more knowledge and information of family planning and access as well (Ishida et al., 2010). In
Ecuador, this difference in access is most likely to reduce since with the Ministerial Agreement
2490 which widens the access to any contraceptive method and service to all men and women of all
ages despite their ethnic and socio economic condition.
Despite the progress in this matter in Ecuador, it is still evident that the TFR has increased in the
adolescent group (CEPAL, 2007). The lack of appropriate sexual education, as it was previously
mentioned, the lack of access to sexual and reproductive health (SRH) services could be some
factors for the early teen pregnancies as they are most likely not (in most cases) a result of a
rational decision to start an active sexual life at ages below 15 years old. Here, factors such as social
and gender pressures due structural problems as machismo-marianismo or abuse of power
(Goicolea et al., 2009), could be other reasons. This will be elaborated in the next section.
6. Gender structures
It is inevitable to talk about sexual behaviour without also talking about sexual and reproductive
rights based in a certain context (Desmond et al., 2005). When discussing teenage pregnancy and its
impact on the socio cultural aspects, it is important to discuss how gender structures play an
important role in this problematic. Gender is not a fixed concept but is constantly in construction
based on actions and practices (Goicolea et al., 2009). As such, families are great institutions in the
Ecuadorean society and determine a gender norm and order in adolescents (Connell, 1987). This
will mark the factors that determine the adolescents´ decisions at short and/or long term: self
control, information and social relationships. So as it is shown in the graph below, adolescent
marital status determines as well adolescent reproductive patterns in terms of how many children
they will have in the future (World Bank, 2012).
38
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The majority of the adolescent mothers in the survey are married (68%) followed by women in a
relationship (21%) and the minority either separated or widows. This indicates that it is important
for adolescent mothers to formalize their relationship with their partner in order to keep their
honour towards society.
As Goicolea et al. (2009) argues in her study, the Ecuadorean adolescents feel more stigmatized by
been a single mother than being an adolescent mother. Thus, the decision in an adolescent girl’s life
will change from a risky behaviour to a non-risky one; such as condom use negotiation or which
kind of relationship they want (Juarez, 2005), and therefore having information about their rights
and needs will make adolescents take free and appropriate decisions related to their sexuality
(Goicolea et al., 2009).
To finalize, it is important to stress that motherhood is not the only goal in women’s life, but it
should be a conscious decision that is accompanied by a human rights based sexual education,
access to adolescent-focused health services, contraceptive method information and overall non-
discrimination or stigma when using and/or participate in the above mentioned services. Once these
goals are achieved, it will inevitable be possible to have a more open debate on other sexual and
reproductive rights that are still illegal in most of developing countries, such as safe abortion. Only
then women will know that they have full freedom in deciding over their bodies and their
relationships with others.
Graph 8:
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4.2 Conclusions
This analysis has focused on 2 key socio-cultural elements that affect teenage pregnancy as a
development problematic: education and gender structures. The lack or inequities related to
these 2 aspects increments the probabilities of an unwanted or mistimed pregnancy in early ages
during adolescence. Becoming mothers when adolescents per se is not an unsolved problem, but
could be when becoming an adolescent mother would limit the mother of accessing a quality
education and health services consequence of discrimination and stigma due early motherhood.
Historically youth population in Latin America and in Ecuador has been high and will continue
increasing until 2040 when it will decrease due to demographic transition results, consequently
urgent actions must be taken in the area of education and health accessibility as they have been
pointed out as major barriers of social equity.
Since adolescents encompasses ages from 10 to 19 it is inadequate to treat them all as a
homogenous group. The attitudes and behaviours will differ greatly in between this complex
stage. Therefore, knowing that 17% of all adolescents were mothers at the ages 10-14 and the
Mean Age of Childbearing of young adolescents is 14 years old it clearly shows the need to
direct policies focused on this population which has been long forgotten.
Evidently throughout the analysis there exists a gap on available information focused on young
adolescents, thus to reach this specific population, mostly who live in impoverished contexts, it
is necessary to implement adequate and disaggregated information that could as well is
available for young adolescents as a powerful tool of empowerment about knowing and
demanding their sexual and reproductive rights and needs.
Having access to an appropriate education will give girls and adolescent’s not only the freedom
to choose and take decisions based on their rights, but make pregnancy a conscious decisions
which will inevitable have an impact over their future plans. These decisions should be based on
relevant information and accessibility and good quality of educative and health services, but
40
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overall to equity in all the environments they will interact in a near future taking conscious and
free decisions over their bodies and minds.
4.3 Potential further research
As the analysis made for this study is based on latest secondary data available (ENDEMAIN 2004)
it is recommended that the next demographic and household survey be developed in Ecuador as
soon as possible to update data and disaggregate it focused on the young adolescents group (10 to
14 years old) who have not been included in previous studies. It will also be recommended to make
an in depth analysis of the impact of the current health and contraceptive policies recently approved
in Ecuador and evaluate the results in all age groups at a national level.
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70348

Do young adolescents matter? An analysis of young adolescence pregnancy

London School of Economics and Political Science

MSc Population and Development

Date of Submission: 2nd of September, 2013

Candidate Number: 70348

(Bearinger et al, 2007).

prevalence (McIntosh and Finkle, 1995).

interventions (Desmond et al., 2005).

its impact in Ecuador.

1.2 ICPD impact in Ecuador

stands currently in terms of social policies.

to the given family planning program (Ministerial Agreement 2490, 2013).

1.3 Research focus

determinant for fertility reduction as it is an indicator of socio economic development when

order for their capabilities to be potentiated (Sen, 1999).

(Dixon-Muller, 2007). Consequently, as adolescents are going through a process of transformation,

3 Sexual Transmitted Infection

considered a development problem in Ecuador.

1.4 Overall research aim and individual research objectives

urban areas and in education or non-educational environments. To comprehend these issues,

increased in some countries (CEPAL, 2007).

America and its effects in Ecuador.

birth in the age group 10 to 14 years in 2004.

importance of including young adolescent’s sexual and reproductive needs.

1.5 Research worth

years old) which is not considered within the survey information.

Chapter 2: Issues and review of related literature

objectives 3 and 4 will be analysed in chapter 3 y 4.

2.1 Why is adolescent pregnancy a development problem?

a) Cairo, paradigms shift for adolescents?

7 Planned Parenthood Federation, USA

in 118 countries” (Goodwin et al., 2000).

this complex group.

prevention as a subcomponent (Bearinger et al., 2007).

Conceptualizing adolescence as a biosocial development of a human being could be limiting.

they will use or use it properly.

being and promote more equitable relationships.

2.2 Adolescent pregnancy a socio-cultural problematic

a) Adolescent fertility in Latin America and Ecuador

industrialization, urbanization, modernization; cultural factors such as the secularization of values,

especially for women.

influence over personal decisions (CEPAL, 2007).

the total population is young); the population will

grow in the next years, and consequently, teenage

pregnancy will stall or increase in certain countries

where the youth population is higher. These

projections should be addressed with increasing

policies of sexual and reproductive rights policies for

the most vulnerable groups in the region.

Pregnancy (ENIPLA - for its acronym in Spanish).

b) Education and fertility in adolescents in Ecuador

indicator, or as a reproductive behaviour cornerstone. At the macro-social level, education is used as

from1987 to 2004. This shows an intrinsically education-fertility relationship which is common

to 2.2 in 2010 (World Bank, 2012).

education groups (Weinberger et al., 1989).

they will have the motivation to avoid a pregnancy (Kirk, 2002).