Abstract
Objective
To analyze municipal- and individual-level factors related to the prevalence of teenage pregnancy in Colombia during 2015.
Methods
We analyzed 660,767 births registers, of which 21.5% recorded adolescent women. At an individual level, marital status, educational level, area of residence, and access to health services were included in the analysis. At the contextual level, Colombian municipal socioeconomic characteristics and proxies of violence and poverty were analyzed. A multilevel logistic regression model was generated with a Markov Chain Monte Carlo estimation method using 100,000 simulations in MLwiN 2.32 software.
Results
Multilevel modeling revealed an increased risk of teenage pregnancy in municipalities with the highest numbers of people expelled by forced displacement (OR 1.21; CI 95%, 1.13–1.29) and with unsatisfied basic needs (OR 1.09; CI 95%, 1.02–1.17). At an individual level, the majority of the teenage women were unmarried and/or had an unstable partnership, a low level of educational, a subsidized health regimen, and resided in the municipal seat.
Conclusions
Municipal contextual variables related to poverty, violence, and social inequity contribute to an increase in teenage pregnancy in Colombia. At the individual level, marital status, educational level, and area of residence is associated with teenage pregnancy. It is therefore imperative to include municipal contextual characteristics in the design of the national political agenda.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Acevedo, K., & Bornacelly, I. (2014). Panel Municipal del CEDE—Centro de Estudios sobre Desarrollo Económico. Retrieved from https://economia.uniandes.edu.co/components/com_booklibrary/ebooks/dcede2014-26.pdf.
Aguilar Moncada, Y. A., Cárdenas León, G. D., & Galeano Méndez, A. M. (2010). Embarazo en la población adolescente en situación de desplazamiento: Estado del arte [Engd, Universidad Nacional de Colombia]. Retrieved from http://bdigital.unal.edu.co/8753/1/535762.2010.pdf.
Aparicio Llanos, A., & Morera Salas, M. (2007). La conveniencia del análisis multinivel para la investigación en salud: Una aplicación para Costa Rica. Población y Salud En Mesoamérica, 4(2).
Baba, S., Iso, H., & Fujiwara, T. (2016). Area-level and individual-level factors for teenage motherhood: A multilevel analysis in Japan. PLoS ONE, 11(11), e0166345. https://doi.org/10.1371/journal.pone.0166345.
Banco Mundial. (2015). Tasa de fertilidad en adolescentes (nacimientos por cada 1.000 mujeres entre 15 y 19 años de edad). Retrieved from https://datos.bancomundial.org/indicator/SP.ADO.TFRT.
Bitzer, J., Abalos, V., Apter, D., Martin, R., Black, A., & Global CARE (Contraception: Access, Resources, Education) Group. (2016). Targeting factors for change: Contraceptive counselling and care of female adolescents. The European Journal of Contraception & Reproductive Health Care: The Official Journal of the European Society of Contraception, 21(6), 417–430. https://doi.org/10.1080/13625187.2016.1237629.
Bonell, C., Allen, E., Strange, V., Copas, A., Oakley, A., Stephenson, J., et al. (2005). The effect of dislike of school on risk of teenage pregnancy: Testing of hypotheses using longitudinal data from a randomised trial of sex education. Journal of Epidemiology and Community Health, 59(3), 223–230. https://doi.org/10.1136/jech.2004.023374.
Castro, R., & Fajnzylber, E. (2017). Income inequality and adolescent fertility in low-income countries. Cadernos De Saude Publica, 33(9), e00203615. https://doi.org/10.1590/0102-311X00203615.
Catalán-Reyes, M. J., & Galindo-Villardón, M. P. (2003). Use of multilevel models in health research. Gaceta Sanitaria, 17(Suppl 3), 35–52.
Centro de Estudios sobre Desarrollo Económico. (CEDE). (n.d.-a). Panel Municipal del CEDE: Panel conflicto y violencia. Universidad de los Andes. Retrieved from https://datoscede.uniandes.edu.co/es/catalogo-de-microdata.
Centro de Estudios sobre Desarrollo Económico (CEDE). (n.d.-b). Panel Municipal del CEDE: Panel de características generales. Universidad de los Andes. Retrieved from https://datoscede.uniandes.edu.co/es/catalogo-de-microdata.
Chávez-Plazas, Y. A., & Bohórquez-Bohórquez, M. C. (2011). Desplazamiento forzado y reconfiguraciones familiares: Una mirada a la situación de madres solteras adolescentes en Soacha. PROSPECTIVA. Revista de Trabajo Social e Intervención Social. https://doi.org/10.25100/prts.v0i16.1171.
Chiavegatto Filho, A. D. P., & Kawachi, I. (2015). Income inequality is associated with adolescent fertility in Brazil: A longitudinal multilevel analysis of 5565 municipalities. BMC Public Health, 15, 103. https://doi.org/10.1186/s12889-015-1369-2.
Congote-Arango, L. M., Vélez-García, M. A., Restrepo-Orrego, L., Cubides-Munevar, Á., & Cifuentes-Borrero, R. (2012). Adolescencia como factor de riesgo para complicaciones maternas y perinatales en Cali, Colombia, 2002–2007. Estudio de corte transversal. Revista Colombiana de Obstetricia y Ginecología, 63(2), 119–126. https://doi.org/10.18597/rcog.188.
Cook, S. M. C., & Cameron, S. T. (2017). Social issues of teenage pregnancy. Obstetrics, Gynaecology & Reproductive Medicine, 27(11), 327–332. https://doi.org/10.1016/j.ogrm.2017.08.005.
Córdova Pozo, K., Chandra-Mouli, V., Decat, P., Nelson, E., De Meyer, S., Jaruseviciene, L., et al. (2015). Improving adolescent sexual and reproductive health in Latin America: Reflections from an International Congress. Reproductive Health, 12(1), 11. https://doi.org/10.1186/1742-4755-12-11.
Daniels, J. P. (2015). Tackling teenage pregnancy in Colombia. Lancet, 385(9977), 1495–1496. https://doi.org/10.1016/S0140-6736(15)60738-3.
Departamento Administrativo Nacional de Estadística. (2017). Estadísticas Vitales- EEVV-2015. COLOMBIA—Estadísticas Vitales—EEVV—2015. Retrieved from http://microdatos.dane.gov.co/index.php/catalog/475/get_microdata.
Diez-Roux, A. V. (2000). Multilevel Analysis in Public Health Research. Annual Review of Public Health, 21(1), 171–192. https://doi.org/10.1146/annurev.publhealth.21.1.171.
Domínguez-Anaya, R., & Herazo-Beltrán, Y. (2011). Edad de la gestante adolescente como factor de riesgo para complicaciones en el embarazo. Cartagena (Colombia) 2009. Estudio de corte transversal. Revista Colombiana de Obstetricia y Ginecología, 62(2), 141–147. https://doi.org/10.18597/rcog.230.
Duncan, C., Jones, K., & Moon, G. (1998). Context, composition and heterogeneity: Using multilevel models in health research. Social Science and Medicine, 46(1), 97–117. https://doi.org/10.1016/S0277-9536(97)00148-2.
Flórez, C. E. (2005). Socioeconomic and contextual determinants of reproductive activity among adolescent women in Colombia. Revista Panamericana De Salud Publica = Pan American Journal of Public Health, 18(6), 388–402. https://doi.org/10.1590/s1020-49892005001000002.
Halpern, C. T., Joyner, K., Udry, J. R., & Suchindran, C. (2000). Smart teens don’t have sex (or kiss much either). The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 26(3), 213–225. https://doi.org/10.1016/s1054-139x(99)00061-0.
Huaynoca, S., Svanemyr, J., Chandra-Mouli, V. C., & Moreno Lopez, D. J. (2015). Documenting good practices: Scaling up the youth friendly health service model in Colombia. Reproductive Health, 12(1), 1–13. https://doi.org/10.1186/s12978-015-0079-7.
Johns, S. E. (2011). Perceived environmental risk as a predictor of teenage motherhood in a British population. Health & Place, 17(1), 122–131. https://doi.org/10.1016/j.healthplace.2010.09.006.
Lara, D., Decker, M. J., & Brindis, C. D. (2016). Exploring how residential mobility and migration influences teenage pregnancy in five rural communities in California: Youth and adult perceptions. Culture, Health & Sexuality, 18(9), 980–995. https://doi.org/10.1080/13691058.2016.1150514.
Lindberg, L., Santelli, J., & Desai, S. (2016). Understanding the decline in adolescent fertility in the United States, 2007–2012. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine, 59(5), 577–583. https://doi.org/10.1016/j.jadohealth.2016.06.024.
Loaiza, E., & Liang, M. (2013). Adolescent pregnancy: A review of the evidence. Resolución 8430 de 1993, (1993). Retrieved from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF.
Ministerio de Salud y Protección Social. (2013). Observatorio Nacional e Intersectorial del Embarazo Adolescente: Guía Metodológica. (Registros, Observatorios, Sistemas de Seguimiento y Salas Situacionales Nacionales en Salud ROSS) [Guía Metodológica]. Ministerio de Salud y Protección Social. Retrieved from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/ED/GCFI/ross-embarazo-adolescentes-oniea.pdf.
Ministerio de Salud y Protección Social. (2016). Resumen Ejecutivo. Encuesta Nacional de Demografía y Salud (ENDS 2015). Retrieved from https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/ENDS-libro-resumen-ejecutivo-2016.pdf.
Morón-Duarte, L. S., Latorre, C., & Tovar, J. R. (2014). Risk factors for adolescent pregnancy in Bogotá, Colombia, 2010: A case-control study. Factores de Riesgo de Embarazo Adolescente En Bogotá, Colombia, 2010: Estudio de Casos y Testigos, 36(3), 179–184.
Pan American Health Organization, United Nations Population Fund, & United Nations Children’s Fund. (2016). Meeting results: Accelerating the reduction of Adolescent Pregnancy in Latin America and the Caribbean. In Accelerating progress toward the reduction of adolescent pregnancy in Latin America and the Caribbean. Report of a technical consultation (pp. 29–38). PAHO Publications. Retrieved from https://lac.unfpa.org/sites/default/files/pub-pdf/Accelerating%20progress%20toward%20the%20reduction%20of%20adolescent%20pregnancy%20in%20LAC%20-%20FINAL.pdf.
Ramírez Gómez, C. (2001). Desarrollo Económico y Social en el Siglo XX: Población e Indicadores Sociales. In G. Misas Arango (Ed.), Desarrollo económico y social en Colombia. Siglo XX (pp. 481–484). Universidad Nacional de Colombia, Facultad de Ciencias Económicas. Retrieved from http://www.fce.unal.edu.co/media/files/CentroEditorial/catalogo/Libros_Digitalizados/M_desarrollo-economico.pdf.
Rodríguez, J. (2007). Maternidad adolescente en América Latina y el Caribe: Tendencias, problemas y desafíos. Desafíos. Boletín de la infancia y adolescencia sobre el avance de los objetivos de desarrollo del Milenio, 4. Retrieved from https://repositorio.cepal.org/bitstream/handle/11362/35990/1/desafios_4_esp_Final_es.pdf.
Salazar, A., Rodríguez, L. F., & Daza, R. A. (2007). Embarazo y maternidad adolescente en Bogotá y municipios aledaños: Consecuencias en el estudio, estado civil, estructura familiar, ocupación y proyecto de vida. Persona y Bioética, 11(2), 170–185.
Salazar-Arango, A., Acosta-Murcia, M. M., Lozano-Restrepo, N., & Quintero-Camacho, M. C. (2008). Consecuencias del embarazo adolescente en el estado civil de la madre joven: Estudio piloto en Bogotá, Colombia. Persona y Bioética, 12(2), 169–182.
Sánchez Valencia, Y. A., Mendoza Tascón, L. A., Grisales López, M. B., Ceballos Molina, L. Y., Bustamente Farfan, J. C., Castañeda, E. M., et al. (2013). Características poblacionales y factores asociados a embarazo en mujeres adolescentes de Tuluá, Colombia. Revista Chilena de Obstetricia y Ginecología, 78(4), 269–281. https://doi.org/10.4067/S0717-75262013000400005.
Savio Beers, L. A., & Hollo, R. E. (2009). Approaching the adolescent-headed family: A review of teen parenting. Current Problems in Pediatric and Adolescent Health Care, 39(9), 216–233. https://doi.org/10.1016/j.cppeds.2009.09.001.
Seneviratne, M. G., Kahn, M. G., & Hernandez-Boussard, T. (2018). Merging heterogeneous clinical data to enable knowledge discovery. PSB, 1, 439–443. https://doi.org/10.1142/9789813279827_0040.
UNESCO. (2017). Early and unintended pregnancy and the education sector: Evidence review and recommendations. United Nations Educational, Scientific and Cultural Organization. Retrieved from https://unesdoc.unesco.org/ark:/48223/pf0000251509.
Upchurch, D. M., Aneshensel, C. S., Sucoff, C. A., & Levy-Storms, L. (1999). Neighborhood and family contexts of adolescent sexual activity. Journal of Marriage and Family, 61(4), 920–933. https://doi.org/10.2307/354013.
Vincent, K. (2012). Schoolgirl pregnancy, motherhood and education: Dealing with difference. Staffordshire: Trentham Books.
Vogel, J. P., Pileggi-Castro, C., Chandra-Mouli, V., Pileggi, V. N., Souza, J. P., Chou, D., et al. (2015). Millennium development goal 5 and adolescents: Looking back, moving forward. Archives of Disease in Childhood, 100(Suppl 1), S43–47. https://doi.org/10.1136/archdischild-2013-305514.
World Health Organization. (2011). WHO Guidelines on Preventing Early Pregnancy and Poor Reproductive Health Outcomes Among Adolescents in Developing Countries. World Health Organization. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK304954/.
World Health Organization. (2020). Adolescent pregnancy. Retrieved from https://www.who.int/es/news-room/fact-sheets/detail/adolescent-pregnancy.
Acknowledgements
The authors would like to thank government and academic entities for the open access databases that allow research purposes. Also, to the epidemiology master’s professor Beatriz Caicedo Velasquez of the Universidad CES in Medellin, Colombia for the methodology feedback. Lastly, to Universidad del Rosario and Fundación Santa Fe de Bogotá for supporting this research. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Aguía-Rojas, K., Gallego-Ardila, A.D., Estrada Bonilla, M.V. et al. Individual and Contextual Factors Associated with Teenage Pregnancy in Colombia: A Multilevel Analysis. Matern Child Health J 24, 1376–1386 (2020). https://doi.org/10.1007/s10995-020-02997-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-020-02997-1