Executive Summary
Adolescent pregnancy is a public health priority due to the risks it poses to the health and well-being of adolescent girls, and their babies. In many contexts, adolescent pregnancy is closely linked to child marriage and early union. The child-marriage rate in Lao People’s Democratic Republic (PDR) is the highest in the region (UNICEF and UNFPA, 2022). Analysis of nationally representative data from Lao PDR revealed that among women aged 20–24 who gave birth before the age of 18, two-thirds conceived in the context of union, but more than one in four (27 per cent) conceived outside of union (Harvey et al., 2022). Data also suggests that pregnancies outside union are becoming more common in Lao PDR (UNICEF and UNFPA, 2022).
In light of these challenges facing adolescent girls, it is worth noting that the Lao Government recognizes the multi-faceted dimensions that make girls vulnerable. Since 2016, the Lao Government has adopted the Noi Framework as a national response. The framework is a holistic approach toward advocacy, programming and evidence generation around adolescent girls to ensure their needs, such as avoiding early pregnancy, are integrated into the Lao Government’s Sustainable Development Goals (SDGs) implementation plans (UNFPA, 2019). The United Nations Population Fund (UNFPA) invests in building systems for capacitating young people to address child marriage and adolescent pregnancy, including the integration of comprehensive sexuality education (CSE) curricula at all education levels, and provision of sexual health information and services, mental health and psychosocial support, and protection services for survivors of gender-based violence.
Introduction
To generate new insights to complement this existing landscape, this qualitative study helps fill the research gaps on adolescent girls’ pathways to adolescent pregnancy in Lao PDR, particularly those that occur outside of union.
Objectives
This study aimed to:
- Understand the different drivers and pathways to adolescent pregnancy
- Co-develop, with adolescents, policy and programming recommendations to effectively address adolescent pregnancy
The findings of this study can help inform strategic investments and interventions that address specific pathways and drivers of adolescent pregnancy, thereby enabling girls to make informed decisions for their relationships and life trajectories.
Methods
Using a participatory, qualitative approach, the study design placed adolescent perspectives at the forefront, using primary data collected with adolescent girls aged 16–20 who experienced pregnancy or birth at age 18 or younger. Study implementation was guided by a working group comprised of representatives from UNFPA and the United Nations Children’s Fund (UNICEF), and two youth advisors from the study country. Data collection was conducted in two provinces and one prefecture – the province of Vientiane, the prefecture of Vientiane (which is the capital city) and Luang Namtha. Each site represents median (Vientiane province and capital city) and high (Luang Namtha) adolescent fertility and premarital conception.
During the first round of data collection, an in-depth, timeline interview approach was used. Framework analysis was applied during preliminary data analysis, and candidate pathway typologies were developed based on girls’ life stories and contributing factors in their pathways to adolescent pregnancy. During the second round of data collection, follow-up interviews were conducted with selected girls to validate and clarify study findings and interpretations and gather girls’ recommendations for programmes and policy.
Results
Through in-depth interviews using a timeline approach with 57 girls, eight pathways to adolescent pregnancy were identified. These pathways were differentiated primarily according to the timing of pregnancy relative to union. Outside-union pregnancy pathways were differentiated further by the context of sex preceding pregnancy (consensual, pressured, forced) and pregnancy intention (unplanned, planned, partner-led). Within-union pregnancy pathways diverged according to pregnancy intention (unplanned, planned) and who initiated the union (couple- or girl-led, or parent- or partner-led). Cross-cutting factors contributing to girls’ pathways to adolescent pregnancy included barriers to sexual and reproductive health (SRH) information and contraceptive access and use; partners’ control over reproductive decision-making; prevalence of pressured and forced sex; community acceptance of child marriage and early union; and attitudes and norms regarding sex and pregnancy outside of union.
Recommendations
During 20 follow-up interviews, adolescent girls recommended that programmes and policies should:
- Ensure that girls have access to detailed, easy-to-understand SRH information
- Help girls to have better access to non-judgemental health care in safe spaces
- Support girls to access and use contraceptives
- Teach girls about negotiating sex and contraceptive use (and include boys and parents in discussions)
- Work toward changing community perspectives that support child marriage and discourage contraceptive use
Discussion
The findings show that adolescent girls in Lao PDR follow diverse pathways to adolescent pregnancy and require support at different decision points in their lives. Many adolescent pregnancies occurred outside of formal marriage or cohabiting union despite the persistence of conservative social ideals that disapprove of sex and pregnancy outside of union. Adolescent girls’ experiences of sex and pregnancy were often influenced by a lack of knowledge about SRH (including contraception), power imbalances with their partners, and girls’ lack of agency over if and when to have sex, use contraceptives and begin childbearing. These were also occurring within sociocultural contexts where parents, community members and adolescent girls viewed child marriage and early union as a socially acceptable alternative to education or work, and as the most acceptable resolution to a pregnancy outside of union.
Conclusion
Toward achieving the Government of Lao PDR’s commitment to the International Conference on Population and Development (ICPD) Agenda, especially to end the high unmet need for family planning among adolescents, it is imperative to address the barriers adolescent girls face to SRH information and contraceptive access and use. As expressed by adolescent girls, girls and boys need access to straightforward and consistent SRH information, especially regarding pregnancy risk and contraception options. Specifically
SDGs, Targets, and Indicators
1. Which SDGs are addressed or connected to the issues highlighted in the article?
- SDG 3: Good Health and Well-being
- SDG 4: Quality Education
- SDG 5: Gender Equality
- SDG 10: Reduced Inequalities
- SDG 16: Peace, Justice, and Strong Institutions
The article discusses adolescent pregnancy, child marriage, and early union, which are issues related to health, education, gender equality, and social norms. These align with the goals of SDG 3, SDG 4, SDG 5, SDG 10, and SDG 16.
2. What specific targets under those SDGs can be identified based on the article’s content?
- Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs.
- Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including among others through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development.
- Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation.
- Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status.
- Target 16.2: End abuse, exploitation, trafficking, and all forms of violence against and torture of children.
The article highlights the need for universal access to sexual and reproductive health services (Target 3.7), education on sexual and reproductive health and rights (Target 4.7), elimination of child marriage and early union (Target 5.3), empowerment and inclusion of adolescent girls (Target 10.2), and ending violence against children (Target 16.2).
3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?
- Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods
- Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessment
- Indicator 5.3.1: Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18
- Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities
- Indicator 16.2.2: Number of victims of human trafficking per 100,000 population, by sex, age group, and form of exploitation
The article implies the use of indicators such as the proportion of women with access to family planning (Indicator 3.7.1), the integration of global citizenship education and education for sustainable development in national policies and curricula (Indicator 4.7.1), the prevalence of child marriage and early union (Indicator 5.3.1), the proportion of people living below a certain income threshold (Indicator 10.2.1), and the number of victims of human trafficking (Indicator 16.2.2).
4. Table: SDGs, Targets, and Indicators
| SDGs | Targets | Indicators |
|---|---|---|
| SDG 3: Good Health and Well-being | Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs. | Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods |
| SDG 4: Quality Education | Target 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including among others through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship, and appreciation of cultural diversity and of culture’s contribution to sustainable development. | Indicator 4.7.1: Extent to which (i) global citizenship education and (ii) education for sustainable development are mainstreamed in (a) national education policies; (b) curricula; (c) teacher education; and (d) student assessment |
| SDG 5: Gender Equality | Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation. | Indicator 5.3.1: Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 |
| SDG 10: Reduced Inequalities | Target 10.2: By 2030, empower and promote the social, economic, and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion, or economic or other status. | Indicator 10.2.1: Proportion of people living below 50 percent of median income, by age, sex, and persons with disabilities |
| SDG 16: Peace, Justice, and Strong Institutions | Target 16.2: End abuse, exploitation, trafficking, and all forms of violence against and torture of children. |
