Number of persons in the target population surveyed and verification that the respondent correctly stated one health benefit of delaying first pregnancy until after 18 years of age

Population-based survey (such as a Knowledge, Attitudes and Practices survey); interviews

When first pregnancies occur in adolescents less than 18 years old, the mothers and their newborns face increased risks of health complications compared to women 20-24 years old. Adolescents are at a higher risk of developing pregnancy-induced hypertension, anemia, and prolonged or obstructed labor.  Controlling for all other factors, compared to women aged 20-24, a 16-17 year old is 1.25 times more likely to hemorrhage or experience very pre-term delivery and an adolescent under 15 is four times more likely to die giving birth and 1.5 times more likely to hemorrhage or experience very pre-term delivery. Newborns may die, be born too soon, too small, or with a low birth weight.  The younger a female is when she first gives birth, the longer her total child-bearing period and the more children she is likely to have, which increases the risks to the life and health of both mothers and children.

This indicator is useful for assessing level of knowledge in a target audience about the benefits of delaying first pregnancy, which is important for family planning counseling, advocating for raising the minimum age of marriage to 18 (if the target population is policy makers), and promoting healthy social norms. It is also useful for establishing formative evidence or evaluating changes in knowledge before and after an intervention.

This indicator primarily addresses improved health outcomes of delaying first pregnancy until after 18 years of age, although there are other benefits to the practice such as the positive impact it has on women’s status and empowerment.  Also, this indicator alone does not provide a measure of how well the information was understood by the audience or of the audience’s attitude or practices.  For instance, a respondent may be able to state several benefits to delaying first pregnancy until after 18 years of age, but still subscribe to the personal belief that his 17 year old married daughter should begin child bearing immediately.

“Healthy Timing and Spacing of Pregnancy: A Trainer’s Reference Guide”, 2008.  USAID and ESD Project.

“Healthy Timing and Spacing of Pregnancies: A Pocket Guide for Health Practitioners, Program Managers, and Community Leaders”, 2006.  USAID and ESD Project.