Author : Oommen C. Kurian

Expert Speak Health Express
Published on Jul 11, 2022
India has managed to reduce teenage pregnancy significantly over these past few years, causing a positive change in infant child mortality rate as well as maternal mortality rate.
World Population Day 2022: Celebrating the reduction of adolescent fertility rate

This article is part of the series — World Population Day.

In 2016, the United Nations Children's Fund (UNICEF), together with the United Nations Population Fund (UNFPA), launched a global initiative to tackle child marriage in 12 countries where the practice was most highly prevalent: Bangladesh, Burkina Faso, Ethiopia, Ghana, India, Mozambique, Nepal, Niger, Sierra Leone, Uganda, Yemen, and Zambia. The programme aimed to achieve results for girls by aligning key stakeholders in education, child protection, social protection, social and behaviour change, gender, health, and other sectors. The UNFPA-UNICEF Global Programme to End Child Marriage worked toward enhancing the capacities of governments and non-government organisations while promoting harmonised action and accountability.

We celebrate World Population Day on 11 July 2022, and the organisers—the United Nations (UN)—remind the world that the focus should be on people, not population. It’s unacceptable to reduce people to mere numbers that strip them of their humanity. Indeed, as UNFPA puts forth, instead of making the numbers work for systems, it is necessary to make the systems work for the numbers by promoting the health and well-being of populations. There have been calls during the pandemic that with possible fertility changes, leaders must urgently support women’s reproductive rights and choices.

It is in this broad context that a new report titled “Motherhood in Childhood: The Untold Story” by UNFPA was released on 27 June 2022, which examined global trends in adolescent pregnancies using techniques that focus on the most vulnerable girls, such as child mothers, girls with repeat adolescent pregnancies, and births that occur in dangerously quick succession.  Interestingly, the report observed that the declines in overall levels of adolescent childbearing in Central and  Southern Asia have been amongst the most dramatic of any world region and that these stark declines have been led by trends from India. As Graph 1 demonstrates, the region’s average mother’s age at first birth, led by India’s decline in adolescent pregnancies, has converged over time with the world average. Along with India, countries witnessing the most impressive declines have been Bangladesh, Egypt, Eswatini, Indonesia, and the Maldives.

Graph 1: Mother’s Median Age at First Birth across Time


This increase in the mother’s median age at birth in India is accompanied in parallel with an impressive decline in the overall fertility rate. A look at the latest National Family Health Survey (2019-21) reveals that when compared to 3.4 in the mid-nineties, the total fertility rate now is just 2.0 children per woman, below the replacement level of fertility of 2.1 children per woman. The rural fertility decline is even more impressive for the same period—from 3.7 to 2.1 children per woman (Graph 2). NFHS 1 to 5 are from 1992–93, 1998–99, 2005–06, 2015–16, and 2019–21 respectively.

Graph 2: Trends in Fertility Rate by Location 

Source: NFHS-5 National Report.

This feat looks even more impressive when we consider the fact that in the 1960s, India faced a rapidly increasing population, with a fertility rate of nearly six children per woman. China had achieved replacement level fertility—primarily owing to its controversial population control measures including the one-child norm—in the nineties. Interestingly, China is now staring at a future of underpopulation, and is shifting its population policy quickly, even adapting a three-child policy to boost incredibly low levels of current fertility. Although India is possibly decades away from such policy U-turns due to its young population and what is known as ‘population momentum’, reportedly, Indian demographers are now ‘arguing less about how scarily high its population might get and more about how scarily low it could go’.

In the past decades, India’s high rate of population growth was driven by an early average age of marriage. However, the latest evidence from the National Family Health Survey 5 (2019-21) suggests that between NFHS 1 and NFHS 5, the greatest decline in fertility has been amongst the 15-19 age group, where the fertility rate declined from 116 per 1,000 population to 43 per 1,000 population (Graph 3). The adolescent fertility rate varies widely across Indian states and union territories—from 91 in Tripura to 2 in Ladakh and Lakshadweep.

Graph 3: The Great Decline: Trends in Adolescent Fertility in India

Source: Compiled by the author from Various NFHS Reports

However, amongst the relatively poor Empowered Action Group (EAG) states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttar Pradesh (UP) and Uttarakhand),  Uttarakhand (19), Chhattisgarh (24), and UP(22) have managed to bring adolescent fertility rates to incredibly low levels, an achievement hardly celebrated in India. Graph 4 shows that barring Bihar, there is improvement across the board in the last decade amongst EAG states. At the same time, Chhattisgarh and UP deserve accolades for bringing down adolescent fertility rates from very high levels in 2005-06 to levels about half of the Indian average, even better than most south Indian states. 

Graph 4: Adolescent Fertility: Trends in the EAG States

Source: Compiled by the author from Various NFHS Reports

Nevertheless, for India, it is only a battle half-won. Latest data indicate that 7 percent of Indian girls aged 15–19 have already been pregnant. Within this age cohort, 5 percent have had a live birth and 2 percent are pregnant with their first child. Teenage pregnancy is higher in rural areas when compared to urban areas. Eight percent of women in rural areas in the age group 15–19 have already begun childbearing. The latest NFHS data indicate that the level of teenage pregnancy decreases with an increasing level of schooling. Data show that 18 percent of girls aged 15–19 with no schooling have already begun childbearing, compared with only 4 percent amongst girls who had 12 or more years of schooling. Pregnancies amongst girls aged 15–19 decrease with the level of wealth as well. Only 2 percent of teenage girls in the highest wealth quintile have begun childbearing, compared with 10 percent of teenage girls in the lowest wealth quintile. Adivasi and Muslim girls have relatively higher rates of teenage pregnancies.

Graph 5: Teenage Motherhood by State/Union Territory (NFHS 5): Percent of pregnant girls aged 15-19

Source: NFHS-5 Country Report.

Graph 5 demonstrates the relative effectiveness of the battle against adolescent pregnancies in Indian states. As evident, states like Uttarakhand, UP, and Chhattisgarh from the EAG grouping, have been able to keep the proportion of girls who have given birth or are pregnant with their first child in the 15-19 age group low. There is ample evidence that teenage pregnancies lead to undernutrition in the infant and has acute negative impacts on the mother’s health, leading to adverse health outcomes for the child and the mother. Undoubtedly, the dramatic reduction in adolescent fertility rates achieved by India, particularly by many EAG states has contributed enormously to the rapid reduction in Infant Mortality Rate (IMR) over the years (Graph 6), and also to improving maternal mortality indicators.

Graph 6: Infant Mortality Rate across NFHS Rounds

Source: The DHS Programme

UNICEF research shows that the girls who have the greatest risk of child marriage are often those hardest to reach, which explains why many states are in such positions as showcased by Graph 5. Girls who marry early predominantly come from poor families, marginalised groups, or rural areas. They are also known to be more likely to be out of school than their luckier peers, constantly at the risk of pregnancy and robbed of the opportunity to fulfil their true potential. This is exactly why the battle against adolescent pregnancies and child marriage is a battle that India needs to win and win fast. This World Population Day, India needs to renew its pledge against adolescent pregnancies and create platforms of cross-learning where other states with similar socio-economic realities can learn from best performers like UP and Chhattisgarh about their respective strategies which worked in their effort to successfully—bring down adolescent fertility from very high levels just a decade and a half ago.

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Oommen C. Kurian

Oommen C. Kurian

Oommen C. Kurian is Senior Fellow and Head of Health Initiative at ORF. He studies Indias health sector reforms within the broad context of the ...

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