Teenage pregnancies: Untangling cause and effect

JC Punongbayan
While it is true that contraception (and learning how to use them) can dramatically reduce the risk of becoming pregnant, there seems to be more to the issue than meets the eye

This week, a series of troubling health trends concerning the youth have been confirmed by a recently-concluded study. 

First, the incidence of teenage childbirth has more than doubled over the past decade. That is, among girls aged 15 to 19, whereas only 6.3% were already mothers in 2002, by 2012 around 13.6% were already mothers.

Second (and expectedly), premarital sex among the youth is also on the rise: In 2002, only 23.2% of youth have engaged in premarital sex, but in 2013 this has increased to 32% (amounting to about 6.2 million youth).

Third, while both teenage males and females have become more likely to engage in premarital sex, the gap between the sexes has declined over the past decade. 

And fourth, a whopping 78% of first instances of premarital sex were unprotected (not only against unwanted pregnancy but also sexually transmitted diseases). Surprisingly, girls were more likely to not use any form of protection during their first sexual encounters.

Not just about condoms

These grim statistics will expectedly be useful additions in the arsenal of arguments of RH law advocates, especially with the decision of the Supreme Court on the suspended RH law drawing nearer than ever.

Indeed, a common knee-jerk reaction to unintended pregnancies (whether among teenage or adult women) is to push for greater access to contraceptives and sex education. 

While it is true that contraception (and learning how to use them) can dramatically reduce the risk of becoming pregnant, there seems to be more to the issue than meets the eye. 

For instance, the World Health Organization reports that as many as 16 million girls aged 15 to 19 give birth each year worldwide, and 95% of all those births occur in low- and middle-income countries. 

Also, teenage pregnancies are more likely to come from poorer segments of society than richer ones, and this holds true whether in poor countries in Sub-Saharan Africa or in rich countries like the US. For instance, a teenage girl in Mississippi is said to be four times more likely to give birth than a similarly situated girl in New Hampshire (where inequality and poverty are much lower). 

Thus, around the world there seems to be a fundamental link between income, poverty, and economic opportunities on the one hand, and teenage pregnancies and childbirth on the other. (This is despite the greater prevalence of contraceptive use and sex education.)

Symptom of poverty?

But of course, correlation does not imply causation. Thus, the link between teenage childbirth and poor economic conditions begs the important (but often neglected) question: Are teenage childbirths a symptom or a cause of poverty?

This question’s importance lies in its policy implications. 

If it is found that teenage childbirth results in mothers’ poor life outcomes – such as dropping out of school or living in poverty – then society’s efforts should focus more toward preventing unintended pregnancies (in which case the RH law can help a lot through sex education and contraceptive access).

But if teenage childbirths are more of a symptom of mothers’ poor economic background, then society’s efforts should focus on more fundamental things like reducing poverty and expanding mothers’ educational and job opportunities (in which case the RH Law may have a more limited impact on the issue).

Cause and effect

Basically, one would like to know whether having a teenage pregnancy results in lower economic prospects for the mother. In practice, the direction of cause and effect is rather difficult to establish. 

For one thing, simply comparing the life outcomes of women who gave and did not give birth as teenagers would be grossly misleading, since women who gave birth as teens may come from fundamentally different backgrounds (and have different traits) than those who do not give birth as teens. 

(It’s like saying sunlight made plant A grow faster than plant B, when in fact the reason why plant B didn’t grow as fast is that you have neglected to give it water the whole time.) 

Hence, to tease out the true impact of teen pregnancy, we want to study women who are virtually indistinguishable from one another in terms of background, but where some of them give birth as teens while others don’t due to some random factor.

In this regard, economists have come up with clever ways of achieving this ideal setup.

For instance, one study compared women of similar background, but where some successfully gave birth as teens while the rest were unlucky and had miscarriages. From this random setup, it turned out that the life outcomes of the two groups of mothers were not significantly different.

Another ideal setup is where two groups of women are similar in background, but some have earlier menstrual cycles, and hence have a greater risk of becoming teenage mothers. This time, the randomness comes from the genetic lottery, and in one study it turns out again that giving birth during teenage years doesn’t seem to cause inferior outcomes later in life.

These techniques, as summarized by one recent study, suggest that teen childbirth doesn’t categorically result in poorer life outcomes for teen moms and their children. Rather, a lot of the correlation between teenage childbirth and incomes results from fundamental differences between larger social issues (such as poverty and inequality) and the unequal opportunities and prospects faced by women who give birth as teens and those who don’t. 

Deeper problems

Above all, economists love exploring questions on cause and effect. And in the case of countries like the Philippines – where poverty and inequality in opportunities remains rife – the rising incidence of teenage pregnancies may well turn out to be a symptom (rather than a cause) of worsening economic conditions. 

To be sure, empirical studies and natural experiments have yet to be conducted to establish the causal link between teen pregnancy and inequality in the country.

But the way we address the alarming rise of teenage pregnancy depends largely on a clear understanding of such link. Because if teenage pregnancies make teen moms and their children worse-off later in life, then measures like the RH Law will definitely improve maternal and child welfare. 

However, if it turns out that teenage pregnancies are merely symptoms of deeper problems such as poverty and inequality, then well-intended measures like the RH law may end up having a more limited impact than previously thought. – Rappler.com

JC Punongbayan holds a master’s degree from the UP School of Economics, where he also graduated summa cum laude in 2009 and currently teaches part-time. His views are independent of the views of his affiliations. Read his related article on the RH law and the need for more data.




JC Punongbayan

Jan Carlo “JC” Punongbayan, PhD is an assistant professor at the University of the Philippines School of Economics (UPSE). His professional experience includes the Securities and Exchange Commission, the World Bank Office in Manila, the Far Eastern University Public Policy Center, and the National Economic and Development Authority. JC writes a weekly economics column for Rappler.com. He is also co-founder of UsapangEcon.com and co-host of Usapang Econ Podcast.