2021Total Fertility Rates, by Maternal Educational Attainment and Race and Hispanic Origin: United States, 2019.

Objective-This report presents 2019 total fertility rates for the United States, by educational attainment and race and Hispanic origin of mother. Methods-Descriptive tabulations of the total fertility rate by educational attainment of mother for the United States are presented and described. The total fertility rate is the average number of children a group of women would expect to have at the end of their reproductive lifetimes. Data are based on the 2003 revision of the U.S. Standard Certificate of Live Birth. Results-In 2019, the U.S. total fertility rate (TFR) for all women aged 15-49 was 1,705 expected births per 1,000 women. TFRs decreased as level of education increased from women with a 12th grade education or less through an associate's and bachelor's degree, and then rose from bachelor's degree through a doctorate or professional degree. Among the race and Hispanic-origin groups, TFRs were highest for Hispanic women (1,939), followed by non-Hispanic black (1,774) and non-Hispanic white (1,610) women. Rates generally declined from the lowest educational level through a bachelor's degree for non-Hispanic white women, and through an associate's degree for Hispanic women, and then generally rose for both groups for women with advanced degrees. TFRs for non-Hispanic black women declined by educational level through a master's degree. Across the race and Hispanic-origin groups, the lowest TFR by educational level was for non-Hispanic black women with a master's degree (1,038), and the highest was for Hispanic women with a 12th grade education or less (3,025). TFRs for non-Hispanic black and Hispanic women with some college credit or less were generally higher than the rates for non-Hispanic white women, but TFRs for non-Hispanic black and Hispanic women with a master's degree or more were generally lower than the rates for non-Hispanic white women.

Births: Final Data for 2019.

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

Births in the United States, 2019.

This report presents selected highlights from 2019 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44), prenatal care timing (the percentage of mothers with first trimester care), source of payment for the delivery (the percentage of births covered by Medicaid), and preterm birth rates are presented. All indicators are compared between 2018 and 2019 and are presented for all births and for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

The Paradoxical Effects of Hurricane Katrina on Births and Adverse Birth Outcomes.

Objectives. To review the trends in pregnancy outcomes after Hurricane Katrina and assess effects of the disaster on research and public health related to pregnant women.Methods. We reexamined the 2004-2006 vital statistics data from Alabama, Louisiana, and Mississippi, assessing what the risk of adverse pregnancy outcomes in the population would have been under varying risk scenarios.Results. We saw a reduction in number of births as well as in low birth weight and preterm birth. If the number of births had stayed constant and the relative higher risk in the "missing" births had been between 17% and 100%, the storm would have been associated with an increased risk instead of a decrease. Because the relative decline in births was larger in Black women, the higher risk in the "missing" births required to create a significant increase associated with the storm was generally not as great as for White women.Conclusions. Higher exposure to Katrina may have produced a reduction in births among high-risk women in the region rather than increasing adverse outcomes among those who did give birth.

Ethnicity, sex composition of living children, and unrealized fertility in Nigeria.

While studies in high-income countries have shown that failure to achieve fertility desires is significantly associated with unfavourable personal circumstances, there is barely any empirical evidence on the factors that influence the pattern of unrealized fertility in sub-Saharan Africa. Using data from the 2018 Nigeria Demographic and Health Survey, this paper investigates the roles of ethnicity and the sex composition of living children on unrealized fertility in Nigeria. The results show that the odds of having unrealized fertility were higher among Hausa-Fulani women compared with women of other ethnic groups in Nigeria. Also, having daughters only (no sons) was associated with higher odds of unrealized fertility, after controlling for other important covariates. The findings suggest that cultural norms and pronatalism significantly influence the fertility desires of women in Nigeria, even at the end of their reproductive lifespan.

State Teen Birth Rates by Race and Hispanic Origin: United States, 2017-2018.

Objectives-This report presents changes in state-specific birth rates for teenagers between 2017 and 2018 by race and Hispanic origin of mother. Methods-Data are from birth certificates of the 50 states and the District of Columbia (D.C.). Teen birth rates, the number of births to females aged 15-19 per 1,000 females aged 15-19, are shown by state for all births and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic females for 2017 and 2018. Results-Birth rates for females aged 15-19 declined in 38 states between 2017 and 2018; nonsignificant declines were reported in eight additional states and D.C. Among non-Hispanic white teenagers, rates declined in 29 states between 2017 and 2018; nonsignificant declines were reported in 16 additional states. Teen birth rates for non-Hispanic black females declined in 10 states between 2017 and 2018; nonsignificant declines were seen in 21 additional states and D.C. For Hispanic teenagers, birth rates declined in 10 states between 2017 and 2018; nonsignificant declines were reported in 30 additional states and D.C. The magnitude of change between 2017 and 2018 varied by state for each race and Hispanic-origin group.

To What Extent Is the Association Between Race/Ethnicity and Fetal Growth Restriction Explained by Adequacy of Prenatal Care? A Mediation Analysis of a Retrospectively Selected Cohort.

Race/ethnicity is associated with intrauterine growth restriction (IUGR) and small-for-gestational age (SGA) birth. We evaluated the extent to which this association is mediated by adequacy of prenatal care (PNC). A retrospective cohort study was conducted using US National Center for Health Statistics natality files for the years 2011-2017. We performed mediation analyses using a statistical approach that allows for exposure-mediator interaction, and we estimated natural direct effects, natural indirect effects, and proportions mediated. All effects were estimated as risk ratios. Among 23,118,656 singleton live births, the excess risk of IUGR among Black women, Hispanic women, and women of other race/ethnicity as compared with White women was partly mediated by PNC adequacy: 13% of the association between non-Hispanic Black race/ethnicity and IUGR, 12% of the association in Hispanic women, and 10% in other women was attributable to PNC inadequacy. The percentage of excess risk of SGA birth that was mediated was 7% in Black women, 6% in Hispanic women, and 5% in other women. Our findings suggest that PNC adequacy may partly mediate the association between race/ethnicity and fetal growth restriction. In future research, investigators should employ causal mediation frameworks to consider additional factors and mediators that could help us better understand this association.

Patterns of Birth and Family Planning Acceptor Rates in Ghana: An Ecological Study.

Despite a reported decline in Ghana's birth rate (BR), the pattern of ecological percent decrease in BR as corresponding to the percent increase in family planning acceptor rate (FPAR) in Ghana is not clear. This study explicitly explored and compared the pattern of birth and FPAR in Ghana from 2004-2015. National FPAR and BR data were retrieved from Ghana Health Service and World Bank. A time- trend descriptive analysis was performed via tableau software. Additionally, a segmented regression was applied to inferentially identify where statistically significant log-linear distinct segments exist in the trends. All segmented-related analysis was performed using joinpoint trend analysis software. Whereas, the highest decline in BR was observed from 2013-2015 (-1.4%), the highest increase in FPAR was rather observed from 2004-2008 (7.4%). Unexpectedly, from 2008-2013, a much higher decrease in FPAR (-5.8%) also yielded a moderate decline in BR (-0.7%). FPAR over the eleven years (2004-2015) increased by 1.1% whereas BR declined by -0.7%. BR in Ghana continues to be on a moderate declining trend. However, the decline was uninterrupted by an increase or decrease in FPAR. For a further decrease in Ghana's birth rate, a multifaceted approach is needed, not only focusing on increasing FPAR but also targeting adherence to FP control methods.

Births in the United States, 2018.

This report presents selected highlights from 2018 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (the number of births per 1,000 women aged 15-44) and teen birth rates are presented. Also shown are the distribution of births with a previous cesarean delivery (vaginal births after previous cesarean [VBAC] and repeat cesarean delivery) and the distribution of births by gestational age. All indicators are compared between 2017 and 2018 and are presented for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic.

The Proximate Determinants of Fertility in Eswatini.

Accelerating downwards the fertility rate remains a priority issue for developmental planning of any country. Fertility transition for most African countries has been slow since attaining their independence. In a period of almost four decades Eswatini experienced high fertility above replacement level fertility of 2.1; total fertility rate has declined from 6 to 4 children per woman from 1968 to 2007. This paper examines the impact of each proximate factor (contraception, postpartum infecundability, abortion and sexual activity) on fertility. Using the cross-sectional data from the 2006-7 Eswatini Demographic and Health Survey (DHS), the revised Bongaarts proximate determinants model of fertility was applied at national level and the analysis was extended to observe educational variation among women aged 15-49. The analysis showed that contraception had the greatest impact of fertility reduction, then sexual activity, postpartum infecundability and induced abortion. Women's educational level had huge negative influence on fertility and positive implication on reproductive choice of using contraception, delaying sexual activity/marriage and childbearing. The results guide on selection of potential social variables amenable to policy aimed at improving women's reproductive behaviour in Eswatini through better educational attainment.

Stalling fertility decline of Israeli Muslims and the demographic transition theory.

The total fertility of Muslims in Israel declined from a level of nearly ten children per woman in the mid-1960s to about 4.5 children per woman in the mid-1980s. It then remained close to 4.5 children per woman for nearly 20 years. The reasons for this long stall in the fertility decline are not understood. This paper explores the roles of marriage patterns and marital fertility in the development of the stall in Muslim fertility decline in Israel from 1986 to 2003. The results show that the fertility decline among Muslims in Israel stalled owing to abrupt discontinuations of declines in both the proportion married and marital fertility. The former is explained by the relaxation of a marriage squeeze that had resulted from past fluctuations in fertility. These findings have implications for debates on the determinants of fertility stalls and for demographic transition theory.

State of South Dakota's Child: 2018.

In 2017, similar to 2016, there was a decrease in total live resident births in South Dakota. Racial minorities comprised 25 percent of these newborns, demonstrating a similar pattern of diversity among births observed nationwide. Unlike 2016, when the state recorded its lowest ever rate of infant mortality (4.8 per 1,000 live births), in 2017 it spiked to 7.8. This increase was primarily observed in the neonatal deaths in both the white and minority population. An increase in births of very low birth weight newborns and deaths due to congenital anomalies partially contributed to this increase. Compared to the nation, a higher percent of the state's infant deaths occur among those with birthweights above 2499 grams. A positive finding apparent in the 2017 mortality data was the decrease in the rate of sudden unexpected infant deaths from what has been observed in recent years. The small number of births in the state requires caution in interpreting findings that show year to year variability. Nonetheless, while the trend in infant mortality in the state is declining, it remains higher than the 2016 rate 5.9 for the nation.

Missing girls among deliveries from Indian and Chinese mothers in Spain 2007-2015.

Deliveries from Indian and Chinese mothers present a higher than expected male:female ratio in their own countries, in northern Europe, EEUU and Canada. No studies have been carried out in southern European countries. We explored whether the high male-to-female ratio common in Indian and Chinese communities, also exists among families from those regions who live in Spain. For that purpose we designed a cross-sectional population-based study containing data on 3,133,908 singleton live births registered in the Spanish Vital Statistics Registry during the period 2007-2015. The ratio of male:female births by area of origin was calculated using binary intercept-only logistic regression models without reference category for the whole sample of births and taking into account a possible effect modification of birth order and sex of the previous males. Interaction effects of sociodemographic mothers' and fathers' characteristics was also assesed. In Spain, the ratio male:female is higher than expected for Indian-born mothers, especially for deliveries from mothers with no previous male births and, to a lesser extent, for Chinese-born women, specifically for third or higher order births and slightly influenced by the sex of the previous births. Therefore, the increased sex male:female ratio observed in other countries among Indian and Chinese mothers is also observed in Spain. This reinforces the notion that culture and values of the country of origin are more influential than the country of residence.

Early adolescent childbearing in Colombia: time-trends and consequences.

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

Total Fertility Rates by State and Race and Hispanic Origin: United States, 2017.

Objectives-This report presents 2017 total fertility rates by state of residence and race and Hispanic origin of mother for the United States. Methods-Data are from birth certificates of the 50 states and the District of Columbia. Total fertility rates, the expected number of lifetime births per 1,000 women given current birth rates by age, are shown by state for all births, and for non-Hispanic single-race white, non-Hispanic single-race black, and Hispanic women for 2017. Results-Total fertility rates varied by state for each race and Hispanic-origin group. In 2017, South Dakota (2,227.5) had the highest total fertility rate of the 50 states and the District of Columbia; the District of Columbia had the lowest (1,421.0). For non-Hispanic white women, the highest total fertility rate was in Utah (2,099.5) and the lowest in the District of Columbia (1,012.0). Among non-Hispanic black women, the highest total fertility rate was in Maine (4,003.5) and the lowest in Wyoming (1,146.0) along with California (1,503.5), Connecticut (1,575.5), Montana (1,641.0), New Mexico (1,651.0), New York (1,574.5), Rhode Island (1,594.0), and West Virginia (1,579.5). For Hispanic women, the highest total fertility rate was in Alabama (3,085.0) and the lowest in Vermont (1,200.5) and Maine (1,281.5).

Births: Final Data for 2018.

Objectives-This report presents 2018 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.79 million births that occurred in 2018 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 through 2018 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2018. Results-3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2018. Birth rates declined for women aged 20-34 and increased for women aged 35-44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017. The preterm birth rate rose for the fourth straight year to 10.02% in 2018; the rate of low birthweight was unchanged at 8.28%. Twin and triplet and higher-order multiple birth rates declined in 2018 (Figure 1).

Changing disparities in teen birth rates and repeat birth rates in Georgia: implications for teen pregnancy prevention.

OBJECTIVE: To understand teen birth trends in Georgia by racial and geographic factors. STUDY DESIGN: We analyzed overall birth and repeat teen birth rates by race, urban/rural status and adequacy of obstetric care from 2008 to 2016 using vital records from all Georgia counties. RESULTS: Overall birth rates among teens analyzed decreased dramatically in Georgia, from 45.63 births per 1000 teens in 2008-2010 to 26.28 per 1000 teens in 2014-2016. Repeat birth rates followed a similar decline, from 9.40 to 4.53 repeat births per 1000 teens over the same time period. These rates decreased in all subgroups of teens but to varying degrees. The difference in birth and repeat birth rates between black and white teens decreased fourfold during this time period, whereas the declines in these rates for teens living in rural versus urban counties and with inadequate versus adequate obstetric care were less pronounced. CONCLUSION: While remarkable reductions in teen birth and repeat birth rates have occurred since 2008, these declines have not been equally experienced by all groups of teens. IMPLICATIONS: Our analysis suggests that persistent disparities in teen birth and repeat birth rates exist, particularly in areas with limited or threatened access to reproductive health care. Applying targeted teen pregnancy prevention initiatives to these areas could help ensure equitable health and social outcomes for teens.

Hypertensive Disorders of Pregnancy and Preterm Birth Rates among Black Women.

OBJECTIVE: The objective of this study was to investigate the role of gestational hypertension (gHTN) and chronic hypertension (cHTN) on rates of preterm birth (PTB) among black women. STUDY DESIGN: Singleton live births between 20 and 44 weeks' gestation among black women in California from 2007 to 2012 were used for analysis. Risk of PTB by subtype and gestational age among women with cHTN or gHTN, including preeclampsia, was calculated via Poisson's logistic regression modeling. Risks were adjusted for maternal factors associated with increased risk of PTB. RESULTS: A total of 154,950 women met the inclusion criteria. Of the 5,948 women in the sample with cHTN, 26.2% delivered preterm; for the 11,728 women with gHTN, 21.6% delivered preterm. Women with gHTN or cHTN had a higher risk of medically indicated and spontaneous PTB, both at less than 32 and 32 to 36 weeks, when compared with nonhypertensive women (adjusted relative risks [aRRs]: 3.4-11.6). Women with superimposed preeclampsia had higher risks of spontaneous (aRR: 2.8, 95% confidence interval [CI]: 2.3-3.4) and medically indicated PTB (aRR: 2.8, 95% CI: 2.0-3.8), especially PTB < 32 weeks, when compared with women with preeclampsia. CONCLUSION: Among black women, superimposed preeclampsia increased the risk for spontaneous and medically indicated PTB, especially PTB < 32 weeks.

Early adolescent childbearing in Colombia: time-trends and consequences / Maternidad prematura adolescente en Colombia: tendencias temporales y consecuencias / Gravidez precoce na adolescência na Colômbia: tendências temporais e consequências

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

La maternidad prematura se ha visto incrementada, especialmente entre niñas con edades comprendidas entre los 10 a 14 años, aminorando mejoras en la salud pública y propagando la marginalización social. El objetivo de este artículo es estudiar los embarazos adolescentes en Colombia y sugerir posibles políticas de intervención. El estudio abarca análisis univariados y multivariados que examinan tendencias y correlacionan el parto en la adolescencia y la mortalidad infantil relacionada, en Colombia, durante el periodo de 2001 a 2011, usando estadísticas vitales completas. El estudio compara, también, mediante un análisis de riesgos relativos, a dos grupos de madres adolescentes, con edades de 10 a 14 y edades de 15 a 19 años, con un grupo de referencia, madres con edades de 20 a 34. Durante el período de estudio, la media anual de la tasa de natalidad se incrementó un 2,6% y un 0,8% en madres con edades de 10 a 14 años, y edades de 15 a 19 años, respectivamente, mientras que decreció a una tasa media de 0,2% anualmente en madres con 20-35 años de edad. Simultáneamente, mientras disminuía en general, la tasa de mortalidad infantil (TMI) del grupo más joven fue consistentemente más alta durante todo el período que la TMI de los grupos con mayor edad. Comparadas con otros grupos, las madres con edades entre 10 a 14 años eran más propensas a no estar casadas, ser procedentes del ámbito rural, indígenas o afro-mulatas, y contar con menor acceso a servicios de salud. El estudio demuestra que la maternidad prematura en adolescentes es un desafío creciente, al menos en Colombia. Estas madres tienen un riesgo más alto de perder a sus bebés mientras están en situación de pobreza. El estudio indica la necesidad de políticas que tengan como objetivo una educación apropiada y cuidados de salud, dirigidos a niñas pobres, desde una edad tan temprana como los 10 años o incluso más jóvenes.

A gravidez na adolescência tem crescido, especialmente na faixa etária de 10 a 14 anos, freando avanços na saúde pública e impulsionando a marginalização social. O objetivo deste artigo é estudar a gravidez na adolescência na Colômbia e sugerir possíveis intervenções de políticas públicas. O estudo consiste em análises univariadas e multivariadas que examinam tendências e correlativos da gravidez na adolescência e da mortalidade infantil associada na Colômbia no período de 2001 a 2011 usando estatísticas vitais completas. O estudo compara, também por meio de análise de risco relativo, dois grupos de mães adolescentes, com idade entre 10 e 14 anos e entre 15 e 19 anos, com um grupo de referência, mães com idade entre 20 e 34 anos. Durante o período do estudo, as taxas médias anuais de natalidade aumentaram em 2,6% e 0,8% entre as mães com idade entre 10 e 14 e entre 15 e 19 anos, respectivamente, ao mesmo tempo em que sofreram uma redução, a uma taxa média anual de 0,2%, entre as mães com idade entre 20 e 35 anos. Ao mesmo tempo, a taxa de mortalidade infantil (TMI) do grupo mais jovem foi consistentemente mais alta do que a dos grupos mais velhos, ainda que tenha sofrido uma redução. Quando comparadas aos outros grupos, mães com idade entre 10 e 14 anos tinham maior probabilidade de serem solteiras, indígenas ou Afro-mulatas, viverem em áreas rurais e terem menos acesso a serviços de saúde. Este estudo demonstra que a gravidez precoce na adolescência é um desafio crescente, pelo menos na Colômbia. Essas mães têm risco maior de perderem seus bebês e, simultaneamente, de serem e permanecerem pobres. O estudo sugere a necessidade de políticas dirigidas à educação e serviços de saúde apropriados para meninas pobres a partir dos 10 anos e até mais jovens.