DHS COMPARATIVE

REPORTS 45

SEXUAL AND REPRODUCTIVE HEALTH 

IN EARLY AND LATER ADOLESCENCE: 

DHS DATA ON YOUTH AGE 10-19

AUGUST 2017

This publication was produced for review by the United States Agency for International Development (USAID). The report was prepared by 

Kerry L.D. MacQuarrie, Lindsay Mallick, and Courtney Allen.

DHS Comparative Reports No. 45 

Sexual and Reproductive Health in Early and Later 

Adolescence: 

DHS Data on Youth Age 10-19 

Kerry L.D. MacQuarrie1

Lindsay Mallick1 

Courtney Allen2

ICF 

Rockville, Maryland, USA 

August 2017 

1

 The DHS Program, Avenir Health 

2

 The DHS Program, ICF 

Corresponding author: Kerry L.D. MacQuarrie, The DHS Program, ICF, 530 Gaither Road, Suite 500, 

Rockville, MD 20850, USA; phone: +1 301-572-0282; fax: +1 301-407-6501; email: 

Kerry.Macquarrie@icf.com 
Acknowledgments: The authors wish to express their gratitude to Thomas Pullum, ICF, for developing a 

Stata program to produce early adolescent fertility rates, an invaluable contribution to this study. We also 

extend our appreciation to Jessica Williamson, Avenir Health, for a thoughtful review of an early draft and 

Erica Nybro, ICF, for recommendations on data visualizations. Their suggestions resulted in numerous 

improvements. We gratefully acknowledge the assistance of Tom Fish, ICF, who prepared maps for several 

indicators in the study. The report benefited from the able editing of Diane Stoy and Chris Gramer’s skills 

with graphics. Thank you. 

Editor: Diane Stoy 

Document Production: Chris Gramer 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about The DHS Program, contact 

The DHS Program, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: 301-407-6500; 

fax: 301-407-6501; email: reports@dhsprogram.com; Internet: www.dhsprogram.com. 

Recommended citation: 

MacQuarrie, Kerry L.D., Lindsay Mallick, and Courtney Allen. 2017. Sexual and Reproductive Health in 

Early and Later Adolescence: DHS Data on Youth Age 10-19. DHS Comparative Reports No. 45. 

Rockville, Maryland, USA: ICF. 
iii 

Contents 

Tables .................................................................................................................................................................... v 

Figures .................................................................................................................................................................. v 

Preface ................................................................................................................................................................ vii 

Abstract ................................................................................................................................................................ ix 

1. Introduction ............................................................................................................................................. 1 

1.1. Background ................................................................................................................................ 1 

1.2. Methods and Data ...................................................................................................................... 1 

2. Adolescents and Marriage ....................................................................................................................... 5 

2.1. Median Age at First Marriage ................................................................................................... 5 

2.2. Age Distribution of First Marriage ............................................................................................ 8 

3. Adolescents and Sexual Debut .............................................................................................................. 17 

3.1. Median Age at First Sex .......................................................................................................... 17 

3.2. Age Distribution of Sexual Debut ........................................................................................... 21 

4. Intersections between Marriage and Sex ............................................................................................... 29 

4.1. Premarital Sex ......................................................................................................................... 29 

4.2. Current Marital and Sexual Activity Status ............................................................................. 32 

5. Contraception ........................................................................................................................................ 35 

5.1. Contraceptive Use During Adolescence .................................................................................. 35 

6. Fertility .................................................................................................................................................. 39 

6.1. Adolescent Fertility ................................................................................................................. 39 

6.2. The Initiation of Adolescent Fertility ...................................................................................... 43 

6.3. Adolescent Fertility Rates and the Total Fertility Rate ........................................................... 45 

7. Maternal Health ..................................................................................................................................... 47 

7.1. Adolescent Birth ...................................................................................................................... 48 

7.2. Antenatal Care ......................................................................................................................... 51 

7.3. Delivery Care ........................................................................................................................... 57 

7.4. Low Birth Weight .................................................................................................................... 60 

7.5. Postnatal Care .......................................................................................................................... 60 

8. Violence ................................................................................................................................................ 63 

8.1. Physical Violence .................................................................................................................... 64 

8.2. Sexual Violence ....................................................................................................................... 69 

9. Discussion and Conclusions .................................................................................................................. 75 

References ........................................................................................................................................................... 77 

Appendix 1. Calculation of Adolescent Fertility Rates ...................................................................................... 81 

Appendix 2. School Attendance ......................................................................................................................... 85 

Appendix 3. Household Wealth Quintiles .......................................................................................................... 87 

Appendix 4. Rural Residence ............................................................................................................................. 89 

Appendix 5. Female Headed Households ........................................................................................................... 91 

Appendix 6. Adolescent Fertility Curves ............................................................................................................ 93 

v 

Tables 

Table 1. Adolescent Data and Survey Attributes............................................................................................ 4 

Table 2. Maternal health indicators to be included in the adolescent report ................................................ 47 

Table A3.1. Percent of women and men age 10-19 among the poorest and richest wealth quintile .................. 87 

Figures 

Fig 1. Median age at first marriage among women age 20-24 ................................................................... 6

Fig 2. Median age at first marriage among men and women age 25-29 ..................................................... 7

Fig 3. Probability of marriage in West Africa ............................................................................................ 9

Fig 4. Probability of marriage in East Africa ............................................................................................ 10

Fig 5. Probability of marriage in Southern and Middle Africa ................................................................. 11

Fig 6. Probability of marriage in North Africa, West and Central Asia ................................................... 12

Fig 7. Probability of marriage in South and Southeast Asia ..................................................................... 13

Fig 8. Probability of marriage in Latin America and Caribbean .............................................................. 14

Fig 9. Median age at first sex among men and women age 20-24 ............................................................ 18

Fig 10. Median age at first sex among women and men age 25-29 ............................................................ 20

Fig 11. Probability of sexual debut in West Africa .................................................................................... 22

Fig 12. Probability of sexual debut in East Africa ...................................................................................... 23

Fig 13. Probability of sexual debut in Southern and Middle Africa ........................................................... 25

Fig 14. Probability of sexual debut in Asia ................................................................................................ 26

Fig 15. Probability of sexual debut in Latin America and Caribbean ......................................................... 27

Fig 16. Prevalence of sex before marriage among women age 15-19 ........................................................ 30

Fig 17. Prevalence of sex before marriage among men age 15-19 ............................................................. 31

Fig 18. Marital status by sexual activity among women and men age 15-19 ............................................. 33

Fig 19. Percent of women age 15-24 who used contraception in the 5 years preceding the survey 

during age 10-19 (all women surveys) ........................................................................................... 36

Fig 20. Percent of women age 15-24 who used contraception in the 5 years preceding the survey 

during age 10-19 (ever-married surveys) ....................................................................................... 37

Fig 21. Adolescent age-specific fertility rates, grouped ages 10-14 and 15-19 .......................................... 40

Fig 22. Adolescent fertility curves, selected countries ............................................................................... 41

Fig 23. Adolescent fertility curves age 10-14 by region for the two surveys in each region with 

the earliest fertility start .................................................................................................................. 44

Fig 24. Total fertility rates and age-specific fertility rates for age 10-14 ................................................... 46

Fig 25. Percentage of women age 15-24 with a birth before age 20 ........................................................... 49

Fig 26. Percentage of women age 15-24 whose most recent birth in the last 5 years occurred 

before age 17 and before age 20 ..................................................................................................... 50

Fig 27. Percentage of women with at least one antenatal care visit for their most recent pregnancy ......... 52

Fig 28. Percentage of women with four or more antenatal care visits ........................................................ 53

Fig 29. Percentage of women who were given iron syrup/tablets .............................................................. 55

Fig 30. Percentage of births delivered in a health facility .......................................................................... 56

Fig 31. Percentage of births delivered by a doctor, nurse, or other trained health worker ......................... 58

Fig 32. Percentage of births perceived to be small or very small at birth ................................................... 59

Fig 33. Percentage of women who received a postnatal check-up within two days of delivering 

their most recent birth ..................................................................................................................... 61

Fig 34. Percentage of women age 15-19 experiencing physical violence since age 15 .............................. 65
vi 

Fig 35. Percentage of women age 15-19 experiencing physical violence since age 15, by 

marital status (selected surveys) ..................................................................................................... 66

Fig 36. Perpetrator of physical violence among never/ever-married women age 15-19 experiencing 

physical violence since age 15 ....................................................................................................... 68

Fig 37. Percentage of women age 15-19 experiencing forced sexual intercourse or other sexual acts ...... 70

Fig 38. Percentage of women age 15-19 experiencing forced sexual intercourse other sexual acts, 

by marital status (selected surveys) ................................................................................................ 71

Fig 39. Perpetrator of first forced sex/sexual act among women age 15-19 experiencing sexual 

violence .......................................................................................................................................... 72

Fig A1. Lexis Diagram showing the exposure, in blue, of women age 15-19 at the time of a survey, 

to ages 10-19 during the 5 years before the survey ........................................................................ 82

Fig A2.1. Percent attended school among women and men age 10-13 .......................................................... 85

Fig A2.2. Percent attended school among women and men age 14-17 .......................................................... 86

Fig A4.1. Percent of women and men age 10-14 who live in rural areas ....................................................... 89

Fig A4.2. Percent of women and men age 15-19 who live in rural areas ....................................................... 90

Fig A5.1. Percent of women and men age 10-14 living in female headed households .................................. 91

Fig A5.2. Percent of women and men age 15-19 living in female headed households .................................. 92

Fig A6.1. Adolescent fertility curves, West Africa ........................................................................................ 93

Fig A6.2. Adolescent fertility curves, East Africa .......................................................................................... 95

Fig A6.3. Adolescent fertility curves, Southern and Middle Africa ............................................................... 97

Fig A6.4. Adolescent fertility curves, North Africa, West and Central Asia ................................................. 98

Fig A6.5. Adolescent fertility curves, South and Southeast Asia ................................................................... 99

Fig A6.6. Adolescent fertility curves, Latin American and Caribbean ........................................................ 100
vii 

Preface 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to provide policymakers and program managers in low- and 

middle-income countries with easily accessible data on levels and trends for a wide range of health and 

demographic indicators. DHS Comparative Reports provide such information, usually for a large number 

of countries in each report. These reports are largely descriptive, without multivariate methods, but when 

possible they include confidence intervals and/or statistical tests. 

The topics in this series are selected by The DHS Program in consultation with the U.S. Agency for 

International Development. 

It is hoped that the DHS Comparative Reports will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program 

ix 

Abstract 

Adolescence is a period of transition from childhood to adulthood when many behaviors and events set the 

stage for adult health. Demographic and Health Surveys (DHS) data are often used to describe adolescents 

age 15-19 but are infrequently used to examine younger adolescents age 10-14. This study employs 

retrospective data from women and men age 15-24—the most recent cohort that experienced adolescence 

in the 5 years preceding the survey—to investigate health outcomes during the full range of adolescent 

years from age 10-19. For 52 countries, this study compiles adolescent sexual and reproductive health 

indicators in the areas of marriage, sexual activity, contraceptive use, fertility, maternal health, and genderbased violence. 

We find marriage among women occurs during adolescence in most countries in West and East Africa 

while men marry after adolescence. Except for South and Southeast Asia, sexual debut occurs during 

adolescence for men and women. Contraceptive use is rare during early adolescence (except in some Latin 

American countries) but increases with age to about 20% among women age 15-19. Age-specific fertility 

rates are imperceptible among the youngest adolescents; even in the country with the highest early fertility 

rates (Mali), there are only 17 births per 1,000 women age 10-14. The earliest detectable adolescent fertility 

occurs at age 13-14 in Mali, Bangladesh, Angola, and Gabon. Overall, roughly 20% of women began 

childbearing before age 20. Over half of all adolescent women in Chad and Niger, and over half of evermarried adolescent women in Afghanistan and Bangladesh have begun childbearing, which is concerning 

given these countries demonstrated some of the lowest use of maternal health care. Physical violence during 

adolescence ranges from around 6% (Kyrgyz Republic) to 53% (Uganda); the experience of sexual violence 

similarly varies. 

These retrospective data provide useful insights on very young adolescents and reveal reproductive events 

rarely occur prior to age 15. 

1 

1. Introduction 

1.1. Background 

Adolescence is typically defined as the period of life between age 10 and age 19 (WHO 1989). This critical 

time of social and biological transition between childhood and adulthood entails numerous milestones and 

new opportunities, roles, and responsibilities (Lloyd 2005). These changes influence not only the 

trajectories of individual lives but also entire cohorts and populations. There were an estimated 1.2 billion 

adolescents age 10-19 in the world as of 2016, with 89% living in low and middle-income countries (US 

Census Bureau 2017). Given their numbers, it is no surprise that such a continued emphasis is placed on 

adolescents in major policy initiatives such as the Sustainable Development Goals and Family Planning 

2020 and that achieving a healthy adolescence is a cornerstone of much local and national development 

programming (Greene and Merrick 2015; Merrick 2015). 

In health and development efforts, much attention is rightly focused on older adolescents age 15-19 because 

many adolescents this age are initiating those experiences and behaviors associated with adulthood such as 

sexual activity, marriage, and childbearing (Kothari et al. 2012). However, there have been recent calls to 

invest more in younger adolescents in order to prepare them for a healthier later adolescence and adulthood 

(Igras et al. 2014; Patton et al. 2016; UNFPA 2016). These calls have been echoed with requests for more 

data on this age group to better understand their current situation and needs (Brady 2011; Engebretsen 2012; 

Lundgren and Amin 2015; McCarthy, Brady, and Hallman 2016; WHO 2011; Woog and Kågesten 2017). 

This study uses Demographic and Health Surveys (DHS) data from 52 countries to describe the sexual, 

maternal, and reproductive health of recent cohorts of adolescents for the full adolescent age range from 

10-19. 

1.2. Methods and Data 

1.2.1. Median Age at First Marriage among Men and Women Age 25-29 

DHS data on older adolescents are readily available and frequently analyzed as DHS surveys sample women 

and men who are currently age 15 and older1

. In most situations, collecting data directly from respondents

who are younger than age 15 is neither cost effective nor free of ethical challenges (Brady 2011; Way 2014). 

As cross-sectional surveys, DHS surveys collect much of their data retrospectively. Retrospective data have 

substantial—and largely untapped—potential to be gleaned to characterize the lives of younger adolescents 

(Way 2014; WHO 2011). 

DHS surveys contain two types of retrospective data: stand-alone retrospective questions and retrospective 

longitudinal schedules that cover a preset period of time preceding the survey. Examples of stand-alone 

retrospective questions from the Woman’s Questionnaire2

 ask about the timing of key life events such as: 

1. In what month and year did you start living with your (husband/partner)? How old were you when 

you first started living with him? 

2. How old were you when you had sexual intercourse for the very first time? 

3. How old were you when your (first) child was born? 

 

1

 Women’s surveys sample women age 15-49, while surveys among men typically extend to age 54 or 59. 2

 Questions 4 and 5 are contained in the Domestic Violence module, an optional module administered with the 

individual woman’s or man’s questionnaire to a subsample of up to one respondent per household and is not 

included in every DHS survey. 
2 

4. How long after you first (got married/started living together) with you (husband/partner) did any 

of these things [acts of physical violence] first happen? 

5. How old were you the first time you were forced to have sexual intercourse or perform any other 

sexual acts? 

Several similar questions are administered in the men’s survey. These questions can determine whether and 

when these events occurred during adolescence. 

The two retrospective schedules used by the DHS surveys are employed in the Woman’s Questionnaire 

only. They are the reproductive calendar3

 and birth histories. The reproductive calendar records month-bymonth, retrospective information on episodes of contraceptive use or non-use and other reproductive events 

for (typically) 5 completed years preceding the survey4

. Reproductive calendar and birth history data can 

situate contraceptive use and births, if they occur, during adolescence. 

The reproductive calendar is a two-column calendar (ICF International 2015). The first column of the 

calendar records (1) pregnancies, births, and terminations,5

 (2) episodes of contraceptive use, and (3) 

episodes of no contraceptive use6

. This involves working from the month of the interview to the beginning 

of the calendar period. The second column records a code for the reason for discontinuation if the 

respondent discontinued using contraception in that month. The reproductive calendars of women who are 

age 15-24 at the time of the interview describe the contraceptive experiences when the women were 

adolescents age 10-19. 

Although the reproductive calendar pertains to the 5 years prior to the survey, birth histories record all 

births7

 that women experience in their lifetime. Births in the 5 years preceding the interview are also entered 

in the reproductive calendar. The birth history records the year, month, and day8

 of birth, age, survival 

status, co-residence, and singleton/multiple status. More detailed information is collected on antenatal, 

delivery, and postnatal care; immunization; and health for children born in the previous 5 years. Birth 

histories place all births within or outside of adolescence for all women. Data from women age 15-24 on 

antenatal, delivery, and postnatal care for births in the previous 5 years refer to births that occurred when 

the women were adolescents age 10-19. 

This study exploits data from both stand-alone retrospective questions and the two longitudinal schedules 

(birth history and contraceptive calendar) to examine the lives of adolescents age 10-19. We examine these 

data among youth age 15-24 in order to describe the experiences of the most recent cohort of adolescents. 

This study includes topics9

 of sexual activity, marriage, contraceptive use, fertility10, maternal health, and 

violence during adolescence. Additional data on school attendance, household headship, residence, and 

 

3

 Sometimes referred to as the contraceptive calendar. 

4

 The exact length of the reproductive calendar is determined by the duration of data collection and the month in which 

the respondent is interviewed. 

5

 Terminations may include induced abortions, miscarriages, and stillbirths. 

6

 An alphabetic P, B, or T code indicates that the respondent experienced a pregnancy, birth, or termination in that 

month. A numeric code 1-9 or alphabetic code J-Y indicates the method of contraception used. The numeric code 0 

indicates that the respondent was not using any method of contraception, and was not experiencing a pregnancy, 

birth, or termination. 

7

 In a few cases, a pregnancy history is administered rather than a birth history. 

8

 Prior to 2015, only year and month of birth were collected. 

9

 Analysis of these topics is based on self-reported data obtained through the individual woman’s and man’s 

questionnaires. 

10 See Appendix 1 for a detailed discussion of the methods we used to calculate adolescent fertility rates. 
3 

wealth are found in the appendices11. We draw on data from DHS surveys conducted since 2010 in 52 

countries. Table 1 displays these surveys and the data they provide. 

Wherever possible, we analyze data from men and women. However, as shown in Table 1, seven country 

surveys did not include a men’s questionnaire. The majority of the 45 surveys with men’s data sampled a 

sub-sample of men. Table 1 also indicates the surveys with women in which data were not collected on 

sexual activity or from a birth history or reproductive calendar. Similarly, the Domestic Violence module 

is an optional module appended to the core questionnaire that was implemented in 38 of the 52 surveys. 

Finally, most surveys are administered to a sample of all women (and men) regardless of marital status. 

However, five surveys restricted eligibility to ever-married women and (where applicable) men, as 

indicated in Table 1. The Indonesia DHS sampled all women but only ever-married men12. This restriction 

to ever-married respondents limits the interpretation of certain indicators as they apply to all adolescents. 

When possible, an adjustment factor accounts for this eligibility restriction. 

 

11 Analysis of school attendance and household characteristics are based on data on all household members obtained 

through the household questionnaires. 

12 A separate special DHS survey was conducted among never-married youth and these data have been analyzed 

elsewhere (Statistics Indonesia - Badan Pusat Statistik et al. 2013). 
4 

Table 1. Adolescent Data and Survey Attributes

Survey/Region 

Women’s 

Survey1 Men’s Survey2

Women’s Birth 

History 

Reproductive 

Calendar Sexual Activity 

Domestic 

Violence 

Module 

West Africa  Benin 2011-12     

Burkina Faso 2010      

Cote d’Ivoire 2011-12     

Gambia 2013      

Ghana 2014     

Guinea 2012    

Liberia 2013     

Mali 2012-13      

Niger 2012     

Nigeria 2013      

Senegal 2015     

Sierra Leone 2013      

Togo 2013-14     

East Africa  Burundi 2010     

Comoros 2012      

Ethiopia 2011     

Kenya 2014      

Malawi 2015-16      

Mozambique 2011      

Rwanda 2014-15      

Tanzania 2015-16      

Uganda 2011      

Zambia 2013-14      

Zimbabwe 2015      

Southern and Middle Africa  Angola 2015-16      

Cameroon 2011     

Chad 2014-15     

Congo 2011-12    

Congo DR 2013-14     

Gabon 2012     

Lesotho 2014     

Namibia 2013      

North Africa, West and Central Asia  Armenia 2010     

Egypt 2014    

Jordan 2012    

Kyrgyz Republic 2012      

Tajikistan 2012     

Yemen 2013   

South and Southeast Asia  Afghanistan 2015      

Bangladesh 2014    

Cambodia 2014      

Indonesia 2012     

Myanmar 2015-16      

Nepal 2011      

Pakistan 2012-13     

Philippines 2013    

Latin America and the Caribbean  Colombia 2015      

Dominican Republic 2013     

Guatemala 2014-15      

Haiti 2012     

Honduras 2011-12      

Peru 2012     

1 The following surveys sample ever-married women: Egypt 2014, Jordan 2012, Afghanistan 2015, Bangladesh 2014, and Pakistan 2012-13. 

2 The following surveys sample ever-married men: Afghanistan 2015, Indonesia 2012, and Pakistan 2012-13. 
5 

2. Adolescents and Marriage 

Marital indicators can illuminate societal and health trends and serve as markers of gender equality and 

women’s health. Later ages at marriage and fewer marriages among adolescents may correlate with 

increased school attendance and employment opportunities for adolescent women. In addition, adolescent 

women who are married at younger ages may bear children at a younger age and are more vulnerable to 

maternal morbidity than older women. Young women who are married may also find it more difficult to 

access reproductive and family planning services and may be more vulnerable to domestic violence (Raj 

2010). This study reports the median age and the age distribution of first marriage during adolescence in 

this section. 

2.1. Median Age at First Marriage 

Median age at first marriage is an interpolated calculation of age by which 50% of a population has 

experienced their first union13. By definition, a median can be calculated for a cohort only if at least 50% 

has married by the start of the age bracket. This study presents medians for women and men age 20-24 to 

describe the marriage experience of the most recent cohort of adolescents. The study also presents medians 

for women and men age 25-29 because of the paucity of countries in which half the population has married 

by this age bracket. Medians are based on respondents of all marital statuses. In the surveys that excluded 

never-married women or men, medians are adjusted to account for this sample restriction14. 

2.1.1. Median age at first marriage among women age 20-24 

Figure 1 shows the median age at first marriage for women age 20-24. No men’s data are displayed because 

no medians can be calculated among men age 20-24 in any study survey. Men simply do not marry during 

adolescence. For the majority of study countries, 50% of women age 20-24 has not experienced a first union 

at an adolescent age, as indicated in pale blue. 

In the 22 countries for which a median can be calculated, the median age at first marriage varies widely 

within and between regions. In West Africa approximately half of the countries in the region have a median 

for women age 20-24, several of them occurring before age 18 (e.g., Burkina Faso: 17.9, Guinea: 17.8, 

Mali: 17.2). The youngest median age at marriage of all study countries is found in Niger, at age 16. 

Similarly, in East, Southern, and Middle Africa, half of the countries have medians occurring in 

adolescence, though only one occurs before age 18. In Chad, the median age at first marriage among women 

age 20-24 occurs at age 16.4. 

Outside of Sub-Saharan Africa, first marriage during adolescence is less common. The medians for women 

age 20-24 are fewer in South and Southeast Asia and Latin America and the Caribbean. Only Afghanistan 

(19.5), Bangladesh (17.2), Nepal (18.9), and the Dominican Republic (19.7) have medians. No medians 

occur for this age group among women in North Africa, West and Central Asia. 

 

 

13 Unions include persons who are married or living with someone as if married and encompass both formal, legally 

recognized marriages and non-formal marriages alike. 14 Surveys that only sampled ever-married women include Afghanistan 2015, Bangladesh 2014, Egypt 2014, Jordan 

2012, and Pakistan 2012-13. Ever-married men were only sampled in Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13. 
6 

Fig 1. Median age at first marriage among women age 20-24 

0 5 10 15 20 25

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2014

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Angola 2015-16

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

[1,2] Egypt 2014

[1,2] Jordan 2012

Kyrgyz Republic 2012

[2] Tajikistan 2012

[2] Yemen 2013

SOUTH AND SOUTHEAST ASIA

[1] Afghanistan 2015

[1,2] Bangladesh 2014

Cambodia 2014

[3] Indonesia 2012

Myanmar 2015-16

Nepal 2011

[1,3] Pakistan 2012-13

[2] Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

[2] Peru 2012

Women 20-24

median not

calculable

Notes:

1 Estimates for the following surveys adjust for samples of ever-married women: Afghanistan 2015, and Bangladesh 2014. 2 The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, Yemen 2013, Bangladesh 2014, 

Philippines 2013, and Peru 2012.

3 Estimates for the following DHS surveys adjust for samples of ever-married men: Afghanistan 2015, Indonesia 2012, Pakistan 

2012-13.
7 

Fig 2. Median age at first marriage among men and women age 25-29 

0 5 10 15 20 25

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2014

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Angola 2015-16

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

[1,2] Egypt 2014

[1,2] Jordan 2012

Kyrgyz Republic 2012

[2] Tajikistan 2012

[2] Yemen 2013

SOUTH AND SOUTHEAST ASIA

[1,3] Afghanistan 2015

[1,2] Bangladesh 2014

Cambodia 2014

[3] Indonesia 2012

Myanmar 2015-16

Nepal 2011

[1,3] Pakistan 2012-13

[2] Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

[2] Peru 2012

Women 25-29

Men 25-29

Notes: 

1 Estimates for the following surveys adjust for samples of ever-married women: Afghanistan 2015, and Bangladesh 2014. 2 The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, Yemen 2013, Bangladesh 2014, 

Philippines 2013, and Peru 2012.

3 Estimates for the following DHS surveys adjust for samples of ever-married men: Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13. 

There is no recorded age at first sex in the following surveys: Egypt 2014, Jordan 2012, Yemen 2013, or Pakistan 2012-13.

median not calculable

median not calculable
8 

2.1.2. Median age at first marriage among women and men age 25-29 

Figure 2 shows the median age at first marriage for women and men age 25-29. These data refer to the 

second most recent cohort of adolescents, i.e., the cohort of women and men that were adolescents 5-9 years 

prior to the survey. There is little variation in the median age at first marriage among men within and 

between regions. All medians occur between ages 22 and 24. Regionally, there are more medians in South 

and Southeast Asia and Latin America and the Caribbean, while in West Africa, many countries do not 

have a median because men are marrying at even older ages and 50% of the population has not yet 

experienced a union by age 25. 

In all countries where there are data for both men and women, median age at first marriage is higher for 

men than for women. This age gap between median age for men and women by country is commonly 

between 3 and 6 years, although this difference varies by region. The largest differences in medians between 

men and women by country are in Sub-Saharan Africa. The difference in median age at first marriage 

between men and women by country is between 6 and 7 years in some countries (Burkina Faso, Ethiopia, 

and Chad), although there is a 7-year difference in Mali and Niger. The difference in medians between the 

sexes within countries is much lower in other regions of the world, and is generally less than a 4-year 

difference. South and Southeast Asia have the smallest differences between men’s and women’s median 

age at first marriage as a region. Median ages are less than 3 years in difference in this region, with the 

median age at first marriage for men and women occurring within a year and a half of each other in Pakistan. 

The median age at first marriage for women age 25-29 is calculated for 29 of the 30 surveys for which it 

could not be calculated for women age 20-24. Four of these countries nonetheless indicate a median during 

adolescence for this older cohort of women age 25-29. These are Benin (19.3), Gambia (19.6), Yemen 

(19.0), and Honduras (19.5). These findings suggest that marriage after adolescence is a recent 

development. 

The medians among women age 25-29 in the remaining 25 surveys confirm the data from the 20-24 age 

group: marriage does not occur during adolescence for most women, but during their 20s. However, a 

majority of countries whose medians do not fall within adolescence occur just after the adolescent period, 

particularly in West and East Africa (Cote d’Ivoire: 20.5; Senegal: 20.0; Togo: 20.2; Angola: 20.4; Burundi: 

20.3; Kenya: 20.5; Pakistan: 20.9; Guatemala: 20.3). The median occurs after age 22 in eight countries. 

Namibia is the only country to have no median for women age 25-29, which indicates an even older age at 

marriage or greater singlehood over the life course. 

2.2. Age Distribution of First Marriage 

Figures 3-8 show the Kaplan-Meier failure function15, which is the probability of having married by each 

single year of age among women age 15-24, by region. Women are displayed in blue and men in red. As 

with medians, analysis of surveys that exclude never-married women or men are adjusted to account for 

this sample restriction16.

 

 

15 The Kaplan-Meier failure function is also referred to as the cumulative density function or cumulative incidence 

function and is simply the complement of the Kaplan-Meier survival function of time: F(t) = 1 – S(t) = Pr(T < t) 

(Box-Steffensmeier and Jones 2004; Cleves et al. 2010). 

16 Surveys that only sampled ever-married women include Afghanistan 2015, Bangladesh 2014, Egypt 2014, Jordan 

2012, and Pakistan 2012-13. Ever-married men were only sampled in Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13. 
9 

Fig 3. Probability of marriage in West Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Benin 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Burkina Faso 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Côte d’Ivoire 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Gambia 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Ghana 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Guinea 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Liberia 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Mali 2012−13

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Niger 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Nigeria 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Senegal 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Sierra Leone 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Togo 2013−14
10 

Fig 4. Probability of marriage in East Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Burundi 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Comoros 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Ethiopia 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Kenya 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Malawi 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Mozambique 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Rwanda 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Tanzania 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Uganda 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Zambia 2013−14

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Zimbabwe 2015
11 

Fig 5. Probability of marriage in Southern and Middle Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Angola 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Cameroon 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Chad 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Congo 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Congo DR 2013−14

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Gabon 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Lesotho 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Namibia 2013
12 

Fig 6. Probability of marriage in North Africa, West and Central Asia 

Notes: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, and Yemen 2013. 

Estimates for the following surveys adjust for samples of ever-married women: Egypt 2014 and Jordan 2012. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Armenia 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Egypt 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Jordan 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Kyrgyz Republic 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Tajikistan 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Yemen 2013
13 

Fig 7. Probability of marriage in South and Southeast Asia 

Notes: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

The following DHS surveys did not sample men: Bangladesh 2014 and Philippines 2013. 

Estimates for the following DHS surveys adjust for samples of ever-married women: Afghanistan 2015, Bangladesh 2014, and Pakistan 2012-13. 

Estimates for the following DHS surveys adjust for samples of ever-married men: Afghanistan 2015, Indonesia 2012, and Pakistan 2012-13. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Afghanistan 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Bangladesh 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Cambodia 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Indonesia 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Myanmar 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Nepal 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Pakistan 2012−13

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Philippines 2013
14 

Fig 8. Probability of marriage in Latin America and Caribbean 

Notes: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

The following DHS surveys did not sample men: Peru 2012. 

In West Africa, fewer than 10% of women age 15 and younger are entering their first union, although there 

are a few countries where a much larger proportion of women age 15 and younger have experienced their 

first union: Guinea (18%), Mali (22%), Niger (29%), Nigeria (15%) (Figure 3). Some countries experience 

steep curves in the cumulative distribution by the end of adolescence that result in approximately 3 in 4 

women being married by age 20 in Mali (75%), Niger (76%), and Burkina Faso (71%). In Ghana, the 

proportion of women likely to be married by the end of adolescence is 27%, which is markedly lower than 

the range of 37% - 76% present in other West African countries that are likely to experience marriage in 

adolescence. Nowhere in West Africa do men experience marriage by the age of 18, and this proportion 

increases very little by age 20. In Niger, 17% of men have married by age 20, which is the highest proportion 

in the region. West Africa also exhibits the largest gaps between men’s and women’s probability of 

marriage. 

With a few exceptions, nearly one in two women marries in adolescence in East Africa (Figure 4). Rwanda, 

an exception, is unlikely to see unions in women younger than age 18, with only 20% of women likely to 

be married in adolescence. For most countries in East Africa, it is not likely for a woman age 15 and younger 

to be married, although in a few countries, more than 10% of women that young have married: Ethiopia 

(12%) and Mozambique (13%). In Malawi and Mozambique, nearly three in four marry by the end of 

adolescence, 65% and 71% respectively. Only in Comoros and in Mozambique, it is likely that at least one 

in five men will experience marriage by the end of adolescence, 21% and 29%, respectively. 

In approximately half of the countries in Southern and Middle Africa, at least one in two women marry 

during their adolescence, which is similar to East Africa (Figure 5). Of note is Chad, where a large portion 

of women age 15 and younger are likely to be married (23%), and 74% are likely to be married in 

adolescence. Namibia is very atypical for the region and other African regions. Fewer than one in five 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Colombia 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Dominican Republic 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Guatemala 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Haiti 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Honduras 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Peru 2012
15 

women are likely to experience their first union in adolescence (13%), and men are not likely to be married 

in adolescence, with the proportion that could expect to be married in this age range between 4%-18%. 

In North Africa, West and Central Asia, it is very unlikely that women or men experience marriage before 

age 15 (Figure 6). The Kyrgyz Republic and Tajikistan have similar age distributions, with approximately 

one in ten women married by age 18. This rapidly increases to 36% and 46%, respectively, by the end of 

adolescence. Marriage in adolescence is a rare event in Armenia and Jordan, with only 23% of adolescent 

women and 2% of adolescent men (in Armenia) entering into marriage by age 20. While very early marriage 

is uncommon throughout the region, 2% of women in Egypt and 7% in Yemen are married by age 15. These 

two countries have the most adolescents married by age 18 (19% and 27%, respectively). By age 20, this 

figure rises to 43-44%, similar to the Kyrgyz Republic and Tajikistan. 

In South and Southeast Asia, adolescent marriage ranges from about one in three women in Myanmar to 

two in three women in Afghanistan (Figure 7). In Bangladesh, three in four women are married by the age 

of 20. While marriage by age 15 is low—about 2%—in Southeast Asian countries, it is higher in South 

Asia. About 8%-9% of women are married by age 15 in Nepal and Afghanistan and this figure reaches 

21% in Bangladesh. 

In South and Southeast Asia, men’s marriage during adolescence lags behind that for women, as it does in 

other regions. This is especially the case in Indonesia and Afghanistan, where the low percentage of men 

married during adolescence suggests substantial spousal age differences. Still, 12% of men are married 

during adolescence in Afghanistan. The age curves for men and women are more similar to one another in 

Cambodia, Myanmar, and Nepal, although fewer men than women are married at each age. Between onequarter and one-third as many men as women are married by age 18 in these countries. By age 20, this ratio 

narrows slightly to half as many men married as women. Here, men’s probability of being married is closer 

to the probability of women being married at any age compared to countries in other regions. 

In Latin America and the Caribbean, between 32% and 51% of women experience their first marriage in 

adolescence (Figure 8). In the Dominican Republic, 11% experience marriage before age 15, which is the 

highest proportion for this age in the region. Like other regions, men experience a very small probability of 

having their first union in adolescence. In Honduras, however, nearly one in ten men (9%) are likely to be 

married by age 18, a notable difference compared with men in all other regions. 

17 

3. Adolescents and Sexual Debut 

Becoming sexually active is a milestone event in social development that may occur during adolescence in 

many parts of the world. The extent to which sexual debut is normative behavior for adolescents can vary 

substantially. DHS surveys in 48 countries collect retrospective data on first sex from women and from 

men in 44 countries17. This section of the report uses these data to describe indicators of sexual activity—

namely sexual debut—regardless of marital or relationship status. Sexual debut can occur within the 

institution of marriage or the context of other relationship types. However, several surveys sample only 

ever-married women or men18. Adjusting for this sample restriction would necessitate assumptions about 

the sexual behavior of non-sampled unmarried adolescents without robust supporting empirical evidence. 

Meanwhile, incorrectly generalizing unadjusted rates of sexual debut among married adolescents to the 

population of all adolescents would likely overestimate true levels of sexual activity. The unadjusted 

estimates presented here are best interpreted as the prevalence or median among ever-married women and 

men. 

3.1. Median Age at First Sex 

3.1.1. Median age at first sex among women and men age 20-24 

Figure 9 presents the median age at first sex among women and men age 20-24. As with age at first 

marriage, medians cannot be calculated for this age group in all study countries, indicated in pale blue and 

pale red in Figure 9. Therefore, we also present median age at first sex among the next oldest cohort, women 

and men age 25-29 in Figure 10. 

 

17 No data on age at first sex are collected in DHS surveys in the Egypt 2014, Jordan 2012, Pakistan 2012-13, and 

Yemen 2013. There are no men’s samples in the Bangladesh 2014, Egypt 2014, Jordan 2012, Peru 2012, Philippines 

2013, Tajikistan 2012, and Yemen 2013 DHS surveys. 

18 Surveys that only sampled ever-married women include Afghanistan 2015, Bangladesh 2014, Egypt 2014, Jordan 

2012, and Pakistan 2012-13. Ever-married men were only sampled in Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13. 
18 

Fig 9. Median age at first sex among men and women age 20-24 

0 5 10 15 20 25

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo (Brazzaville) 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Kyrgyz Republic 2012

[2] Tajikistan 2012

SOUTH AND SOUTHEAST ASIA

[1,3] Afghanistan 2015

[1,2] Bangladesh 2014

Cambodia 2014

[3] Indonesia 2012

Myanmar 2015-16

Nepal 2011

[2] Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

[2] Peru 2012

Women 20-24

Men 20-24

median not calculable

median not calculable

Notes: 

1 Estimates for the following surveys are based on samples of ever-married women: Afghanistan 2015 and Bangladesh 2014.

2 The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, Yemen 2013, Bangladesh 2014, 

Philippines 2013, and Peru 2012.

3 Estimates for the following DHS surveys are based on samples of ever-married men: Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13.

There is no recorded age at first sex in the following surveys: Egypt 2014, Jordan 2012, Pakistan 2012-13, or Yemen 2013.
19 

Figure 9 indicates that sexual debut occurs during adolescence for most women in all West African, 

Southern and Middle African, and Latin American and Caribbean countries in this study and in most study 

countries in East Africa. Women’s youngest median age at sexual debut appears in Mozambique (16.1), 

Chad (16.5), Congo (16.3), Liberia (16.2), and Niger (16.2). The median age at first sex occurs during 

women’s adolescence in just three South and Southeast Asian countries, where marriage age is also low 

(Afghanistan, Bangladesh, and Nepal) and in no West and Central Asian countries in the study. The highest 

adolescent median age at first sex is in Afghanistan (19.9), followed closely by Gambia and Burundi (19.8). 

In the remaining Asian countries and in Comoros and Rwanda, sexual debut is not a part of women’s 

adolescent experience. 

Patterns are similar among men age 20-24, although there are more countries for which a median age cannot 

be calculated for men than for women in West Africa. Meanwhile, the converse pattern is evident in 

Comoros, Armenia, and the Kyrgyz Republic: the median age at first sex occurs during adolescence for 

men age 20-24 but such a median cannot be calculated for women of the same age. These findings suggest 

differential age mixing in sexual partnerships in these countries. 

In most countries where medians are calculated for both sexes, there is little difference in sexual debut by 

sex and medians are relatively similar, with almost all occurring within a year of each other. Men’s median 

age at sexual debut is consistently older than that for women in West Africa, while in Latin American and 

Caribbean countries, it is consistently younger than that for women. The absence of medians calculated for 

men in Asian countries indicates men experience later sexual debut than women in these regions. In East, 

Southern, and Middle Africa, however, women experience sexual debut earlier than men in about half the 

countries while men experience sexual debut earlier than women in the other half. 

3.1.2. Median age at first sex among women and men age 25-29 

Figure 10 illuminates age patterns in sexual debut among women and men age 25-29 where these data are 

absent for the younger cohort. In all countries, the median age at first sex often occurs within close ages for 

the two sexes. These gaps between medians are usually less than 3 years, with medians commonly occurring 

within 1 to 2 years of each other. The largest difference in medians between men and women age 25-29 is 

in Niger, where the median age at first sexual intercourse occurs 6.6 years later for men than for women. 

In West Africa, this median occurs at older ages in men than in women. In other African countries where 

the median is at a younger age for men than in women, such as in Kenya, Comoros, and half of the countries 

in Southern and Middle Africa, these medians occur very close in age. In South and Southeast Asia, the 

median age among men age 25-29 is older than for women. In North Africa, West and Central Asia and 

Latin America and the Caribbean, the opposite is true in that women begin having sex later than men. 

 
20 

Fig 10. Median age at first sex among women and men age 25-29 

0 5 10 15 20 25

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo (Brazzaville) 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Kyrgyz Republic 2012

[2] Tajikistan 2012

SOUTH AND SOUTHEAST ASIA

[1,3] Afghanistan 2015

[1,2] Bangladesh 2014

Cambodia 2014

[3] Indonesia 2012

Myanmar 2015-16

Nepal 2011

[2] Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

[2] Peru 2012

Women 25-29

Men 25-29

median not calculable

median not calculable

Notes: 

1 Estimates for the following surveys are based on samples of ever-married women: Afghanistan 2015 and Bangladesh 2014.

2 The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, Yemen 2013, Bangladesh 2014, 

Philippines 2013, and Peru 2012.

3 Estimates for the following DHS surveys are based on samples of ever-married men: Afghanistan 2015, Indonesia 2012, and 

Pakistan 2012-13.

There is no recorded age at first sex in the following surveys: Egypt 2014, Jordan 2012, Pakistan 2012-13, or Yemen 2013.
21 

In the 10 countries for which no median could be calculated among women age 20-24, data for women age 

25-29 indicate that sexual debut, on average, occurs in their early 20s, ranging from age 21 in Rwanda and 

the Philippines and age 21.1 in the Comoros to age 22.7 in Armenia and age 22.8 in Myanmar. There is a 

wider range of sexual debut among men age 25-29 among the 14 countries for which a median could not 

be calculated among younger men: the median age at first sex ranges from age 20.4 in Burkina Faso to age 

23.5 in Myanmar. No median age at first sex can be calculated for men in the Comoros, Ethiopia, and 

Bangladesh, even among this older age group. 

3.2. Age Distribution of Sexual Debut 

Figures 11-15 show the Kaplan-Meier failure function19 of the probability of first sex by age among 

respondents age 15-24, by region. Women are displayed in blue, and men in red. These figures more finely 

portray patterns of sexual debut at each year and month of age. The figures show that, in most regions, the 

onset of sexual activity is most rapid during adolescence—most notably, after age 15—as reflected by the 

steepest portion of the curve apparent during these years. Adolescent men and women exhibit similar 

patterns, with men’s sexual debut occurring somewhat later than women’s sexual debut. The South and 

Southeast Asia region belies the general age pattern, with sexual debut at older ages than elsewhere among 

both women and men. 

More than three in four women and two in four men have first had sex by age 20 in most West African 

countries (Figure 11). The probability of sexual debut during adolescence is nearly universal in Liberia, 

Sierra Leone, and Côte d’Ivoire, where between 91% and 99% of women have experienced sexual debut 

by age 20, and 75% to 86% for men. More than three quarters of women (87% in Liberia) have experienced 

sexual debut by age 18 and approximately one quarter by age 15. Sexual debut during adolescence is lowest 

in Senegal and the Gambia, where 8% to 9% of women have experienced first sex by age 15, with 

approximately one-third by age 18 and one-half by age 20. A minority of men have experienced sexual 

debut by age 20 in these countries (27% and 40%, respectively). The differential between men’s and 

women’s age patterns of sexual debut are largest in Niger, followed by Mali. While 86-88% of women have 

experienced first sex by age 20 in these countries, only 27% of men in Niger and 45% of men in Mali have. 

There are no measurable levels of sexual debut in early adolescence, before age 13 or 14, in any study 

country. 

In East Africa, first sex begins at later ages (Figure 12). Fewer women and men have experienced sexual 

debut by the end of adolescence than in West Africa. In most countries in the region, 13-15% of women 

have had sex by age 15 and 70-85% by age 20. Only 4-5% of women have had first sex by age 15 in 

Burundi, Rwanda, and Zimbabwe. Less than half of women (43-47.5%) have had sex by the end of 

adolescence in Comoros, Ethiopia, and Rwanda and less than half of men in Burundi, Ethiopia, and 

Rwanda. Mozambique is the exception in this region, with more than a quarter of women having had first 

sex by age 15 and 96% by age 20, with only slightly lower percentages at these ages among men. The age 

curves for men closely align with those for women in East Africa. However, in nearly every country, more 

men than women experience sexual debut during the earliest adolescent years. Women catch up between 

age 15-18 so that more women than men experience sexual debut by the end adolescence. Comoros and 

Ethiopia display a different pattern, with a greater percentage of men having experienced first sex than 

women at each age. The differentials between the sexes is largest in Ethiopia, where more women than men 

have experienced sexual debut during adolescence, and in Comoros, where more men than women have 

experienced sexual debut. 

 

19 The Kaplan-Meier failure function is also referred to as the cumulative density function and is simply the 

complement of the Kaplan-Meier survival function of time: F(t) = 1 – S(t) = Pr(T < t) (Box-Steffensmeier and Jones 

2004; Cleves et al. 2010). 
22 

Fig 11. Probability of sexual debut in West Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Benin 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Burkina Faso 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Côte d’Ivoire 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Gambia 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Ghana 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Guinea 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Liberia 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Mali 2012−13

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Niger 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Nigeria 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Senegal 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Sierra Leone 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Togo 2013−14
23 

Fig 12. Probability of sexual debut in East Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Burundi 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Comoros 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Ethiopia 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Kenya 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Malawi 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Mozambique 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Rwanda 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Tanzania 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Uganda 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Zambia 2013−14

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Zimbabwe 2015
24 

As shown in Figure 13, the pattern of women’s sexual debut in Southern and Middle Africa resembles that 

of West Africa more than East Africa. In most countries, about two in 10 women have had first sex by age 

15 (ranging from 18% in Cameroon and Gabon to 25% in Chad) and 82-94% have had first sex by age 20. 

Sexual debut by age 15 is somewhat less frequent in Lesotho (6%) and Namibia (7%), although the percent 

of women who experience sexual debut by age 20 reaches 80% and 77% in these countries, respectively. 

Like East Africa, the age patterns of sexual debut are very similar for both sexes in Southern and Middle 

Africa. Slightly more men than women have experienced sexual debut at every age in adolescence in Gabon, 

Lesotho, and Namibia, and at least during the early adolescent years in Angola and the Congo (Brazzaville). 

More adolescent women than men have experienced first sex at each age in Cameroon and Chad, with the 

differentials being noticeably sizable in Chad. 

In sharp contrast to the other regions of the world, the onset of sexual activity is not a part of the adolescent 

experience for the majority of women in Asia20 (Figure 14). Nepal, where early marriage is common, is the 

exception. Here, 8% of women have experienced sexual debut by age 15, 38% by age 18, and 58% by age 

20. 

Adolescent women do not experience first sex until after age 15 in Armenia, the Kyrgyz Republic, and 

Tajikistan, where about one in 10 women have had first sex by age 18 in these countries. In Cambodia, 

Indonesia, Myanmar, and the Philippines, only 1-2% have had first sex by age 15, although 15-20% have 

by age 18. Less than a majority of women (24-46%) have experienced first sex by the end of adolescence 

in these seven countries. 

Because the sample only included ever-married women, the proportion of ever-married women who have 

had experienced sexual debut during adolescence is higher in Afghanistan and, especially, in Bangladesh. 

The proportion having had first sex by age 15 at 12% and 30%, respectively, and by age 18 at 57% and 

77%, respectively. First sex during adolescence is near universal in Bangladesh, with 94% of ever-married 

women having experienced sexual debut by age 20. 

Men have an earlier sexual debut than women in West and Central Asia and, by the end of adolescence, a 

majority of men have experienced first sex in Armenia (55%) and the Kyrgyz Republic (69.5%). This is 

not the case in South and Southeast Asia. In these countries, a minority of men have experienced first sex 

by the end of adolescence in Cambodia (26%), Myanmar (23%), and Nepal (45.5%) and the levels of sexual 

debut are similar between men and women throughout adolescence. The sample of men in Indonesia is a 

sample of ever-married men, while the sample of women is of all women, which makes comparisons in the 

age distribution of sexual debut difficult. No data were collected from men in Bangladesh, the Philippines, 

and Tajikistan. 

 

 

20 Since no retrospective data on sexual debut were collected in the Egypt 2014, Jordan 2012, Pakistan 2012-13, and 

Yemen 2013 DHS, they are omitted. 
25 

Fig 13. Probability of sexual debut in Southern and Middle Africa 

Note: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Angola 2015−16

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Cameroon 2011

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Chad 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Congo 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Congo DR 2013−14

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Gabon 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Lesotho 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Namibia 2013
26 

Fig 14. Probability of sexual debut in Asia 

Notes: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

No data on age of first sex were collected in the following surveys: Egypt 2014, Jordan 2012, Pakistan 2012-13, and Yemen 2013.

The following DHS surveys did not sample men: Bangladesh 2014, Philippines 2013, and Tajikistan 2012. 

Estimates for the following DHS surveys are based on samples of ever-married women: Afghanistan 2015 and Bangladesh 2014. 

Estimates for the following DHS surveys are based on samples of ever-married men: Indonesia 2012. 

 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Afghanistan 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Armenia 2010

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Bangladesh 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Cambodia 2014

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Indonesia 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Kyrgyz Republic 2012

0.00 0.25 0.50 0.75 1.00

10 15 18 20 25

age

Myanmar 2015−16

0.00 0.25 0.50 0.75 1.00

10 15 18 20 25

age

Nepal 2011

0.00 0.25 0.50 0.75 1.00

10 15 18 20 25

age

Philippines 2013

0.00 0.25 0.50 0.75 1.00

10 15 18 20 25

age

Tajikistan 2012
27 

Sexual debut during adolescence is more common in Latin America and the Caribbean (Figure 15), 

although it is not a universal experience. About three in four women have had first sex by age 20, ranging 

from 59% (Guatemala) to 85% (Colombia). However, sexual debut occurs after adolescence for about 40% 

of women in Guatemala, Peru, and Honduras. Sexual debut is common during adolescence, but it occurs 

during later adolescence rather than earlier adolescence: About 15% of women have had first sex by age 15 

and about half of women by age 18 in most countries. These figures are closer to 8% and 40%, respectively, 

in Guatemala and Peru where sexual debut is the most delayed in the region. 

Fig 15. Probability of sexual debut in Latin America and Caribbean 

Notes: 

Cumulative distribution function (F(t)=1-S(t)) estimated from respondents age 15-24. 

The following DHS survey did not sample men: Peru 2012. 

Men experience an earlier sexual debut than women do in Latin America and the Caribbean. The probability 

of experiencing first sex is greater for men than women at every age and in all five countries where 

comparisons are possible. Approximately three in ten men have had sex by age 15 and this figure increases 

rapidly to over 85% by age 20, except in Guatemala. With the latest age at sexual debut, approximately 

14% of Guatemalan men have had sex by age 15, 53% by age 18% and 73% by age 20. The differential 

between women and men is greatest in Haiti and Honduras. 

women

men

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Colombia 2015

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Dominican Republic 2013

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Guatemala 2014−15

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Haiti 2012

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Honduras 2011−12

0.00 0.25 0.50 0.75 1.00 10 15 18 20 25

age

Peru 2012

29 

4. Intersections between Marriage and Sex 

For some adolescents, marriage provides the first occasion for sexual intercourse. Elsewhere, where the age 

at marriage is high or rising, a period of time emerges in which adolescents may engage in sexual activity 

outside of marriage (Lloyd et al). The relative sequencing of sexual debut and marriage in the life course 

varies country to country as does the extent to which sexual activity occurs within or outside the confines 

of marriage. The degree to which premarital sexual activity—for adolescent women or men—is socially 

sanctioned or occurs in practice varies across the globe. Expressed norms about sexual behavior are contextspecific but gendered, which suggests that differences by sex are to be expected. This section of the study 

quantifies premarital sex in study countries. It also presents the distribution of marital status and current 

sexual activity among adolescent women and men. 

4.1. Premarital Sex 

Figure 16 displays the prevalence of premarital sex among adolescent women currently age 15-1921; Figure 

17 displays these data for adolescent men22. Adolescents are considered to have had premarital sex if (a) 

they are unmarried and report ever having had sexual intercourse or (b) the date of first sex precedes their 

date of marriage. 

The lowest levels of premarital sex among women occur in West, Central, South, and Southeast Asia. 

Namely, the percentage of women age 15-19 who have had sex before marriage is the lowest—0.2%—in 

Armenia, followed by Tajikistan (0.4%), the Kyrgyz Republic (1.5%), Cambodia (1.5%), and Indonesia 

(2.6%). Premarital sex is also low outside of this region in the Gambia (3.8%), Ethiopia (4.7%), and Senegal 

(5.7%). Premarital sex is higher, although still a minority of adolescent women, in Latin America and the 

Caribbean and in North and East Africa. 

In contrast, the highest levels are concentrated in Southern and Middle Africa followed by parts of West 

and East Africa. A majority of adolescent women age 15-19 have experienced premarital sex in Angola 

(56.1%), Congo (55.9%), Côte d’Ivoire (50.6%), Gabon (58.1%), Liberia (64.2%), Mozambique (50.2%), 

and Sierra Leone (52.7%). 

The regional patterns of premarital sex among adolescent men age 15-19 is similar to that among women. 

Levels are lowest in West, Central, South, and Southeast Asia and higher in Southern and Middle Africa 

and, to a lesser extent, in West and East Africa. However, premarital sex is also uncommon among 

adolescent men in Niger and Ethiopia, distinguishing themselves from the overall pattern for their regions. 

The highest levels of premarital sex among adolescent men are in the Latin American and Caribbean 

countries in this study, which diverges from patterns observed among adolescent women. 

Generally, a higher proportion of adolescent men age 15-19 than women of the same age has experienced 

premarital sex. However, in most West African countries, more adolescent women have experienced 

premarital sex than adolescent men. 

The differences can be stark. In the Comoros, 29.9% of adolescent men age 15-19 have experienced 

premarital sex contrasted to just 7.2% of adolescent women, which is a difference of 22.8 percentage points. 

The differences between adolescent men and women are greatest in Latin America and the Caribbean, as 

seen in Honduras (29.9 percentage points), the Dominican Republic (28 percentage points), and Haiti (24.8 

percentage points). In Liberia, where premarital sex is more common among adolescent women (64.2%) 

than adolescent men (40.9%), there is a 23.3 percentage point difference in the other direction. 

 

21 Data on sexual activity are unavailable from the Egypt 2014, Jordan 2012, Pakistan 2012-13, and Yemen 2013 

DHS surveys. 

22 No surveys were conducted among men in the Bangladesh 2014, Egypt 2014, Jordan 2012, Pakistan 2012-13, 

Peru 2012, Philippines 2013, Tajikistan 2012, and Yemen 2013 DHS surveys. There are too few cases in Indonesia 

2012 DHS to facilitate analysis. 
30 

Fig 16. Prevalence of sex before marriage among women age 15-19 

Mali

Chad

Niger

Angola

Ethiopia Nigeria

Namibia

Tanzania

Zambia

Kenya

DRC

Myanmar

Afghanistan

Mozambique

Indonesia

Congo

Cameroon

Zimbabwe

Gabon

Ghana

Guinea

Uganda

Nepal

Cote

d'Ivoire

Senegal

Burkina

Faso

Benin

Tajikistan

Cambodia

Malawi

Kyrgyz

Republic

Liberia

Bangladesh Philippines

Armenia

Lesotho

Burundi

Rwanda

Comoros

Gambia

Sierra

Leone

Togo

Colombia

Peru

Honduras

Guatemala

Haiti

Dominican

Republic

0% - 15%15.1% - 30%30.1% - 45%45.1% - 64.2%
31 

Fig 17. Prevalence of sex before marriage among men age 15-19 

Mali

Chad

Niger

Angola

Ethiopia Nigeria

Namibia

Tanzania

Zambia

Kenya DRC

Myanmar

Afghanistan

Mozambique

Congo

Cameroon

Zimbabwe

Gabon

Ghana

Guinea

Uganda

Nepal

Cote

d'Ivoire

Senegal

Cambodia

Malawi

Kyrgyz

Republic

Liberia

Armenia

Lesotho

Burundi

Comoros

Burkina

Faso

Benin

Togo

Sierra

Leone

Rwanda

Gambia

Colombia

Honduras

Guatemala

Haiti

Dominican

Republic

0% - 15%15.1% - 30%30.1% - 45%45.1% - 70.7%
32 

4.2. Current Marital and Sexual Activity Status 

Current marital status is a helpful indicator for understanding the level of marriage among adolescents at a 

given point in time. In Figure 18, we further show current marital status (married and unmarried) for 

adolescent women men age 15-19. Among unmarried adolescents, we also show whether or not they are 

sexually active. Adolescents who have had sex in the previous 30 days are considered sexually active. 

Married adolescents are assumed to be sexually active. 

Less than 30% of women age 15-19 are currently married in any country, with the exception of Niger, 

where 61% in this age range are married. Although there is variation within and among regions, Africa 

reports more marriage among adolescent women than Asia and Latin America and the Caribbean. There 

are less than 10% of adolescent women married in Ghana, Burundi, Rwanda, Namibia, Armenia, and the 

Kyrgyz Republic. Among unmarried women, sexual activity varies widely. In some countries, there are 

more unmarried and sexually active women than married women. This is true for Ghana, Liberia, Sierra 

Leone, the Democratic Republic of the Congo, Namibia, and Colombia. There are also countries that exhibit 

almost no sex outside of marriage. This is true for one in three countries in countries West and East Africa, 

and is nearly universal in Asian countries. It is clear that most adolescent women remain unmarried and not 

sexually active. Among men, there are stark differences in marital status in adolescence. In no country 

where men of all marital statuses were married are there more than 10% of men who are married. Although 

the majority of adolescent men are unmarried and not sexually active, sex outside of marriage is more 

prevalent for men than for women. With large variances within and among regions, some countries exhibit 

a notable amount of sex outside of marriage. Mozambique, Angola, and the Democratic Republic of the 

Congo have approximately one in three adolescent men who are having sex outside of marriage. There is 

almost no reported sex among unmarried men in Asian countries. 

 
33 

Fig 18. Current marital and sexual activity status among women and men age 15-19 

0% 20% 40% 60% 80% 100%

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

[1,2,4] Egypt 2014

[1,2] Jordan 2012

Kyrgyz Republic 2012

[2] Tajikistan 2012

[2] Yemen 2013

SOUTH AND SOUTHEAST ASIA

[1,3] Afghanistan 2015

[1,2] Bangladesh 2014

Cambodia 2014

[3] Indonesia 2012

Myanmar 2015-16

Nepal 2011

[1,3] Pakistan 2012-13

[2] Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

[2] Peru 2012

Women

Unmarried, not sexually active Unmarried, sexually active Married

0% 20% 40% 60% 80% 100%

Men

Unmarried, not sexually active Unmarried, sexually active Married

Notes:

1 Estimates for the following DHS surveys are based on samples of ever-married women: Afghanistan 2015, Bangladesh 2014, Egypt 2014, Jordan 2012, and Pakistan 2012-13. 2 The following DHS surveys did not sample men: Egypt 2014, Jordan 2012, Tajikistan 2012, Yemen 2013, Bangladesh 2014, Philippines 2013, and Peru 2012. 3 Estimates for the following DHS surveys are based on samples of ever-married men: Afghanistan 2015, Indonesia 2012, and Pakistan 2012-13. 4 There is no recorded data on sexual activity in the following DHS surveys: Egypt 2014, Jordan 2012, Yemen 2013, and Pakistan 2012-13.

35 

5. Contraception 

Prior research indicates that adolescent women may experience greater unmet need for family planning 

than their adult counterparts (Darroch et al. 2016; MacQuarrie 2014). The Family Planning 2020 Initiative, 

with its ambitious goal of 120 million additional users by the year 2020, makes particularly salient the 

contraceptive behavior of adolescent cohorts who are entering their reproductive years (Dasgupta et al. 

2017; FP2020 2016; Stover and Sonneveldt 2017). The risks of pregnancy are greater at young maternal 

ages, which suggests that increased contraceptive use during adolescence is desirable to improve poor 

maternal and infant health outcomes (Winter et al. 2014). 

DHS surveys of women typically incorporate a reproductive calendar that records reproductive events—

episodes of contraceptive use (or non-use) as well as pregnancies and births—for each month in the 5 years 

preceding the survey. Therefore, these retrospective data collected from each cohort of women characterize 

the experiences while 5 years younger. For example, calendar data from women age 15-19 describe the 

contraceptive experiences during age 10-14 while data from women age 20-14 describe the contraceptive 

experiences during age 15-19. Of the 52 study surveys, 41 surveys23 administered the reproductive calendar, 

yielding the data on adolescent contraceptive use presented in this study. 

5.1. Contraceptive Use During Adolescence 

Figures 19 and 20 present the percent of women age 15-24 who used contraception at some point during 

the 5 years preceding the survey during age 10-19, which provides a comparison of early adolescence with 

later adolescence. Figure 19 shows these data for samples of all women, whether married or unmarried, 

while Figure 20 shows these data for samples that surveyed only ever-married women. 

5.1.1. Adolescent contraceptive use among women of all marital statuses 

Figure 19 shows that contraception is rarely used during the early adolescent years with nearly all study 

surveys registering well below 10% of women used any method of contraception between age 10-14. Peru 

is the exception, where 23% of women report having used contraception between age 10-14. Contraceptive 

use in this age group is relatively high in two of the other three Latin American and Caribbean surveys—

Colombia (8%) and Honduras (6%) and, outside of this region, Benin (9%). Contraceptive use in this age 

group is nearly imperceptible in the North African, West and Central Asian and South and Southeast Asian 

surveys in this study. 

Contraceptive use during age 15-19 is comparably higher in most study surveys and reaches close to 20% 

of women or higher in 15 countries. During these ages, contraception is again highest in Peru (66%) and 

noticeably more common in the three other Latin American and Caribbean countries, Colombia (57%), 

Honduras (47%), and Guatemala (26%), and in Namibia (43%), Liberia (41%), Zimbabwe (35%), and 

Malawi (33%). In contrast to the pattern exhibited by most countries, there is little difference in the use of 

contraception in the two age groups in Lesotho and Benin. 

 

 

23 The surveys that did not administer the reproductive calendar are: Cameroon 2011, Chad 2014-15, Congo 2011-

12, Congo Democratic Republic 2013-14, Côte d’Ivoire 2011-12, Dominican Republic 2013, Gabon 2012, Guinea 

2012, Haiti 2012, Philippines 2013, and Togo 2013-14. 
36 

Fig 19. Percent of women age 15-24 who used contraception in the 5 years preceding the survey 

during age 10-19 (all women surveys) 

0 20 40 60 80

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Gambia 2013

Ghana 2014

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Cambodia 2014

Indonesia 2012

Myanmar 2015-16

Nepal 2011

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Guatemala 2014-15

Honduras 2011-12

Peru 2012

age 10-14

age 15-19
37 

5.1.2. Adolescent contraceptive use among ever-married women 

Figure 20 shows the percent of ever-married women who have used contraception in the 5 years preceding 

the survey. Five surveys sampled only ever-married women: Egypt 2014, Jordan 2012, Afghanistan 2015, 

Bangladesh 2014, and Pakistan 2012-13. In these five surveys, contraceptive use is rare during age 10-14 

except in Bangladesh, where 19% of ever-married women age 15-19 used a method of contraception at 

some point during age 10-14. In all five countries, contraceptive use in later adolescence exceeds that during 

early adolescence, ranging from about 11% of ever-married women age 20-24 in Afghanistan and Pakistan 

to 26% in Egypt and Jordan and the majority of women in Bangladesh (60%). 

Fig 20. Percent of women age 15-24 who used contraception in the 5 years preceding the survey 

during age 10-19 (ever-married surveys) 

Contraceptive use is known to vary by marital status (MacQuarrie 2014; MacQuarrie et al. 2015). However, 

the retrospective reproductive calendars do not capture marital histories that would be needed to 

disaggregate contraceptive use by marital status, and only a measure of current marital status is available. 

Nonetheless, these samples of ever-married women allow some contrast with contraceptive experience of 

adolescents in the all-women samples. 

This study did not distinguish between the use of modern methods and traditional methods of contraception. 

Modern methods represent the majority of current contraceptive use in nearly all study countries. 

Traditional methods are currently used by substantial proportions of all women (more than 10%) only in 

Armenia, Jordan, Cambodia, and Peru with a smaller proportion (5-10%) in Bangladesh, Pakistan, 

Guatemala, and Honduras. 

0 20 40 60 80

NORTH AFRICA, WEST AND CENTRAL ASIA

Egypt 2014

Jordan 2012

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Pakistan 2012-13

age 10-14

age 15-19

39 

6. Fertility 

The onset of fertility changes adolescent lives in profound ways. Childbearing marks a transition from 

childhood into adulthood. The birth of a first child, particularly during adolescence, shapes educational, 

occupational, and other life opportunities and alters an individual’s life trajectory far into adulthood. 

Parenthood may confer a change in social status along with new roles and responsibilities. 

Fertility indicators are seldom reported for very young adolescents. Fertility rates are typically calculated 

for women age 15-49, because broad consensus in the demographic community defines this age range as 

the reproductive life span for women. However, the same retrospective birth history data, from which agespecific fertility rates are calculated for older women, are available to describe the fertility experiences of 

adolescents as young as age 10. This section presents grouped and single year age-specific fertility rates for 

adolescent women age 10-19. 

6.1. Adolescent Fertility 

Figure 21 shows grouped adolescent age-specific fertility rates (ASFR) for the 5 years prior to the survey 

for women age 10-14 and age 15-1924. These fertility rates are shown as births per 1,000 women. See 

Appendix 1 for a discussion of the methods used to calculate adolescent fertility rates. 

It is expected that ASFR would be higher for the 15-19 age group than for the 10-14 age group, given the 

predictable pattern of ASFR for women age 15-49. Figure 21 shows that fertility is negligible in this 

youngest age group in all countries, as compared to fertility among women age 15-19. Although there is 

substantial variation in ASFR among the older adolescent age group, ASFR are consistently compressed in 

a narrow range close to zero among the youngest adolescent age group. Within this narrow band, the highest 

ASFR for women age 10-14 are in West Africa followed by Southern and Middle Africa. Mali has the 

highest ASFR with 17 births per 1,000 women age 10-14 followed by Angola (11) and Guinea (10). 

Bangladesh (9) and Mozambique (6) stand out for having higher than average early adolescent fertility rates 

for their regions. In most North African, West and Central Asian countries and many South and Southeast 

Asian countries, ASFR are nearly immeasurable for women age 10-14. 

Among the older adolescents, the ASFR varies considerably from a high of near 200 births per 1,000 women 

in Niger (210) and Chad (197) to a low of near 25 births in Armenia (28) and Jordan (27). In general, ASFR 

are higher among adolescent women age 15-19 in the three African regions than they are in the two Asian 

regions and Latin America and the Caribbean. Rwanda has a distinctively low ASFR (44) among women 

age 15-19 compared with the other countries in East Africa. 

Figure 22 shows fertility curves of single-year ASFR for women age 10-19 for the two countries in each 

region with the highest and the lowest adolescent fertility rates. Fertility curves for all study countries are 

found in Appendix A5.1-A5.6. By showing fertility levels (and their 95% confidence bands) at each year, 

fertility curves can better convey the age distribution of fertility during adolescence. 

 

24 ASFR are calculated accounting for truncation in the sample at the youngest ages and, where necessary, for evermarried samples. 
40 

Fig 21. Adolescent age-specific fertility rates, grouped ages 10-14 and 15-19 

0 50 100 150 200

WEST AFRICA

Benin 2011−12

Burkina Faso 2010

Côte d’Ivoire 2011−12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012−13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013−14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015−16

Mozambique 2011

Rwanda 2014−15

Tanzania 2015−16

Uganda 2011

Zambia 2013−14

Zimbabwe 2015

SOUTHERN & MIDDLE AFRICA

Angola 2015−16

Cameroon 2011

Chad 2014−15

Congo 2011−12

Congo DR 2013−14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST & CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH & SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Indonesia 2012

Myanmar 2015−16

Nepal 2011

Pakistan 2012−13

Philippines 2013

LATIN AMERICA & CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014−15

Haiti 2012

Honduras 2011−12

Peru 2012 ASFR 10−14 ASFR 15−19
41 

Fig 22. Adolescent fertility curves, selected countries 

Continued...

 50 100150200250300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Niger 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Ghana 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Mozambique 2011

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Rwanda 2014−15

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Chad 2014−15

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Namibia 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Yemen 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Jordan 2012
42 

Fig 22. Adolescent fertility curves, selected countries—continued

Note: 

Selected two countries in each region with the highest and lowest adolescent fertility rates, respectively 

 50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Bangladesh 2014

50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Myanmar 2015−16

50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Honduras 2011−12

50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Haiti 2012
43 

Figure 22 indicates that among the highest adolescent fertility countries in the three African regions, Niger, 

Mozambique, and Chad, and Bangladesh in South and Southeast Asia, fertility begins to rise steeply from 

age 14-15 through the later adolescent years, but levels out between ages 18 and 19. In all other countries 

shown here, there is a more steady, albeit more gradual, increase in the age-specific fertility rates through 

the mid and older adolescent ages. 

This figure also shows the wide range in adolescent fertility rates within each region. In Niger, West Africa, 

the ASFR approaches 300 births per 1,000 women by age 19. The highest adolescent fertility countries in 

East Africa (Mozambique, 236) and Southern and Middle Africa (Chad, 274) are near 250 births per 1,000 

women by age 19. In contrast, the ASFR is 100-150 births per 1,000 women in Ghana (124), Rwanda (103), 

and Namibia (141), the lowest adolescent fertility countries in these regions. The range is somewhat more 

narrow in Latin America and the Caribbean, with ranges in ASFR at age 19 of 109 in Haiti to 144 in 

Honduras. In South and Southeast Asia, the ASFR at age 19 of 163 in Bangladesh contrasts with that of 79 

in Myanmar. In North Africa, West and Central Asia, the range extends from 148 at age 19 in Yemen to 69 

in Jordan. Interestingly, although both Bangladesh and Yemen indicate an ASFR of roughly 150 births per 

1,000 women age 19, adolescent fertility begins earlier in Bangladesh and is higher at each age along the 

curve up to age 19. 

6.2. The Initiation of Adolescent Fertility 

Fertility curves are typically presented for women of reproductive age 15-49. These typical curves begin at 

age 15 with some level of fertility greater than 0. Fertility appears as if out of thin air because fertility curves 

do not extend from the onset of risk. The above figure (and Appendix A5.1-A5.6) fills this gap by showing 

fertility at the earliest ages at which it emerges. Figure 24 provides a closer look at the starting point of 

adolescent fertility by displaying at a larger scale the single-year, age-specific fertility rates for the youngest 

adolescents age 10-14. Specifically, Figure 23 shows fertility curves for the two countries in each region 

with the earliest starting ages for fertility25. The scale is enlarged and extends only to 70 births per 1,000

women to zoom in on differences in a very small region of the fertility curve. Each of the selected countries, 

having the highest early start to adolescent fertility, is an outlier in their respective regions. 

In none of these countries with the earliest onset of fertility is there measurable fertility prior to age 12. 

These figures indicate some variation in the onset of fertility both within and across regions after age 12. 

There is some fertility by age 13 in Mali (but not Côte d’Ivoire) and Bangladesh (but not Nepal) and, to a 

lesser extent, in both Angola and Gabon. In all other regions, fertility does not begin until age 14. Fertility 

among very young adolescents, even by age 14 for example, is even less apparent in North Africa, West 

and Central Asia (Tajikistan and Yemen), Latin America and the Caribbean (Honduras and Guatemala), 

and in Nepal and the Comoros. 

 

 

25 “Highest earliest start” of fertility was assessed at ages 12 and 14. 
44 

Fig 23. Adolescent fertility curves age 10-14 by region for the two surveys in each region with the 

earliest fertility start 

Continued...

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Mali 2012−13

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Côte d’Ivoire 2011−12

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Comoros 2012

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Mozambique 2011

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Gabon 2012

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Angola 2015−16

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Tajikistan 2012

0 10 20 30 40 50 60 70

ASFR (per 1,000 women)

10 11 12 13 14

age

Yemen 2013
45 

Fig 23. Adolescent fertility curves age 10-14 by region for the two surveys in each region with the 

earliest fertility start—continued

Note: 

Selected two countries in each region with the highest earliest starting fertility rates assessed at ages 12 and 14 

6.3. Adolescent Fertility Rates and the Total Fertility Rate 

Figure 24 plots the total fertility rate (TFR) for each study country and its ASFR for the youngest 

adolescents age 10-14. Each region is indicated by color. This figure allows us to examine whether there is 

any association between the TFR and the ASFR for women 10-14. Stated otherwise, does the initiation of 

fertility early in adolescence have any relationship to the total fertility at the end of women’s reproductive 

lives? 

A relationship between the ASFR and TFR would not be unexpected since the TFR is the number of 

children a woman would have over her lifetime if she experienced the prevailing ASFR at each age. 

However, the TFR is calculated from ASFRs for age 15-49, which excludes that for age 10-14. Furthermore, 

the empirical relationship between the ASFR for the youngest adolescents and TFR has not been tested 

because the ASFR for this age group is seldom computed. The bivariate regression line fit to these data 

indicates the statistical magnitude of any such association. 

The bivariate regression indeed indicates that the ASFR for women age 10-14 is positively associated with 

total fertility (p=0.000). Countries with an earlier start to fertility have a higher total level of fertility. 

Specifically, the TFR is on average 0.19 higher with each unit increase (each additional birth per 1,000 

women) in the ASFR for women age 10-14 in the study countries. 

 

0 10 20 30 40 50 60 70

A

SFR (per 1,000 women)

10 11 12 13 14

age

Nepal 2011

0 10 20 30 40 50 60 70

A

SFR (per 1,000 women)

10 11 12 13 14

age

Bangladesh 2014

0 10 20 30 40 50 60 70

A

SFR (per 1,000 women)

10 11 12 13 14

age

Honduras 2011−12

0 10 20 30 40 50 60 70

A

SFR (per 1,000 women)

10 11 12 13 14

age

Guatemala 2014−15
46 

Mali has the highest ASFR (17 births per 1,000 women age 10-14) and one of the highest TFRs (6.3) of all 

study countries. Burundi and Niger are each outliers with a higher TFR than would be predicted by their 

ASFR for age 10-14. Burundi has a high TFR of 6.1 despite an ASFR of just 0.59 among women age 10-

14, while Niger’s high TFR of 7.6 (the highest among study countries) is even higher than would be 

expected with an ASFR of 9 among those age 10-14. Meanwhile, Armenia and Bangladesh are the outliers 

with lower TFRs than would be predicted by their early adolescent ASFR. Bangladesh has a TFR of just 

2.3 despite an early ASFR of 9 among women age 10-14. Armenia has a TFR of 1.7 and an ASFR for age 

10-14 that does not register above 0.0. 

Fig 24. Total fertility rates and age-specific fertility rates for age 10-14 

Mali

Niger

Burundi

Armenia

Bangladesh

y = 0.1895x + 3.6881

0

1

2

3

4

5

6

7

8

0 2 4 6 8 10 12 14 16 18

TFR

ASFR 10-14

West Africa East Africa

Southern & Middle Africa North Africa, West & Central Asia

South & Southeast Asia Latin America & Caribbean
47 

7. Maternal Health 

Adolescent pregnancy and birth are proven risk factors for multiple adverse health consequences for both 

the mother and child. Young women who become pregnant during their teenage years are at an increased 

risk of developing eclampsia, puerperal endometritis, systemic infections, and maternal death (Ganchimeg 

et al, 2014; Chen et al, 2006; Conde-Agudelo, Beliza, and Lammers 2005). Children born to adolescent 

mothers have increased risks of low birth weight and premature birth, which contribute to early neonatal 

death (Ganchimeg et al, 2014; Chen et al, 2006; Conde-Agudelo, Beliza, and Lammers 2005). Research 

indicates that these risks are attributable to the underdeveloped body of younger adolescent women (Scholl, 

Hediger, and Belsky, 1994). In addition, adolescents face disadvantages related to socio-economic factors. 

For example, research shows they receive either insufficient or sub-standard care during pregnancy and 

childbirth, when compared with older age groups (Jaychandran, Chapotera and Stone, 2016; Loto et al., 

2004). However, even after controlling for these sociodemographic and health systems factors, adolescents 

remain at risk (Ganchimeg et al, 2014), which further necessitates adequate antenatal and childbirth care. 

In this chapter, we present indicators of maternal health care for women age 15 to 24 who have begun 

childbearing during adolescence. Table 2 provides an overview of the indicators, their definitions, and the 

population bases used for the analysis in this section. To analyze adolescent pregnancy and birth, we 

restricted our denominator to women with a live birth in the 5 years preceding the survey if their most recent 

birth occurred before age 20. Percentages calculated for women or births in Bangladesh are based on 

pregnancies or births in the 3 years preceding the survey. In this table, we disaggregate these indicators by 

exact age at birth, either before age 17 or between ages 17 and 19. We chose these age groups based on an 

examination of the frequency of births by each year of adolescence. Small sample sizes in most countries 

restricted analysis of younger adolescent groups, in which the unweighted number of women with a birth 

in younger age groups is less than 50. We present confidence intervals to provide insight into differences 

between groups, although we did not conduct significance testing. The analysis conducted among women 

in Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan is based on an ever-married sample of women. 

Table 2. Maternal health indicators to be included in the adolescent report 

Indicator Definition Population Base

Adolescent birth Percentage of women who have had at least one 

birth before age 20 

All women interviewed age 15-24 

Age at most recent birth Percentage of women who had a birth in the five 

years preceding the survey and the most recent 

birth occurred before age 17 and before age 20 

Any antenatal care (ANC) Percentage of women with at least one antenatal 

care visit for their most recent pregnancy 

Women age 15-24 with a live birth in the five 

years preceding the survey, disaggregated by 

women whose most recent birth occurred either 

Four or more ANC Percentage of women with four or more antenatal before age 17 or between age 17 and 19 

care visits for their most recent pregnancy 

Mother was given iron syrup/tablets 

during pregnancy 

Percentage of women who were given iron 

syrup/tablets during their most recent pregnancy 

Birth delivered in a facility Percentage of births delivered in a facility All births that occurred within the five years 

preceding the survey, disaggregated by age at 

mothers birth, either before age 17 or between 

17 and 19 

Birth delivered by a skilled birth 

attendant 

Percentage of births delivered by a doctor, nurse 

or other trained health worker 

Low Birth Weight Percentage of births perceived to be small or very 

small at birth 

Postnatal care for the mother Percentage of women who received a postnatal 

check-up within two days of delivering their most 

recent birth 

Women age 15-24 with a live birth in the two 

years preceding the survey, disaggregated by 

women whose most recent birth occurred either 

before age 17 or between age 17 and 19 
48 

7.1. Adolescent Birth 

Figure 25 shows the percentage of women age 15-24 who had one birth, two births, and three or more births 

before age 20. The total percent of women who have had any number of births before age 20 varied by 

region, although the least amount of variation is seen in Latin America and the Caribbean (LAC), where 

between 20% to 30% of women in these countries had an adolescent birth—most commonly only one birth. 

There was a large range in adolescent parity in South and Southeast Asia, where we found that Bangladesh 

and Afghanistan presented with the largest proportions of adolescent births at over 60% of women in 

Bangladesh and about 55% of women in Afghanistan having at least one birth before age 20. However, in 

Afghanistan, women who had given birth before age 20 most commonly had two or more births, and 18% 

of women reported three or more births during adolescence. However, it is worth noting again that the 

proportions presented here for Afghanistan and Bangladesh (as well as Egypt, Jordon, and Pakistan), are 

among a sample of ever-married women only. In South and Southeast Asia, adolescent childbearing is much 

lower—with less than 20% total with three or more births being rare. Armenia, the Kyrgyz Republic, and 

Myanmar had the lowest proportion of young women who had given birth before age 20, around or less 

than 10%. In West Africa, no less than 20% of women in each country had an adolescent pregnancy before 

age 20, with Mali and Niger having the highest proportions of women with any number of births and women 

with greater adolescent parity. 
49 

Fig 25. Percentage of women age 15-24 with a birth before age 20 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

Myanmar 2015-16

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 1 birth 2 births 3 or more no births

Note: 

Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
50 

Fig 26. Percentage of women age 15-24 whose most recent birth in the last 5 years occurred before 

age 17 and before age 20 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

Myanmar 2015-16

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

before 17 before 20

Notes: 

1. Bangladesh is calculated among women with a birth within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
51 

Figure 26 illustrates the percent of women who had a birth in the 5 years preceding the survey (or 3 years 

for Bangladesh), for which the most recent birth occurred before age 17 and before age 20. These two age 

groups of women serve as the denominators for indicators of antenatal care (ANC). With half a dozen 

exceptions (Bangladesh, Mali, Guinea, Chad, Niger, and Angola), less than 7% of women in each country 

had a most recent birth in the preceding 5 years before age 17. This highlights the paucity of data for 

indicators of maternal health in early adolescence. In three countries, Armenia, the Kyrgyz Republic, and 

Tajikistan, less than 1% of women age 15-24 had a birth in the previous 5 years before age 17. Since the 

unweighted sample in this age group was less than 25, we suppressed these results in the following figures 

on ANC and postnatal care (PNC), which draw from reports on the most recent pregnancy with a live birth. 

Even when we examined all births in the 5 years preceding the survey by age, the sample size was still 

insufficient. Thus, we suppressed results for the birth-related indicators. For four countries (Burundi, 

Jordan, Myanmar, and Rwanda), there were only between 25 and 49 unweighted women with a most recent 

birth before age 17. We labeled these four countries with parenthesis to alert the reader to use caution when 

interpreting the results for the younger adolescent group. 

7.2. Antenatal Care 

Figure 27 presents the percentage of women under 17 and between 17 and 19 who had a birth within the 

previous 5 years and who had at least one ANC visit during their most recent pregnancy. Overall, the 

majority of women in all countries obtain at least one ANC visit, and in most countries, the proportion of 

women in both age groups ranges from 80% to 100%. The LAC region has the most consistent and highest 

reports within any given region, although overall only several countries have particularly low ANC 

coverage. These include Nigeria in West Africa, Ethiopia in East Africa, and Afghanistan in South and 

Southeast Asia. There was a tendency for the 17-19 year olds to have higher coverage compared with those 

under age 17 in about two-thirds of the countries with sufficient sample sizes for both age group. However, 

these differences appeared to be generally insignificant, although we noted significant differences between 

age groups only in Nigeria. 
52 

Fig 27. Percentage of women with at least one antenatal care visit for their most recent pregnancy 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

(Myanmar 2015-16)

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

(Jordan 2012)

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo 2011-12

Congo DR 2013-14

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

(Rwanda 2014-15)

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

(Burundi 2010)

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 < age 17 age 17-19

Notes: 

1. Bangladesh is calculated among women with a birth within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
53 

Fig 28. Percentage of women with four or more antenatal care visits 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

(Myanmar 2015-16)

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

(Jordan 2012)

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo 2011-12

Congo DR 2013-14

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

(Rwanda 2014-15)

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

(Burundi 2010)

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Bangladesh is calculated among women with a birth within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
54 

As expected, fewer women in both age groups obtained the recommended four or more ANC visits during 

their last pregnancy in the previous five years. Figure 28 presents these results. Overall, just under 60% of 

young women with a birth in the previous 5 years in all countries had four or more ANC visits during their 

last pregnancy. We see variation both across and within region. While all countries in LAC had high 

coverage of at least one ANC, we found that for four or more ANC visits, Haiti was an outlier in the region. 

About 60% of women in each age group in Haiti attended four or more visits, while over 80% of women 

in other countries in the region attended ANC four or more times. There were other regional differences as 

well. For example, in North Africa, West and Central Asia, Yemen had low coverage, particularly for those 

age 17 to 19, while both age groups in Jordan had over 90% coverage. In South and Southeast Asia, women 

in Afghanistan, Bangladesh, and Pakistan in both age groups had low attendance and close to 90% of 

women in Indonesia and Philippines achieved the recommended level of attendance. In East Africa, 

Ethiopia again stood out with low coverage. Although we only saw a definitive significant difference 

between the two age groups in Nigeria and Indonesia, there was a tendency for women age 17 to 19 to have 

more coverage than those under age 17. 

Figure 29 shows the percent of women who consumed iron supplements during their most recent pregnancy 

for women who gave birth during their adolescence in the 5 years before the survey. Iron consumption is 

high—over 70% in about two-thirds of the countries included here. We found no pattern of similarities 

within regions. Within each region, one or two countries had notably low coverage. Most notably, in West 

Africa, less than 50% of women under age 17 with a birth in Nigeria consumed iron during their most recent 

pregnancy. In East Africa, Ethiopia’s coverage was particularly low and was close to 10% for women in 

each age group. In Kenya, only around 30% or less of women in both age groups consumed iron during 

their most recent pregnancy. In North Africa, West and Central Asia, women in Armenia and Yemen (only 

those age 17 to 19) consumed iron least often, with less than 30% in each country. Less than 40% of all 

adolescent women in Afghanistan and those under age 17 in Pakistan consumed iron during their most 

recent pregnancy. This contrasts with much higher coverage among women in South and Southeast Asian 

countries. We only saw significant differences in Nigeria by age group. Unlike ANC indicators, we did not 

find any insignificant patterns of differences by age groups among the remaining countries. 
55 

Fig 29. Percentage of women who were given iron syrup/tablets 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

Myanmar 2015-16

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

(Jordan 2012)

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Bangladesh is calculated among women with a birth within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
56 

Fig 30. Percentage of births delivered in a health facility 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

Myanmar 2015-16

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Bangladesh is calculated among births occuring within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
57 

7.3. Delivery Care 

Figure 30 shows the percent of births in the 5 years preceding the survey delivered in a health facility by 

women either under age 17 or between age 17 and 19. As with indicators calculated among most recent 

births, we found large variations within regions. In West Africa, both age groups in Benin have the highest 

proportion of facility based deliveries at just under 90%, while in Niger only slightly over 30% of children 

of mothers of both age groups and closer to 20% of births to women under age 17 in Nigeria are born in 

facilities. In East Africa, we found children in Ethiopia were least commonly born in facilities compared 

with all other countries (close to 10%). Yet, in Rwanda, about 95% of births to women in their adolescence 

occurred in health facilities. In Southern and Middle Africa, just over 20% of births in Chad and over 90% 

of births in the Congo were facility based deliveries among adolescents of all ages. In LAC, there is a large 

gap between proportion of facility deliveries between Colombia and the Dominican Republic (close to 

100%) and Haiti (under 40% for births women age 17 to 19). In North Africa, West and Central Asia, 

facility based delivery overall is quite high over 95% of births to teenage women. Yemen stands out with 

low facility delivery (just over 30%). All births to women under age 17 in Tajikistan were delivered in a 

facility. In South and Southeast Asia, facility delivery is lower as a whole than most regions, except for 

Cambodia. We saw significant differences by age group in Nigeria, Namibia, Afghanistan, and possibly 

Cambodia, where births to older teens were more likely delivered in health facilities compared with younger 

teens. In Tajikistan, however, we saw a difference by age, although births to women under age 17 more 

often occurred in a health facility compared with older adolescents, although the sample of births to women 

under age 17 only totaled 59 unweighted cases. 

Figure 31 shows the percent of births to adolescent women where a skilled birth attendant (SBA) was 

present at birth, disaggregated by births to women under age 17 and births to women age 17 to 19. We saw 

approximately the same coverage of SBA as facility delivery, particularly when comparing regional 

variations. The same countries with low coverage for facility delivery in each region also had low coverage 

for SBA, such as in Niger, Nigeria, Ethiopia, and Chad. Yemen had higher coverage of SBA than facility 

delivery, as did Indonesia, Philippines, and Comoros, while there were notably fewer births delivered by a 

SBA than in a facility in Togo and Congo. The SBAs delivered births in Nigeria, Namibia, and Afghanistan 

significantly more often to women age 17 to 19 compared with births to women under age 17. Just over 

half of all the countries had better coverage of both facility delivery and SBA among older adolescents, 

although for both indicators, the differences were largely insignificant, except in the few countries cited. 
58 

Fig 31. Percentage of births delivered by a doctor, nurse, or other trained health worker 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

(Myanmar 2015-16)

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Bangladesh is calculated among births occuring within three years of the previous survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
59 

Fig 32. Percentage of births perceived to be small or very small at birth 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

Pakistan 2012-13

Nepal 2011

(Myanmar 2015-16)

Indonesia 2012

Cambodia 2014

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

Lesotho 2014

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

Rwanda 2014-15

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

Comoros 2012

Burundi 2010

EAST AFRICA

Togo 2013-14

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

Ghana 2014

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Bangladesh is calculated among births occuring within three years of the previous survey.

2. Question is not included in surveys in the Philippines and Colombia.

3. Countries in parenthesis have between 25 and 49 unweighted number of births to women under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

4. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.
60 

7.4. Low Birth Weight 

Figure 32 shows the percent of births to women under age 17 or women age 17 to 19 perceived to be small 

or very small at birth by their mother. Overall, few births were perceived to be low birth weight—less than 

20% in each country, with a few exceptions. Senegal, Ethiopia, Yemen, and Haiti appear to have the highest 

proportion of children perceived as small at birth (between 30% and 40%) and Kenya’s mothers reported 

small births least frequently (less than 10%). In most countries, there were higher proportions of small 

births reported among mothers under age 17 than women age 17 to 19. The differences were insignificant, 

except in Nigeria, Togo and Peru. 

7.5. Postnatal Care 

Figure 33 includes women age 17 and under and women age 17 to 19 who had a birth in the 2 years 

preceding the survey and who received postnatal care (PNC) within 2 days of delivery for their most recent 

birth in that time. We found that receipt of PNC is inconsistent across countries and within regions. Ethiopia, 

Chad, and Colombia have the lowest proportions of adolescents with PNC during their most recent 

pregnancy in the previous 2 years. Adolescents age 17 to 19 in Armenia, the Kyrgyz Republic, and Peru 

have the highest proportions of PNC. We did not observe differences by age groups. The larger confidence 

intervals seen in this figure reflect the small samples of women with recent births in the two years preceding 

the survey in those age groups.
61 

Fig 33. Percentage of women who received a postnatal check-up within two days of delivering their 

most recent birth 

0% 20% 40% 60% 80% 100%

Peru 2012

Honduras 2011-12

Haiti 2012

Guatemala 2014-15

Dominican Republic 2013

Colombia 2015

LATIN AMERICA AND THE CARIBBEAN

Philippines 2013

(Pakistan 2012-13)

(Nepal 2011)

Myanmar 2015-16

Indonesia 2012

(Cambodia 2014)

Bangladesh 2014

Afghanistan 2015

SOUTH AND SOUTHEAST ASIA

Yemen 2013

Tajikistan 2012

Kyrgyz Republic 2012

Jordan 2012

Egypt 2014

Armenia 2010

NORTH AFRICA, WEST AND CENTRAL ASIA

Namibia 2013

(Lesotho 2014)

Gabon 2012

Congo DR 2013-14

Congo 2011-12

Chad 2014-15

Cameroon 2011

Angola 2015-16

SOUTHERN AND MIDDLE AFRICA

Zimbabwe 2015

Zambia 2013-14

Uganda 2011

Tanzania 2015-16

(Rwanda 2014-15)

Mozambique 2011

Malawi 2015-16

Kenya 2014

Ethiopia 2011

(Comoros 2012)

Burundi 2010

EAST AFRICA

(Togo 2013-14)

Sierra Leone 2013

Senegal 2015

Nigeria 2013

Niger 2012

Mali 2012-13

Liberia 2013

Guinea 2012

(Ghana 2014)

Gambia 2013

Cote d'Ivoire 2011-12

Burkina Faso 2010

Benin 2011-12

WEST AFRICA

 <17 17-19

Notes: 

1. Question is not included in the Mozambique survey.

2. Countries in parenthesis have between 25 and 49 unweighted number of women with a birth under 17 and results should be 

interpreted with caution; figures based fewer than 25 unweighted cases were suppressed.

3. Afghanistan, Bangladesh, Egypt, Jordan, and Pakistan are based on data from an ever-married sample of women.

63 

8. Violence 

Gender-based violence is a problem for women of all ages, but has been identified as a particular concern 

for adolescents who may lack social status and empowerment, and because women who marry at young 

ages may be at increased risk (Bruce 2012; Falb et al. 2015; Johnson et al. 2015; MacQuarrie 2009; 

Peterman, Bleck, and Palermo 2015). Thirty-eight surveys administered the Domestic Violence module as 

a part of their women’s questionnaire (ICF International 2016). This module collects data on women’s 

experiences with multiple forms of violence. Of relevance to this study, we report on adolescent women’s 

experiences with physical and sexual violence. 

Our physical violence measure is restricted to adolescent women age 15-19 who have experienced an act 

of physical violence since age 15. This is a composite measure26 that includes several specific acts 

committed by a current or former husband/partner adapted from the Conflict Tactic Scales (Straus 1990): 

1. Slap 

2. Twist arm or pull hair 

3. Push, shake, or throw something at her 

4. Punch with his fist or with something that could hurt 

5. Kick, drag, or beat up 

6. Try to choke or burn on purpose 

7. Threaten or attack with a knife, gun, or any other weapon 

It also includes “yes” responses to the following questions: 

1. Did any previous (husband/partner) ever hit, slap, kick, or do anything else to hurt you 

physically? 

2. From the time you were 15 years old has anyone (other than (your/any) 

(husband/partner)) hit you, slapped you, kicked you, or done anything else to hurt you 

physically? 

We similarly restrict our analysis of sexual violence to the sample of women age 15-19. However, our 

sexual violence measure includes any act of sexual violence the woman has experienced, regardless of her 

age at the time of the incident(s). This is also a composite measure27 that includes these acts by a current or 

former husband/partner: 

1. Physically force her to have sexual intercourse with him even when she did not want 

to 

2. Physically force to perform any other sexual acts she did not want to 

3. Force with threats or in any other way to perform sexual acts she did not want to 

It also includes a “yes” response to either of the questions: 

1. Did any previous (husband/partner) physically force you to have intercourse or perform any other 

sexual acts against your will? 

2. At any time in your life, as a child or as an adult, has anyone ever forced you in any way to have 

sexual intercourse or perform any other sexual acts when you did not want to? 

 

26 The items comprised in this measure have been determined a priori to constitute physical violence and have been 

validated in numerous DHS surveys (MacQuarrie, Winter, and Kishor 2015; MacQuarrie, Winter, and Kishor 2014). 

27 The items comprised in this measure have been determined a priori to constitute sexual violence and have been 

validated in numerous DHS surveys (MacQuarrie, Winter, and Kishor 2015; MacQuarrie, Winter, and Kishor 2014). 
64 

8.1. Physical Violence 

8.1.1. Experience of physical violence during adolescence 

Figure 34 shows the percentage of women age 15-19 who have experienced physical violence since age 15. 

These data are available for 38 surveys28. The prevalence of physical violence varies greatly from country 

to country and there are no striking regional patterns. While it may appear that physical violence is generally 

higher in West East, and Middle and Southern Africa than elsewhere, there are a sufficient number of 

counterfactuals to prevent us from confidently drawing such a conclusion. 

The highest levels of physical violence experienced by adolescents are found in Uganda (53.3%), Sierra 

Leone (44.4%), and Cameroon (44.1%). The lowest levels are found in the Kyrgyz Republic (6.3%), 

Cambodia (6.8%), and Tajikistan (7.3%). Most countries indicate that between 15-35% of women age 15-

19 have experienced physical violence since age 15. 

In 24 countries, the experience of physical violence during adolescence varies significantly by marital 

status, as shown in Figure 35. In 10 countries, there were no statistically significant differences by marital 

status and in four countries with samples of ever-married women29, such differences could not be tested. 

 

28 The following 14 surveys did not administer the Domestic Violence module: Benin 2011-12, Ghana 2014, Guinea 

2012, Liberia 2013, Niger 2012, Senegal 2015, Burundi 2010, Ethiopia 2011, Congo 2011-12, Lesotho 2014, 

Armenia 2010, Yemen 2013, Bangladesh 2014, and Indonesia 2012. 

29 These are Egypt 2014, Jordan 2012, Afghanistan 2015, and Pakistan 2012-13. 
65 

Fig 34. Percentage of women age 15-19 experiencing physical violence since age 15 

 

0 10 20 30 40 50 60

WEST AFRICA

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Mali 2012-13

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Comoros 2012

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo DR 2013-14

Gabon 2012

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Cambodia 2014

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012
66 

Fig 35. Percentage of women age 15-19 experiencing physical violence since age 15, by marital 

status (selected surveys) 

0 10 20 30 40 50 60 70 80 90

WEST AFRICA

Burkina Faso 2010

Nigeria 2013

Togo 2013-14

EAST AFRICA

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo DR 2013-14

Gabon 2012

Namibia 2013

SOUTH AND SOUTHEAST ASIA

Myanmar 2015-16

Nepal 2011

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

never married ever married
67 

Figure 35 indicates that, in the great majority of countries where significant differences exist, adolescent 

women who have ever been married are more likely to have experienced physical violence than their nevermarried peers. The opposite pattern is evident in Burkina Faso and Nigeria, where physical violence is more 

common among never-married women (1.8-2.3 times more likely). Small numbers of ever-married women 

in some countries such as Namibia means greater uncertainty around their estimates of physical violence 

than among never-married women. 

The absolute differences are most sizable in Rwanda (36 percentage points) and Gabon (31 percentage 

points). Relative differences are sizable in numerous countries. Ever-married adolescent women are more 

than twice as likely to have experienced physical violence compared to their never-married counterparts in 

Rwanda, Tanzania, Nepal, the Philippines, and every Latin American and Caribbean country in the study. 

Ever-married women in the Dominican Republic are more than three times more likely to have experienced 

physical violence. 

8.1.2. Perpetrators of physical violence against adolescents 

Figure 36 shows the perpetrator of physical violence among the adolescent women who experienced such 

violence since age 15, by marital status30. The left panel displays these data for never-married and the right 

panel displays these data for ever-married women. The total may sum to more than 100% because women 

may report more than one perpetrator. 

Never-married women and ever-married women report sharply different types of perpetrators. Nevermarried women most commonly report that they experienced physical violence perpetrated by a family 

members, followed by another perpetrator, usually a teacher. More than one-half of adolescents report a 

family member (usually a parent) as the perpetrator in East Africa, while more than 8 in 10 women do so 

elsewhere. More than 70% of adolescent women report someone other than family or partner as the 

perpetrator in Kenya and Uganda. Elsewhere, this figure ranges from 4% (Tajikistan) to 45% (Zimbabwe). 

Intimate partners are infrequently the perpetrator of physical violence among never-married adolescents. 

The exceptions are the Comoros (19%) and Congo Democratic Republic and Gabon (12% each). 

Among ever-married women, in contrast, an intimate partner is reported to be the most common perpetrator 

of physical violence in most countries. Even where an intimate partner is not the most common perpetrator 

(Burkina Faso, Gambia, Comoros, Haiti), they are more commonly a perpetrator among ever-married 

women than among never-married women. The proportion of ever-married women reporting a physically 

violent intimate partner ranges from 23% (Comoros) to 98% (Namibia). Family members are also frequent 

perpetrators of physical violence among ever-married adolescent women, as they were among nevermarried women. The proportion of ever-married women reporting family member as the perpetrator ranges 

from 11% (Nepal) to 91% (Comoros), with no particular regional pattern evident. 

Unlike never-married women, other perpetrators do not figure prominently in ever-married women’s 

experience of physical violence. Even where other perpetrators are more common (Togo, Kenya, Uganda, 

the Philippines), they are eclipsed by family members and intimate partners as perpetrators of physical 

violence. 

 

30 The following surveys are omitted because there were fewer than 50 cases reporting physical violence: Jordan 

2012, Cambodia 2014, Pakistan 2012-13. 

The following surveys are omitted because they lack data on never-married women: Egypt 2014, Afghanistan 2015. 
68 

Fig 36. Perpetrator of physical violence among never/ever-married women age 15-19 experiencing 

physical violence since age 15 

 

0 20 40 60 80 100 120 140 160

WEST AFRICA

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Mali 2012-13

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Comoros 2012

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo DR 2013-14

Gabon 2012

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Kyrgyz Republic 2012

Tajikistan 2012

SOUTH AND SOUTHEAST ASIA

Myanmar 2015-16

Nepal 2011

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

never-married women

family member intimate partner other

0 20 40 60 80 100 120 140 160

ever-married women
69 

8.2. Sexual Violence 

8.2.1. Experience of sexual violence among adolescents 

Seven surveys in this study include the Domestic Violence module but did not collect data on sexual 

violence: Burkina Faso 2010, Côte d’Ivoire 2011-12, Egypt 2014, Jordan 2012, Pakistan 2012-13, the 

Philippines 2013, and Peru 2012. For the remaining 31 countries, Figure 37 shows the proportion of 

adolescent women age 15-19 who ever experienced forced sexual intercourse or other forced sexual acts. 

In contrast to the physical violence indicator, this indicator is not limited to sexual violence experienced 

during adolescence or to any age period. This figure indicates the experience of sexual violence occurring 

before the age of 15 and that occurring before age 19 or their current age. 

With some notable exceptions, the prevalence of sexual violence is higher in East Africa and parts of 

Southern and Middle Africa. It is rarest in the Kyrgyz Republic and Tajikistan and reported by fewer than 

10% of women throughout West Africa, South and Southeast Asia, and Latin America and the Caribbean. 

The highest levels of sexual violence are evident in Cameroon (21%), Uganda (20%), and Congo 

Democratic Republic (16%). 

In all but a few countries, the proportion of women who experienced sexual violence in later adolescence 

(between the age 15-19 or their current age) outpaces the violence experienced during childhood or early 

adolescence (before age 15). For example, in Mali, with average levels of sexual violence for the countries 

in this study, 8% of adolescent women age 15-19 have experienced forced sexual intercourse or acts but 

less than 1% have experienced this violence before age 15. Substantial levels of childhood or early 

adolescent sexual violence are nonetheless noted in Rwanda, Uganda, Cameroon, and Gabon. In Guatemala 

and Kenya, more than two-thirds of adolescent women report that the sexual violence they experienced 

occurred before age 15, although overall levels are relatively low. 

 
70 

Fig 37. Percentage of women age 15-19 experiencing forced sexual intercourse or other sexual acts 

 

0 10 20 30 40

WEST AFRICA

Gambia 2013

Mali 2012-13

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Comoros 2012

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo DR 2013-14

Gabon 2012

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Kyrgyz Republic 2012

Tajikistan 2012

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Cambodia 2014

Myanmar 2015-16

Nepal 2011

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

before age 19 before age 15
71 

Fig 38. Percentage of women age 15-19 experiencing forced sexual intercourse other sexual acts, by 

marital status (selected surveys) 

0 10 20 30 40 50 60 70

WEST AFRICA

Mali 2012-13

EAST AFRICA

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo DR 2013-14

Namibia 2013

SOUTH AND SOUTHEAST ASIA

Cambodia 2014

Myanmar 2015-16

Nepal 2011

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

never married ever married
72 

Figure 38 shows the prevalence of sexual violence disaggregated by marital status for those 21 countries 

where those differences were statistically significant. It indicates that sexual violence is more common 

among ever-married women compared with never-married women. The differences are substantial in nearly 

every country. Angola, Cambodia, Myanmar, and Guatemala may be possible exceptions. Levels of sexual 

violence typically exceed 10% among ever-married women—and exceed 35% in four countries. 

Meanwhile, levels among never-married women range from less than 1% to 15%. 

8.2.2. Perpetrators of sexual violence against adolescents 

Figure 39 shows women’s reports of the sexual violence perpetrator for the first time they experienced 

forced sexual intercourse or acts. These data are omitted for countries31 with few women reporting sexual 

violence. The total sums to 100% because women could report only one perpetrator. 

Fig 39. Perpetrator of first forced sex/sexual act among women age 15-19 experiencing sexual 

violence 

“Other” perpetrators—usually a friend or a stranger—are the most commonly reported perpetrator of sexual 

violence in the majority of countries—11 of 16 countries for which these data are available. They are a 

close second most common perpetrator in four other countries. The percent of adolescent women reporting 

 

31 The excluded countries in which the number of women reporting forced sexual intercourse or other sexual acts are 

fewer than 50 unweighted cases are: Gambia 2013, Comoros 2012, Kenya 2014, Chad 2014-15, Namibia 2013, 

Tajikistan 2012, Cambodia 2014, Myanmar 2015-16, and Nepal 2011. 

0 10 20 30 40 50 60 70 80 90 100

WEST AFRICA

Mali 2012-13

Nigeria 2013

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Congo DR 2013-14

Gabon 2012

LATIN AMERICA AND THE CARIBBEAN

Honduras 2011-12

family member intimate partner other
73 

an “other” person as the perpetrator of their (first) incident of sexual violence ranges from 27% in 

Mozambique to 69% in Uganda. 

An intimate partner is the most commonly reported perpetrator of sexual violence in four countries: Sierra 

Leone (46%), Mozambique (67%), Zimbabwe (39%), and Congo Democratic Republic (50%). A sizable 

minority of adolescent women report an intimate partner perpetrator in Cameroon (44%) and Rwanda 

(38%). The percent of adolescent women reporting the perpetrator of sexual violence to be an intimate 

partner ranges from just 4% in Gabon to 67% in Mozambique. 

Family members are rarely the most common perpetrator of sexual violence. The exception is Gabon, where 

53% of women report a family member. A family member is also frequently reported in Honduras (39%), 

although this is not the most common perpetrator there. Outside of these two countries, the percentage of 

women reporting the perpetrator of sexual violence to be a family member ranges from 5% in Mozambique 

to 31% in Angola. 

 

75 

9. Discussion and Conclusions 

This study exploits retrospective data among respondents age 15-24 to describe the adolescent lives of those 

age 10-19. The analyses presented here indicate that much can be learned about even the youngest 

adolescents by using data commonly collected in surveys of older women (and men) of reproductive age 

(Way 2014; WHO 2011). The calculation of fertility rates for adolescents as young as age 10 is one 

particular innovation in youth indicators, as is the estimate of contraceptive use during adolescent years 

from the reproductive calendar. 

Although adolescence is a period of profound changes, many sexual and reproductive behaviors with which 

the public health community is concerned begin to emerge in adolescence, but are deferred until older ages 

for large proportions of respondents in many countries. The study found that women experience marriage 

during adolescence in 22 countries, mostly in West and East Africa and parts of South Asia. For the 

remaining majority of countries (except Namibia), marriage occurs in the early 20s or later for most women. 

Men everywhere marry at older ages that are beyond adolescence, which are suggestive of typical age 

mixing patterns. 

Becoming sexually active is typical during adolescence for men and women alike, except in South and 

Southeast Asia. Sexual debut during adolescence is most common in West, Southern, and Middle Africa. 

Differences between the sexes in the age pattern of sexual debut are most narrow in East Africa. Similarly, 

levels of sex before marriage are lowest in Asia and highest in West, Southern, and Middle Africa. Although 

the age at which adolescent women and men become sexually active is similar, premarital sex is more 

common among men than among women. Where marriage and sexual debut occur during adolescence, 

these experiences are less common among the youngest adolescents (age 10-14), but quickly increase with 

each year of age among older adolescents (age 15-19). 

Contraceptive use is also rare during early adolescence, with the possible exception of parts of Latin 

America and Caribbean (e.g., Peru). Contraceptive use increases with age so that roughly one in five 

adolescent women have used contraception between ages 15-19 in many countries. 

Similarly, single-year and grouped age-specific fertility rates are negligible among the youngest adolescents 

in all study countries. In Mali, with the highest rates, there are a mere 17 births per 1,000 women age 10-

14. The grouped fertility rate varies greatly among older adolescents from approximately 25 to 200 births 

per 1,000 women age 15-19. There are no measurable single-year fertility rates prior to age 12; the earliest 

apparent adolescent fertility occurs at age 13-14 in Mali, Bangladesh, Angola, and Gabon. Nonetheless, 

study data indicate that roughly one in five adolescent women have begun childbearing during adolescence, 

on average. The proportion of adolescents who have had at least one birth varies regionally from a range of 

about 10% in North Africa, West and Central Asia to 50-60% in parts of South Asia, where multiple 

adolescent births were common. 

Maternal health care indicators show a large variation in coverage across and within regions. Overall, the 

highest levels of maternal care before, during, or after birth are found in North Africa, West and Central 

Asia, and Latin America and the Caribbean. The lowest levels of maternal care are found in Ethiopia, Niger, 

and Nigeria as well as in Afghanistan, Bangladesh, Chad, and Niger. This is a pattern that should elicit 

concern because these latter four countries are countries where more than one-half of women have had at 

least one child in adolescence and about 20% or more of these women (only ever-married women in 

Afghanistan and Bangladesh) have had more than one child before age 20. 

The study also indicates that nearly one in four women, on average, experience physical violence during 

the age 15 to 19. The highest magnitude of physical violence during later adolescence is found in Uganda, 

Sierra Leone, and Cameroon, while the lowest levels appear in the Kyrgyz Republic, Tajikistan, and 
76 

Cambodia with a range extending from 53% to 6%. Although rarer than physical violence, lifetime 

experience of sexual violence (ranging from 8-21%) is highest in East, Southern, and Middle Africa and 

also lowest in Kyrgyz Republic and Tajikistan. Married adolescent women are more likely to have 

experienced either physical violence or sexual violence, bearing out earlier expressed concerns (Bruce 

2012; Johnson et al. 2015; Peterman, Bleck, and Palermo 2015). Married adolescent women are most likely 

to experience physical violence that is perpetrated by an intimate partner, eclipsing family members who 

are the most common perpetrator among never-married adolescents. The most common perpetrator of 

sexual violence against adolescents is a friend or stranger. 

While DHS data are frequently employed to assess the situation of older adolescents and youth age 15-24, 

these data have been underutilized to describe the lives of very young adolescents. This study demonstrates 

the capacity of DHS data to describe the full span of adolescence (Way 2014; WHO 2011) and yields much 

needed information about these youngest adolescents to meet the demand among youth program managers, 

policymakers, and researchers (Engebretsen 2012; Igras et al. 2014; Lundgren and Amin 2015; McCarthy, 

Brady, and Hallman 2016; Woog and Kågesten 2017). The results presented here indicate most sexual and 

reproductive events of interest are in later adolescence or even at older ages. These findings yield important 

information for programs that specifically target either older or younger adolescents and simultaneously 

provide further evidence that direct reports from very young adolescents would be of limited value except 

in specific situations. The indicators in this study are a first step to exploiting existing data in novel ways 

to understand a population for whom empirical evidence may be sparse. We anticipate that our efforts will 

be joined by those of other researchers who will continue to develop further indicators from these data and 

more deeply investigate the analytic relationships among adolescent characteristics and experiences. 

 
77 

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81 

Appendix 1. Calculation of Adolescent Fertility Rates 

This study includes age-specific fertility rates for five-year age intervals 10-14 and 15-19 and single-year 

rates for ages 10 through 19, based on exposure and births during the 5 years (60 months) before the survey. 

This appendix describes the calculation of those rates. 

The calculations for the grouped age interval 15-19 and single year ages 15 through 19 are completely 

consistent with standard DHS practice. That is, contributions to the numerators (births) and denominators 

(exposure) come from the birth histories for women age 15-24 at the time of the survey, which comprise 

all the births and exposure to the risk of a birth while age 15-19 in the past 5 years. Women age 20-24 

contribute about half of the exposure and women age 15-19 contribute the remainder. 

The calculations for age interval 10-14 and single years age 10 through 14 require modifications. The usual 

procedure would require access to birth histories for women age 10-19 at the time of the survey. However, 

DHS surveys do not include women under age 15. Therefore, the rates are limited to contributions from 

women age 15-19 at the time of the survey, who represent about half of the total births and exposure. 

Figure A1 is a Lexis diagram that illustrates all the exposure to ages 10-19, in the past 5 years, of women 

who are age 15-19 at the time of the survey. The vertical axis is completed years of age at the date of 

interview and the horizontal axis is the ordinal number of years before the survey. The blue-shaded 

parallelogram shows the exposure, of women who were age 15-19 at the time of the survey, to age 10-19 

during the 5 years before the survey. The gray triangle at the upper left would be filled by contributions to 

the rate for ages 15-19 from women age 20-24 at the time of the survey, referred to above. The gray triangle 

at the bottom right of the figure shows the combinations of age and time for which the survey respondents 

cannot provide any information. This absence of any data in the gray triangle at the bottom right is described 

as censoring due to the age 15 cutoff for eligibility in DHS questionnaires. 
82 

Fig A1. Lexis Diagram showing the exposure, in blue, of women age 15-19 at the time of a survey, to 

ages 10-19 during the 5 years before the survey 

Black lines enclose a 3x3 square for ages 12-14 during the 3 years before the survey. DHS survey final 

reports present fertility rates in the past 3 years and the past 5 years. Contributions to that square for fertility 

in the past 3 years would come only from women age 15-17 at the time of the survey. The youngest age 

group for which three-year fertility rates could be estimated are for women age 12-14. Such rates were 

estimated but are not presented in the current study. 

Our procedure to deal with the censoring at age 15 is as follows. First, for the single year rates, we simply 

divide the births by the exposure, corresponding to the blue areas in the rows for ages 10, 11, 12, 13, and 

14. No adjustments are made, although the information is incomplete; this is exactly what would be done 

for single-year rates at any age. The diagram shows almost complete exposure to age 14, because within 

the 5 years before the survey, the birth histories for women age 16, 17, 18, and 19 at date of interview will 

all include a full year of exposure and births while age 14, and the only loss of exposure is half a year for 

those women who were age 15 at the time of the survey. In effect, we assume that the missing half year 

would have the same expected ratio of births to exposure as what we observe. The rate for age 14 is 90% 

complete. 
83 

Similarly for the other single year rates, the rate for age 13 is 70% complete; the rate for 12 is 50% complete; 

the rate for age 11 is 30% complete; and the rate for age 10 is 10% complete. The rates for ages 10 and 11 

have the least data, but these rates are the lowest. The time period to which the data refer moves steadily 

backward for the lower ages. The data for age 10 are located entirely in the fifth year before the survey. 

However, as stated, the rates for the earliest ages are extremely low. 

Second, we want to calculate a rate for ages 10-14 in the past 5 years. If we were to divide the observed 

number of births by the observed woman-years of exposure in the lower left blue triangle, the five-year rate 

would be biased toward the ages with the most data. The rates for these ages are low, but there is a steep 

gradient by age that must be taken into account. Failing to correct for this bias toward data from later ages 

would produce fertility rates that overestimate fertility in the age group. 

The approach we have taken is to weight the exposure to each year of age in inverse proportion to its 

completeness. To be specific, say that R is the five-year rate for ages 10-14 and r10 through r14 are the 

single-year rates for ages 10 through 14, calculated as just described. The woman-years of exposure to each 

year of age, in the birth histories, is E10 through E14. Then R is calculated as 

R = ቂB10 + ቀ

B11

3 ቁ + ቀ

B12

5 ቁ + ቀ

B13

7 ቁ + ቀ

B14

9 ቁቃ

ቂE10 + ቀ

E11

3 ቁ + ቀ

E12

5 ቁ + ቀ

E13

7 ቁ + ቀ

E14

9 ቁቃ.

This R yields a good estimate of the usual five-year rate that would be produced if we had birth histories 

for women age 10-14 at the time of the survey, unless there was a large amount of temporal variation in the 

underlying birth probabilities for single years of age 10 to 14 within the past 5 years. 

Two other types of weights that are involved in all estimates of fertility rates deserve mention here. First, 

every case is weighted by the sample weight, (v005), which is inversely proportional to the sampling 

probability for that case. The sample weights correct for under-sampling and over-sampling in the survey 

design and for differential non-response. 

Second, in samples that are limited to ever-married women, the sample weights are multiplied by an “allwomen factor” (awfactt), which compensates for omission of women, especially young women, who were 

omitted from the survey because it was determined in the household questionnaire that they had never been 

married. The all-women factor inflates the denominators of the fertility rates, in effect adding exposure to 

the risk of childbearing for the omitted women, but leaves the numerators unchanged, because of an 

assumption that women do not have any births prior to marriage. In countries that consider it socially 

unacceptable to ask an unmarried woman whether she has had any children and therefore exclude nevermarried women from the individual interview, the only births before age 15 that will be detected by a survey 

are to women who married before age 15. The fertility rates in this study to which this weight applies are 

those from the following surveys: Afghanistan 2015, Bangladesh 2014, Egypt 2014, Jordan 2012, and 

Pakistan 2012-13. 

All fertility rates presented in this study were estimated using a Stata 14 program authored by Thomas 

Pullum in March 2017 for the express purpose of calculating single-year and five-year grouped ASFRs with 

censored data for ages 10-19. This program is a modification of another Stata program written by Thomas 

Pullum to estimate age-specific fertility rates, total fertility rates, and general fertility rates for ages 15-49 

from DHS data. The all women factor adjustment was suggested by Kerry MacQuarrie. The specific 

adjustment for censoring was suggested by Trevor Croft. Alternative adjustments would be possible but 

likely would produce nearly identical estimates. 

85 

Appendix 2. School Attendance 

Fig A2.1. Percent attended school among women and men age 10-13 

0 20 40 60 80 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 10-13 Men 10-13

Notes:

Indonesia and Philippines surveys did not include school attendance.

Figure is based on de-facto population reported in the household survey
86 

Fig A2.2. Percent attended school among women and men age 14-17 

0 20 40 60 80 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 14-17 Men 14-17

Notes:

Indonesia and Philippines surveys did not include school attendance

Figure is based on de-facto population reported in the household survey.
87 

Appendix 3. Household Wealth Quintiles 

Table A3.1. Percent of women and men age 10-19 among the poorest and richest wealth quintile

 

Women 10-14 Women 15-19 Men 10-14 Men 15-19

poorest richest poorest richest poorest richest poorest richest

Western Africa

Benin 2011-12 20.0 18.0 13.9 26.8 21.9 14.4 17.9 19.4

Burkina Faso 2010 21.6 19.9 15.8 30.3 22.3 16.3 18.9 22.1

Cote d'Ivoire 2011-12 16.8 21.7 14.4 30.8 18.7 16.3 15.6 24.0

Gambia 2013 20.9 17.7 18.9 22.8 19.9 16.8 17.4 20.8

Ghana 2014 21.5 16.1 20.6 19.2 25.0 16.2 24.1 15.0

Guinea 2012 20.9 21.5 15.5 26.1 19.8 19.0 17.9 24.5

Liberia 2013 14.9 26.0 12.3 30.9 20.2 17.5 14.2 27.5

Mali 2012-13 17.9 22.6 15.2 30.2 20.7 18.7 17.7 25.0

Niger 2012 18.7 21.4 16.1 25.3 22.1 19.6 14.7 29.3

Nigeria 2013 21.3 19.5 17.1 20.2 20.8 17.6 18.1 19.0

Senegal 2015 21.9 18.3 19.9 20.6 21.5 17.0 19.1 22.2

Sierra Leone 2013 16.6 21.9 16.4 27.4 19.5 17.6 16.2 28.6

Togo 2013-14 23.3 17.4 16.7 27.5 25.1 13.1 21.7 16.6

Eastern Africa

Burundi 2010 19.9 18.5 18.3 22.4 17.6 19.6 17.7 23.6

Comoros 2012 21.0 18.8 17.3 19.2 24.9 15.3 16.6 22.2

Ethiopia 2011 19.9 20.1 17.4 25.7 20.9 16.2 17.4 23.0

Kenya 2014 22.8 14.9 16.8 20.7 24.5 14.1 20.4 14.5

Malawi 2015-16 19.6 18.8 18.4 22.8 20.7 17.4 16.1 23.7

Mozambique 2011 19.3 21.6 17.9 25.8 19.4 18.6 14.6 25.8

Rwanda 2014-15 19.4 18.0 15.7 25.2 19.2 18.9 15.0 23.5

Tanzania 2015-16 21.6 15.5 17.6 28.8 22.3 15.2 18.0 20.4

Uganda 2011 21.2 17.2 16.3 25.2 19.4 14.7 16.8 19.1

Zambia 2013-14 19.4 19.2 15.5 27.1 19.8 16.2 13.3 23.6

Zimbabwe 2015 20.8 16.5 17.7 22.6 22.8 15.4 15.5 18.3

Southern and Middle Africa

Angola 2015-16 18.1 21.5 16.8 24.8 21.1 20.4 15.9 28.1

Cameroon 2011 21.4 19.0 14.3 23.7 22.4 15.8 16.1 22.6

Chad 2014-15 18.9 19.6 18.2 24.3 17.2 19.8 16.8 25.6

Congo 2011-12 18.6 23.6 14.9 22.4 21.6 19.1 14.7 22.0

Congo DR 2013-14 18.4 19.4 16.1 26.6 18.6 18.2 15.6 22.4

Gabon 2012 17.3 21.6 14.4 23.0 22.4 21.8 17.1 23.7

Lesotho 2014 23.5 16.2 15.6 21.5 24.8 14.1 15.3 18.0

Namibia 2013 26.1 17.7 19.4 23.1 24.7 15.7 20.4 18.4

North Africa, West and Central Asia

Armenia 2010 24.5 18.5 21.8 20.8 24.8 19.6 23.3 18.6

Egypt 2014 24.0 17.1 23.4 19.0 22.3 17.8 26.7 18.2

Jordan 2012 21.4 18.0 22.0 19.5 21.7 18.8 22.6 17.9

Kyrgyz Republic 2012 22.1 12.9 18.6 23.1 22.6 15.3 22.1 18.1

Tajikistan 2012 25.0 19.6 19.3 21.0 24.4 17.9 22.1 20.8

Yemen 2013 21.3 18.1 17.3 20.5 20.6 18.3 18.5 19.1

Asia

Afghanistan 2015 21.4 19.4 19.2 22.7 20.3 18.4 20.9 21.2

Bangladesh 2014 24.0 17.6 16.4 19.2 24.7 15.5 18.0 20.0

Cambodia 2014 23.8 16.3 17.8 21.4 24.4 14.8 20.8 17.3

Indonesia 2012 22.7 18.6 17.3 21.9 22.4 19.9 18.7 20.0

Myanmar 2015-16 24.6 15.2 19.6 20.2 23.9 16.4 20.2 17.4

Nepal 2011 23.7 16.9 19.3 17.9 22.0 17.7 15.9 19.4

Pakistan 2012-13 21.4 16.9 17.3 20.0 21.4 17.4 17.2 19.1

Philippines 2013 24.9 16.0 16.6 22.8 26.1 15.9 21.9 17.1

Latin America and Caribbean 

Colombia 2015 25.1 17.4 19.4 18.8 26.7 16.9 21.2 20.3

Dominican Republic 2013 18.5 19.3 19.2 20.7 21.9 14.1 20.3 19.8

Guatemala 2014-15 23.2 15.0 18.6 18.5 24.0 15.4 18.3 18.4

Haiti 2012 20.3 20.2 17.3 22.7 24.4 16.8 20.5 18.1

Honduras 2011-12 22.7 16.0 17.9 20.1 24.2 15.2 21.3 17.2

Peru 2012 25.9 14.1 17.3 21.1 26.2 13.7 21.0 16.8

Note: Table is based on de jure population reported in the household survey. 

89 

Appendix 4. Rural Residence 

Fig A4.1. Percent of women and men age 10-14 who live in rural areas 

0 20 40 60 80 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Indonesia 2012

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 10-14

Men 10-14

Note: Figure is based on de jure population, i.e., usual residents.
90 

Fig A4.2. Percent of women and men age 15-19 who live in rural areas 

0 20 40 60 80 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Indonesia 2012

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 15-19

Men 15-19

Note: Figure is based on de jure population, i.e., usual residents.
91 

Appendix 5. Female Headed Households 

Fig A5.1. Percent of women and men age 10-14 living in female headed households 

0 10 20 30 40 50 60 70 80 90 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Indonesia 2012

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 10-14

Men 10-14

Note: Figure is based on de jure population, i.e., usual residents, as reported in the household survey.
92 

Fig A5.2. Percent of women and men age 15-19 living in female headed households 

0 10 20 30 40 50 60 70 80 90 100

WEST AFRICA

Benin 2011-12

Burkina Faso 2010

Cote d'Ivoire 2011-12

Gambia 2013

Ghana 2014

Guinea 2012

Liberia 2013

Mali 2012-13

Niger 2012

Nigeria 2013

Senegal 2015

Sierra Leone 2013

Togo 2013-14

EAST AFRICA

Burundi 2010

Comoros 2012

Ethiopia 2011

Kenya 2014

Malawi 2015-16

Mozambique 2011

Rwanda 2014-15

Tanzania 2015-16

Uganda 2011

Zambia 2013-14

Zimbabwe 2015

SOUTHERN AND MIDDLE AFRICA

Angola 2015-16

Cameroon 2011

Chad 2014-15

Congo 2011-12

Congo DR 2013-14

Gabon 2012

Lesotho 2014

Namibia 2013

NORTH AFRICA, WEST AND CENTRAL ASIA

Armenia 2010

Egypt 2014

Jordan 2012

Kyrgyz Republic 2012

Tajikistan 2012

Yemen 2013

SOUTH AND SOUTHEAST ASIA

Afghanistan 2015

Bangladesh 2014

Cambodia 2014

Indonesia 2012

Myanmar 2015-16

Nepal 2011

Pakistan 2012-13

Philippines 2013

LATIN AMERICA AND THE CARIBBEAN

Colombia 2015

Dominican Republic 2013

Guatemala 2014-15

Haiti 2012

Honduras 2011-12

Peru 2012

Women 15-19

Men 15-19

Notes: Figure is based on de jure population, i.e., usual residents, as reported in the household survey.
93 

Appendix 6. Adolescent Fertility Curves 

Fig A6.1. Adolescent fertility curves, West Africa 

Continued...

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Benin 2011−12

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Burkina Faso 2010

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Côte d’Ivoire 2011−12

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Gambia 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Ghana 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Guinea 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Liberia 2013
94 

Fig A6.1. Adolescent fertility curves, West Africa—continued

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Mali 2012−13

50 100150200250300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Niger 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Nigeria 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Senegal 2015

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Sierra Leone 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Togo 2013−14
95 

Fig A6.2. Adolescent fertility curves, East Africa 

Continued...

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Burundi 2010

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Comoros 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Ethiopia 2011

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Kenya 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Malawi 2015−16

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Mozambique 2011

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Rwanda 2014−15

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Tanzania 2015−16
96 

Fig A6.2. Adolescent fertility curves, East Africa—continued

 50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Uganda 2011

50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Zambia 2013−14

50 100 150 200 250 300

A

SFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Zimbabwe 2015
97 

Fig A6.3. Adolescent fertility curves, Southern and Middle Africa 

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Angola 2015−16

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Cameroon 2011

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Chad 2014−15

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Congo 2011−12

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Congo DR 2013−14

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Gabon 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Lesotho 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Namibia 2013
98 

Fig A6.4. Adolescent fertility curves, North Africa, West and Central Asia 

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Armenia 2010

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Egypt 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Jordan 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Kyrgyz Republic 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Tajikistan 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Yemen 2013
99 

Fig A6.5. Adolescent fertility curves, South and Southeast Asia 

 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Afghanistan 2015

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Bangladesh 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Cambodia 2014

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Indonesia 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Myanmar 2015−16

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Nepal 2011

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Pakistan 2012−13

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Philippines 2013
100 

Fig A6.6. Adolescent fertility curves, Latin American and Caribbean 50 100 150 200 250 300 ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Colombia 2015

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Dominican Republic 2013

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Guatemala 2014−15

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Haiti 2012

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Honduras 2011−12

50 100 150 200 250 300

ASFR (per 1,000 women)

10 11 12 13 14 15 16 17 18 19

age

Peru 2012