High adolescent fertility: Implications for health and education of offspring and safe motherhood in rural Uganda

Between 1989 and 2009, we annually collected data on pregnancies, family planning use, education level and marital status in 10,008 female adolescents aged 11-19 years, and obtained their HIV status. School attendance increased during the study period, with higher school enrolment observed among girls with educated parents. Fertility rates rose from 9/1000 in 14 year olds to 200/1000 in 19 year olds. Adolescent Fertility Rate (AFR) decreased from 0.7 in 1990-94 to 0.5 in 2005-09 due to fertility decrease among adolescents with secondary education from 0.7 to 0.3 in the same period, and increase in secondary school attendance. Higher fertility was among the ever married, those with lower education, and the HIV positives with AFR of 0.9 compared to 0.6 of HIV negative adolescents. By the age of 20 years, 2% of adolescent girls were HIV infected. The ever married (AFR=2.2) had 8 times the fertility of the never married (AFR=0.25). Of the self-reported sexually active adolescents, 20.4% used family planning (56%-condoms, 42%-injections, and 2.4%-pills), and 14% had unfavourable pregnancy outcomes. Inter-sectoral interventions are urgently needed to empower adolescent girls in preventing pregnancy, HIV infection, and early school drop-out during their initial sexual encounters.