UNFPAState of World Population 2003
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HOME: STATE OF WORLD POPULATION 2003: Overview of Adolescent Life
State of World Population
Overview of Adolescent Life
Gender Inequality and Reproductive Health
HIV/AIDS and Adolescents
Promoting Healthier Behavior
Meeting Reproductive Health Services Needs
Comprehensive Programmes for Adolescents
Giving Priority to Adolescents
Sources for Boxes
Graphs and Tables

Overview of Adolescent Life

Why is Reproductive Health Important?
Adolescent Reproductive Health and Poverty
A Changing World
Education and Employment
Ensuring a Better Future: Investment in Youth

Adolescent Reproductive Health and Poverty

Reducing poverty requires progress in addressing adolescent reproductive health needs.

Education is a key for breaking the transmission of poverty from one generation to the next. Yet studies show that the poor are more likely to not complete schooling.(5) Consequently, they are deprived of the education on reproductive health and sexuality that is provided at higher grade levels and do not know how to find health information.

Poorer young women are likely to marry earlier.(6) In the wealthiest 20 per cent of the population, marriage before age 18 is relatively rare (less than 30 per cent, in countries where the national average exceeds 50 per cent). In Nigeria, almost 80 per cent of the poorest young women marry before age 18 while only 22 per cent of the richest do.

Differences in adolescent fertility are driven by many factors, including life opportunities, service access, provider attitudes, sociocultural expectations, gender inequalities, educational aspirations and economic levels. Fertility differences between the poorest and richest strata in many countries are among the largest of any health indicator.(7) Early childbearing in poor families perpetuates an intergenerational cycle of poverty.

Modern contraceptive use among adolescents is generally low, but increases with economic status. Fewer than 5 per cent of the poorest young use modern contraception. Inequities in access to family planning increase the likelihood of unwanted or ill-timed births. (See Chapter 2).

Poorer young women are less likely to have their births attended by a skilled health worker. The richest young women are two to eight times more likely to have their births attended by a medical professional. Skilled attendance is important for the health of the mother and the child, particularly when there are delivery complications. The younger the mother, the greater the chance that she will face complications during pregnancy and childbirth. Also, those who are poor have the least access to health care services to deal with increased pregnancy and delivery risks.

HIV/AIDS is a disease associated with poverty. Poor women are least able to negotiate safer sex and more likely to accept partners with hopes of material benefit. This social vulnerability is compounded by a lack of information. Poor women are less likely to know that HIV/AIDS is sexually transmitted.

POVERTY AND ECONOMIC GROWTH The number of youth in the world surviving on less than a dollar a day in 2000 was an estimated 238 million, almost a quarter (22.5 per cent) of the world’s total youth population.(8) About 462 million young people live on less than $2 a day. South Asia has the largest concentration of young people in extreme poverty (106 million) followed by sub-Saharan Africa (60 million), East Asia and the Pacific (51 million) and Latin America and the Caribbean (15 million).

Eleven large countries account for 77 per cent of the 238 million young people living in extreme poverty—India, China, Nigeria, Pakistan, Bangladesh, the Democratic Republic of Congo, Viet Nam, Brazil, Ethiopia, Indonesia and Mexico. Youth poverty also correlates closely with national indebtedness.


Lower fertility and higher than expected AIDS-related mortality are combining to slow global population growth, according to the latest UN projections. But World Population Prospects: The 2002 Revision shows that population is still growing rapidly in the world’s poorest countries.

Now 6.3 billion, world population will grow to an estimated 8.9 billion people by 2050. Nearly all of the 2.6 billion increase will be in the developing countries of Africa, Asia and Latin America.

The United Nations Population Division revises its projections every two years, and the 2002 projection for 2050 is lower by 400 million than the one made in 2000. An increase in projected AIDS-related deaths (278 million by 2050) account for half of the revision; the rest is the result of lower fertility and smaller family size.

The UN report shows that investment in reproductive health programmes, including family planning, has helped reduce fertility in developing countries from six children per woman in 1960 to around three today. Further declines in fertility are contingent on the ability of couples worldwide to realize their desire for smaller families.

Continued investment is critical. The Population Division notes that if women have, on average, half a child more than its “most likely” projection scenario, world population could rise to 10.6 billion by 2050.

The unprecedented number of adolescents alive today—1.2 billion, a reflection of high fertility a generation ago—will ensure continued population growth for decades even as families get smaller. While adolescents’ share of the total population will decrease over time, their total numbers will stay within the range of 1.2 to 1.3 billion throughout the next 50 years. Enabling young women to postpone childbearing and to space births more widely is therefore key to slowing the momentum of population growth.

Growth rates and fertility are falling much more slowly in the poorest countries than elsewhere. The 49 least developed countries are expected to grow from 668 million people today to 1.7 billion by 2050, and their share of the world’s adolescent population will increase from 14 to 25.6 per cent. Sub-Saharan Africa’s share will grow from 14 to 24.6 per cent.

The higher projection of AIDS-related deaths results from a more thorough assessment of the epidemic’s severity in individual countries, and underscores the urgent need for increased spending on HIV/AIDS prevention and treatment. See Sources

AN OPPORTUNITY While population growth and persistent poverty in developing countries are linked in a vicious cycle, the large number of young people alive today presents a unique economic opportunity. As fertility rates decline, the proportion of the population of working age (15 to 60) increases relative to that of “dependent” ages (0 to 15 and 60 and over). This opens a “demographic window”.(9) With appropriate investments in health and education and conducive economic policies and governance, countries can mobilize their young people’s potential, and launch an economic and social transformation. The demographic window will close as populations age and dependency increases once more.

Countries like Thailand and the Republic of Korea have already taken advantage of their “demographic window” by investing in social programmes to secure dramatic economic growth. The window is now opening for a large group of countries where fertility has declined sharply in the last two decades. For the least developed countries, with the highest fertility and slowest declines, the window will not open until after 2050 (Figure 2).(10)

Figure 2 : Peak of Demographic Window of Opportunity, Selected Regions

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Opportunities vary considerably within countries; levels of dependency are highest in poor families, where fertility levels are highest.(11) Persistent high fertility in poor households undermines the prospects for development. Taking advantage of the demographic window calls for investments in health (including reproductive health) and education for the poorest families.

In many regions and countries it will be the adolescents of today who will be part of the working age population when the demographic bonus reaches its peak. Investing in their health, education and skills and establishing a supportive policy framework for economic and social growth should be a critical priority. In the least developed countries, even greater investments will be needed to improve the quality of life and governance and accelerate the demographic transition—opening the window of opportunity wider and earlier.

Teachers, spiritual leaders, employers, governments and communities must help young people, and their parents, as they prepare to exercise the rights and responsibilities of adulthood. Political systems must find ways to involve young people in making and executing the policies that shape their lives. The remainder of this chapter provides a glimpse into the range of situations that must be addressed.

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