UNFPAState of World Population 2003
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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


Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7


1. Miller, B. D. 1997. “Social Class, Gender and Intrahousehold Food Allocations to Children in South Asia.” Social Science And Medicine 44(11): 1685-1695; and Das Gupta, M. 1987. “Selective Discrimination Against Female Children in Rural Punjab, India.” Population and Development Review 13(1): 77-100.

2. Leslie, J., E. Ciemins, and S. B. Essama. 1997. “Female Nutritional Status across the Life-span in sub-Saharan Africa 1: Prevalence Patterns.” Food and Nutrition Bulletin 18(1): 20-43. Anthropometric survey measures do not show significant differences at young ages in most settings, but disadvantage need not be severe to teach and reinforce unequal gender norms.

3. Leach, F. 1998. “Gender, Education and Training: An International Perspective.” Gender and Development 6(2): 9-18.

4. Agarwal, B. 1994. “Gender and Command over Property: A Critical Gap in Economic Analysis and Policy in South Asia.” World Development 22(10): 1455-1478.

5. Heise, L. L., J. Pitanguy, and A. Germain. 1994. Violence Against Women: The Hidden Health Burden. World Bank Discussion Papers. No. 255. Washington, D.C.: The World Bank.

6. UNICEF. 2001. Early Marriage: Child Spouses. Innocenti Digest. No. 7. Florence, Italy: UNICEF Innocenti Research Centre. Web site: www.unicef-icdc. org/publications/pdf/digest7e.pdf.

7. UNICEF, UNAIDS, and WHO. 2002. Young People and HIV/AIDS: Opportunities in Crisis. New York: UNICEF.

8. This section depends highly on the work of: Mensch, B. S., S. Singh, and J. Casterline. (Forthcoming.) “Trends in the Timing of First Marriage among Men and Women in the Developing World.” Paper presented at the Annual Meeting of the Population Association of America, Minneapolis, Minnesota, 1-3 May 2003. To be included in the forthcoming National Academy of Sciences publication of the Transitions to Adulthood project.

9. South America and the former Soviet countries of Asia did not have as many as a fifth of marriages to teenage women between 1970 and 1980. Their declines have been correspondingly small.

10. See: United Nations. 2003. Concise Report on World Population Monitoring: 2003: Population, Education and Development: Report of the Secretary- General (E/CN.9/2003/2). New York: United Nations.

11. Implementation is clearly more important than the laws themselves. More than 20 countries have increased legal marriage age since 1990 but no clear relation to the practice is yet apparent. The relative importance of formal and customary legal systems varies considerably.

12. For these analyses, following demographic convention, marriage includes all the different forms of socially recognized unions: cohabitation, consensual unions, “free unions” and marriage that is legitimated by custom, religious rites or civil law. An inclusive definition is needed for cross-country comparisons since the frequency of different forms of union varies considerably across cultures. Only heterosexual unions are included in these data sets.

13. This section uses national data and unweighted national averages for regions calculated from: United Nations. 2000. World Marriage Patterns 2000. New York: Population Division, Department of Economic and Social Affairs, United Nations. Spreadsheet available at link at: www.un.org/esa/ population/publications/worldmarriage/ worldmarriage.htm. This database includes the last available survey from 152 countries. The National Academy of Sciences analyses (see: Mensch, Singh, and Casterline [Forthcoming.]) impose restrictions that allow them to use only 117 countries, and their trend data are based on 74 countries with multiple surveys.

14. Eastern Europe averages are higher. In some Commonwealth of Independent States, nearly 4 per cent of adolescent men are married.

15. Half or more of 15-19 year old women have ever been married in Afghanistan, Bangladesh, Congo, Democratic Republic of the Congo, Mali, Niger and Uganda.

16. The Central Asian Republics and Kazakhstan average 40 per cent, South Central Asian countries approach this level, several sub-regions average at or near one third (Middle Africa, Eastern Europe, Central America and Micronesia). The lowest rates of early marriage (below 15 per cent) are found in Northern Africa, East Asia, the Caribbean, Western and Northern Europe and Australia and New Zealand.

17. These regions include Eastern, Middle and Western Africa, the Central Asian Republics and Kazakhstan and South Central Asia. Countries exceeding 80 per cent levels include: in South Central Asia, Nepal, India, Afghanistan, Bangladesh and the Maldives; in Western Africa, Benin, the Gambia, Burkina Faso, Guinea, Mali and Niger; in Middle Africa, Angola, Chad, Central African Republic, Democratic Republic of the Congo; in Eastern Africa, Malawi, Mozambique and Uganda.

18. UNICEF 2001.

19. Greene, M. E. 1997. “Watering the Neighbour’s Garden: Investing in Adolescent Girls in India.” Regional Working Papers. No. 7. New Delhi: The Population Council.

20. Arends-Kuenning, M., and S. Amin. 2000. “The Effects of Schooling Incentive Programs on Household Resource Allocation in Bangladesh.” Policy Research Division Working Paper. No. 133. New York: The Population Council.

21. Unisa, S. 1995. “Demographic Profile of the Girl Child in India.” Social Change: Issues and Perspectives 25(2-3): 30-37; and Hussain, R., and A. H. Bittles. 1999. “Consanguineous Marriage and Differentials in Age at Marriage, Contraceptive Use and Fertility in Pakistan.” Journal of Biosocial Science 31(1): 121-138.

22. Sources: Singh, S., and R. Samara. 1996. “Early Marriage Among Women in Developing Countries.” International Family Planning Perspectives 22(4): 148-157, 175; Mensch, B., J. Bruce, and M. E. Greene. 1998. The Uncharted Passage: Girls’ Adolescence in the Developing World. New York: The Population Council; Hersh, L. 1998. “Issues at a Glance: Giving up Harmful Practices.” Washington, D.C., Advocates for Youth. Web site: www.advocates foryouth.org/publications/iag/ harmprac.htm, accessed 8 June 2003.

23. Clark, S. 2003. “Early Marriage and HIV Risks in Sub-Saharan Africa.” Unpublished manuscript.

24. Sources: Singh and Samara 1996; Mensch, Bruce, and Greene 1998; and Hersh 1998.

25. Ellsberg, M. 2002. “Reproductive Health Consequences of Gender-based Violence.” Paper presented at “Technical Update on Gender-based Violence (GBV) and Reproductive Health/HIV (RH/HIV),” Interagency Gender Working Group/United States Agency for International Development, Washington, D.C., 1 May 2002, See: www.prb.org/Content/NavigationMenu/ Measure_Communication/Gender3/ Gender-Based_Violence_and_ Reproductive_Health_and_HIV_AIDS_ 3-c.htm, accessed 7 June 2003; and WHO. 2001. WHO Multi-country Study on Women’s Health and Domestic Violence. Geneva: WHO. See: www.who.int/mipfiles/2255/FinalVAW progressreportforwebpagewithout cover.pdf, accessed 21 April 2003.

26. Nepal Health Education, Information, and Communication Center and UNFPA. 1995. “Arrange the Marriage of Your Daughter After 20 Years of Age” (Item No. PO NEP 64). Poster. Kathmandu: Nepal Health Education, Information, and Communication Center, Nepal Ministry of Health. Web site: www.jhuccp.org, accessed 19 April 2003.

27. Zhu, H. 1996. “Arranged Marriages Annulled by Law.” China Population Today 13(3): 15.

28. Chandrasekhar, R. 1996. “Childhood in Rajgarh: Too Young for Wedlock, Too Old for the Cradle.” Economic and Political Weekly 31(40): 2721-2722.

29. The relevant projects are described on the web sites: www.myrada.org/ belgaum.htm, www.myrada.org/ madakasira.htm, www.myrada.org/ hdkote.htm, accessed 8 June 2003.

30. Amin, S., et al. 1997. “Transition to Adulthood of Female Factory Workers: Some Evidence from Bangladesh.” Policy Research Division Working Papers. No. 102. New York: The Population Council.

31. The World Bank. 2003. “Public and Private Initiatives: Working Together in Health and Education.” Washington, D.C.: The World Bank. Web site: www.worldbank.org/html/extdr/hnp/ health/ppi/pubpri2b.htm, accessed 21 April 2003.

32. See: Amin, S., and G. Sedgh. 1998. “Incentive schemes for school attendance in rural Bangladesh.” Policy Research Division Working Paper. No. 106. New York: The Population Council; and Arends-Kuenning, M., and S. Amin. 2000. “The Effects of Schooling Incentive Programmes on Household Resource Allocation in Bangladesh.” Policy Research Division Working Paper. No. 133. New York: The Population Council.

33. The World Bank 2003.

34. Greene 1997.

35. United Nations. 2002. World Population Monitoring 2002: Reproductive Rights and Reproductive Health: Selected Aspects (ESA/P/WP.717). New York: Commission on Population and Development, United Nations.

36. Age at menarche decreases as nutrition improves in poorly fed populations. A plateau is reached in the early teens from which further declines are unlikely. See for example and references: Khan, A. D., et al. 1995. “Age at Menarche and Nutritional Supplementation.” The Journal of Nutrition 125: 1090S-1096S; and Whincup, P. H., et al. 2001. “Age of Menarche in Contemporary British Teenagers: Survey of Girls Born between 1982 and 1986.” British Medical Journal (322): 1095-1096.

37. Brown, A., et al. 2001. Sexual Relations among Young People in Developing Countries: Evidence from WHO Case Studies (WHO/RHR/01.8). Occasional Paper. Geneva: Family and Community Health, Department of Reproductive Health and Research, WHO; and Jejeebhoy, S., and S. Bott. 2003. “Non- Consensual Sexual Experiences of Young People: A Review of the Evidence from Developing Countries.” Paper presented at the 2003 Annual Meeting of the Population Association of America, Minneapolis, Minnesota, 1-3 May 2003.

38. Brown, et al. 2001.

39. Meier, A. 2003. “The Effects of Sexual Activity on Adolescent Well-being.” Paper presented at the 2003 Annual Meeting of the Population Association of America, Minneapolis, Minnesota, 1-3 May 2003.

40. This discussion relies heavily on the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction: Brown, et al. 2001.

41. Hoff, T., L. Greene, and J. Davis. 2003. National Survey of Adolescents and Young Adults: Sexual Health Knowledge, Attitude and Experiences. Menlo Park, California.: Henry J. Kaiser Family Foundation.

42. Brown, et al. 2001.

43. See: Demographic and Health Surveys conducted between 1998 and 2001. Calverton, Maryland: ORC Macro. Web site: www.measureDHS.com.

44. Ibid.

45. Population Reference Bureau. 2000. The World’s Youth 2000: Data Sheet. Washington, D.C.: Population Reference Bureau.

46. Mendez Ribas, J. M., S. Necchi, and M. Schufer. 1995. “Risk Awareness and Sexual Protection: Perceptions and Behaviour among a Sexually Active Population, Argentina.” Buenos Aires, Argentina: Hospital Clinic, University of Buenos Aires. Unpublished progress report cited in: Brown, A., et al. 2001.

47. Frase-Blunt, M. 6 October 2002. “The Sugar Daddies’ Kiss of Death.” The Washington Post.

48. Brown, et al. 2001.

49. In some settings, e.g., portions of Africa, sexual relations and childbearing are part of the extended process leading to marriage. Even in developed countries historical rates of first deliveries in the first six months of marriage have been significant. See Bledsoe, C.H., and B. Cohen. 1993. Social Dynamics of Adolescent Fertility in Sub-Saharan Africa. Washington D.C.: National Academies Press.

50. In this case the pregnancy precedes care-seeking. It does not indicate causation or vulnerability. See: Brown, et al. 2001.

51. The largest proportion of abortions are in married women of older ages. The proportions of young girls who are sexually active can be small; in the minority who become pregnant the proportion opting for abortion remains high. See: Brown, et al. 2001. Also see: Mundigo, A., and C. Indriso (eds.) 1999. Abortion in the Developing World. London: Zed Books.

52. Only Kazakhstan and the Philippines report sufficient conceptions for meaningful reporting. See: Brown, et al. 2001.

53. Ali, M. M., N. Gupta, and I. da Costa Leite. 2003. “Conception and Contraception among Young Single Women: An International Comparison.” Paper presented at the Annual Meeting of the Population Association of America, Minneapolis, Minnesota, 1- 3 May 2003.

54. Ibid. Results are reported for 15-24 year old women. Later analyses may provide information on under 20 year olds.

55.Ibid. Only Armenia, Kazakhstan and the Philippines had the required detailed information. These data were self-reported.

56. Ibid. These included Bolivia, Brazil, Colombia, the Dominican Republic, Guatemala, Nicaragua, Paraguay and Peru. Common law unions are relatively common in the region.

57. Finger, W. 2000. “Sex Education Helps Prepare Young Adults.” Network 20(3): 10-15.

58. Various country studies cited in: Best, K. 2000. “Many Youth Face Grim STD Risks.” Network 20(3): 4-9; Hope Enterprises, Ltd. 2002a. Report of Adolescent Condom Survey: Jamaica: 2001. Prepared for the Commercial Market Strategies Project. Kingston, Jamaica: Hope Enterprises, Ltd; and Waszak, C., and M. Wedderburn. 2001. “Baseline Community Youth Survey.” Unpublished final report for the UNFPA VIP/Youth Project. Research Triangle Park, North Carolina, and Kingston, Jamaica: Family Health International and Hope Enterprises, Ltd. See also: Jejeebhoy and Bott 2003.

59. Wood, K., and R. Jewkes. 1997. “Violence, Rape, and Sexual Coercion: Everyday Love in a South African Township,” p. 41. Gender and Development 5(2): 41-46.

60. Dreyer, A., J. Kim, and N. Schaay. 2002. “Violence against Women: What Do We Want to Teach Our Teachers?” ID21 Research Highlight. Brighton, United Kingdom: ID21 Research Development. Web site: www.id21.org/Education/ EgveDreyer.html.

61. United States Department of State. 2002. Victims of Trafficking and Violence Protection Act 2002: Trafficking in Persons Report. Washington, D.C.: Office to Monitor and Combat Trafficking in Persons, United States Department of State; and Arlacchi, Pino. 2000. “Against All the Godfathers: The Revolt of the Decent People.” The World Against Crime, Special Issue of the Giornale di Sicilia: 7

62. Coalition to Abolish Slavery and Trafficking. 2002. “Fact Sheet on Trafficking.” Los Angeles, California: Coalition to Abolish Slavery and Trafficking. Web site: www.trafficked-women.org/factsheet.htm, accessed 13 December 2002; and Richard, A. O. 2000. International Trafficking in Women to the United States: A Contemporary Manifestation of Slavery and Organized Crime. An Intelligence Monograph. Director of Central Intelligence, Exceptional Intelligence Analyst Program. Washington, D.C.: Center for the Study of Intelligence, Central Intelligence Agency.

63. UNICEF. 1997. The Progress of Nations 1997. New York: UNICEF.

64. UNICEF, UNAIDS, and WHO 2002.

65. Ibid.

66. Huntington, Dale. 2001. Anti-Trafficking Programs in South Asia: Appropriate Activities, Indicators and Evaluation Methodologies: Summary Report of a Technical Consultative Meeting: 11-13 September 2001, Kathmandu, Nepal. New Delhi: The Population Council.

67. Lowe, D. 2002. “Perceptions of the Cambodian 100 Per Cent Condom Use Program.” Pp. 9-14 in: “Documenting the Experiences of Sex Workers.” Draft report for the POLICY Project. Washington, D.C.: POLICY Project, the Futures Group.

68. UNICEF, UNAIDS, and WHO 2002.

69. UNAIDS. 1999. Reducing Girls’ Vulnerability to HIV/AIDS: The Thai Approach (UNAIDS/99.34E). UNAIDS Case Study. Best Practices Collection. Geneva: UNAIDS. Web site: www.unaids.org/publications/documents/ children/young/reducingcse.pdf, accessed 21 December 2001; and Royal Thai Embassy. 1997. “Children Prostitution.” Washington, D. C.: Royal Thai Embassy. Web site: www.thaiembdc.org/socials/childprs.htm, accessed 21 December 2001.

70. Balk, D. 2000. “To Marry and Bear Children: The Demographic Consequences of Infibulation in Sudan.” Pp. 55-71 in: Female ‘Circumcision’ in Africa: Culture, Controversy, and Change, edited by B. Shell-Duncan and Y. Hernlund. 2000. Boulder, Colorado: Lynne Rienner Publishers.

71. Wassef, N. 2001. “Male Involvement in Perpetuating and Challenging the Practice of Female Genital Mutilation in Egypt.” Pp. 44-51 in: Men’s Involvement in Gender and Development Policy and Practice: Beyond Rhetoric, edited by C. Sweetman. Oxford: Oxfam.

72. UNFPA. 2000. The State of World Population 2000: Lives Together, Worlds Apart: Men and Women in a Time of Change. New York: UNFPA; and UNFPA web site, “Frequently Asked Questions on Female Genital Cutting”: www.unfpa.org/gender/faq_fgc.htm.

73. El-Zanaty, F., et al. 1996. Egypt Demographic and Health Survey 1995. Calverton, Maryland: Macro International, Inc.; and Ministère de la Promotion de la Femme, de l’Enfant et de la Famille. 1998. Plan National d’Eradication de l’Excision a l’Horizon 2007. Bamako, Mali: Ministère de la Promotion de la Femme, de l’Enfant et de la Famille.

74. Carr, D. 1997. Female Genital Cutting: Findings from the Demographic and Health Surveys Program. Calverton, Maryland: Macro International, Inc.

75. Family Care International. 1999. Meeting the Cairo Challenge: A Summary Report: Implementing the ICPD Programme of Action. New York: Family Care International.

76. UNIFEM. n.d. “Circumcision With Words: Fighting FGM in Kenya.” Web site: www.unifem.undp.org/newsroom/ documents/kenyapro.pdf, accessed 10 January 2003.

77. Boland, R. 2003. Population and Law database (Harvard University). Special compendium provided on request.

78. Tostan. 2003. “Vaccination Project Leads To Large Abandonment Of Female Genital Cutting And Early Marriage In Senegal.” Web site: www.tostan.org/ news-May25_03.htm, accessed 6 July 2003.

79. McLucas, S. 2001. “Stop Excision.Net: Report from Mali.” See web site: www.geocities.com/StopExcision/report .html, accessed 10 January 2003.

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