Adolescent SexualBehavior andReproductiveOutcomes

Despite recent global declines in the rate of early childbear-ing, adolescent childbearing is a persistent challenge in many countries. Early motherhood is widely recognized as having negative consequences for the health of the young woman and her infant, as well as for their future economic, educational and social prospects.1–4 These risks are partic-ularly important in regions such as Central America, where poverty levels are high and access to resources is low.5–7 Compared with older mothers, adolescent mothers are at an increased risk of pregnancy-related complications; maternalmortality among adolescents aged 15–19 is twice as high as that among older women.8–11 Each year, 2.5mil-lion adolescents worldwide undergo unsafe abortions, which put them at additional risk of adverse outcomes.12–14 In addition to these physical health risks, adolescentmoth-ers attain lower levels of education, have fewer economic opportunities and experience higher rates of poverty,2–4,15 and their children are at increased risk of neonatal mortal-ity, preterm birth, low birth weight and developmental de-lays.16–21 Furthermore, the children of adolescentmothers aremore likely to suffer neglect andmalnutrition, often due to the poorer social and economic status of their moth-ers.22,23 Such children also face elevated risks of low edu-cational attainment and of teenage parenthood.24–26 Adolescent fertility is high in Central America: The lat