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Dissertation
An urban approach to adolescent birth rates in Latin America
Doctor of Philosophy (Ph.D.), Drexel University
Mar 2022
DOI:
https://doi.org/10.17918/00001244
Abstract
Introduction: Heterogeneities in the urban environment in Latin America (LA) suggest that upstream factors might have implications for the high adolescent birth rates (ABR). We quantified the variability of ABR in LA cities, and examined how different characteristics of the city and sub-city social environment, city-levels of women's empowerment (WE) and gender inequality, and the availability of service facilities/amenities are associated with ABR. Methods: We estimated sub-city ABR for years 2014-2016 in 363 cities of more than 100,000 residents in nine LA countries. We used vital registration, census, survey, and other publicly available data to characterize the city and sub-city social environment. We combined census-derived socioeconomic indicators that reflected living conditions (LC) and population educational attainment (PEA). We constructed a gender inequality index (GII) and three scores reflecting WE in the employment, education, and health care spheres. We also obtained the density per square km2 of service facilities/amenities for 92 cities in Mexico for the period 2008-2017 and assessed their association with ABR. Results: The median sub-city ABR across 1403 sub-cities nested within 363 cities in nine countries was 58.5 live births per 1000 women 15-19 years old. We found substantial variability across cities within countries and across sub-cities within cities. The intraclass correlation coefficient estimation showed that 37% of the variability occurs between countries and 47% between cities. Higher homicide rates, grater population growth, and higher GII were associated with higher ABR. Better sub-city LC, higher sub-city PEA, and higher city levels of WE in the three spheres were associated with lower ABR. In Mexico, we found that an increase in the density of schools, pharmacies, recreation facilities, and off-premises alcohol outlets were associated with a decrease in ABR. Furthermore, we found that municipalities with a higher density of schools, pharmacies, health care, and recreation facilities had lower ABR while those with a higher density of on-premises alcohol outlets had higher ABR. Conclusions: Addressing social, economic, and gender inequality as well as violence might help reduce ABR in LA. In addition, investment in infrastructure and urban planning presents an alternative pathway to tackle ABR.
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Details
- Title
- An urban approach to adolescent birth rates in Latin America
- Creators
- Ariela Braverman Bronstein - Drexel University, Urban Health Collaborative
- Contributors
- Ana Victoria Diez Roux (Advisor)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Philosophy (Ph.D.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Number of pages
- 108 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Dana and David Dornsife School of Public Health; Epidemiology and Biostatistics; Drexel University
- Other Identifier
- 991017491192704721