Beyond Fertlity Perception: Understanding Why Adolescent Fertility Remains High in Bangladesh

Pregnancy during adolescence is often described as a health issue. But the circumstances that led to that pregnancy can tell a much bigger story. Who decides when a girl marries? Who decides when she becomes pregnant? Can she continue her education? Can she negotiate contraception? And does she have a meaningful say in decisions within her marriage?

These questions are central to understanding adolescent fertility in Bangladesh.

National data continue to show a difficult picture. UNICEF reports an adolescent birth rate of 92 births per 1,000 girls aged 15 to 19 in Bangladesh. The latest study, based on the 2022 Bangladesh Demographic and Health Survey, offers another way to look at the problem. Rather than treating adolescent fertility simply as a question of contraceptive use, the study examines how marriage or cohabitation, partner characteristics, and household circumstances are connected to early childbearing.

The researchers analysed data on 2,449 ever-married girls aged 15 to 19, with 1,601 complete cases used in the main statistical analysis. Among them, 26.9% had first lived with their husbands before age 15, while 58.2% began cohabitation between 15 and 17. Girls who first cohabited at 18 or 19 had substantially lower odds of adolescent fertility than those who began before 15.

The finding is significant from an SRHR perspective because it shifts attention towards timing and agency. Delaying marriage and cohabitation gives adolescents more time to remain in education, develop life skills and make informed decisions about reproduction. WHO’s 2025 guideline similarly identifies preventing child marriage, improving access to contraception and strengthening girls’ education and economic opportunities as key measures for preventing early pregnancy.

The Bangladesh study also found that the characteristics of husbands mattered. Girls whose husbands had higher education had lower adjusted odds of adolescent fertility, while a spousal age gap of 11 years or more was associated with higher odds. These associations do not prove that partner education or age difference directly causes pregnancy. However, they point towards the importance of power, communication and decision-making within relationships.

There is an important caution. The study is currently a medRxiv preprint and has not undergone peer review, so its findings should not be treated as final evidence. It is also based on cross-sectional data, meaning it can identify associations but cannot establish causation. The authors themselves call for longitudinal research to better understand the pathways involved.

Still, the direction of the evidence is consistent with broader international research. WHO reports that adolescent mothers face higher risks of complications such as eclampsia and infection, while their babies face higher risks of preterm birth and low birth weight. It also identifies child marriage, limited education, poverty and barriers to contraception as interconnected drivers of adolescent pregnancy.

For Bangladesh, the policy lesson is therefore broader than increasing contraceptive availability. Adolescents need accurate SRHR information, youth-friendly services, protection from child marriage, opportunities to remain in school and greater power to participate in reproductive decisions.

Reducing adolescent fertility should not be about controlling when girls become mothers. It should be about ensuring that girls have the freedom, information and opportunity to decide their reproductive futures. 

Source: https://www.medrxiv.org/content/10.64898/2026.07.21.26358612v1.full.pdf