CONTEXT: Nicaragua has one of the highest adolescent fertility rates in the world, but little is known about why approximately half of Nicaraguan women give birth before age 20.
METHODS: Data from the 2001 Nicaragua Demographic and Health Survey were used to examine the sexual and reproductive behavior of 3,142 females aged 15–19. Age at sexual debut and age at first birth were assessed using life table analysis, and the impacts of various factors on these measures were then examined in Cox proportional hazard models. Among sexually active females, current use of modern contraceptives was examined using logistic regression analysis.
RESULTS: In Cox models, rural residence, rising levels of education and greater wealth were associated with older age at sexual debut (hazard ratios, 0.8, 0.5 and 0.9, respectively). When these factors were accounted for in multivariate analysis, age at first birth was positively associated with age at first sex: Having had first sex before age 15 was associated with an increased risk of having an earlier first birth (1.7–2.4), whereas having first had sex at age 16 or later was associated with a decreased risk (0.2–0.7). Among sexually active females, current use of a modern method was positively associated with being married or in a stable union and with having given birth (5.8 and 4.5, respectively), and negatively associated with lacking health care autonomy and wanting a baby within two years (0.4 and 0.6, respectively).
CONCLUSIONS: Interventions that improve young women's education and economic opportunities might help them delay both sexual debut and childbearing, and efforts are also needed to facilitate their access to contraceptives, particularly for unmarried women.