Maternity in adolescence in Brazil: high fertility rates and stark inequalities across municipalities and regions

Adolescent childbearing is a major public health challenge in Brazil, with a fertility rate of 43.6 births per 1,000 girls aged 15-19 years in 2022. This study investigated inequalities in adolescent fertility rates across Brazilian municipalities and regions and explored their association with sociodemographic characteristics, namely municipal deprivation and population size. Data from the Brazilian Information System on Live Births and the 2022 Demographic Census were analyzed. The study included births occurring between 2020 and 2022, excluding municipalities with fewer than 50 births over the three-year period. Municipal adolescent fertility rates were compared with average estimates observed in countries classified by income level and described according to quintiles of the Brazilian Deprivation Index and population size. Inequalities within each geographic region were assessed using the mean absolute difference from the regional mean and range. Substantial disparities in adolescent fertility rates were found across regions, with the North and Northeast exhibiting the highest estimates, while the South and Southeast showed comparatively lower rates. The Central-West presented intermediate values. We also found vast inequalities across municipalities, with a small proportion - mostly in the North - experiencing exceptionally high adolescent fertility rates. Municipalities with higher levels of deprivation had markedly higher adolescent fertility rates, underscoring the influence of broader socioeconomic factors on adolescent fertility. These results emphasize the need for targeted interventions and policies that address these underlying contextual determinants to effectively reduce fertility rates among girls in Brazil.