Geographic disparities and municipal deprivation drive staggering inequalities and high levels of adolescent fertility in Brazil: a nationwide analysis of 8 million births across five thousand municipalities
1
International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
2
Departamento de Epidemiologia, Universidade de São Paulo, São Paulo, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2173
ABSTRACT
ABSTRACT:
Adolescent childbearing remains a critical public health challenge in Brazil, with a national fertility rate of 43.6 births per thousand girls aged 15–19 in 2022. This study investigated subnational inequalities in adolescent fertility rates (AFR) across 5,502 Brazilian municipalities and explored associations with municipal deprivation and population size. Using data from the National Live Births Information System (2020–2022) and the 2022 Demographic Census, municipal AFRs for age groups 10–14 and 15–19 were calculated and compared against AFR bands constructed from average rates of countries classified by World Bank income levels. Results revealed substantial regional disparities. The North region exhibited the highest median AFR (77.1), more than double that of the South (35.0). For younger adolescents (10–14 years), the North’s median rate was nearly four times higher than the South's. Nationally, 22% of municipalities fell within the "low-income" AFR band (≥65 births per thousand), while only 31% reached levels comparable to Brazil’s own upper-middle-income or high-income country standards. In the North, a staggering 76% of municipalities were in the low-income AFR band. Linear regression models demonstrated that municipal deprivation, measured by the Brazilian Deprivation Index (IBP), was a powerful predictor, explaining 64.6% of AFR variability. Highly deprived municipalities showed markedly higher rates across all regions. While population size was significantly associated with AFR—showing an inverted U-shaped pattern peaking in towns of 10,000–50,000 people—its explanatory power was marginal compared to deprivation. The high levels of AFR are in contrast with the Brazilian total fertility rate, currently at 1.6. Our findings underscore that adolescent fertility in Brazil is deeply rooted in socioeconomic vulnerability. Effective reduction of these rates requires regionally tailored, multi-sectoral policies that address underlying structural inequalities, improve educational access, and strengthen primary healthcare services specifically for vulnerable adolescents
Adolescent childbearing remains a critical public health challenge in Brazil, with a national fertility rate of 43.6 births per thousand girls aged 15–19 in 2022. This study investigated subnational inequalities in adolescent fertility rates (AFR) across 5,502 Brazilian municipalities and explored associations with municipal deprivation and population size. Using data from the National Live Births Information System (2020–2022) and the 2022 Demographic Census, municipal AFRs for age groups 10–14 and 15–19 were calculated and compared against AFR bands constructed from average rates of countries classified by World Bank income levels. Results revealed substantial regional disparities. The North region exhibited the highest median AFR (77.1), more than double that of the South (35.0). For younger adolescents (10–14 years), the North’s median rate was nearly four times higher than the South's. Nationally, 22% of municipalities fell within the "low-income" AFR band (≥65 births per thousand), while only 31% reached levels comparable to Brazil’s own upper-middle-income or high-income country standards. In the North, a staggering 76% of municipalities were in the low-income AFR band. Linear regression models demonstrated that municipal deprivation, measured by the Brazilian Deprivation Index (IBP), was a powerful predictor, explaining 64.6% of AFR variability. Highly deprived municipalities showed markedly higher rates across all regions. While population size was significantly associated with AFR—showing an inverted U-shaped pattern peaking in towns of 10,000–50,000 people—its explanatory power was marginal compared to deprivation. The high levels of AFR are in contrast with the Brazilian total fertility rate, currently at 1.6. Our findings underscore that adolescent fertility in Brazil is deeply rooted in socioeconomic vulnerability. Effective reduction of these rates requires regionally tailored, multi-sectoral policies that address underlying structural inequalities, improve educational access, and strengthen primary healthcare services specifically for vulnerable adolescents
| eISSN: | 2654-1459 |
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