Drivers of adolescent pregnancy decline in five adolescent sexual and reproductive health and rights exemplar countries: a quantitative decomposition analysis

Summary: Background: In 2023, there were 9·9 million births among adolescents aged 15–19 years in low-income and middle-income countries, with an estimated half of those births unintended. Cameroon, Ghana, Malawi, Nepal, and Rwanda stand out as exemplar countries experiencing some of the largest declines in adolescent fertility (ie, the demographic concept of livebirths per woman) globally between 2000 and 2023 relative to countries with similar socioeconomic change during this period. We aimed to examine how these five countries reduced adolescent pregnancy by decomposing declines into key determinants.