ArticleBMJ global health2026
Return-on-investment for interventions to reduce adolescent pregnancy and child marriage in Southeast Asia: a five-country modelling study.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAdolescent pregnancy remains a concern in Southeast Asia, with pregnancy both a driver and an outcome of child marriage or union. For Cambodia, Indonesia, the Philippines, Lao People's Democratic Republic (PDR) and Malaysia, this study aimed to calculate the benefit-cost ratio of investing in evidence-based interventions to prevent adolescent pregnancy and child marriage, considering their complex interdependencies.
methodsThe population of girls aged 15-19 years was modelled at a national level, stratified by marriage, poverty and school enrolment status (known risk factors for pregnancy). Time-varying inputs for sociodemographics, contraception use, pregnancy and marriage were taken from population surveys (eg, Demographic and Health Survey [DHS]) and census data. A targeted review identified interventions with sufficient cost and effectiveness evidence for inclusion in modelling. A baseline scenario (constant intervention coverage over 2024-2030) was compared with investment scenarios, with interventions scaled up to reach an aspirational 95% coverage by 2030.
resultsEvidence-based interventions included in-school comprehensive sexuality education, cash transfers, educational support, life skills training, livelihood training and community dialogue. Across the five countries, baseline scenario intervention costs were US$1.4 billion over 2024-2030, with a projected 2.4 million unintended adolescent pregnancies and 2.1 million child marriages among girls 15-19 years. Scale-up of all interventions to reach 95% coverage by 2030 would cost an additional US$5.0 billion and, in return, avert 1.3 million unintended pregnancies and 1.1 million child marriages. This was estimated to generate US$13.2 billion in economic benefits by 2050 with a benefit-cost ratio of 2.7, increasing to 9.7 if interventions were maintained to 2050 and lifetime benefits considered. Achieving a more modest 50% intervention coverage by 2030 produced similar benefit-cost ratios but with reduced total impact.
conclusionFor every US$1 invested to scale up and maintain high coverage of evidence-based interventions to reduce child marriages and adolescent pregnancies in Cambodia, Indonesia, the Philippines, Lao PDR and Malaysia, US$9.7 could be returned to the economy in the longer term.
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