Impact Evaluation of Salud Mesoamerica Initiative on Adolescent Fertility in Costa Rica

This study investigates the effect of a large-scale comprehensive intervention in Costa Rica aimed at reducing adolescent pregnancy among the poorest districts by integrating reproductive health services into the national health system with an intersectoral approach. The model was designed and developed under Salud Mesoamerica Initiative, an innovative public-private partnership that sought to improve reproductive, maternal and child health services among the poorest in the Mesoamerican region. Using a difference-in-differences approach and district-level vital records from 2000-2019, findings reveal a significant reduction in adolescent fertility rates for those aged 10 to 19 (11.3% reduction relative to the pre-treatment mean), particularly among females aged 10-14 (24% reduction relative to the pretreatment mean). Our findings provide valuable lessons on how primary care systems of low-middle income countries could address the sexual and reproductive health needs of adolescents which are often an underserved population.