Strengthening health systems to reduce adolescent fertility: an analysis of Chile's experience, 2010-2023

Adolescent pregnancy remains a persistent and inequitable in Latin America. Chile has achieved one of the fastest declines in adolescent fertility in the region, offering insights into how policy and health system responses may accelerate progress.MethodsWe conducted a national descriptive-analytical case study using a mixed-methods approach to examine policies, programs, and health system transformations implemented in Chile between 2010 and 2023. Data sources included administrative data, repeated cross-sectional surveys, policy documents, and scientific literature. The analysis was guided by frameworks on political prioritization and health system building blocks.ResultsAdolescent fertility among girls aged 15-19 declined from 51.6 births per 1,000 in 2010 to 10.6 in 2023 (- 79%). This reduction coincided with sustained political commitment, rights-based health system reforms, and expansion of adolescent-responsive primary care services. Access to contraception-including long-acting methods-increased substantially, alongside improvements in service delivery and health system capacity. Declines occurred alongside persisting and, in some cases, widening socioeconomic inequalities. As a result, marked socioeconomic and territorial inequities in contraceptive uptake persist.ConclusionsChile's experience suggests that rapid declines in adolescent fertility can occur alongside coordinated, rights-based policies and strengthened health systems, particularly with expanded access to contraception. However, causal attribution cannot be established.