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Maternal mortality statistics underscore how societies have failed women, especially young women in developing countries. As many as 529,000 women die each year from complications of pregnancy and childbirth. Pregnancy is the leading cause of death for young women ages 15 through 19. The reproductive health of adolescent women depends on biological, social, and economic factors. Programs must provide education, family planning services, and pre- and postnatal care to reduce morbidity and mortality among young women.
Contraceptive Use and Pregnancy among Adolescents
- Modern contraceptive use has increased but remains low among sexually active young women in many developing countries. For example in Haiti, 33 percent of single sexually active young women and nine percent of their married peers used a modern method of contraception. Among sexually active female Nigerian high school students, 47 percent used the rhythm method of contraception; 21 percent, oral contraceptive pills; and six percent, condoms.
- About 90 percent of adolescent births (12.8 million) occur each year in developing countries. In sub-Saharan Africa and southern Asia, 28 to 29 percent of women give birth by age 18.
Adolescent Women and Their Infants: at Risk for Injury, Illness, and Death
- Adolescents age 15 through 19 are twice as likely to die during pregnancy or child birth as those over age 20; girls under age 15 are five times more likely to die.[2,6,7]
- Each year, at least two million young women in developing countries undergo unsafe abortion. Unsafe abortion can have devastating consequences, including cervical tearing, perforated uterus, hemorrhage, chronic pelvic infection, infertility, and death.[7,8]
- In Nigeria, complications of abortion account for 72 percent of all deaths in young women under age 19; moreover, half (50 percent) of all maternal deaths result from illegal abortion among Nigerian adolescents.
- Infants of adolescents are at increased risk for death. In fact, the infants of adolescent mothers are more likely to die before their first birthday than are the infants of older mothers.
- Complications during childbirth account for almost 25 percent of newborn deaths. Preterm delivery and low birth weight are other reasons for deaths among infants born to adolescent mothers.
Why Girls Are More Vulnerable than Older Women
- Many biological, economic, and cultural factors—such as poverty, malnutrition, immature reproductive tract, child marriage, and gender inequities may compromise the health of a pregnant adolescent
- Child marriage is one of the cultural factors that work against adolescent women. Married women under age 18 report being less able than older married women to discuss contraceptive use with their husband. Thus child marriage is also associated with early childbearing. In Chad, Guinea, Mali, and Niger—where child marriage is prevalent—half of all teen women give birth before age 18.
- Child marriage also puts young women at greater risk of HIV. Results from a study in Kenya and Zambia showed that married 16- to 19-year-old females were 75 percent more likely to have HIV than their sexually active unmarried peers.
- Gender inequities put girls at greater risk than boys and affect many aspects of young women’s lives including reduced opportunities for education, employment, and control over their own reproductive health. Lack of education can also affect health when it limits young women’s knowledge about nutrition, birth spacing, and contraception.
Family Planning Can Reduce Adolescent Maternal Mortality
Reproductive health care, including family planning services, can help women—including adolescents—to prevent unintended pregnancy, complications during pregnancy and delivery, and unsafe abortion.
- Worldwide, over 200 million women have no access to modern, effective contraception. In the developing world, lack of access to family planning results in some 76 million unintended pregnancies each year.
- Experts say that contraceptive use could prevent up to 35 percent of maternal deaths and when contraceptive use increases, countries’ infant mortality rates go down. In countries where less than 10 percent of women use contraception, the infant mortality rate is 100 deaths per 1,000 live births compared to 52 per 1,000 in countries where over 30 percent of women use contraception.
- Worldwide, disapproving providers and community discourages young people from seeking reproductive health care. Family planning services need to be “youth-friendly” in order to encourage young women to seek reproductive health care.
Programs and Initiatives
- The World Health Organization says there is an urgent need for programs that address the health and safety of pregnant adolescents and that teach these young women the skills to build a successful future. The U. S. Agency for International Development (USAID) identifies critical factors for improving adolescent maternal health: encouraging young women to use prenatal care to identify and treat malaria, anemia, and other health issues; providing obstetric care to ensure the safe delivery of young mothers and their infants; and postnatal care to identify post-partum health issues, provide newborn care, and offer contraception to accomplish birth spacing.
- One effective, comprehensive program increased knowledge of contraception and reproductive health among Chilean school girls age 12 to 17. The program decreased pregnancy rates among students by providing information about both abstinence and contraception, being youth-friendly, offering referral for reproductive health care, and encouraging open dialogue between parents, teachers, health care professionals, and youth.
- In India, Reproductive Health of Young Adults in India (RHEYA) focused on educating youth about delaying marriage and pregnancy and about using contraception. Fifteen percent of young couples who were exposed to RHEYA used contraception to delay their first child compared to just over one percent of young couples in the control group.
- In Nepal, the Adolescent Girls Initiate for Reproductive Health focused on improving reproductive health information and dialogue and access to services. Baseline data indicated that 63 percent of girls ages 10 through 14 were aware of family planning methods compared to 99 percent at the end of the project.
- Programs in Burkina Faso offered peer educators and reproductive health services at some Youth for Youth centers. Compared to other centers where most clients were male, these centers recorded that 77 percent of attendees were young women.
- Profamilia, a Columbian family planning association, incorporated a youth focus into its services and documented an increase of 37 percent in adolescent clinic visits.
- World Bank. Maternal Mortality [Public Health at a Glance] 2006; http://www.worldbank.org; accessed 4/5/2007.
- UNFPA (2004). State of World Population, 2004; http://www.unfpa.org/swp/2004/english/ch9/page5.htm; accessed 3/21/2007.
- National Research Council & Institute of Medicine, Lloyd CB, ed. Growing Up Global: the Changing Transitions to Adulthood in Developing Countries. Washington, DC: National Academies Press, 2005.
- Population Reference Bureau. The World’s Youth 2006 Data Sheet; http://www.prb.org/pdf06/WorldsYouth2006DataSheet.pdf; accessed 2/21/2007.
- Okpani AOU, Okpani JU. Sexual activity and contraceptive use among female adolescents: a report from Port Harcourt, Nigeria. African Journal of Reproductive Health 2000; 4(1): 40-47.
- World Health Organization, UNFPA. Pregnant Adolescents. Geneva: WHO, 2006.
- UNFPA (2005). State of World Population 2005: The Promise of Equality. New York: Author.
- Zabin LS, Kiragu K. The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa. Studies in Family Planning 1998; 29:210-232.
- Airede LR, Ekele BA. Adolescent maternal mortality in Sokoto, Nigeria. Journal of Obstetrics &Gynaecology 2003; 23:163-165.
- Phipps MG et al. Young maternal age associated with increased risk of neonatal death. Obstetrics & Gynecology, 2002; 100:481-486.
- Save the Children. State of the World’s Mothers, 2006. Washington, DC: Author, 2006.
- International Center for Research on Women. Too Young to Wed. Washington, DC: ICRW, 2006.
- UNFPA (2003). State of World Population 2003. New York: Author.
- USAID (2006). USAID’s Family Planning Services [Family Planning]; http://www.usaid.gov/our_work/global_health/pop/news/issue_briefs/
fpservices.html; accessed 4/5/2007.
- Alan Guttmacher Institute. Family Planning Can Reduce High Infant Mortality Levels [Issues in Brief, 2002, no. 2] New York: Author.
- USAID (2005).Technical Areas: Adolescent Maternal Health. [Maternal and Child Health]; http://www.usaid.gov/our_work/global_health/mch/mh/techareas/
adolescent.html; accessed 1/17/2007.
- Toledo V et al. Impacto del programa de educación sexual: Adolescencia Tiempo de Decisiones. Sogia 2000; 7(3); http://www.cemera.uchile.cl/sogia/sogia.html.
- Pathfinder International. Reproductive Health of Young Adults in India: the Road to Public Health, 2006; http://www.pathfind.org/site/DocServer/Pathfinder_Rheya.pdf?docID=7401; accessed 3/27/2007.
- Centre for Development & Population Activities (CEDPA). A Gift for RH Project, Nepal: Endline Evaluation. Washington, DC: Author, 2002.
Written by Kathryn Graczyk
April 2007 © Advocates for Youth