Complications of adolescent pregnancy and its prevention

Representative image. Photo: acrosticpertu.files

Marriage during teen age or adolescence is unacceptably high in Bangladesh like many other developing countries.  This leads to high maternal mortality and morbidity. WHO estimates about 16 million girls aged 15 to 19 years and two million girls under the age of 15 give birth every year. Worldwide, one in five girls has given birth by the age of 18. In the poorest regions of the world, this figure rises to one in three girls.
In Bangladesh, according to UNICEF's State of the World's Children 2009 report, 64% girls are married before they reach the age of 18. As a result, both maternal and child mortality rates are increasing in the country.
With early marriage comes early pregnancy. One-third of teenage girls aged 15 to 19 years are mothers or pregnant in Bangladesh today, with adolescent mothers more likely to suffer birth complications than adult women, the British Medical Journal reports.
Teenage mothers are twice as likely as adult mothers to die from pregnancy and childbirth-related complications, with mothers younger than 14 facing the greatest risks.
In fact, research shows that the risk of maternal mortality could be five times higher for mothers aged 10 to 14 than for those aged 20 to 24, while babies born to mothers younger than 14 are 50% more likely to die than babies born to mothers older than 20.
Teenage mothers are more likely to suffer from obstructed delivery and other severe childbirth- and pregnancy-related complications like obstetric fistula, perineal tear, prolapsed ctc. This results in higher morbidity and mortality for them and their children. A third of women are either pregnant or mothers by age 20, and this proportion is not declining, the report observed.
According to the International Centre for Diarrhoeal Diseases and Research, Bangladesh, these individual outcomes suggest larger social consequences, including higher population growth, higher rates of maternal mortality and a higher number of orphans.
The complications of adolescent pregnancy
Complications from pregnancy and childbirth are the leading causes of death among girls aged 15-19 years in many low- and middle-income countries. Stillbirths and newborn deaths are 50% higher among babies of adolescents, who are also more likely to have low birth weight, having a long-term impact on their health and development. A lack of physical readiness for pregnancy, combined with risky lifestyle choices such as smoking and drug abuse, increase the chance of complications.
Having babies during adolescence has serious consequences for the health of the girl and her infant, especially in areas with weak health care systems. In some countries, adolescents are less likely than adults to obtain skilled care before, during and after childbirth. The common complications are:
Unsafe abortion
Pregnant adolescents are more likely than adults to have unsafe abortions. An estimated three million unsafe abortions occur globally every year among girls aged 15-19 years and that contribute to long term health problems and maternal deaths.
Premature Labor
Teenage mothers face the possibility of premature labor. Physically, teenage mothers have immature reproductive organs that may not be prepared to carry an infant to term. Sexually transmitted diseases and smoking also increase the risk of preterm labor and birth.
High Blood Pressure
The increased demand for blood flow during pregnancy can put strain on a teenage mother's undeveloped cardiovascular system to carry the extra circulatory load. High blood pressure during pregnancy and other complications like preeclampsia, eclampsia can result in reduced fetal birth weight and growth and place the mother at risk of many complications and even death.

Anemia
Combined with a diet poor in iron-rich foods, which is common among teens, anemia (low iron) can result. Anemia can be treated during pregnancy by consuming iron-rich foods or iron supplements as needed.

Obstructed labour
Immaturity in growth of birth passage leads to long labour and obstructed labour with all its adverse consequences like perineal tear, prolapsed, obstetric fistula( leads to continuous leakage of urine and stool) etc.
Prevention of complications
Adolescent pregnancy is a major contributor to maternal and child mortality, and to the vicious cycle of ill-health and poverty. The Global strategy for women's and children's health, launched by the United Nations Secretary-General in 2010, stresses the importance of addressing the health and welfare of adolescent girls in order to achieve the fifth Millennium Development Goal on maternal mortality reduction.
Teens can increase the possibility of having a healthy pregnancy, and reduce possible complications, by seeking early prenatal care and following a healthy lifestyle
In May 2011, the World Health Assembly adopted a resolution urging Member States to accelerate actions to improve the health of young people. It included these specific measures:
* reviewing and revising policies to protect young people from early child-bearing;
* providing access to contraception and reproductive health care services; and
* promoting access to accurate information on sexual and reproductive health.
WHO published guidelines on how to prevent early pregnancies and poor reproductive outcomes among adolescents in low- and middle-income countries. They contain evidence-based recommendations on actions that countries can take, targeting six key objectives:
* reducing marriage before the age of 18;
* creating understanding and support to reduce pregnancy before the age of 20;
* increasing the use of contraception by adolescents at risk of unintended pregnancy; reducing coerced sex among adolescents;
* reducing unsafe abortion among adolescents; and
* increasing skilled antenatal,     childbirth and postnatal care among adolescents.

The writer is ex-President, Obstetrical and Gynaecological Society of Bangladesh.