[This article has been published in Spanish in The Huffington]
Teenage pregnancy is one of the circumstances with the most negative consequences on the health and life options of adolescent girls
There are 590 million adolescent girls (aged between 10 and 19 years) in the world today. Due to gender inequalities and the fact that they are of reproductive age, these girls belong to a particularly vulnerable population. Teenage pregnancy is one of the circumstances with the most negative consequences on the health and life options of these young people. Every year, an estimated 16 million teenage girls aged between 15 and 19 years and 2.5 million girls under 15 years become mothers, 95% of whom live in low- and middle-income countries.
Adolescent pregnancy has negative effects on the health of both the mother and her newborn child. Some 70,000 adolescent girls die every year in low- and middle-income countries due to complications related to pregnancy and childbirth (currently the leading cause of death among girls aged from 15 to 19). A higher proportion of children born to adolescent mothers are delivered preterm or with low birth weight, and mortality rates in this group are much higher than among the children of mothers who give birth when they are 20 years or older. In addition, adolescent mothers receive less care or lower quality care during pregnancy and labour than older women.
There is a close relationship between teenage pregnancy and child marriage
There is a close relationship between teenage pregnancy and child marriage (marriage or cohabitation before the age of 18 years), especially in sub-Saharan Africa. In that region, most adolescent mothers are married, and 38% of women aged between 20 and 24 years report having married before their 18th birthday, whereas worldwide this figure is 21% (UNICEF data, 2018).
Child marriage is associated with numerous risk for girls, including high risk pregnancy and childbirth, dropping out of school, domestic violence and scant personal autonomy which greatly conditions their future life choices.
A comparison of the group of women who marry before they are 18 and those who marry later reveals that repeated unwanted pregnancies, obstetric fistula and domestic violence are all more prevalent in the younger group, who also have less access to contraception.
Despite their demographic weight and the serious violation of their human rights, married teenage mothers are a historically neglected group
Despite their demographic weight and the serious violation of their human rights, married teenage mothers are a historically neglected group, probably due to the erroneous belief that it is “too late to intervene”. Therefore, this is a group which, until now, we have literally left behind.
It is now essential to move beyond approaches to adolescent health focused almost exclusively on prevention (of early pregnancy, sexually transmitted infections, etc.) and on single girls and to prioritise strategies aimed at the group of married teenage mothers. We can and should promote interventions to improve the health and life options of this group of young and sometimes even very young women (under 15 years of age), who are still in a formative stage and at the beginning of their lives.
How can we do this? First, by providing adequate and accessible health services designed to meet the needs of adolescent mothers and give them access to the contraception they need to delay motherhood and prevent unwanted pregnancies. At the same time, we should be working with communities to increase their knowledge and understanding of issues relating to the health and rights of girls, including access to education as well as topics related to marriage, adolescent pregnancy and personal autonomy. These interventions should seek to promote changes in attitudes and behaviours, especially with respect to access to and use of contraceptives, the most effective way of preventing maternal deaths.
We must redefine policies and programmes to improve the services offered to teenage mothers and their children in developing regions
Services that address the needs of teenagers are not yet a reality and there are still important knowledge gaps with respect to the youngest group (girls aged 10 to 14 years) and girls in situations of social exclusion (school dropouts, single mothers, and girls who are HIV-positive). We must redefine policies and programmes to improve the services offered to teenage mothers and their children in developing regions, one of the most vulnerable but least researched groups in the world.
Interventions should also encourage adolescent mothers to continue their education or to return to school—paradoxically taking advantage of the window of opportunity afforded by the fact that they are already mothers and have demonstrated their fertility. Irrespective of marital status or whether or not they are mothers, all girls have a right to education. However, girls who become pregnant are often the victims of discriminatory practices on the part of educational authorities and governments, which prevent them from continuing their education or make it difficult for them to return to school or college after they become mothers. These practices are just one more obstacle, added to others such as the cost of schooling, the lack of family or social support and the stigma these girls experience in communities and schools.
Current data on the prevalence of child marriage and adolescent pregnancy, together with demographic projections for the coming decades, especially in the 47 least developed countries and sub-Saharan Africa (a region where the population in 26 countries will double between 2017 and 2050), indicate that any strategy to significantly improve maternal and newborn health (remember the health-related SDG3 goals on maternal and neonatal mortality, universal access to reproductive health care and education, and the objectives of achieving gender equality and poverty reduction) will depend on addressing the needs of this population group.
In the last two decades, the number of child marriages has remained stable or declined slightly.
Progress has been made in recent years on the legal regulation of child marriage and on raising awareness about the issue in many countries. In the last two decades, the number of child marriages (especially in areas, such as West and Central Africa, where they are more prevalent) has remained stable or declined slightly. However, in some countries, including the Central African Republic and some parts of Latin America, an upward trend has been observed in the marriage of girls younger than 15 years. Legislative changes are the first step, but these must be accompanied by funding and accountability mechanisms in each country.
As members of the development and health community, we have an obligation to critically evaluate our strategies, budgets and research priorities for the coming years and to ask ourselves if we are really prioritising this important issue that is central to the sustainability of humanity as a whole.
[On the occasion of the Day of the Girl Child, we launched a serie of photos on reproductive health and girls on our Instagram, taken by our colleague Clara Pons. You can see all here]