This is the second in a series of excerpts from the 2013 State of World Population report released recently by the United Nations Population Fund.

APPROXIMATELY 70,000 adolescent girls in Jamaica and other developing countries die each year from pregnancy and childbirth-related complications — the leading cause of death of older adolescent females, according to the World Health Organisation (WHO).

In the 2013 State of World Population Report, the United Nations Population Fund stressed that “adolescents who become pregnant tend to be from lower-income households and be nutritionally depleted”.

The report, which focuses on adolescent pregnancy, is entitled Motherhood in Childhood: Facing the challenge of adolescent pregnancy. Citing the WHO, it observes that “health problems are more likely if a girl becomes pregnant within two years of menarche or when her pelvis and birth canal are still growing”. Below is an excerpt:

Obstetric fistula

“Physically immature first-time mothers are particularly vulnerable to prolonged, obstructed labour, which may result in obstetric fistula, especially if an emergency Caesarean section is unavailable or inaccessible.

“Obstetric fistula is a debilitating condition that renders a woman incontinent and, in most cases, results in a stillbirth or the death of the baby within the first week of life.

“Between two million and 3.5 million women and girls in developing countries are thought to be living with the condition. In many instances, a woman — or girl — living with obstetric fistula is ostracised from her home and her community and is at risk of poverty and marginalisation.

Unsafe abortion

“Compared to adults who have unsafe abortions, adolescents are more likely to experience complications such as haemorrhage, septicaemia, internal organ damage, tetanus, sterility and even death (International Sexual and Reproductive Rights Coalition, 2002). Some explanations for worse health outcomes for adolescents are that they are more likely to delay seeking and having an abortion, resort to unskilled persons to perform it, use dangerous methods and delay seeking care when complications arise.

Adolescents make up a large proportion of patients hospitalised for complications of unsafe abortions. In some developing countries, hospital records suggest that between 38 per cent and 68 per cent of those treated for complications of abortion are adolescents (International Sexual and Reproductive Rights Coalition, 2002).

Sexually transmitted infections

“Worldwide each year, there are 340 million new sexually transmitted infections (STIs). Youth between the ages of 15 and 24 have the highest rates of STIs. Although STIs are not a consequence of adolescent pregnancy, they are a consequence of sexual behaviour — non use or incorrect use of condoms — that may lead to adolescent pregnancy. If untreated, STIs can cause infertility, pelvic inflammatory disease, ectopic pregnancy, cancer, and debilitating pelvic pain for women and girls. They may also lead to low birth-weight babies, premature deliveries and life-long physical and neurological conditions for children born to mothers living with STIs.

Health risks to infants and children

“The health risks to the infants and children of adolescent mothers have been well documented. Stillbirths and newborn deaths are 50 per cent higher among infants of adolescent mothers than among infants of mothers between the ages of 20 and 29 (WHO, 2012a). About one million children born to adolescent mothers do not make it to their first birthday. Infants who survive are more likely to be of low birth weight and be premature than those born to women in their 20s. In addition, without a mother’s access to treatment, there is a higher risk of mother-to-child transmission of HIV.

Health risks to girls giving birth before age 15

Research indicates that very young adolescents in low- and middle-income countries have double the risk for maternal death and obstetric fistula than older women (including older teens), especially in sub-Saharan Africa and South Asia (Blum et al, 2013).

As young people transition from the early to late adolescent years, sexual and reproductive behaviours contribute to diverging mortality and morbidity patterns by gender, with younger adolescent girls facing an increased risk of sexual coercion, sexually transmitted infections, including HIV, as well as the gender-specific consequences of unintended pregnancies and psychological trauma (Blum et al., 2013).

Psychological impact

“Millions of girls are forced into marriage every year, and an estimated 90 per cent of adolescents who give birth are married. This means millions move from being a child to being a married mother with adult responsibilities with little time in between. One day, they are under a parent’s authority. The next, they are under a partner’s or husband’s authority, perpetuating and reinforcing a cycle of gender inequality, dependence and powerlessness.

“In the transition from childhood to forced marriage and motherhood, a girl may experience stress or depression because she is not psychologically prepared for marriage, sex or pregnancy, and especially when sex is coerced or non-consensual. Depending on her home and community environments, she may feel stigmatised by an early pregnancy (especially if it is outside of marriage) and seek an abortion, even in settings where abortions are illegal and unsafe, often accepting the risk of a disastrous health outcome.”