Health cannot be understood only in terms of the biomedical determinants but is influenced by social and cultural mores. Health hazards arising out of high-risk and teenage pregnancy is a perfect illustration of the above. The WHO defines period of adolescence to lie between 10-19 years and consequently the pregnancy during this period is treated as teenage pregnancy, a state of high-risk maternity. In developing nations like India most of teenage pregnancy occur within the wedlock which can be clearly contrasted with unwed pregnancy in developed world.
High-Risk Pregnancies: Causes
In the present day, the growing chasm created by the “biosocial” gap, or the gap between the awareness of reproductive capability and the social consensuses, coupled with the increased opportunities of socialization between males and females without adequate sex education and awareness, has considerably increased the incidences of early pregnancies, especially in the teenage years, and consequently even high-risk pregnancies.
In addition to all these, poor nutrition, lack of appropriate health care services and adequate counselling is another great cause of these high-risk maternities.
Child marriage is deeply rooted in the cultural values, especially in rural India. Despite strong laws relating to child marriage, this traditional practice is a reality and is prevalent in various regions. Statistically speaking, 18.2% of women aged between 20 and 24 years are married by the age of 15 years and 47.4% by the age of 18 years. 16% of adolescents between 15 and 19 years are already seen to be in the childbearing phase of their lives. The rate is considerably higher in rural areas i.e. 22.21% than in the urban areas. Hence this abhorrent practice in conjunction with the already poor health status, socio economic disabilities, low literacy rates and lack of awareness is magnifying the problem. Further the problem of gender inequality adds to the woes of these teenage mothers.
The Banes of Teenage Pregnancy
There are several complications which arise due to the tender age of the prospective mother. It is important to appreciate that most of the health problems faced by these girls is due to the inherent biological immaturity. In fact, even adequate pre-natal care does not eliminate the risk completely. However, the economic conditions and the callous attitude towards the health of the mother generally have a further detrimental effect upon the health of the teenage mother.
It is pertinent to appreciate that anemia is the most common problem in case of teenage mother. In fact, the risk of anemia and preterm labor is thrice more likely in case of teenage mothers. They are also 2 times more at risk to stem hypertensive problems in pregnancy and low birth weight. Teenage pregnant girls need more attention for prevention and treatment of anemia, preeclampsia, eclampsia and low birth weight, prematurity.
It is not just these complications but also pregnancy is a leading cause of death among teenage girls in the developing world. Early pregnancies, especially in very young mothers (typically between 10 and 14 years) are often than not associated with a 5-times higher maternal mortality rate than the MMR in the women between 20 and 24 years. In fact, teenage pregnancies are also one of the leading causes of neonatal deaths and other complications, with a perinatal mortality rate and neonatal mortality rate that are respectively 7-16 times and 2.5-18 times greater due to the presence of associated risk factors. Even the late neonatal mortality in infants borne by very young mothers reflects to be 2.2 times greater than among infants with above 18-years mothers. It is not surprising by these statistics that an estimated 70,000 girls and around one million infants die due to the above-mentioned menace each year.
Initiatives and Policy by the Government
As stated above, most of the pregnancy in India is within marriage and hence there seems to be a direct link between child marriage and early pregnancy. Although there are strict laws in place with respect to child marriage but this practice continues to plague the Indian social fabric. The Hindu marriage act 1956 makes child marriage illegal and the new legislation known as Protection of Child Marriage Act, 2006 enhances the punishment for child marriage as well as the fine. However, the problem lies in the implementation part as the people implementing the laws are also part of the same societal setup and have the same cultural values. Hence most of the cases of child marriage go unreported.
Further the government has in accordance to the Reproductive and Child Health Program Phase II (RCH II) of the MoHFW, Adolescent Reproductive and Sexual Health (ARSH) services provided for counselling services and sexual health care at the primary, secondary and tertiary levels on fixed dates and in fixed clinics.
The Ministry of Health and Family Affairs in the light of the ever-increasing number of anemic teenage girls has developed the Weekly Iron and Folic Acid Supplementation (WIFS) program to cater to this enormous health challenge. The work regarding this program is in progress and states are in various stages of preparation for the same.
To tackle the prevalent under-nutrition, especially among young girls and women folk, that undermines their reproductive health and causes complications during pregnancy, the Ministry of Women and Child Development has launched Nutritional Program for Adolescent Girls (NPAG) which provides for a certain amount of food grains to girls only. The amount is decided based on their weight. 1607,568 girls have benefitted from the scheme so far. Along with this, for lactating mothers and pregnant women, a program known as Integrated Child Development Scheme was launched by the ministry to supervise their nutritional needs.
There are several policies and programs both by the government as well as independent bodies like UNICEF which are in place to address the issue of maternal deaths. For example, the recent Pradhan Mantri Surakshit Matritva Abhiyan or Yojana which forwards the agenda of ‘safe motherhood’. The scheme emphasizes on the management of health care facilities to pregnant women especially in rural and economically backward areas. Through initiatives such as free maternity services for women and children (such as free health check-up especially in their 9th month) and a nationwide scale-up of emergency referral systems and maternal death audits, the scheme further provides for a healthy life for the pregnant women and the baby through a safe delivery and timely treatment, and thus move towards a marked reduction in the MMR.
However, despite these baby-steps towards curbing the issue of teenage and other high-risk pregnancies, no clear policy exists on tackling teenage and high-risk pregnancy in India. It becomes important to note that only improved level of education and awareness with respect to the ills of teenage pregnancy can be the effective steps towards its reduction.
Conclusion
Teenage pregnancy still remains one of the most pertinent health care issues in rural India. It is a multifaceted problem requiring multilayered solution. It should also be appreciated that the problem seems to be more prevalent in the low socio-economic society and therefore demands education and awareness.
Though the risk associated with such high-risk pregnancy cannot be eliminated completely but obstetrical problems can be managed by modern medicine and consequently the complications can be diminished. Hence the health care departments must treat such pregnancy as involving “high risks” and properly monitor such pregnancy by educating the mothers to have more number of antenatal visits so that the complications can be detected at the earliest. Further awareness programs with regards to the use of contraceptives should also be encouraged. Providing them with affordable and safe contraceptive can play an instrumental role in preventing teenage pregnancies.
Education, nutritional support, and family planning, as well as social and community preparedness, especially among school-going girls, through the creation of awareness around delaying marriage, reproductive health, family life, and population education will definitely go a long way to transform today, adolescent girls into healthy and responsible women, giving birth to a healthy future generation.
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