Health for Young Mothers

Dr. Arvind Dubey

The term 'young mother' usually refers to a girl who gets pregnant as a teenager because for a
healthy pregnancy, the mother to-be should be at least 18 years old. Nationally, as many as 30
percent of adolescent girls currently aged 15–19 are married and under pressure to bear a first child
early in the marriage. A substantial number of adolescent girls in India (13 percent) have begun
childbearing by age 17and are under high obstetric risk. Moreover, a number of social and
economic disadvantages are associated with early marriage, including low levels of educational
attainment, limited or even nonexistent peer networks, and restricted mobility do add to this risk.
So nothing strange if despite significant economic growth in the past decade, India still has the
highest number of under-five deaths in the world.

Maternal Mortality Rate (MMR)

Maternal mortality means women are dying of causes related to pregnancy and child birth. India's
current Maternal Mortality Rate (MMR) is 254 in 100,000 live births. According to the World
Health Organisation (WHO), half of all maternal deaths in South Asia occur in five Indian states -
Rajasthan, MP, UP, Bihar and Orissa. We have committed ourselves as part of the UN's
Millennium Development Goals (MDGs) to bring the MMR down to 109 by 2015, in just five
years. Is that possible?

Studies show MMR among scheduled tribes and scheduled castes is higher than in women of other
castes. It is higher among illiterate women than those having completed middle school. The key
determinant seems to be access to healthcare. Less-developed villages had a significantly higher
MMR than moderately or well-developed villages.

According to UNICEF:

• Only 15% of mothers in India receive adequate prenatal care, resulting in a staggering
number of unnecessary maternal and child deaths.
• Maternal mortality in India is 100 times higher than that of most industrialized nations.
• 63 out of every 1,000 children born in India die before one year of age.
• 30% of Indian infants are born with low birth weight.

Health Risks of Early Pregnancy

When a woman is too young, pregnancy can be dangerous for both mother and infant. Even under
optimal conditions, young mothers, especially those under age 17, are more likely (risk of death
may be two to four times higher) than women in their 20s to suffer pregnancy-related
complications and to die in childbirth. In a study of nearly 11,000 pregnancies over a 5-year period,
outcomes in a hospital in West Bengal, India, varied by age as follows:

Maternal Perinatal Deaths (Deaths upto

Women's Deaths/1,000 Average Premature after 7 days of pregnancy) per
Age Births Birth Weight Births (%) 1,000 Births
12 to 19 3.80 1.9 kg 20 29.6
20 to 30 2.55 2.5 kg 16 18.4
31+ 1.07 2.65 kg 11 4.3

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Source: Mishra & Dawn 1986

Problems in young mothers

• There are many issues concerning the higher rates of nutritional and obstetric problems
associated with adolescent pregnancy. The ignorance and immaturity can result in higher
morbidity and mortality among mothers and babies.
• Health wise teenage mothers have a much higher risk for anaemia, gestational diabetes,
pregnancy induced hypertension, lower genital tract infections (which may lead to
premature labour and delivery), caesarean section because of pre-maturity, large baby
within a small pelvis, foetal distress and sudden infant death syndrome. These risks are
higher for young women not only because of their age but also because births to younger
women often are first births, which are riskier than second, third, or fourth births.
• Socioeconomic factors, including poverty, malnutrition, lack of education, and lack of
access to prenatal care or emergency obstetrical care can further increase a young woman's
risk of pregnancy-related complications.
• Untreated pregnancy-induced hypertension can cause heart failure or stroke and result in
the death of both the mother and infant. Hypertension occurs most often among women
having their first child and accounts for a large proportion of maternal deaths in women
under age 20.
• Among the young, as with older women, risks are greatest for poor women, who are most
malnourished and have the least opportunity for prenatal care.
• Low immunity is the major cause for infections in early mothers.
• A young mother is more likely to suffer an excessive loss of blood during delivery as well.
• The stress that accompanies having a baby at a young age could also result in increased
anxiety levels and depression.
• Cephalopelvic disproportion— It means that the woman's pelvic opening is too small to
allow the infant's head to pass through during delivery. Therefore it can slow or prevent
vaginal delivery by normal route). In some cases, if caesarean section cannot be performed,
the woman's uterus ruptures, and both mother and infant die. Cephalopelvic disproportion is
common in very young women whose pelvic growth is not complete and women of any age
who are of small stature because childhood malnutrition stunted their growth. The
prolonged labour associated with cephalopelvic disproportion increases the risk of fistula, a
tear between the vagina and the urinary tract or rectum, which allows urine or faeces to leak
out through the vagina. In India fistula injuries occur most commonly in women under age
20, and obstructed labour causes most of these injuries. Fistula is reparable through surgery.
For women who cannot get proper care, however, it often leads to lifelong disability and
ostracism.
• Iron-deficiency anaemia- An anaemic woman is five times more likely to die of
pregnancy-related causes than a woman who is not anaemic. Anaemic women are less able
to resist infection and less able to survive haemorrhage or other complications of labour and
delivery. Anaemia also contributes to premature delivery and low birth weight. Iron-
deficiency anaemia is particularly common among pregnant women, and young pregnant
women are more likely than older women to be anaemic, even in developed countries. A
diet lacking absorbable iron, and malaria cause most anaemia in pregnant women. To avoid
anaemia during adolescence, young girls need twice as much iron as adults of the same
weight.
• Lack of prenatal care. Adequate prenatal care can reduce pregnancy-related mortality
(deaths) and complications, especially among very young women. In developing countries,
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 however, many women get no prenatal care, and young women are least likely to get care,
even in developed countries. When they do so, it is often late in pregnancy. Even where
available, prenatal care services may not be used because child-bearing is considered
normal for young women and thus is seen to require no medical attention. Hypertension and
the toxaemias of pregnancy can only be detected with antenatal care.
• Septic abortions- In many rural areas couples do not use any spacing methods and women
conceive within 7 months of having given birth. These abortions are performed by quacks.
As a result there are a high number of abortion-related deaths which do not get reported
under maternal mortality. Second trimester (fourth month to sixth month of pregnancy)
abortion is a big reason for rising maternal mortality.

Risks for infants

• Pregnancy before age 20 also poses risk to the young woman's infant. An immature and
weak body is less likely to carry to term a healthy baby. Studies show that mortality and
morbidity (Disease or ill health) rates are higher among infants born to young mothers.
Young mothers, especially those under age 15, have higher rates of premature labour
(Delivery before 37 weeks of pregnancy), spontaneous abortion (miscarriages), stillbirth
(Death of baby inside the womb itself), and low birth weight infants. For the infant who
survives, the higher risk of death persists throughout early childhood.
• Infants born to such teenage mothers are at higher risk of complications of pre-maturity,
low weight, accidental trauma and poisoning, minor acute infections, lack of immunization
or vaccinations and developmental delays.
• Children born to women married as minors are significantly more vulnerable to
malnutrition, for reasons that appear to extend beyond the socioeconomic vulnerabilities
associated with child marriage, such as rural residence and low maternal education. These
findings highlight the need to increase efforts to reduce adolescent marriage and to delay
childbirth among adolescent wives, particularly within rural India, where adolescent
marriage occurs among the majority of females.

Social and Economic Consequences

For young women just beginning their adult lives, the risks of childbearing do not end with
delivery. Compared with a woman who delays childbearing until her 20s, the woman who has her
first child before age 20 is more likely to:

• Obtain less education,

• Have fewer job possibilities and lower income,
• Be divorced or separated from her partner
• Live in poverty.

The economic consequences of early parenthood often are more extreme and longer-lasting today
than in the past. Increasingly, young women as well as young men find that they need wage-
paying jobs, and they need education to get those jobs. Where young women's opportunities for
economic advancement are scarce, as in rural areas of many developing countries, early
childbearing may not worsen a young woman's already poor economic prospects. Most urban areas,
however, offer a young woman some opportunity for a paying job if she has the skills. Thus in
cities a woman who has a child before age 20 may suffer the same economic setbacks as her
counterpart in developed countries, largely because her education has been cut short. The poorest

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women are the most likely to have children while young, and those having children while young
also are likely to remain in poverty.

Educational consequences

Young women who begin childbearing early complete less schooling than women who delay
childbearing until their 20s. In developing countries schoolgirls who become pregnant rarely return
to school, whether they are married or not.

So what are the solutions?

Planned pregnancy, Regular light exercises and a Balanced diet hold the promise

• Teenage mothers have a higher prenatal risk during child bearing. In young women
subsequent pregnancies should be discouraged as rapid repeat pregnancy in young mothers
increases prenatal risks.
• Immaturity, unhealthy eating habits, nutritional deficiencies and detrimental lifestyle have
the capacity to adversely affect the health of the mother and unborn baby alike. Hence, a
planned pregnancy is always recommended as it prepares both the parents, mentally as well
as physically, to be able to face this life-altering adventure.
• Giving one iron tablet to a woman during her pregnancy is too late. The real problem is
food. It is all about food, the cost of food and the nutrition content therein. These pregnant
women have to fetch the water, make fuel, work the buffaloes, etc., all on the measly
amount of food they can afford. How can the nutritive intake be enough? It becomes a
negative calorie balance.
• A diet with a good balance of various nutrients essential for a healthy body is recommended.
Fresh fruits and vegetables are especially recommended as they are high in nutritional
content but low in fats. Foods rich in vitamin C help in strengthening the immune system
thus decreasing the risks of numerous infections and health disorders. Folic acid is an
essential nutrient that reduces the risk of birth defects related to the heart, brain and nervous
system.
• Regular light exercises and sufficient rest are also recommended for a normal pregnancy.
• Visiting a gynaecologist before trying to conceive will also help in ruling out complications
and concerns pertaining to the pregnancy

Contraceptive counselling

Since unprotected sex is the main cause of teenage pregnancies, contraceptive counselling is highly
important in order to prevent them, especially repeat ones. Clinics, private medical offices, or
NGOs can play a major role in providing counselling. Birth control pills, the most popular form of
contraception for teenagers, should be taken regularly or as advised else teenagers risk pregnancy.
On the other hand, barrier methods such as condoms, diaphragms, and foam have high failure rates
among teenagers. This is due to sporadic and improper use. To avoid pregnancy in the event of
unprotected sexual intercourse, teenagers should be made aware of emergency contraception.
Though all these help teenage girls avoid getting pregnant even after having sex, the best way
however is to educate them on the importance of abstinence and /or having safe sex.
Unfortunately most of our young girls have never given much importance to contraception and
only think about it after they have had an unwanted pregnancy.

Place of delivery

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The most important challenge lies in the place of delivery. In states like Uttar Pradesh and Orissa,
over two-thirds of deliveries take place at home, and through the support of family members or
traditional birth attendants. Until about two generations ago, even in urban India many deliveries
took place at home, but today in middle class households, hospital delivery has become the rule. It
is widely assumed that hospital delivery is safer for mothers and infants.

There is literature now available from different parts of the world showing that for low-risk cases,
home-based deliveries are comparable if not safer than hospital deliveries. Additionally in home-
based deliveries babies can be breast-fed earlier, and women complain of fewer back-aches, and
are physically more comfortable and free of stress. Compared to women who intended home
delivery, women with hospital-based deliveries, also showed higher rates of medical interventions
like Caesarean sections as well as other interventions like induction, rupture of membranes, and use
of pain-killers. These studies have shown that babies were better off in home deliveries.

Early diagnosis and quick referrals

Early diagnosis of high-risk pregnancies and complications and quick referrals are of paramount
importance. But is institutionalising deliveries the answer? By requiring 100% institutional
deliveries will result in the abolishing of the dais (Traditional Birth Attendants) probably increased
MMR. If there were a skilled birth attendant (SBA) at the time of each delivery or for antenatal
checkups for each pregnancy, he or she can recognize a high-risk pregnancy or a potential
complication and refer the mother to a district hospital or closest emergency care unit.

Educate the girl child

Girl is a future mother. Education of girl will make a significant impact in reducing maternal and
infant mortality as it is evident by very low levels of these deaths in Kerala where female literacy is
highest. Besides this, literacy in general also makes significant dent in reducing different
mortalities.

Correct recording of database

All the health care plans are made on the basis of surveys and databases created by concerned
departments. Quite often this job is taken casually and consequently the databases so created are
either inadequate or fake. How an effective planning can be expected from such databases. So
irregularities in creation of these should be taken seriously and to be dealt with iron hands.

National programmes

The current strategy for reducing maternal deaths hinges on-

• ASHA (Accredited Social Health Activist)-A village level health worker identifies pregnant
women, and motivates them to avail services.
• Janani Suraksha Yojna- It provides financial support to poor women, above the age of 19
years, for their first two deliveries, and a third only if she undergoes sterilization at the time
of delivery.
• Skilled birth attendant-The skilled birth attendant will be a person with the ability to not
only delivery babies, but to handle life-threatening risks immediately.

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 • Universal institutional delivery- Birth should occur only in government health centres and
hospitals, or in private nursing homes where the doctors will be provided with a fixed fee
for normal delivery or for caesarean operations.
• Increasing Emergency Obstetric Care- Providing a basic package of services at Primary
Health Centres and at Rural Hospitals.

Science in the service of young mothers

From avoiding unintentional pregnancies, early diagnosis of pregnancy or premature labour, foetal
monitoring, intensive care units to help premature baby survival, breast feeding to avoid maternal
deaths, science helps in every sphere of maternal and infant health especially to young mothers
who are on higher risk for complication or deaths during delivery.
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