October 12, 2015
Written by By Judith Helzner, Visiting Scientist, Women & Health Initiative, Harvard T.H. Chan School of Public Health and Margaret Greene, Director, GreeneWorks
In September 2015, the importance of addressing the needs of adolescents was affirmed at the launch of the new Every Woman Every Child global strategy at the United Nations General Assembly events in New York. As the press noted, “This new strategy explicitly states the importance of addressing the needs of adolescents, young people aged between 10 and 19.”
Childbearing holds greater risks for adolescent mothers, girls 10-19 years old, and their newborns than for older women – even those just a bit older, in the 20-24 age group. While the Global Maternal Newborn Health Conference (GMNHC) will dedicate some time to adolescents, there are many reasons for donors, policy makers and program implementers interested in newborn and maternal health to more emphatically prioritize adolescents.
Adolescents represent a vulnerable and underserved group, so the conference theme of equity applies to them. Addressing the contraceptive needs of adolescents can be challenging and controversial; after all, unmarried adolescents are often judged punitively if they are sexually active, and young married girls are often expected to prove their fertility early in marriage.
A new publication, called The Case for Investing in Research to Increase Access to and Use of Contraception among Adolescents, has been produced under the auspices of the Alliance for Reproductive, Maternal and Newborn Health. The complete report and a four-page policy brief are publicly available.
Among the findings, the report highlights the increased risks of poor outcomes associated with childbearing for adolescents and their children and the significant returns on investing in increasing adolescent access to contraception:
Pregnant adolescents in low-resource settings are less likely to have skilled care for prenatal and delivery care than even women 19-23 years old (Reynolds et al. 2006).Adolescent girls are at increased risk of illness and death from complications of pregnancy and childbirth, and mortality rates are four times as high in poor countries as in rich countries, a difference that is even greater for young women in Africa and South Asia.The children of adolescent mothers face increased risks of neonatal mortality (the younger the mother, the higher the mortality rate), malnutrition, and impaired cognitive ability.The increased risk neonatal mortality is explained partially by lower socioeconomic status for younger vs. older mothers (including the stigma associated with premarital pregnancy and its effect on access to support) and by a higher incidence of newborns who are preterm, low birth weight, and small for gestational age (Zabin and Kiragu 1998, Sharma et al. 2008, Phipps et al. 2002).
What are the implications of the increased risk of morbidities and mortality? Early childbearing can have lasting negative effects on adolescents and their children and incur significant costs for societies, health systems and themselves, due to lost opportunities for school and work.
There is a great need to pay more attention to adolescents within the maternal and newborn health communities, including investing more in adolescent research (including evaluation) and programs. Strengthening the evidence, and increasing the use of existing evidence, helps maximize the effectiveness of investments.
Increasing the supply of contraceptive services for young people, and increasing adolescent demand for them, are crucial interventions. As supplies are expanded, demand is increased and we strengthen the evidence on programs, we must “segment the market” of adolescents rather than assuming that they are one heterogeneous group: they are both married and unmarried, mothers and not, girls and boys, poor and well-off, uneducated and in school, urban and rural residents, and aged anywhere from 10 to 19 years old. This is a group with a diverse range of needs.
In summary, this is a call to the maternal and newborn health experts involved in the upcoming GMNHC to make three commitments to adolescent health:
Prioritize contraception for adolescents as a crucial preventive/public health measureEnsure sufficient research and evaluation so that funds are used effectivelyRecognize that adolescent contraception is a means of advancing global health priorities and promotes adolescent rights
Photo: “International Day of the Girl Child for 2014 Empowering Adolescent Girls: Ending the Cycle of Violence.” © 2013 Ramesh Lalwani, used under Creative Commons Attribution License: http://creativecommons.org/licenses/by/2.0/
Reynolds, H. W., Wong, E. L., et al. (2006). Adolescents’ use of maternal and child health services in developing countries. International Family Planning Perspectives. 32(1): 6-16.
Phipps, M. G., Blume, J. D., et al. (2002). Young maternal age associated with increased risk of postneonatal death. Obstetrics & Gynecology. 100(3): 481-486.
Sharma, V., Katz, J., et al. (2008). Young maternal age and the risk of neonatal morality in rural Nepal. Archives of Pediatrics & Adolescent Medicine. 162(9): 828-835.
Zabin, L. S. and Kiragu, K. (1998). The health consequences of adolescent sexual and fertility behavior in sub-Saharan Africa. Studies in Family Planning. 29(2): 210-232.