Recently, Global Childhood Report 2019 released by UK-based NGO Save the Children has stated that India has been gradually improving its performance in preventing child marriage and related health indicators.
According to the report, India has strived to bring down the number of married girls in the age group of 15-19 years by 51% in the last 19 years. The report said the country’s average performance across a set of indicators related to child health has also improved.
The country’s score on Childhood Index is up 137 points at 769 from 632, with teenage births having declined 63% since 2000, and 75% since 1990. The index score reflects the average level of performance across a set of eight indicators related to child health, education, labour, marriage, childbirth and violence.
The report, however, highlighted that even today child marriage prevalence is higher in rural areas when compared with urban areas, with figures at 14.1% and 6.9% for rural and urban areas, respectively, for the 15-19 years age group.
Key facts about India
- India has one of the highest rates of early marriage in the world.
- The recent National Family Health Survey (NFHS) estimates that 27 percent of girls in India are married before their 18th birthday, that’s a third of all our young women.
- India has one of the world’s highest numbers of teenage pregnancies which occur in the context of marriage.
What is Teenage Pregnancy?
Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20. Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth. For girls aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age. Risks of low birth weight, premature labor, anemia, and pre eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc.)
Teenage pregnancies are associated with social issues, including lower educational levels and poverty. Teenage pregnancy in developed countries is usually outside of marriage and carries a social stigma. Teenage pregnancy in developing countries often occurs within marriage and half are planned. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems. When used in combination, educational interventions and access to birth control can reduce unintended teenage pregnancies.
Adolescent pregnancies are a global problem that occurs in high, middle, and low income countries. Around the world, adolescent pregnancies are more likely to occur in marginalized communities, commonly driven by poverty and lack of education and employment opportunities.
- Approximately 16 million girls aged 15 to 19 years and 2.5 million girls under 16 years give birth each year in developing regions (2) (3).
- Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally* (4).
- Every year, some 3.9 million girls aged 15 to 19 years undergo unsafe abortions (1).
- Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years,
For some adolescents, pregnancy and childbirth are planned and wanted. In some contexts, girls may face social pressure to marry and, once married, to have children. Each year, about 15 million girls are married before the age of 18 years, and 90% of births to girls aged 15 to 19 years occur within marriage.
For many adolescents, pregnancy and childbirth are neither planned nor wanted. Twenty-three million girls aged 15 to 19 years in developing regions have an unmet need for modern contraception. As a result, half of pregnancies among girls aged 15 to 19 years in developing regions are estimated to be unintended.
Adolescents face barriers to accessing contraception including restrictive laws and policies regarding provision of contraceptive based on age or marital status, health worker bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and adolescents’ own inability to access contraceptives because of knowledge, transportation, and financial constraints. Additionally, adolescents face barriers that prevent use and/or consistent and correct use of contraception, even when adolescents are able to obtain contraceptives: pressure to have children; stigma surrounding non-marital sexual activity and/or contraceptive use; fear of side effects; lack of knowledge on correct use; and factors contributing to discontinuation (for example, hesitation to go back and seek contraceptives because of negative first experiences with health workers and health systems, changing reproductive needs, changing reproductive intentions).
In some situations, adolescent girls may be unable to refuse unwanted sex or resist coerced sex, which tends to be unprotected. Sexual violence is widespread and particularly affects adolescent girls: about 20% of girls around the world experience sexual abuse as children and adolescents (11). Inequitable gender norms and social norms that condone violence against women put girls at greater risk of unintended pregnancy.
Adolescent pregnancy remains a major contributor to maternal and child mortality, and to intergenerational cycles of ill-health and poverty. Pregnancy and childbirth complications are the leading cause of death among 15 to 19 year-old girls globally, with low and middle-income countries accounting for 99% of global maternal deaths of women ages 15 to 49 years (4), (12).
Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years. Additionally, some 3.9 million unsafe abortions among girls aged 15 to 19 years occur each year, contributing to maternal mortality and lasting health problems. Furthermore, the emotional, psychological and social needs of pregnant adolescent girls can be greater than those of other women.
Early childbearing can increase risks for newborns, as well as young mothers. In low- and middle-income countries, babies born to mothers under 20 years of age face higher risks of low birthweight, preterm delivery, and severe neonatal conditions (5). Newborns born to adolescent mothers are also at greater risk of having low birth weight, with long-term potential effects.5 In some settings, rapid repeat pregnancy is a concern for young mothers, which presents further risks for both the mother and child (13)
Economic and Social Consequences
Adolescent pregnancy can also have negative social and economic effects on girls, their families and communities. Unmarried pregnant adolescents may face stigma or rejection by parents and peers and threats of violence. Similarly, girls who become pregnant before age 18 are more likely to experience violence within marriage or a partnership.7 With regards to education, school-leaving can be a choice when a girl perceives pregnancy to be a better option in her circumstances than continuing education, or can be a direct cause of pregnancy or early marriage. An estimated 5% to 33% of girls ages 15 to 24 years who drop out of school in some countries do so because of early pregnancy or marriage (14).
Based on their subsequent lower education attainment, may have fewer skills and opportunities for employment, often perpetuating cycles of poverty: child marriage reduces future earnings of girls by an estimated 9% (14). Nationally, this can also have an economic cost, with countries losing out on the annual income that young women would have earned over their lifetimes, if they had not had early pregnancies.
WHO published guidelines in 2011 with the UN Population Fund (UNFPA) on preventing early pregnancies and reducing poor reproductive outcomes (15). These made recommendations for action that countries could take, with 6 main objectives:
- Reducing marriage before the age of 18 years. Estimates suggest a 10% reduction in child marriage could contribute to a 70% reduction in a country`s maternal mortality rate (16).
- Creating understanding and support to reduce pregnancy before the age of 20 years.
- Increasing the use of contraception by adolescents at risk of unintended pregnancy. If this need was to be met, 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths could be averted each year (1).
- Reducing coerced sex among adolescents.
- Reducing unsafe abortion among adolescents.
- Increasing use of skilled antenatal, childbirth and postnatal care among adolescents.