When a young girl has to carry a baby to full term, she faces the risk of heavy bleeding after delivery and could develop a dangerously high blood pressure, orthopedic problems, diabetes or a chronic lung disease later in life.
The recent case of a ten-year-old girl in India who was raped and denied an abortion by Indian courts, is one of a series of recent cases of girls being raped, impregnated and then being denied abortion. She delivered a baby girl on Thursday (August 17). There’s a surge of interest in this subject as well, with writers taking various stands from the legal to the emotional. Much has already been written about the current policy, laws, potential amendments and procedural aspects on this subject.
But there are also several medical outcomes due to pregnancy, labour and delivery, in mothers of a young age, especially the age of ten to 15. Some of these are also long term consequences.
In the adolescent age group, there is a shortage of data for those between the ages of ten and 15, although this is the group being most affected by the spate of rapes, pregnancies and denials of abortion. Data is abundant for outcomes in older adolescents, but this cannot be extrapolated directly to the younger age group of ten to 15 year old girls. One can only conjecture that following the trends, outcomes would be worse as age reduces.
The physical outcomes of pregnancies for girls in that age group are coloured to a large extent by social factors. At this age, almost universally, pregnancies are unplanned and outside the context of marriage or consensual union. There is complete dependence on the family for financial means, decision making and emotional support. The other major confounding factor in the physical outcomes is geography.
Maternal mortality varies from ten per 100,000 live births in developed countries (Scandinavia, Europe) to 500 or more per 100,000 live births in countries in sub Saharan Africa and the war-ridden countries of the middle East. It also varies within a country, especially one that is as diverse in its health provisions as India. In the context of the present 10-year-old girl in question, there is intense public attention and she will be looked after at a premier tertiary care hospital. This may not be the case with every 10-year-old girl who is in the same situation.
The most prominent data is on the starkest indicator of physical outcomes – death. The risk of death for the young adolescent is 30-50% greater than for a woman in her 20s in the same geographical area and with similar healthcare facilities. Most of this data comes from countries where the maternal mortality rate is high.
In pregnancy, the main physical risks to young adolescents are anemia and developing a dangerously high blood pressure leading to convulsions (preeclampsia and eclampsia). The other risks that are substantially increased are the risk of bleeding heavily after a delivery and infections of the uterus and genital tract. In terms of the route of delivery, it would be a common understanding that girls younger than 15 years should have a cesarean birth due to an undeveloped pelvic bone structure and risk of damage to it.
However, the weight of the baby at birth tends to be low due to restricted growth and prematurity. If there are no other complications and labour begins, the chances of a normal delivery are in the same range as a woman in her 20s. The risk of traumatic injury to the lower genital tract is not increased in spite of the young age. Offsprings of mothers younger than 15 years have a high risk of being born with a low weight, being born preterm. There is however, no increased risk of birth asphyxia.
Long-term health risks
In terms of long-term health risks, having an early pregnancy and giving birth gives rise to a number of problems to the mother and child. Women who have delivered their first child very early have nearly twice the risk of developing chronic health conditions such as orthopedic problems, diabetes, high blood pressure and chronic lung disease in later life. Babies born to mothers of very young age also face a higher risk of long-term health problems stemming from growth restriction, preterm birth and low birthweight. The risks to offsprings in the long term include high blood pressure, diabetes and premature death.
There could be a profound impact on mental health due to a number of factors – physical and/or sexual assault, social exclusion, pregnancy and delivery. There may be existing issues with mental health which get magnified. Overall, there is an association of depression and conduct disorders with adolescent pregnancy. Emotional trauma, difficulty in relationships, high-risk behaviour patterns and their consequences may further harm physical and mental health.
Hypothetically, if one considers the present 10-year-old girl in question, there is a medical indication to induce labour (not “terminate pregnancy”) on the grounds that she would risk preeclampsia and eclampsia. However, it would have been a long, arduous delivery and the preterm neonate will require special care. Of course, a termination of pregnancy – ideally in the first few weeks or even before 20 weeks – would have been safer than delivery but the legal process did not move fast enough for her to be successful here, and now she has delivered a baby girl.
The physical, mental and emotional health problems that occur with pregnancy and delivery at very young age do not completely address the big picture including the loss of educational opportunities, perpetuation of maternal poverty and having to live in a socially disadvantaged environment. There is a need to acknowledge adolescent pregnancies as a special group needing more access to reproductive health. We also need broader reproductive health services to help adolescents prevent pregnancies or births at very young ages.
Parikshit Tank is consultant obstetrician and gynecologist at Ashwini Maternity and Surgical Hospital, Mumbai.