Pregnancy and childbirth are leading causes of death in teenage girls in developing countries
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7449.1152-a (Published 13 May 2004) Cite this as: BMJ 2004;328:1152All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Exactly: teenage pregnancy is the culprit for many deaths and
complications in women. Not only the immediate ones but later in middle
age this also effects the Health.
In our day to day experience in this part of world we are facing the
problem. We have investigated academically too and hereby present the
Summary of our results:
We studied the relation of age at first pregnancy to the major modifiable
CAD risk factors and out come of Acute Coronary syndrome in rural women
aged
40-59 years.
Method: This is a hospital based descriptive prospective cross
sectional study using self reported age at first pregnancy of 120 rural
women admitted for the first time with the confirmed diagnosis of Acute
Coronary syndrome. Age on admission, demography, documentations of major
modifiable CAD risk factors and out come of Acute Coronary syndrome were
extracted from hospital case record and analyzed by standard research
methodology. Chi 2 tests were used for comparison.
Results: The mean age at first pregnancy of 120 CAD patients was 19.2
years
(Range 14-29 years. Mode= 18-20 years). 51(42.5%) patients were aged 49
years or younger, 69(57.5%) were within the age group of 50-59 years at
the time of first attack of Acute Coronary syndrome. 64(53.3%) patients
reported their age as 19 or younger at the time of first pregnancy (Study
Group). While 56 (46.7 %) were within the age group of 20-29 years on
first pregnancy (Control group). 18 (28 %) patients of teenage pregnancy
were suffering from metabolic syndrome in comparison of 23 (41 %) in
control group having three major modifiable CAD risk factors or more.
27(42%) of study group vs. 20(35.7 %) control had two risk Factors. Two
(3%) of study group vs. one (2%) control had Diabetes Mellitus only.
8(12.5%) of study group vs. one (2%) control had Arterial Hypertension
only. Nine (15%) of study group vs. five(11%) control had Dyslipidemia
only. 52 (81%) of ACS cases with teenage pregnancy (study group) vs.
13(23.3%) control resulted in Acute Myocardial infarction. (P<_0.0001. _1219="_1219" of="of" study="study" group="group" vs.="vs." _3257.2="_3257.2" control="control" had="had" unstable="unstable" angina.="angina." p="p"/> Conclusion: This study suggests the significant association of
teenage pregnancy with AMI as an outcome of ACS. This also reveals that
teenage pregnancy and early child bearing may contribute to the process of
Metabolic Syndrome and premature Acute Coronary syndrome in women.
Competing interests:
None declared
Competing interests: No competing interests
RESPECTED AUTHOR
THIS IS A VERY NICE ARTICLE AND IS A REAL EYE OPENER.THE FIGURES AND THE
STATISTICS ARE REALLY SHOCKING AND ALARMING.
EVEN THOUGH ONE KNOWS THAT SUCH A PROBLEM DOES EXIST I AM NOW REALLY
WONDERING THAT IF THIS IS KNOWN TO PEOPLE THEN WHY ARE NOT ANY STEPS HAVE
BEEN TAKEN TO SPREAD AWARENESS AMONG THE PEOPLE(THE TEENS) WORLD AROUND OR
STEPS TAKEN TO CONTROL THEM.
I GUESS DOCTORS SHOULD REALLY HAVE A SERIOUS LOOK AT THE ARTICLE AND
MAY BE SHOW IT TO THE "YOUNG GENERATION" BECAUSE I FEEL "SEEING IS
BELIEVING".
JUST SIMPLY SPEAKING ABOUT THIS DOESNT REALLY HELP UNTIL A HARD COPY
OF SUCH A STUDY MENTIONING THE STATS IS REALLY SHOWN WITH IT.
I SERIOUSLY FEEL THAT THIS ARTICLE SHOULD HAVE MADE IT EVEN BIGGER BY
GEETING PRINTED IN ONE OF THE TOP JOURNALS OF THE WORLD AND NOT JUST BMJ.
Competing interests:
None declared
Competing interests: No competing interests
The author's findings are as accurate as they could be. No doubt
prevailing sociocultural and economic environment favours the present
trends in maternal morbidity and mortality and other reproductive health
indices among adolescents in developing countries of Africa especially.
While the immediate and remote causes are known, however the entire
world looks on and allow this catastrophy to continue with all the
attending consequences. This is happening when billions of dollars are
being spent on WMDs, planning and executing wars with only but lame and
sporadic responses to the issues of dying young mothers in the world's
poor countries. The world needs a coalition of its rich coutries, a
strong will and desire, concerted efforts and strong partnerships to take
on the monstrous hazards of reproduction in the world's poor
countries. Its one war that no country will object, a battle front no
army will desert, a course no General will abandon and an effort
applaudable by all.
Competing interests:
None declared
Competing interests: No competing interests
The unacceptable high maternal and perinatal mortality and morbidity
in adolescent pregnancies highlighted by Susan is alarming and eye opener
but not very surprising as experienced by doctors working in developing
countries. Adolescent pregnancies (15-19 years)contribute to 19% of total
fertility in India and record the highest maternal mortality rates (1). As
a child herself, an adolescent girl requires significant nutrition during
adolescent growth spurt. As an adolescent mother with preexisting
malnutrition, the competing nutritional needs of pregnancy and growth ,
will affect the growth of the fetus and hence the birth weight of the
child (2).Although legally the marriage age for girls in India is 18
years, the rule is often flouted especially in rural areas. These girls
are often frankly anaemic or have very poor iron stores developing frank
anaemia during pregnancy. They tend to be less educated and don't use
contraception. Being housewives, they are often very poor and financially
dependent on their husbands who themselves are struggling to settle down
in life. They usually don't avail of maternity services. All these factors
are important determinants of poor pregnancy outcomes. Low birth weight is
the major adverse outcome for the perinatal mortality and morbidity.All
those involved in care of these girls have a noble duty to improve their
pregnancy outcome. The government should implement " Child Marriage
Restraint Act". Most important is enforcement of girl child school
education which is the single most important factor to delay marriage
,improve nutrition, motivate use of contraception and thus improve
maternal and perinatal outcome in these girls as has been the experience
of SriLanka and Kerala state in South India which have one of the best
maternal outcome of the developing world inspite of the average per capita
income (3,4).
References
1. Mehra S, Agrawal D.Adolscent health determinants for pregnancy and
child health outcomes among the urban poor. Ind Pediatr 2004;41:1-8.
2. UNICEF. Early Marriage Child Spouses:Innocenti Digest, No 7 March
2001. Available from URL:http://www.unicef-icdc.or/publica-tions/pdf.
accessed October 31.3003.
3. Sharma JB. Nutritional anaemia during pregnancy in non-
industrialised countries. In:Studd J,(ed) Progress in Obstetrics and
Gynaecology.Edinburgh: Churchill Livingstone Vol 15. 2003: 103-122.
4. Pitrof R, Johanson R. Safe motherhood-an achievable and worthwhile
aim. In: Studd J,(ed) Progress in Obstetrics and Gynaecology,vol
12.Edinburgh:Churchill Livingstone,1996:47-57
Competing interests:
None declared
Competing interests: No competing interests
It would have been more informative to show the relative maternal
morbidity and mortality rates for very young mothers in the Third World
and the United States (where teenage pregnancy rates are high). This I
suspect would have highlighted the really big problem in Third World
countries - that of seriously deficient maternity services for all
mothers.
'Family planning', unless based on mutual respect between the sexes,
which natural techniques require, will only lead to greater exploitation
and abuse of young girls.
Competing interests:
None declared
Competing interests: No competing interests
Dear sir:
Susan (2004) informs us about millions of death of teenager mothers
and also their infants in developing countries each year. This is
unsurprising because infant and maternal mortality rate [IMMR] in
particular teenagers, < 16 years of age, is also very high in some of
the developed countries of the West but certainly not as high as in poor
countries of the world.
In poor countries particularly in small villages, girls get married
at very young age and teenagers don't have any sense of family planning
there. Marriages are enforced on them by ignorant parents and young
husbands also don't follow strictly family planning principles and
therefore early teenager pregnancies are the net results. Reporductive
medicine is quite underdeveloped in poor countries and teenagers are not
mindful of regular antenatal follow-ups. Overall, health care delivery to
infants and teenager mothers in developing countries is scarce and hence
IMMR are vey high.
This is the high time that each government in developing world should
allocate adequate financial resources in order to develop infant and
maternal services that may help prevent teenager pregnancies and hence
premature infant and maternal deaths.
Reference:
Susan Mayor. Pregnancy and childbirth are leading causes of death in
teenage girls in developing countries. BMJ 2004; 328: 1152-a
Competing interests:
None declared
Competing interests: No competing interests
We read the article on teenage pregnancy and maternal mortality by
Susan Mayor with great interest. The statistics emerging from developing
countries are indeed appalling and should be an eye opener for world
governments, system powers and prevelidged establishments to take
hurricane measures in this regard.
A similar article written by Jim Lobe( Washington DC, 4th May 2004)
at the World Revolution homepage www.worldrevolution.org emphasizes the
same issues.The article mentions that more than one million infants - and
an estimated 70,000 adolescent mothers - are dying each year in developing
countries because young girls are marrying and having children before they
are ready for parenthood, according to the 38-page report, 'Children
Having Children'.
The criteria used to rank the countries include six indicators of
women's well-being - lifetime risk of maternal mortality; per capita
contraception use; percent of births attended by trained personnel,
incidence of anemia among pregnant women; adult female literacy rate; and
participation in the national government - and four indicators of
children's well-being - infant mortality rate; gross primary enrollment
rate; access to safe water; and extent of malnutrition. Thus, a mother in
the bottom ten countries is 26 times more likely to see her child die in
the first year of life and 750 times more likely to die herself in
pregnancy or childbirth than a mother in the top ten countries.
So where do we stand? What are the remedial measures? From where do
we get funds to implement the changes? Questions are challenging and the
task to abridge the gap between the statistics of the wealthiest and
poorest nations is daunting.We need to ensure strict legal laws for
forbidding childhood and early marriage.In addition provision of basic
school education with emphasis on reproduction and child health, family
planning and knowledge about contraception will go a long way in improving
the gloomy scenario.
Sincerely yours
Competing interests:
None declared
Competing interests: No competing interests
The case for deferring children into mid-adulthood
Thank you for your thoughtful article on the subject of the 5th
Annual State of the World's Mothers Report released by Save the Children.
In researching maternal age in developing nations, I was saddened to read
the figure that 55% of all women in West Africa give birth to their first
child by twenty.
My hope is that the greater humanitarian community will put aside
archaic notions about birth control and family planning. As in my
opinion, the quickest way of eliminating the exploitation of children
though labor or the sex trade is by helping raise the age of their parents
before they are born. Delayed parenthood would allow all families to
prepare more fully for the care and education of their children. With a
more mature parent, there is also less risk of neglect, abuse and
abandonment.
Thank you for reminding us that this is a global crisis, and one that
cannot be ignored when we know that a child is suffering anywhere.
Sincerely,
Elizabeth Madrigal
PO Box 968,
Ridgefield, WA., USA 98642
Competing interests:
None declared
Competing interests: No competing interests