After the story of a 10-year-old Ohio girl crossing state lines to get an abortion caught national attention last week, some abortion opponents have suggested the child should have carry her pregnancy to term.
But midwives and doctors who work in countries where teenage pregnancy is common say those pushing very young girls to carry their pregnancies to term may not understand the brutal toll of pregnancy and of childbirth on the body of a child.
“Their bodies are not ready for delivery and it is very traumatic,” said Marie Bass Gomez, midwife and senior nurse at the Reproductive and Child Health Clinic at Bundung Maternal and Child Health Hospital. in Gambia.
The crucial problem is that a child’s pelvis is too small to allow even a small fetus to pass through, said Dr Ashok Dyalchand, who has worked with pregnant teenagers in low-income communities in India for more than 40 years. year.
“They have a long labor, obstructed labor, the fetus presses on the bladder and on the urethra”, sometimes causing pelvic inflammatory disease and the breakdown of tissue between the vagina and the bladder and rectum, said Dr. Dyalchand, who leads an organization called Institute of Health Management Pachod, a public health organization serving marginalized communities in central l ‘India.
“It’s a pathetic state, especially for girls under 15,” he added. “Complications, morbidity and mortality are much higher in girls under 15 than in girls aged 16-19 although 16-19 year olds have twice the mortality of women in their 20s. and more.”
The phenomenon of young girls having babies is relatively rare in the United States. In 2017, the last year for which data was available, there were 4,460 pregnancies among girls under the age of 15, just under half of which ended in abortion, according to the Guttmacher Institute, which supports abortion rights and regularly surveys clinics.
But globally, complications from pregnancy and childbirth are the leading cause of death for girls aged 15 to 19, according to the World Health Organization.
Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and pre-eclampsia, emergency cesarean delivery and postpartum depression, according to a 2014 assessment published in the Journal of Neonatal-Perinatal Medicine.
Babies born to girls are more often preterm and have low birth weight, said Dr. Willibald Zeck, maternal and newborn health coordinator for the United Nations Population Fund, who has frequently delivered young mothers while working as a gynecologist in Tanzania and then supervised maternal health programs in Nepal and the Philippines.
While a pregnant 10-year-old in Ohio might have access to antenatal care and a caesarean section that would lessen the effects of obstructed labor, the experience of pregnancy for a young girl is the same in India as in the United States, says Dr. Dyalchand. “The girls would go through more or less exactly the same kind of complications: the only difference is that because of access to better health care, they might not have the same kind of terrible outcomes. But that does not mean that the girl’s body and her life will not be scarred.
Dr. Shershah Syed, a gynecologist and maternal mortality expert in Pakistan, regularly provides care for pregnant girls as young as 11 years old. He said good prenatal care can prevent a hole from developing between the wall of the bladder or rectum and the vagina — called a fistula – which causes leakage of urine or feces which is not only painful (leakage of urine causes burning sores) but also a source of enormous shame and humiliation.
But even good prenatal care cannot prevent high blood pressure or urinary tract infections that are common among very young mothers, he said.
“In normal physiology, a 10-year-old child is not supposed to be pregnant. The fact is that she is a child and the child cannot deliver a child, she is not ready,” said said Dr Syed, adding: “And the mental torture she will go through, it is unmeasurable.
In the cases he has seen, early pregnancy stunts the very young mother’s physical growth, and also often her mental development, as many girls drop out of school and lose normal social interaction with their peers, a- he declared. But while an anemic mother struggles to complete her pregnancy, the fetuses take over the nutrients and continue to grow, until they’ve grown far beyond what a young mother’s pelvis can offer.
“They go to work for three days, four days, five days, and after that labor usually the baby is dead. And then when the head collapses, the baby is delivered,” said Dr Syed, who is one of South Asia’s leading experts on repairing obstetric fistula, a common consequence of obstructed labor. in pregnant girls.
In almost all of these cases, the girl developed a vesicovaginal fistula, a hole between the wall of the bladder and the vagina. In a quarter of cases, prolonged labor will also cause a fistula of the rectum, so the girl constantly loses urine and feces.
If fistula victims learn that treatment is available and come to his clinic, Dr. Syed said he can fix their condition. But the process requires a long recovery: a bladder fistula takes about five weeks to heal, while a rectal fistula requires four or five months.
In 1978, Dr. Dyalchand began his career in public health in a small district hospital in rural Maharashtra, on the west coast of India. In her first week, two young pregnant girls died of hemorrhage, one during labor, the other at the entrance to the hospital, before she even got inside. This launched him into a long career of working with communities to convince them to delay the age of marriage and first conception for girls.
This intervention has had considerable success and, Dr. Dyalchand noted, India has also steadily expanded access to abortion. The procedure is legal up to 24 weeks of pregnancy.
In The Gambia, Ms Bass Gomez said her clinic is able to offer good antenatal care to pregnant girls, but that does little to alleviate the wider trauma of the experience. Her clinic is designed to serve adults, she says. “But when you have a child who comes in just as pregnant, it’s really traumatic for the child,” she said. “It’s not comfortable, this environment, it’s not made for them. You can tell they are struggling. There is a lot of shame and disgrace.
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