Girls with more formal education are better equipped to fulfil their potential in life. They tend to know about health-care practices and are less likely to become pregnant at a very young age. They are more likely to marry later, have fewer and better-spaced pregnancies, and seek prenatal and post-natal care. It is estimated that two maternal deaths can be prevented for every additional year of school attendance per 1,000 women.
The healthy growth and development of a girl through adolescence helps to prepare her for healthy pregnancies during her childbearing years.
In addition to education and health care, girls need a nutritious diet during childhood and adolescence to reduce problems later in pregnancy and childbirth. A nutritious diet includes iodized salt and foods rich in essential minerals and vitamins such as beans and other pulses, grains, green leafy vegetables, and red, yellow and orange vegetables and fruits. Whenever possible, milk or other dairy products, eggs, fish, chicken and meat should be included in the diet.
Girls who stay in school are more likely to delay marriage and childbirth. Early pregnancy can have serious consequences for adolescents under 18 years old, particularly for those under 15 years old. Adolescent girls and their babies are at much higher risk of complications and death.
It is important to empower girls to avoid early pregnancy and inform both girls and boys about the risks of early pregnancy as well as sexually transmitted infections, including HIV. They both need to develop the skills to make healthy life choices that also support equality and respect in relationships.
Genital cutting of girls and women can cause severe vaginal and urinary infections that can result in sterility or death. It can also cause dangerous complications during childbirth.
Health workers and community outreach programmes can help raise awareness of harmful practices and the importance for adolescents to delay marriage and pregnancy for their health and well-being.
Families need to understand the high risks of early pregnancy. If an adolescent girl marries early and/or becomes pregnant, her family should provide her with support and ensure she obtains the health services she needs.
Adolescent girls, women, pregnant women and new mothers need the best foods available: milk, fresh fruit and vegetables, meat, fish, eggs, grains, peas and beans. All of these foods are safe to eat during pregnancy and while breastfeeding.
Women will feel stronger and be healthier during pregnancy if they eat nutritious meals, consume greater quantities of nutritious food and get more rest than usual. Nutritious foods rich in iron, vitamin A and folic acid include meat, fish, eggs, green leafy vegetables, and orange or yellow fruits and vegetables.
After childbirth, women also need nutritious meals and a greater quantity of food and rest. Breastfeeding mothers need about 500 extra calories per day, the equivalent of an additional meal.
During prenatal visits, a trained health worker can provide the pregnant woman with iron-folic acid or multiple micronutrient supplements to prevent or treat anaemia. Malaria or hookworm infection can be treated if needed. The health worker can also screen the pregnant woman for night blindness and, as necessary, prescribe an adequate dosage of vitamin A to treat the woman and contribute to the healthy development of the fetus.
If the pregnant woman thinks she has anaemia, malaria or hookworms, she should consult a trained health worker.Salt consumed by families should be iodized. Iodine in a pregnant woman's and young child's diet is especially critical for the healthy development of the child's brain. Goitre, a swelling at the front of the neck, is a clear sign that the body is not getting enough iodine. A diet low in iodine is especially damaging during the early stages of pregnancy and in early childhood. Women who do not have enough iodine in their diet are more likely to have an infant who is mentally or physically disabled. Severe iodine deficiency can cause cretinism (stunted physical and mental growth), stillbirth, miscarriage and increased risk of infant mortality
When a young woman begins to be sexually active, she needs information about pregnancy and the risks of sexually transmitted infections (STIs), including HIV. She should be able to recognize the early signs of pregnancy. If she becomes pregnant, she should be supported to receive prenatal care early in the pregnancy from a trained health worker. She should learn about the normal phases of pregnancy and how to keep herself and her baby healthy during the pregnancy. She needs to know the warning signs of serious pregnancy complications.
A pregnant woman needs at least four prenatal visits with a trained health worker during every pregnancy. The first prenatal visit should take place as early as possible, ideally in the first three months (the first trimester) of pregnancy, and the other three visits can be scheduled to take place at predetermined times during the remainder of the pregnancy.
To help ensure a safe and healthy pregnancy, a trained health worker or skilled birth attendant should:
A pregnant woman who is HIV-positive should consult a trained health worker for counselling on how to reduce the risk of infecting her baby during pregnancy, childbirth and breastfeeding and how to care for herself and her baby. A pregnant woman who thinks she may be infected with HIV should be supported to get tested and receive counselling. The father-to-be should also be tested and counselled (refer to the HIV chapter for more information).
Every pregnant woman and her family need to know that pregnancy and childbearing can have risks. They should be able to recognize the warning signs.
It is generally recommended that women give birth in a facility and with a skilled birth attendant, since complications cannot be predicted. For some women, this is even more important because the possibility of complications increases if they:
A pregnant woman should be supported to recognize the signs of labour and know when it is time to seek a skilled birth attendant to assist with the birth.
The signs of labour include any one of the following:
Warning signs during pregnancy include:
Signs that mean help is needed immediately include:
During the prenatal visits, the pregnant woman and her family should be supported in preparing for the birth and possible complications by developing a plan that specifies:
Because conditions may change, the plan for the birth and possible complications should be updated during every prenatal care visit as the pregnancy progresses.
The plan for emergency care in case of complications should include the location of the nearest maternity clinic or hospital and the resources needed to quickly get the woman there at any time of the day or night.
All pregnant women should have access to a maternity clinic or hospital when they give birth. This is particularly important if the woman and her family are aware that the birth is likely to be difficult. In some cases, where distance and/or an expected risky birth are factors, it may be preferable to have the mother-to-be move closer to the clinic or hospital as her due date approaches so she is within quick reach of health services.
Health workers, families and communities need to give special attention to pregnant adolescents because they are at higher risk of pregnancy complications and in some cases they may lack the influence to make family decisions or ask for assistance..
Every pregnancy deserves attention because there is always a risk of something going wrong with the mother, baby or both. Many dangers, illnesses or even death can be avoided if the woman plans to give birth attended by a skilled birth attendant, such as a doctor, nurse or midwife, and makes at least four prenatal visits to a trained health worker during the pregnancy.
The likelihood of the mother or the baby becoming ill or dying is reduced when childbirth takes place in a properly equipped health facility with the assistance of a skilled birth attendant, who also checks regularly on the mother and baby in the 24 hours after delivery.
When the pregnant woman is ready to give birth, she should be encouraged to have a companion of her choice accompany her to provide her with continuous support during childbirth and after birth. In particular, the companion can support the woman in labour to eat and drink, use breathing techniques for different stages of childbirth, and arrange for pain and discomfort relief as needed and advised by the skilled birth attendant.
During and immediately following childbirth, the skilled birth attendant will:
Post-natal care assisted by a skilled birth attendant is important to help ensure the survival and health of the mother and her newborn. During the first hours after childbirth and the first week and month of life, newborn babies are particularly vulnerable.
After childbirth the skilled birth attendant will:
For the mother and/or child with complications, the skilled birth attendant will:
The first days and weeks are especially risky for low-birth weight babies. The majority of newborn deaths occur in low-birth weight babies. Many of these babies could be saved with post-natal care provided by a skilled birth attendant who will:
Newborns need to be carefully cared for around the clock, loved, kept clean and warm, and fed. Mothers and fathers or other primary caregivers who meet their basic needs contribute to building the foundation of the babies' future health, happiness, growth, learning and development.
A newborn thrives when she or he is:
A skilled birth attendant will:
Babies born early or with low birthweight or babies with other special needs require special care, love and attention to ensure their survival and optimal growth and development.
A skilled birth attendant can play a critical role in instructing the mother and father on how to care for their baby with special needs.
Some babies may need extra care at a special care unit of a hospital until they are sufficiently developed or well enough to go home with the parents. If a baby is not yet able to breastfeed, the mother can express her milk and safely store it so it can be fed to the baby using a sterilized feeding tube, spoon or cup.
Caring for a newborn brings joy to the mother and father as well as anxiety and fatigue as they adjust to having full-time care of the new baby in their lives. Since newborns are generally dependent on their parents to provide for their every need, mothers and fathers need to take good care of themselves. Breastfeeding mothers especially need to eat more nutritious food, and all mothers should get more rest. A father can support the mother while she breastfeeds by caring for the household and other children or by caring for the newborn while she rests.
If a pregnant woman smokes, her child is more likely to be born underweight. Her child is also more likely to have coughs, colds, croup, pneumonia or other breathing problems.
A pregnant woman can damage her own health and the health of the fetus by drinking alcohol or using narcotics. These substances can severely affect a child's physical and mental development. The mother-to-be should stop drinking alcohol and/or taking drugs as soon as she plans a pregnancy or suspects she is pregnant. If she has difficulty stopping, she should seek medical advice and support from a trained health worker, a health centre or a substance-abuse organization.
A pregnant woman should not take medicines during pregnancy unless they are absolutely necessary and prescribed by a trained health worker.
To ensure proper physical growth and mental development of the child, women of childbearing age, pregnant women, mothers and young children need to be protected from smoke from tobacco or cooking fires; from pesticides, herbicides and other poisons; and from pollutants such as lead found in water transported by lead pipes, in vehicle exhaust and in some paints.
Families and communities can especially help pregnant women, mothers and their children by supporting smoke-free environments so they do not inhale damaging secondary tobacco smoke.
Workplaces should protect women of childbearing age, pregnant women and mothers from exposure to harmful smoke, poisons and pollutants that can affect their health and that of their children.
Violence and abuse are unacceptable at any time. Women who are abused during pregnancy may suffer from early labour and could lose their babies as a result. Babies can be born with low birthweight, which can affect their health and survival.
Health workers, families and communities should be aware of these dangers, provide protection, and work to prevent and eliminate violence against women. Local authorities, with support from organizations and community leaders, have the responsibility to: 1) take action to prevent violence against women and challenge social norms that increase women's risk for violence and abuse; 2) enforce laws protecting women from violence and abuse; and 3) provide accessible protection and support services for abused women.
Worldwide, nearly 60 per cent of women of childbearing age were in the labour force as of 2006. Many women work in the informal economy, where their work is not recorded, regulated or protected by public authorities. Whether women work in the formal or informal economy, it is important that protective measures are put in place in communities, with support from the government and civil society, to safeguard the health and economic security of women, children and families.
Protective measures can include:
Maternity leave: A mother has the right to a period of rest when her child is born, means to support herself and her family, and a guarantee that she can return to work when her leave is finished.
Employment protection: This is a guarantee that pregnant women and new mothers will not be discriminated against and lose their job or job entitlements (pension, paid holiday leave, etc.) due to pregnancy, maternity leave or time off for childbirth
Cash (income) support and medical benefits: Working pregnant women and mothers and their newborns and families generally need cash support and medical care benefits. Cash support replaces a portion of lost income caused by the interruption of the women's work due to pregnancy, childbirth and newborn care. Medical benefits are needed by pregnant women, new mothers and newborns for prenatal, childbirth and post-natal services, and hospitalization when necessary.
Health protection: The pregnant or nursing woman should not be obliged to perform work that can affect her health or that of her child. Where there is a risk, changes in her work conditions should be made to reduce workplace health risks. The woman should return to her job when it is safe for her to do so, or she should be provided with an equivalent job with the same remuneration.
Breastfeeding: Mothers should have the right to breastfeed a child after returning to work, because breastfeeding has major benefits for the health of the mother and her child. Mothers should be entitled to take one or more breaks, or a reduction in work hours for breastfeeding, which should not be subtracted from her paid work time.
Many dangers of pregnancy and childbirth can be avoided if women have access to quality health care during pregnancy and childbirth and after childbirth.
All women have the right to the services of a skilled birth attendant, such as a doctor, nurse or midwife, and to emergency care if complications should arise.
Quality health care that offers information and counselling enables women and men to make informed decisions about their reproductive health. A woman in need of maternal care should be supported by her husband or partner and family to take good care of herself and her baby and to reach a health facility when needed, including for prenatal care, childbirth, post-natal care and emergency care.
Governments, with support from communities, should make sure that the cost of health services does not prevent women, including adolescent girls, from using them. Other barriers such as the cost of transport, long distances, difficult roads and cultural practices also need to be addressed to ensure access to health services.
Health-care providers should be supported through regular training to maintain and improve their technical and communication skills needed to provide quality health care. They should be trained to treat all women with respect, to be sensitive to cultural norms and practices, and to respect a person's right to confidentiality and privacy. They need to be sensitive and understanding of the particular needs of adolescents, and know how to support and counsel them in caring for themselves and their babies.
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