A range of social, cultural, biological and service delivery factors contribute to the high levels of adolescent pregnancy and childbirth:
Pregnancy and childbirth in adolescence are risky for the health of both mother and baby
This situation is not unique to unmarried adolescents as the married ones may not be aware of the importance of antenatal care. For various reasons, the adolescent woman is more likely to deliver at home. The older women in the home feel that a traditional birth attendant is equipped to carry out the delivery, her services are cheaper and she is easily accessible. A trained birth attendant or a hospital is usually thought of when things get out of hand and complications have already set in.
The risks are high, starting from the antenatal period, through labour and the postpartum period. Adolescent mothers are most likely to give birth to low weight babies and both the mother and child face higher mortality and morbidity.
Pregnancy related complications that occur more commonly in adolescents than in adults
Problems in the antenatal period
Problems during labour and delivery
Problems in the postpartum period
Problems affecting the baby
Adolescent pregnancies and deliveries require much more care than adult pregnancies and all efforts must be made to reduce the occurrence of problems. This includes early diagnosis of pregnancy, effective antenatal care, effective care during labour and delivery, and during the postpartum period.
Early diagnosis of pregnancy
Health service providers and other adults like family members in more regular contact with the adolescent, have the shared responsibility of creating an environment in which she feels able to share information about her situation, especially if she is unmarried. She may not know that she is pregnant because she may not remember the dates of her last menstrual period, or because her periods are not regular. She may even want to hide her pregnancy or seek ways of terminating it. Being aware of these issues, and being on the lookout for telltale signs of early pregnancy such as nausea will help ensure an early diagnosis of pregnancy so that care is started early and complications are avoided.
Many complications can be detected and many can be avoided if the adolescent is able to access good antenatal services. Pregnancy-induced hypertension (Pre-eclampsia) can easily be detected and referred to the PHC for management. In case of more serious complications (such as pre-eclampsia, eclampsia, and abruptio placentae), referral to a woman’s hospital is essential. Anaemia and malaria too can be detected and treated during routine antenatal care. Screening for STIs can lead to early referral and early treatment, if required. Iron and folic acid supplements will prevent anaemia to a large extent. Most importantly, antenatal visits could help identify those adolescents, who are at risk of preterm labour, though interventions to address this are limited.
Antenatal care also provides a valuable opportunity for the provision of information and counseling support that adolescents need. This is especially important in the case of adolescents, especially unmarried ones, because of their greater need for support.
Counseling during pregnancy
Information and counseling support is the right of every pregnant woman who reaches a health centre and pregnant adolescents have special needs and questions and concerns of their own. They must be given an opportunity to raise and discuss these issues.
Their needs must be matched with competent and sensitive counseling support in terms of the socio-cultural environment that has to be faced, the options available in terms of the pregnancy; the access to health services for routine antenatal care and in case of emergency; the danger signs that need to be aware of, etc.
Counseling should also include care of the newborn and prevention of an early repeat pregnancy.
Since adolescents are more at risk of STIs including HIV/AIDS, voluntary counseling and testing (VCT) services should be made available to them. As ANMs/LHVs, you should know where the nearest VCT centres is, to be able to refer your clients for screening.
Management of labour and delivery
If the pregnancy in an adolescent is normal and with no complications and anaemia is treated adequately, labour starts at term, and the infant is in cephalic presentation, labour is not at increased risk. Counsel the client for institutional delivery at PHC.
However, if the adolescent is severely anaemic, postpartum haemorrhage can be a dangerous possibilty. In very young adolescents, pre-term labour as well as obstructed labour are more likely to occur. Such adolescents are at high risk and it is advisable to encourage hospital delivery. The family should be advised to make arrangements for transportation to the hospital, when needed.
Besides observing and monitoring, supporting the woman is very important and studies have shown that continuous empathetic support during labour, provided by a technically qualified nurse or midwife results in many benefits both to the mother and the baby.
This includes the prevention, early diagnosis and treatment of postnatal complications in the mother and her baby. It also includes information and counselling on breastfeeding, nutrition, contraception and care of the baby. The adolescent mother will require special support on how to care for herself and her baby.
Contraception: It is very important that too early repeat and unplanned pregnancies should not occur for lack of access to contraceptive services. The postpartum period presents a good opportunity for taking steps towards pregnancy prevention and for promoting dual protection by encouraging condom use.
Nutrition of the mother: The lactating adolescent needs adequate nutrition to meet her own as well as the extra needs required for breast-milk production.
Breastfeeding: Exclusive breast feeding is recommended for 6 months. A young adolescent, especially one who is single - would require extra support in achieving breastfeeding successfully.
Adolescent pregnancy very often leads to unsafe abortion especially if the girl is unmarried. The consequences of this type of abortion can be life threatening. Although abortion is legal in India, it is estimated that four million Indian women a year still resort to illegal abortions because of social stigma, lack of awareness and lack of access to health facilities that offer technically competent services.
Medical Termination of Pregnancy Act
The Medical Termination of Pregnancy Act was passed in 1971. The Act was intended to grant women freedom from unwanted pregnancies, especially when there was social censure or medical risk involved. Apart from these benefits, it also ensured that abortion services became easily accessible.
The aim of the Act is to allow for the termination of certain pregnancies by registered medical practitioners. If a pregnancy is terminated by someone who is not a registered medical practitioner, it would constitute an offence punishable under the Indian Penal Code.
When MTP is permitted
According to the Act, abortion may be permitted only in certain cases:
As long as the above conditions are fulfilled, a doctor can terminate a pregnancy without fear of being prosecuted under the Indian Penal Code.Whose consent is required?
A pregnancy can be terminated only with the informed consent of the pregnant woman; no other person’s consent needs to be obtained.
In the case of a pregnant woman, less than eighteen years old, and in the case of a pregnant woman, more than eighteen years old but of unsound mind, the consent of her guardian must be obtained in writing.
Where can a MTP be performed?
MTPs can be performed only at the centres certified by the government. These centers could be located in public or private sector.
The rights of the pregnant woman
Whenever a woman requests that her pregnancy be terminated, she must be informed of her rights under the Act.
Also, whenever a pregnancy has been terminated, the medical practitioner should record the prescribed information. However, the name and address of the woman, who has requested or obtained a termination of pregnancy, should be kept confidential, unless she herself chooses to disclose that information.
If a person who is not a medical practitioner, who has not completed the prescribed training course, performs the termination of a pregnancy, can be convicted and penalised with a fine or imprisonment for a period not exceeding 10 years.Sources :