Boon of giving birth?

Dr Madhura Mandlik, Senior Resident,

Department of Obstetrics and Gynaecology,

LTMMC and LTMGH, Mumbai

A girl becomes a woman when she starts menstruating and attains her reproductive maturity. This implies that she gains her capacity to give birth. India has a staggering 253 million adolescent population, aged between 10-19 years. Out of these 11.8 million teenage pregnancies every year (1). 

Pregnancy in adolescent years is not only an aggravating global health issue but also equally challenging for the young girls who experience it.

Teenage pregnancy in India is especially stigmatised. This pregnancy can be borne from early marriage, forced marriage and non-consensual intercourse. Unfortunately, even today, the deeply engraved custom of child marriage still prevails in rural India, much furthers gives impetus to underage pregnancy. Poor connectivity, restricted availability of skilled professionals in rural area, lack of awareness and stigmatisation, contribute in worsening the maternal and neonatal outcomes. 

Teenage physiology predisposes to obstetrics complications like pre-eclampsia and eclampsia, anaemia, small and low birth weight babies. 

Apart from physical complications, the young minds may suffer from depression, anxiety, social disgrace and guilt. 

As an obstetrician in one of the apex institutes in urban India, we see multitude of patients, with myriad complications. Teenage pregnancies, rape, obstetric complications owing to underage pregnancy is something we aren’t unfamiliar with. Apart from treating them as an obstetrician, it is imperative we show them compassion and humanity! Many of the girls are stuck in this situation and have no way out. They face criticism not only from the society but also from their parents and family. Many a times, the parents are unaware and the young girls come to us for medical terminations with their friends or alone! 

So involving a psychologist, psychiatrist and medical social worker is equally important for holistic care of such young women. Listening to their problems, being empathetic and helping them link with welfare organisations is our duty! 

The government has taken step by implementing the POCSO act in 2012 and amending the Medical Termination of pregnancy act in 2021. 

The Protection of children from sexual offences act encompasses children, whom, under the act have been defined as less than 18 years. It includes, sexual assault of an underage child, aggravated sexual assault, and child pornography. This act is gender neutral and helps in faster redressal of complains with setting up of special courts.

I still remember, the day of my emergency duty. A 19-year-old unmarried primigravida, vitally unstable came to our emergency medical services and we were called to examine her as she complained of pain in abdomen and passage of something per vaginum. The girl was learning and working at the same time and came from the suburb in the city. She was completely yellow. Her pulse and bp were not recordable and she had a spontaneous abortion. The girl knew she was pregnant but hadn’t disclosed to her family and out of fright she most likely had an unsafe abortion outside. Unfortunately, she succumbed and her post mortem showed peritonitis and a diagnosis of septic abortion was given. It was disheartening to see this plight in such a big city, so a but obvious question came into our head; What would be the plight of such girls, suffering the same consequences in rural India? How many such young girls die ? 12% of maternal deaths are attributed to septic abortion. And this still remains a leading cause of maternal mortality.

Another step taken by the government to decrease maternal mortality and aid in making safe abortion options more available, is the amendment of the MTP Act in 2021. The below table summarises the differences.

Teenage or underage pregnancy, irrespective of consensual or non-consensual nature, is a socio-economic and emotional burden to the girl, her family and the child born as well. They tend to be neglected. Higher risk of adverse outcomes makes it important to involve prevention strategies. Jane Fonda has rightly quoted, if adolescent pregnancy prevention is to become a priority, then our strategy, as advocates, must contain two key elements: civic engagement and education.

International Institute for Population Sciences (IIPS) and ICF. National Family Health Survey (NFHS-4), 2015–16: India. Mumbai: IIPS; 2017.!/

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