The InterDependent

MEXICO CITY -- Hidden in much of the discussion and speculation about why maternal mortality is defying global efforts to lower it to levels promised by the Millennium Development Goals is one vital statistic: the frequent deaths of adolescent girls too young to bear children.

Evidence has been mounting worldwide that adolescent pregnancies, a major cause of death among this age group (at the UN, it is 10 to 19 years old) worldwide, are also a big factor in the larger picture of maternal mortality – a woman’s death at any stage of pregnancy and childbirth. Here in Mexico, for example, demographers are finding that a key to the mystery on why maternal deaths remain high when other human development factors are improving lies in disaggregating by age these usually preventable deaths.

Once an age group has been identified, explanations (if not always solutions) become easier. Where maternal mortality is persistent, says Javier Dominguez, a national program officer for reproductive health at the United Nations Population Fund in Mexico, the situation of adolescents should be a priority and focusing on early sexual activity may not be the most important place to begin.

Any adolescent girl whose body may not be strong enough for childbirth faces more health risks in pregnancy than an adult woman, Dominguez says. Additional contributing factors are poverty, malnourishment, anemia, lack of prenatal health care, susceptibility to sexually transmitted diseases (including HIV-AIDS) and a denial of contraceptives because providers are either censorious or are simply low on supplies. Unsafe and illegal abortions among adolescents – when deaths are actually reported and many are not – increase the overall maternal mortality rates.

The Population Fund has programs in many countries specifically targeted to adolescents. In China, for example, it has projects that help young people better understand the reproductive systems and the responsibilities involved in sexual relations. In Mexico, there are a range of projects from reproductive health education to support for recreational and education programs that give teenagers safe places to congregate. In Ethiopia, a UN-supported youth center provides information and counceling on HIV-AIDS, and a well-stocked library draws in neighborhood teens looking for a quiet place to read and study.

Viviane Moos/UNFPA

In Mexico City, teen pregnancies are 25 per 1,000 girls; while in remote places like Oaxaca, above, the rate can jump to 100 per 1,000.

The difference in living standards and absence or presence of teen-friendly contraceptive providers – remembering that most teenage girls become pregnant not out of choice – can have measureable effects, said Felix Velez, secretary-general of Mexico’s National Population Council. He noted that in Mexico City, where fertility rates (how many births a woman may have in her lifetime) have fallen to European levels, teen pregnancies are also relatively low: 25 per 1,000 girls, about the level of Spain, he said. In poorer, more remote states like Oaxaca and Guerrero, Velez said, the number of pregnant teens may be 100 in 1,000.

The concern is universal. Unicef highlighted the problem of adolescent death in pregnancy or childbirth in its 2011 State of the World’s Children report. Unicef statistics show that more than half the girls in India are malnourished, on par with sub-Saharan African countries. India has the world’s highest number of maternal deaths, a figure not unrelated to the fact that 38 percent of Indian girls are married by age 18, says a report last month by a correspondent in India for the Women’s eNews network in New York.

A main reason that Ethiopian girls become runaways, officials there say, is that teenagers want to avoid forced early marriages and the almost inevitable crippling pregnancies that follow. Girls tell their stories painfully: one admitted in an interview that she had stolen a family goat to sell to pay a trafficker to take her Addis Ababa, the capital. She had to fight off his sexual advances along the way.

The UN Population Fund has two programs combating child marriage in Ethiopia, which has one of the highest children marriage rates in the world (girls as young as 5 years old are married). One program, Berhane Hewan (Amharic for "light of eve") teaches adolescent girls awareness and skills to avoid early marriage. The project is carried out by the Ethiopian government and local groups.

The United States Agency for International Development has been focusing on teen pregnancies and related deaths since at least 2009. Secretary of State Hillary Clinton has made it a priority in the State Department as she has stepped up American support for programs for girls and women.

In 2010, the Asian Forum of Parliamentarians on Population and Development published a guide to maternal health for legislators that made the link to teens a fundamental truth. The forum called for full contraceptive support for girls, including safe abortions when necessary. The guidebook says: “Maternal health can no longer be programmed successfully, unless done in tandem with neonatal, child and adolescent health.”