The world’s latest development report card, the >Millennium Development Report 2013 , says the world is still short of meeting targets in reducing child and maternal mortality. To turn this around, reducing adolescent pregnancy and child marriage are essential. Countries, including >India and Nigeria which account for more than a > third of all deaths in children under five , must focus on the poorest girls and women.
This clearly shows that investing in girls and women is linked the achievement of nearly every Millennium Development Goal.
Yet, millions of girls don’t get opportunities to live out their true potential. They are married early and begin child bearing at ages when they are not ready to be mothers. Globally, one in 3 women aged 20-24 were married before they were 18. In India: 47 per cent girls aged 20-24 were married before their 18th birthday; a fifth of babies are born to girls aged 15-19 ; and almost half of maternal deaths occur among girls and young women aged 15-24.
Child and maternal morality are critically linked to adolescent pregnancy. A child is 50 per cent more likely to die when born to a mother less than 20 years old than a mother 20-29 years old. The risk of an adolescent girl dying in child birth is twice that of a woman in her 20s.
Adolescent pregnancy is not just a health issue; it is a development issue. When girls marry young, they drop out of school. The price is lost potential: lack of opportunities, constrained life options and stubborn poverty for the poorest, first-time young mothers and their communities. Adolescent pregnancy perpetuates the cycle of discrimination and poverty.
Most adolescents in India
Investing in adolescent girls helps break cycles of poverty. This growing realisation is defining the world’s new sustainable development goals, after the MDGs expire in 2015, and the ICPD Plan of Action beyond 2014. There are more than 500 million girls in the developing world. India alone has 105 million adolescent girls. India’s progress is key to the world’s success in meeting development goals. There are more adolescents in India today than ever before, and more than in any other country. Their numbers are set to grow as India’s largest ever young population is projected to grow rapidly for more than a decade.
For far too many of these girls, pregnancy has little to do with choice. It is rooted in gender inequality, forced marriage, lack of education, sexual violence and coercion. Its consequences reverberate throughout the life of the girl and generations to come.
Complications from pregnancy and child birth continue to be the leading cause of death among adolescent girls aged 15-19 in low and middle income countries. Adolescent girls also face high levels of illnesses and death as a result of unsafe abortion. In 2008, there were an estimated 3 million unsafe abortions in developing countries aged 15-19. In India, there is little data on how many adolescents seek abortion. Given the stigma attached to premarital sex, we know even lesser about how many unmarried adolescents seek unsafe abortions.
Limited access to contraception
These outcomes are often a consequence of limited access to and use of contraception among adolescents. In developing countries overall, 22 per cent of adolescent girls aged 15-19 who are married or in union use contraceptives, compared to 61 per cent of married girls and women aged 15-49. In India, just 7 per cent of married adolescents aged 15-19 use a modern family planning method, and their use is even lower at 2 per cent in Bihar and 4 per cent in Uttar Pradesh. In fact, adolescents aged 15-19 have the highest unmet need for birth spacing methods, critical to the health of the mother and child. The fact that adolescent girls continue to report a need for sterilisation, shows we need to do much more to give young women viable reproductive choices.
We must make fulfilling the reproductive right of young people a top priority. Young people need a core package of adolescent-friendly productive health services, including contraceptives and comprehensive sexuality information, to enable them to make informed decisions about their own lives.
The government of India’s >RMNCH+A strategy is a landmark step in this direction. It recognises that we cannot achieve development goals without fulfilling adolescent needs. It also recognises, for the first time, the reproductive needs of unmarried adolescents.
Reducing adolescent pregnancy is about empowering girls. When girls have a choice, they marry later. Investing in girls, developing their social and economic assets means healthier families and higher levels of gender equality. This in turn makes for stronger societies and more vibrant economies. Investment in adolescent girls is an investment in development for everyone.
Twenty one-year-old Bahalin Minz from the Oran tribe in southern Odisha, where over half of adolescent girls are married before their 18th birthday, addressed a U.N. gathering recently and made the case for investing in education for girls. While many of her friends are teenage mothers, she attends college and is planning a career in computer education. Adolescence education programme in her college, she says, has given her the ability to make choices about her health and relationships, when and whom to marry, and how many children to have. This is what makes investing in adolescent girls so important.
Frederika Meijer is UNFPA Representative India and Bhutan.