After reports of a 10-year-old Ohio girl crossing state lines to have an abortion garnered nationwide attention last week, some prominent anti-abortion opponents suggested the baby had to carry her pregnancy to term.
But midwives and doctors working in countries where teenage pregnancies are common say those who insist that very young girls carry pregnancies to term may not understand the brutal consequences of pregnancy and childbirth on the baby’s body.
“Their bodies are not ready for childbirth and it is very traumatic,” said Marie Bass Gomez, a midwife and senior nurse at the Reproductive and Child Health Clinic at Bundung Maternal and Child Hospital in The Gambia.
The critical problem is that the baby’s pelvis is too small to allow even a small fetus to pass through. Ashok Dyalchand, who has worked with pregnant adolescent girls in underserved communities in India for over 40 years.
“They have prolonged labor, difficult labor, the fetus presses on the bladder and urethra,” which sometimes causes pelvic inflammatory disease and rupture of tissue between the vagina, bladder, and rectum. Dyalchand, who leads an organization called Pachod Health Management Institute, a public health organization serving marginalized communities in central India.
“It’s a pitiful state, especially for girls under 15,” he added. “Complications, morbidity and mortality in girls under the age of 15 are much higher than in girls aged 16 to 19, although mortality at the age of 16 to 19 is twice as high as in women aged 20 and older “.
The phenomenon of young girls having children, relatively rare In the United States. According to the Guttmacher Institute, which supports the right to abortion and conducts regular surveys of clinics, in 2017, the latest year for which data were available, there were 4,460 pregnancies among girls under the age of 15, of which just under half ended in abortion.
But worldwide, complications associated with pregnancy and childbirth leading cause of death for girls 15-19 years old, according to the World Health Organization.
Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency caesarean section, and postpartum depression. 2014 estimate published in the Journal of Neonatal Perinatal Medicine.
Babies born to girls are more likely to be premature and have a low birth weight. Willibald Zeck, maternal and newborn health coordinator for the United Nations Population Fund, who frequently gave birth to new mothers while working as a gynecologist in Tanzania and later managed maternal health programs in Nepal and the Philippines.
While a pregnant 10-year-old girl in Ohio may have access to antenatal care and a caesarean section, which will mitigate the effects of obstructed labor, the experience of pregnancy for a young girl in India is the same as in the United States. Dr. Dyalchand said. “Girls will face more or less exactly the same complications: the only difference is that, due to access to better health care, they may not have the same dire consequences. But this does not mean that the girl’s body and her life do not remain scars.
Dr. Shershah Syed, a gynecologist and maternal mortality expert in Pakistan, regularly provides care for pregnant girls as young as 11 years old. He said that good prenatal care can prevent an opening between the wall of the bladder or rectum and the vagina, called a fistula that causes leakage of urine or feces, which is not only painful (the leaked urine causes burning ulcers), but is also a source of great shame and humiliation.
But even good prenatal care cannot prevent hypertension or urinary tract infections, which are common in very young mothers, he said.
“In normal physiology, a 10-year-old child should not be pregnant. The fact is that she is a child, and a child cannot give birth to a child, she is not ready, ”says the doctor. Syed said, adding, “And the mental torture she will go through is unmeasurable.”
In the cases he has seen, early pregnancy stunts a very young mother’s physical growth, as well as often her mental development, because many girls drop out of school and lose normal social interactions with peers, he said. But while the anemic mother struggles to carry the pregnancy, the fetuses receive the appropriate nutrients and continue to grow until they surpass the capacity of the young mother’s pelvis.
“They give birth for three days, four days, five days, and after these births, usually the child dies. And then, when the head collapses, then the baby will be born, ”said the doctor. Syed, who is one of the foremost experts in South Asia on the elimination of obstetric fistula, a common consequence of obstructed childbirth in pregnant girls.
In almost all of these cases, the girl developed a vesicovaginal fistula, an opening between the wall of the bladder and the vagina. In a quarter of cases, prolonged labor also causes a fistula of the rectum, so that the girl constantly leaks both urine and feces.
If fistula sufferers find out that treatment is available and go to his clinic, Dr. Syed said he could fix the condition. But the process requires a long recovery: a bladder fistula heals in about five weeks, and a rectal fistula takes four or five months.
In 1978 Dr. Dyalchand began his career in public health at a small district hospital in rural Maharashtra on the west coast of India. In his first week, two young pregnant girls bled to death – one during childbirth, the other at the entrance to the hospital before she could get inside. This marked the beginning of his long career of working with communities to persuade them to delay marriageable age and first conception in girls.
This intervention has shown significant success and dr. Gyalchand noted that India is also steadily expanding the availability of abortions. The procedure is allowed up to 24 weeks of pregnancy.
In the Gambia, Mrs. Bass Gomez said her clinic can offer good prenatal care to pregnant girls, but it does little to blunt the greater trauma of the experience. According to her, her clinic is designed to serve adults. “But when you have a similarly pregnant child, it really traumatizes the child,” she said. “It’s not comfortable, this environment, it’s not made for them. You can tell they are struggling. There is a lot of shame and disgrace.”