Teen pregnancies and contraceptive needs

By Rina Mukherji
29 Jul 2010

Reducing unintended pregnancies among adolescents will not only reduce maternal and newborn deaths, but will also improve the educational and employment opportunities for young women.

Preventing unintended pregnancies among adolescent women can greatly reduce maternal and newborn deaths and disability adjusted life years (dalys), which currently accounts for 16 per cent of all dalys lost among adolescent and young women aged 15-29 years in developing countries, according to analytical fact sheets prepared by the Guttmacher Institute and the International Planned Parenthood Federation (IPPF). The analysis is based on data from the United Nations Population Fund (UNFPA) and was presented at the recently-concluded Women Deliver Conference in Washington.

An estimated 2.7 million adolescents become pregnant unintentionally every year. Adolescent mothers account for 12 per cent of all births in South Central and Southeast Asia, 16 per cent of all births in sub-Saharan Africa, and 18 per cent of all births in Latin America and the Caribbean. Almost all unintended adolescent pregnancies in South Central and Southeast Asia occur among married women, compared with an estimated 54 per cent in Sub-Saharan Africa and 51 per cent in Latin America and the Caribbean.

In Sub-Saharan Africa, 15 percent of unmarried adolescents are sexually active and want to prevent pregnancy, as do 11 percent in Latin America and the Caribbean. In fact, half of all sexually active adolescent women in these two regions who want to prevent pregnancy are unmarried.

There are an estimated 260 million girls and 280 million boys aged 15-19 in developing countries, according to the Population Division of the United Nations.
Although about 818 million women of reproductive age want to avoid pregnancy, 140 million women are not using any form of contraception, while another 75 million use less effective traditional methods.

In all regions, birthrates have declined over the past 30 years, but still vary widely by region. The biggest decrease has been in South Central Asia, where births dropped from an estimated 90 per 1000 women to 73 per 1000 in 2005.
Each year the use of modern contraceptives prevents 3.1 million unintended pregnancies all over the world, including 1.1 million in South Central and Southeast Asia.

Fulfilling all needs for modern family planning would prevent 7.4 million adolescent unintended pregnancies each year. The total cost of meeting the contraceptive needs of sexually active adolescents would be highest - that is $271 million - in low-income countries, which have the greatest need of creating and expanding their health service infrastructures, and lowest in upper-middle and high-income countries, that is, $ 104 million.

Reducing unintended pregnancies will not only greatly reduce maternal and newborn deaths, but will also improve the educational and employment opportunities for young women, and in turn, contribute to the improvement in the status of women, greater family savings, reduction in poverty and increased economic growth. It will also enable young women in developing countries to get longer schooling, gain productive experience in the labour market before marriage and childbearing, and develop the readiness for parenthood.

IPPF and the Guttmacher Institute recommend that contraceptive services be responsive to the special needs of adolescent women, and be provided in a manner that sexually active adolescents are not stigmatized. For this, family life education for the young in school and reaching out to those who are not attending school is suggested.
In every developing country, early marriage and early childbearing are common among women plagued by poverty and with little education. Whether single or married, adolescent mothers are found to have very little monetary resources of their own. Inadequate knowledge of contraception, high risk of sexual violence, and little independence in deciding on the timing or spacing of births make them especially vulnerable. Consequently, adolescents account for 14 percent, or an estimated 2.5 million unsafe abortions that occur in the developing world.

It is estimated that fully meeting the demand for contraception can avert 53 million unintended pregnancies each year, resulting in 22 million fewer unplanned births, 25 million fewer induced abortions, and 7 million fewer miscarriages.

The elusive MDG-5

By Rina Mukherji
30 Jun 2010

Reducing maternal mortality is critical for every nation but the key to achieving MDG 5 lies in achieving MDG 3 - promoting gender equality and empowering women.

Of all the millennium developments goals, MDG 5 - improve maternal health and reduce the maternal mortality ratio by three quarters between 1990 and 2015, and to achieve universal access to reproductive health - has been the slowest moving to accomplish. Over half a million women die every year at childbirth or pregnancy-related causes. Besides, for every woman who loses her life due to pregnancy, between 15 and 30 women suffer from life-long illness and disability.

More than 50 per cent maternal deaths at childbirth occur in 6 countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo. Maternal mortality is a major tragedy since it is inextricably to another statistic - the death of newborns. For instance, a study conducted in Malawi reported a 3.35 times increased risk of death among children whose mothers had died, with most children's deaths occurring during the first year of life.

Researchers in Nepal reported that maternal death was associated with a 54-times increased risk of death of infants who were 4-24 weeks of age. In Bangladesh, a study done by Matlab (and published in The Lancet), showed a devastating effect of maternal death on the survival of children, with the cumulative probability of children surviving to the age of 10 years being just 24 percent compared with a 89 percent survival rate of those whose mothers had not died.

More than 10,000 new born babies die every day, amounting to almost 4 million deaths each year. The major causes of maternal mortality are obstructed labour, sepsis, haemorrhage, unsafe abortions, and eclampsia and hypertensive disorders. Some of these, namely sepsis, obstructed labour and hence asphyxia, also account for the death of new- born children. A good number of maternal and new born deaths are the result of malaria, tetanus, pneumonia, diarrhoea, and of course, HIV/AIDS. Sadly, all of these are preventable.

The main stumbling blocks to achieving the aforementioned targets of MDG 5 are lack of finance and the shortage of healthcare providers and trained personnel.
Recognizing this, United Nations Secretary-General Ban Ki-Moon recently unfolded a Joint Action Plan at the Women Deliver Conference in Washington that called upon the international community to increase investment in maternal, newborn and reproductive health over current funding levels by at least an additional US $12 billion, increasing the same annually to an additional US $20 billion by 2015.

The Joint Action Plan calls on increasing the number of health care professionals and managers, and ensure information and services that are sensitive to women, especially those who are poor and marginalized. It also calls for the development of monitoring and accountability mechanisms that address wider socio-economic, political and cultural barriers to maternal and newborn health care for improved policies and programmes. With the Bill and Melinda Gates Foundation pledging $ 1.5 billion to maternal, newborn and child health which, according to Ms Melinda Gates, is slated to be spent in India, Ethiopia and other countries for the training of health workers, developing improved antibiotics, and finding better ways to treat haemorrhages, there is a ray of hope.

But alongside strong commitments to a good healthcare policy, it is equally important to pay due heed to factors that adversely affect maternal mortality- namely, access to education and women's empowerment. In fact, the key to achieving MDG 5 lies in achieving MDG 3-promoting gender equality and empowering women, which can, in turn, help us achieve MDG 4-reduce child mortality.

Maternal mortality, for the most part, affects adolescent married or unmarried mothers all over the developing world. It is primarily on account of an unmet need for contraception. But the lack of education severely impedes access to such information, and results in mothers being deprived of the necessary emergency obstetric care. Besides, most significantly, education means empowerment in the form of employment, and hence, ready cash for emergency health needs.

As impressive as its impact on fertility, higher educational attainment - especially completion of several years of secondary school - increases women's earnings, improves their life expectancy, the health outcomes of pregnancy and childbirth, and reduces infant mortality. Since women in many societies are likely to spend most of their lives in and close to homes, education facilitates the skills and confidence that can build capacity for mobilization, particularly as regards to health.

At the same time, one needs to come to terms with ground realities when chalking out programmes meant to ensure maternal health. In India, the Janani Suraksha Yojana has clocked impressive results in most parts of the country by getting women to deliver in hospitals rather than homes. But, it must be recognized that institutional deliveries can pose a problem in regions that lack a good transport infrastructure to travel over rough terrain, or are too far from health facilities. In such cases, it is wiser to train traditional birth attendants in the basics of hygiene and emergency obstetric care, so that difficult deliveries can also be successfully handled.

The UNFPA has already recognized the importance of midwives, and has initiated plans to regularize and train them all over the developing world, in collaboration with the International Confederation of Midwives. In our country, Magsaysay Award winner Dr Rajanikant Arole was the first to recognize the importance of the traditional dais (in north India) or sais ( as they are termed in West Bengal), and had taken to training them to safely manage deliveries in rural areas. Several non-governmental organizations are already working in this direction. It is high time that we regularize these efforts on a nationwide scale, and save our mothers from dying when giving birth. Mothers' lives are precious; it is time we worked to save them for the sake of families, communities and nations.

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Copenhagen can't compensate them

By Rina Mukherji
30 Jan 2010

Surabala Das lost her fertile land and now survive with difficulty

As industrialised nations refuse to drastically cut down their GHG emissions, the poor living on the coastlines bear the brunt of the rising seas.


Surabala Das, a widow, was once the owner of 10 bighas of fertile land in Gobardhanpur, on G plot of Patharpratima block in Sundarbans. Surabala and her family became environmental refugees when all their farmland disappeared into the sea. Her eldest son died of an undiagnosed fever, and the younger son abandoned his family for better prospects. Surabala, her elder daughter-in-law, and her two teenage grand-daughters now survive by begging and doing menial jobs.

As coastlines erode, beaches shrink and islands disappear, our coastal people lose their homes and livelihoods. Well-off farmers and fisherfolk become bankrupt, and end up as environmental refugees dependent on charity.

In Kerala and West Bengal, the two worst-affected coastal Indian states, sea level rise caused by global warming has meant destitution and loss of livelihood and an end to a dignified life to many women.

Two islands in the Indian Sundarbans - Lohachhara and Suparibhanga were gobbled up by the rising seas in 1982. Several other islands are losing huge chunks in their southern portions to the Bay of Bengal. Ghoramara - one of the largest islands in the Sundarbans, is now just a small patch of what it once was. Sagar, adjacent to Ghoramara, and the largest of the islands, is losing 100 bighas to the sea.

Patharpratima block is made up of 15 grampanchayats that operate under its aegis. The block headquarters is located on Patharpratima island. Four of the grampanchayats are located on the mainland, while the rest are on various islands in and around Patharpratima. Of the islands, G plot and K plot are badly affected by the rising sea, with many of their villages having disappeared over the years.

G Plot originally comprised nine villages - Gobardhanpur, Budobudir Tat, Indrapur, Sitarampur, Sattadaspur and north and south Surendraganj. Some 12 years ago, Gobardhanpur was entirely swallowed up by the Bay of Bengal. The southern part of Sitarampur has entirely disappeared, while the northern part of Sitarampur is slowly getting eroded in chunks. As farmlands, homes and hearths disappear into the sea, families lose their livelihoods and are rendered bankrupt. For women, this has often translated into destitution and abandonment.


Anima and her husband, Ashwini Patra owned 16 bighas of land in Gobardhanpur. Since the sea swallowed up their lands, they had to move north along the same island to take refuge. Her family of eight, which includes her parents-in-law, and four children must now make do by fishing and occasional menial jobs in the fields, as and when offered. They have yet to get Below Poverty Line (BPL) cards, although they have scraped and saved out of their meagre means to manage a roof on their heads. Anima Mondol and her family had to leave Ghoramara island 14 years ago when most of the island went under water. The family lost 40 bighas of fertile land and had to take refuge in Jibantola, Rudranagar on Sagar island. Deprived of his livelihood, her husband now goes to sea as a boatman on fishing fleets, and is away most of the time. She must fend for her family of four children and her aged mother-in-law, earning out of menial jobs on farms and homes.

It is a sad irony that the Sundarbans - which has borne the brunt of a rising sea, and stronger and more frequent cyclonic storms over the past decade, does not have electricity in most of its homes. Where electricity is available, such as in G-plot, Sagar and a few other islands, it is confined to a few hours after dusk. Even so, not many can afford the solar connections. And yet, there are an estimated 50,000 environmental refugees in the Sundarbans, who are trying to survive after being displaced by nature.

In Kerala and West Bengal sea level rise caused by global warming has meant destitution and loss of livelihood and an end to a dignified life to many women.
The situation has become more poignant after Cyclone Aila caused sea water to overrun farmlands in May 2009; rendering it impossible to grow crops for a year or more. Thousands have streamed into the overcrowded slums of Kolkata, creating infrastructural problems that shall, in turn, soon strain the civic services. The few who continue to stay on in the Sundarbans are confronted with a shortage of drinking water, since sea water has overrun all open reservoirs. Saline water has also affected groundwater in many parts, making life extremely difficult in this densely-populated region.

The situation is equally heart-rending in Kerala in southern India. Uncontrolled sand-mining and a rising sea level have devoured beaches, destroyed fishing villages and turned groundwater resources saline.

Jacinta, who used to vend fish, and husband John, a fisherman, were a well-off couple until they lost their home in a fishing village in Thiruvananthapuram district, as well as their catamarans and nets to the gushing waters of the Arabian Sea. The temporary shelter provided to them is 5 km from the coast, making fish-vending difficult. Jacinta now works as domestic help in the city, while John does odd jobs in the vicinity. Jacinta's friend Josephine and her husband, Lewis, are now living off odd jobs in the city. At the shelter, they share an overcrowded room with another family. Their four daughters are married, but their once-healthy teenage son, Leslie, is often down with respiratory ailments and fever.

Carmel and Stephen lost their house three years ago and now work as coolies in the city. Stephen struggles to find work as he is disabled, so the family depends on the earnings of Carmel and her son, Paulo.

The smoky confines of the tin-roofed shelter turn Joseph and Stella nostalgic about their once self-sufficient past. Losing their boat and house in Poonthura village has turned the couple and their five children into environmental refugees. They suffer from bronchial asthma, and income is erratic. Four of their children have moved out to seek employment in other states.

Can the climate negotiators, from the leading developed and developing nations, who played a cruel joke on such vulnerable people by agreeing to Copenhagen Document, ever see these climate refugees in the eye and fulfil their basic entitlements of food, clothing and shelter that a rising sea and global warming have deprived them of?