Preventing Early Pregnancy and Pregnancy-Related Mortality and Morbidity in Adolescents in Developing Countries: The Place of Interventions in the Prepregnancy Period

This paper applies a life-course perspective to the problem of early pregnancy and pregnancy-related mortality and morbidity in adolescents in developing countries. It describes the contribution that two categories of “pregnancy-focused” programmes make—firstly, the provision of effective care and support in the antenatal, childbirth, and postnatal periods (downstream programmes), and secondly, the provision of effective promotive, preventive, and curative care in the prepregnancy period (midstream programmes). It then makes the case for these pregnancy-focused programmes to be set within the context of a third type of programmes, upstream programmes, that is, the provision of promotive and preventive care that contributes to children and adolescents—both male and female—being well nourished, healthy, knowledgeable about their health, and motivated and empowered to protect their health. It provides examples of successful initiatives of all three types of programmes. Finally, it discusses some practical considerations in planning, implementing, and monitoring these three programmes in a coherent manner. 1. Introduction About 16 million adolescent girls between 15 and 19 years old give birth each year, accounting for roughly 11% of all births worldwide. Around 95% of these births occur in developing countries [1]. Evidence suggests that a significant number of girls between 10–14 years old also give birth in some countries. Analysis of surveys conducted in 51 studies from mid-1990s to the early 2000s showed that up to 10% of girls were mothers by the age of 16, with the highest rates in sub-Saharan Africa and South-Central and South-Eastern Asia [2, 3]. For some of these young mothers, pregnancy and childbirth are planned and wanted. For many others they are not. They get pregnant because they are under pressure to marry and to bear children early, because they do not know how to avoid a pregnancy or are unable to obtain condoms and contraceptives to do so, or because they are unable to refuse unwanted sex or to resist coerced sex. Furthermore, when they get pregnant, they are less likely than adults to be able to obtain legal and safe abortions if they want to terminate their pregnancies, or obtain skilled prenatal, childbirth, and postnatal care. Many adolescents enter pregnancy in poor health and nutritional state [4]. Further, childbirth at an early age is associated with greater health risks for the mother. In developing countries, complications of pregnancy and childbirth are the leading cause of death in young women aged 15–19 years [5]. Because a