What pregnancy and childbirth do to young girls’ bodies

After reports of a 10-year-old Ohio girl crossing state lines to get an abortion drew national attention last week, some prominent anti-abortion activists suggested the child should have carried her pregnancy to term.

But midwives and doctors working in countries where pregnancies in young adolescent girls are common say those who are pushing for very young girls to carry pregnancies to term may not understand the brutal toll pregnancy and childbirth takes on a woman’s body have child.

“Their bodies are not ready for birth and it’s very traumatic,” said Marie Bass Gomez, midwife and senior nurse officer at the Reproductive and Child Health Clinic at Bundung Maternal and Child Health Hospital in The Gambia.

The critical problem is that a child’s pelvis is too small to allow even a small fetus to pass, said Dr. Ashok Dyalchand, who has worked with pregnant adolescent girls in low-income communities in India for more than 40 years.

“They have long labor, obstructed labor, the fetus is pressing on the bladder and on the urethra,” which is sometimes caused pelvic inflammatory disease and tissue tears between the vagina and bladder and rectum, said Dr. Dyalchand, who runs an organization called the Institute of Health Management Pacod, a public health organization that serves marginalized communities in central India.

“It’s a pathetic condition, especially for girls under the age of 15,” he added. “Complications, morbidity and mortality are much higher in girls under 15 than in girls 16-19, although 16-19 have twice the mortality rate of women 20 and older.”

The phenomenon of young girls having babies is relatively rare in the United States. In 2017, the most recent year for which data was available, according to the Guttmacher Institute, which campaigns for abortion rights and regularly surveys clinics, there were 4,460 pregnancies among girls under the age of 15, almost half of which ended in abortion.

But worldwide, complications related to pregnancy and childbirth are the leading cause of death for girls aged 15 to 19, according to the World Health Organization.

According to a 2014 review published in the Journal of Neonatal-Perinatal Medicine, young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency caesarean section, and postpartum depression.

Babies born to girls are more likely to be premature and have a low birth weight, said Dr. Willibald Zeck, the maternal and neonatal health coordinator at the United Nations Population Fund, who frequently delivered babies to young mothers while working as a gynecologist in Tanzania and later oversaw maternal health programs in Nepal and the Philippines.

While a pregnant 10-year-old in Ohio may have access to prenatal care and a cesarean section, which would lessen the effects of labor failure, the experience of pregnancy for a young girl in India is the same as in the United States. said dr Dyalchand. “The girls would go through more or less exactly the same kind of complications: the only difference is that they might not face the same terrible consequences due to access to better healthcare. But that doesn’t mean the girl’s body and her life won’t be scarred.”

dr Shershah Syed, a gynecologist and maternal mortality expert in Pakistan, regularly ministers to pregnant girls as young as 11. He said good prenatal care can prevent the formation of a hole between the wall of the bladder or rectum and the vagina – called a a fistula – leading to leakage of urine or faeces that is not only painful (the leaked urine causes burning sores) but is also a source of tremendous shame and humiliation.

But even good prenatal care cannot prevent high blood pressure 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 point is, she’s a child and the child can’t bear a child, she’s not ready,” said Dr. Syed, adding, “And the mental torture she’s going to go through is immeasurable.”

In the cases he’s seen, early pregnancy stunts the very young mother’s physical growth and often her intellectual development as well, because many girls drop out of school and lose normal social contact with their peers, he said. But while an anemic mother struggles to endure the pregnancy, the fetuses adapt nutrients and continue to grow until they have far exceeded what a young mother’s pelvis can provide.

“You go into labor for three days, four days, five days, and after that labor the baby is usually dead. And then when the head is collapsed, the baby is born,” said Dr. Syed, one of South Asia’s foremost experts in repairing obstetric fistulas, a common consequence of impaired labor in pregnant girls.

In almost all of these cases, the girl has developed a vesicovaginal fistula, a hole between the bladder wall and the vagina. In a quarter of cases, the prolonged childbirth also causes a rectal fistula, so the girl constantly loses both urine and feces.

When fistula patients learn that treatment is available and make their way to his clinic, Dr. Syed that he can fix the condition. But the process requires a long recovery: A bladder fistula takes about five weeks to heal, while a rectal fistula takes four or five months.

In 1978 Dr. Dyalchand started his public health career in a small district hospital in rural Maharashtra on India’s west coast. In his first week, two young pregnant girls bled to death – one in labor, the other at the entrance to the hospital before she even made it inside. It began a long career working with communities to persuade them to postpone the age of marriage and first conception for girls.

This intervention has shown considerable success and, according to Dr. Dyalchand, India has also steadily expanded access to abortion. The procedure is legal up to the 24th week of pregnancy.

In The Gambia, Ms. Bass Gomez said her clinic is able to offer pregnant girls good prenatal care, but that does little to mitigate the greater trauma of the experience. Her clinic is geared toward serving adults, she said. “But when a kid comes in right away pregnant, it’s really traumatizing for the kid,” she said. “It’s not comfortable, this environment, it’s not adjusted to it. You can say they are fighting. There is much shame and disgrace.”

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