What pregnancy and childbirth do to girls’ bodies

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

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

“Their bodies are not ready for childbirth and it is very traumatic,” said Marie Bass Gomez, a midwife and senior nursing 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 through, said Dr. Ashok Dyalchand, who has worked with pregnant adolescents in low-income communities in India for more than 40 years.

“They have long labor, obstructed labor, the fetus pushes down over the bladder and over the urethra,” sometimes causing pelvic inflammatory disease and the breakdown of tissue between the vagina and the bladder and rectum, said Dr. Dyalchand, who runs an organization called the Pachod Institute of Health Management, a public health organization that serves underserved communities in central from India.

“It’s a pathetic state, particularly for girls under the age of 15,” he added. “Complications, morbidity and mortality are much higher in girls under 15 than in girls aged 16 to 19, although 16 to 19 year olds have two times higher mortality than in women aged 20 and older.”

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

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

Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, emergency cesarean delivery, and postpartum depression, according to a 2014 assessment published in the Journal of Neonatal-Perinatal Medicine.

Babies born to girls are often premature and have low birth weights, said Dr. Willibald Zeck, coordinator of maternal and newborn health at the United Nations Population Fund, who frequently delivered babies to young mothers while worked as a gynecologist in Tanzania and later oversaw maternal health programs in Nepal and the Philippines.

While a 10-year-old pregnant girl in Ohio could have access to prenatal care and a C-section that would mitigate the effects of obstructed labor, the experience of pregnancy for a young girl is the same in India as it is in the United States, said Dr. Dyalchand. “Girls would go through more or less exactly the same type of complication – the only difference is that due to access to better medical care, they may not have the same type of dire outcomes. But that does not mean that the girl’s body and her life are not marked”.

Dr. Shershah Syed, a gynecologist and maternal mortality expert in Pakistan, provides regular care to pregnant girls from the age of 11. She said that good prenatal care can prevent a hole from developing between the wall of the bladder or the rectum and the vagina. she called a fistula, which causes leakage of urine or feces that is not only painful (urine leakage causes burning sores) but also a source of enormous shame and humiliation.

But even good prenatal care can’t prevent high blood pressure or urinary tract infections that are common in very young mothers, she said.

“In normal physiology, a 10-year-old girl is not supposed to be pregnant. The point is that she is a girl and the girl cannot give birth, she is not ready,” said Dr. Syed, adding: “And the mental torture that she will go through, that cannot be measured.”

In the cases she has seen, early pregnancy stunts the very young mother’s physical growth and often her mental development as well because many girls drop out of school and miss out on normal social interaction with their peers, she said. But while an anemic mother struggles to carry the pregnancy, the fetuses appropriate the nutrients and continue to grow, until they have far outgrown what a young mother’s pelvis can produce.

“They go into labor for three days, four days, five days, and after that labor, usually the baby is dead. And then when the head collapses, the baby is born,” said Dr. Syed, who is one of South Asia’s foremost experts on obstetric fistula repair, a common result of obstructed labor in pregnant girls.

In almost all of these cases, the girl developed a vesicovaginal fistula, a hole between the bladder wall and the vagina. In a quarter of cases, prolonged labor will also cause a fistula of the rectum, due to which the girl constantly loses urine and feces.

If fistula sufferers find out that treatment is available and go to his clinic, Dr. Syed said it 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 to 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 women bled to death, one during labor and the other at the hospital entrance before he could enter. He started him on a long career of working with communities to convince them to delay the age of marriage and first conception in girls.

That intervention has shown considerable success, and, Dr. Dyalchand noted, India has also been steadily expanding access to abortion. The procedure is legal up to 24 weeks of pregnancy.

In The Gambia, Ms. Bass Gómez said her clinic can offer good antenatal care to pregnant girls, but that does little to mitigate the greater trauma of the experience. Her clinic is designed to serve adults, she said. “But when you have a similarly pregnant girl, it’s really traumatic for the girl,” she said. “It is not comfortable, that environment, it is not prepared for them. You can tell they are fighting. There is a lot of shame and disgrace.”

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