In India, there is little access to information or counselling about the risks of early pregnancy and contraception. No wonder teenage pregnancies and childbirth complications are among the leading causes of death among young women
Teenage pregnancies and childbirth complications are among the leading causes of death among female between 15 and 19 years of age. The same age group also contributes 19 per cent of the total rural fertility in India. This phenomenon is at its peak in Jharkhand (28 per cent), West Bengal (25 per cent) and Bihar (25 per cent), all in the eastern region. The level of teenage mothering is lowest (less than five per cent) in Himachal Pradesh, Goa and Jammu & Kashmir.
In several States like Bihar, Rajasthan, West Bengal, Jharkhand and Madhya Pradesh, almost half the girls are married before 18, foregoing educational and employment opportunities. A high percentage of teenage mothers begin child bearing immediately after marriage and contribute to higher fertility levels long thereafter. Young mothers being physically immature, often experience obstructed labour, pre-eclampsia (hypertension), eclampsia, leading to death or disability. They are also prone to deliver premature or low birth weight babies. The conclusion that women aged 15 to 19 years have higher maternal death rates compared to those aged between 20 and 24 is stating the obvious.
No wonder children born to minus 20 mothers have a 50 per cent higher risk of dying by the first birthday than those born to older mothers. Child mortality is as high as 25 per cent in Uttar Pradesh and Madhya Pradesh. In the worst league stand three States — Madhya Pradesh, Jharkhand and Bihar — which jointly account for producing more than 58 per cent of India’s scrawny offspring, contributing to India’s shameful record of supplying 40 per cent of the world’s underweight children. That 38 per cent of the less than three-year-old children are stunted, is just another sad statistic (Too much to take in and hence best disregarded).
Almost universally young women do not have access to information or counselling about the risks of early pregnancy and contraception. When 20 per cent pregnancies are unplanned, much greater attention needs to be paid to this sub-sector of adolescent pregnancies. The move to include pregnancy testing kits in the repertoire of the village ASHA is a step in the right direction as is the easier availability of the ‘morning after pill’. The challenge still lies in making these options available incognito and also to enable women to have safe abortions in secrecy. Neither is feasible today as privacy and secrecy are virtually unattainable in rural settings.
The illegality about sex determination has frightened people which is good. But it has also confused couples about the legitimacy of first trimester abortions, which are perfectly legal and absolutely necessary when the woman does not want a child and a pregnancy has been thrust on her. More so when the woman has little or no access to family planning and is incapable of negotiating condom use with her husband.
The population momentum is on us and cannot be stalled now. But the deluge of teenage pregnancies can be slowed down by pushing up the age of marriage, not by law but by attempting to change social custom. The National Population Policy 2000 recommends cash incentives and rewards for couples who marry after the legal age of marriage, register the marriage, have the first child after the mother is 21 and adopt a terminal method after the birth of the second child. The logic behind this is that babies born to very young mothers are much more likely to be below par physically and mentally. Since the woman’s body needs about two years to recover fully from pregnancy and childbirth, an additional incentive should be given for 36 months spacing between the first and second child. Linking the child’s health with the mother’s health should be an important focus of adult literacy messaging, instead of harping on age-old ‘chota parivar’ dictums.
Indian Railways deserves to be complimented for displaying 19 posters on their website highlighting responsible parenthood and in particular appealing to newly married couples not to be pressurised by aspiring grandparents and sundry relatives impatient to cuddle the newborn; or to display one’s mardanagi by taking bets to announce a pregnancy in the very first year of marriage. With slogans like ‘agar ma banegi bacchi tow neev rahegi kacchi’ and ‘baccho ko paida karna baccho ka khel nahi’ the messages target the responsibility cast by parenthood without hectoring about family planning per se.
If Indian Railways can do this on its website one can only hope that it will not be long before it displays the posters at railway stations where millions of people congregate throughout the day and most of the night. The strategy can become an example for other public and private sector giants, particularly those with a massive presence (and enormous goodwill) in rural areas.
Were rural post offices, petrol stations, banks and the FMCG players to target a mindset change in favour of later marriages and support delayed child births, they can instill enormous credibility to important social messages. They can help rescue hapless adolescents from a premature generational cycle propelled by societal pressure to prove fertility. They could also dispel the all-pervading ‘munna ho gaya’ obsession which has precipitated a fast worsening gender ratio.