But midwives and doctors working in countries where pregnancy is common among young teenage girls say those who push very young girls to carry their pregnancies to term may not understand the brutal impact pregnancy and childbirth can have on a child’s body. “Their bodies are not ready for childbirth and it’s very traumatic,” said Marie Bass Gomez, midwife and senior clinical nurse at the Reproductive and Child Health Clinic at Bundung Maternal and Child Health Hospital in The Gambia. The critical issue is that a child’s pelvis is too small to allow the passage of even a small fetus, said Dr. Ashok Dyalchand, who has worked with pregnant teenagers in low-income communities in India for more than 40 years. “They have a long labor, labor is obstructed, the fetus is carried down into the bladder and urethra,” sometimes causing pelvic inflammatory disease and rupture of tissue between the vagina and the bladder and rectum, said Dr. Dyalchand, head of an organization . it’s called the Pachod Institute of Health Management, a public health organization serving marginalized communities in central India. “It’s a pathetic situation especially for girls under 15,” she added. “Complications, morbidity and mortality are much higher in girls under 15 than in 16- to 19-year-old girls, although 16- to 19-year-olds have twice the mortality of women 20 and older.” The phenomenon of young girls having babies is relatively rare in the United States. In 2017, the latest year for which data was available, there were 4,460 pregnancies among girls under 15, with less than half ending in abortion, according to the Guttmacher Institute, which advocates for abortion rights and regularly surveys clinics . However, globally, complications related to pregnancy and childbirth are the leading cause of death for girls aged 15-19, according to the World Health Organization. Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and pre-eclampsia, emergency cesarean delivery and postpartum depression, according to a 2014 review published in the Journal of Neonatal-Perinatal Medicine. Babies born to girls are more often premature and have low birth weight, said Dr. Willibald Zeck, the maternal and newborn health coordinator for the United Nations Population Fund, who often delivered babies for young mothers while working as a gynecologist in Tanzania and later supervised. 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 that will 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 the exact same complication: The only difference is that because of access to better health care they might not have the same kind of dire outcomes. But that doesn’t mean the girl’s body and life aren’t marked.” Dr. Shershah Syed, a gynecologist and maternal mortality specialist in Pakistan, regularly provides care to pregnant girls as young as 11. She said good prenatal care can prevent a hole from developing between the wall of the bladder or rectum and the vagina — called a fistula — that causes leaking urine or feces that isn’t just painful (leaking urine causes gas). but also a source of immense 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 child is not supposed to be pregnant. The point is that she is a child and the child cannot give birth to a child, she is not ready,” said Dr. Said, adding: “And the mental torture she will undergo is immeasurable.” In the cases she’s seen, early pregnancy stunts the very young mother’s physical growth, and also often her mental growth, because many girls drop out of school and miss out on normal social interaction with peers, she said. But while an anemic mother struggles to carry the pregnancy, the fetuses get the proper nutrients and continue to grow, until they have well outgrown what a young mother’s pelvis can provide. “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, that’s when the baby is born,” said Dr. Syed, one of South Asia’s pre-eminent specialists in obstetric fistula repair, a common outcome of obstructed labor in pregnant women. 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, prolonged labor will also cause rectal fistula, causing the girl to leak both urine and faeces constantly. If fistula sufferers learn there is a treatment available and come to his clinic, Dr. Said said he can repair the condition. But the procedure 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 began his career in public health in 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 in childbirth, the other at the entrance to the hospital, before he could get inside. It began a long career of working with communities to persuade them to delay the age of marriage and first conception for girls. This intervention has shown significant success and, Dr. Dyalchand noted, India is also steadily expanding access to abortion. The procedure is legal up to the 24th week of pregnancy. In Gambia, Ms Bass Gomez said her clinic is able to provide good antenatal care to pregnant girls, but this does little to ease the greater trauma of the experience. Her clinic is designed to serve adults, she said. “But when you have a child come in as pregnant it’s really traumatic for the child,” she said. “It’s not comfortable, this environment, it’s not for them. You can tell they are struggling. There’s a lot of shame and embarrassment.”
