Meeting Reproductive Health Service Needs
Widespread adolescent pregnancy and childbearing, with their accompanying risks, pose a serious public health concern, and also contribute to rapid population growth in many countries. Young people additionally face high rates of sexually transmitted infections and HIV/AIDS. This underscores the need for far greater access to youth-friendly reproductive and sexual health services. Services should be provided in a gender sensitive, youth appropriate way, as part of coordinated development efforts.
Young people are often discouraged from seeking reproductive health services because of disapproval by providers and the community, as well as their own uncertainty and lack of knowledge. Countering this calls for a variety of interventions: improving the policy climate; fostering community support; addressing adolescents’ needs for information and skills; and establishing responsive, age-sensitive services.
Designing programmes that can do all this, be financially sustainable and expand in scale is a major challenge. Success depends on government leadership and implementation, positive policies and laws, and the effective use of existing networks of public health facilities, schools, and other community organizations to reach a majority of the youth population.
Pregnancy is a leading cause of death for young women aged 15 to 19 worldwide, with complications of childbirth and unsafe abortion being the major factors.(1) For both physiological and social reasons, women in this age group are twice as likely to die in childbirth as those in their twenties. Girls under age 15 are five times as likely to die as those in their twenties.(2)
Girls who are not fully developed physically encounter difficulties in sex, pregnancy and labour. Obstructed labour is especially common among young women giving birth for the first time. In Ethiopia, one study found that obstructed labour accounted for 46 per cent of maternal deaths.(3)
Worldwide, some 14 million women and girls between ages 15 and 19—both married and unmarried—give birth each year.(4) Women who start having children in adolescence tend to have more children overall and at shorter intervals than those who start later.(5)
In Bangladesh, more than half of all women have their first child by age 19.(6) In other developing countries, between one quarter and one half of all young women give birth before turning 18.(7) African countries have the highest levels of adolescent fertility and the largest variation in rates compared with other areas.(8)
In East Asia, increases in age at marriage and low incidence of premarital sexual activity have resulted in low levels of childbearing among adolescents.(9)
UNSAFE ABORTION Young women aged 15-19 account for at least one fourth of the estimated 20 million unsafe abortions performed each year, which result in some 78,000 deaths.(10) Adolescents disproportionately resort to unsafe abortion due to the limited availability and high cost of quality medical abortion procedures and because they have more unwanted pregnancies than older women.(11)
OBSTETRIC FISTULA For every woman who dies in childbirth, some 15 to 30 survive but suffer chronic disabilities, the most devastating of which is obstetric fistula. Fistula is an injury to a woman’s birth canal that leaves her leaking urine and/or faeces. Young women under age 20 are especially prone to developing fistulas if they cannot get a Caesarean section during prolonged obstructed labour. Prevalence is highest in impoverished communities in Africa and Asia. Causes include early childbearing, poverty, malnutrition, lack of education and limited access to emergency obstetric care. It is estimated that three to four women develop fistulas for every 1,000 live births in areas with high maternal mortality rates.(12)
FISTULAS AND EARLY CHILDBEARING
Millions of young women
get pregnant each year, before their bodies
have fully matured, increasing their risk of
complications during childbirth. Obstetric
fistula is the most devastating disability
that can happen to a young woman who
survives a difficult childbirth.
During obstructed labour, the prolonged
pressure of the baby’s head against
the mother’s pelvis cuts off the blood supply
to the soft tissues surrounding her
bladder, rectum and vagina. The injured
tissue then rots away, leaving a hole, or fistula.
The baby usually dies and the woman
is left with humiliating, chronic incontinence.
She may also suffer from frequent
bladder infections, ulceration of the genital
area and nerve damage to her legs.
The results are life shattering. Rather
than being comforted for the loss of her
child, she is often rejected by her husband,
shunned by her community and blamed for
her condition. While some women receive
support from their families, others are
forced to beg for a living. Surgical repair
has up to a 90 per cent success rate and
women can usually have more children.
Sadly, most poor women are either unaware
that surgery is available, or cannot
access or afford it.
Until now, it was estimated that 2 million
women were living with fistulas
worldwide. However, a new report by
UNFPA and EngenderHealth indicates that
these figures are too low. The report maps
the occurrence of fistula in nine African
countries and indicates that there could be
as many as 1 million women living with
fistula in Nigeria alone.
UNFPA is working with partners to prevent
and treat fistula in Africa and Asia. In
Chad, for example, 150 women underwent
fistula surgery through UNFPA support.
Fistula was once common throughout the
world, but has been eradicated in areas
such as Europe and North America
through improved obstetric care. Obstetric
fistulas are virtually unknown in places
where early marriage is discouraged,
young women are educated about their
bodies and skilled medical care—including
emergency referrals—is provided at