Academic journal article International Family Planning Perspectives

Adolescents' Use of Maternal and Child Health Services in Developing Countries

Academic journal article International Family Planning Perspectives

Adolescents' Use of Maternal and Child Health Services in Developing Countries

Article excerpt

CONTEXT: Because of high levels of early childbearing in developing countries, pregnancy and childbirth are the leading causes of death among women aged 15-19. Use of skilled antenatal and delivery care improves maternal outcomes through the prevention, management and treatment of obstetric complications, and infant immunizations prevent many childhood diseases.

METHODS: Logistic regression analysis of Demographic and Health Survey data for 15 developing countries examined adolescents' use of antenatal care, delivery care and infant immunization services compared with use by older women.

RESULTS: In general, the use of maternal and child health care did not vary by mother's age. In five of the 15 countries, women aged 18 or younger were less likely than women aged 19-23 to use either antenatal care or delivery care, or both (odds ratios, 0.5-0.9). Younger mothers in six countries were less likely than older mothers to have their infants immunized, particularly for diphtheria, pertussis and tetanus and for measles (0.5-0.8). The association of age and health care use was largely limited to Bangladesh, India, Indonesia, Nicaragua, Peru and Uganda. In Latin America, controlling for parity allowed differences between adolescents and older women to emerge. Except in Uganda, there were no differences in health care use by mother's age in the African countries.

CONCLUSION: Country-specific investigations are needed in Asia to better understand the reasons for differences in service use by age. In general, further systematic evidence would help identify long-term interventions that will be most effective in increasing adolescents' use of maternal and child health services.

International Family Planning Perspectives, 2006, 32(1):6-16

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In parts of the developing world where fertility rates are high, teenage pregnancy and early marriage are common. Worldwide, adolescents have more than 14 million births each year, and more than 90% of these occur in developing countries. (1) The proportion of teenage women who are mothers or are currently pregnant is greatest in Sub-Saharan Africa (20-40%). (2) The proportions are lower in other regions: 6-21% in Asia--with Bangladesh an outlier at 35%--and 13-25% in Latin America.

As a result of high levels of early childbearing in developing countries, pregnancy and childbirth are the leading causes of death among women aged 15-19. (3) Compared with older women, teenagers are at increased risk for poor maternal and infant outcomes, (4) particularly maternal death and having an infant who is low-birth-weight or dies. (5) The risk of maternal death during childbirth is 2-4 times as high among adolescents younger than 18 as among women aged 20 or older. (6) Compared with babies born to women aged 20-29, babies born to women younger than 20 have a 34% higher risk of death in the neonatal period, largely because of their increased risk of being low-birth-weight, (7) and a 26% higher risk of death by age five. (8)

Determinants of poor maternal and infant outcomes include poverty; cultural factors that restrict women's autonomy, promote early marriage or support harmful traditional practices; nutritional deficiencies; reproductive factors such as young age at first birth; distance to health services, and inadequate health care behavior or use of services. (9) Pregnant adolescents are disproportionately affected by these factors. (10) Programs to delay first births to adolescents would mitigate risks to maternal and infant health associated with maternal factors such as short height, low weight and inadequate nutrition, but it is not clear how delaying first births would affect the social advantages or disadvantages of early childbearing. For example, adolescents who become pregnant may cut their education short because they are forced to leave school. Yet early childbearing may improve a woman's social status because in some cultures it is an important step toward marriage. …

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