After the account of a 10-year-old Ohio girl crossing state borders to have an abortion attracted national attention last week, some prominent abortion opponents suggested that the child should have taken the pregnancy to term.
But midwives and doctors who work in countries where pregnancy is common among young girls in adolescence say that those who push for very young girls to become pregnant may not understand the brutal strain of pregnancy and childbirth on a child’s body.
“Their bodies are not ready for birth, and it is very traumatic,” said Marie Bass Gomez, a midwife and senior nurse at the Department of Reproduction and Child Health at the Bundung Maternal and Child Health Hospital in Gambia.
The critical problem 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 teenage girls in low-income communities in India for more than 40 years.
“They have long births, prevented births, the fetus carries down on the bladder and urethra,” sometimes causing pelvic inflammatory disease and rupture of tissue between the vagina and bladder and rectum, said Dr. Dyalchand, who heads an organization called the Institute of Health Management Pachod, a public health organization that serves marginalized communities in central India.
“It is a pathetic condition especially for girls under the age of 15,” he added. “Complications, morbidity and mortality are much higher in girls under 15 than girls 16 to 19, although 16 to 19 have twice the mortality rate as women 20 and up.”
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 the age of 15, and just under half ended in abortion, according to the Guttmacher Institute, which supports abortion rights and examines clinics regularly.
But 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 mothers’ age is associated with an increased risk of maternal anemia, infections, eclampsia and pre-eclampsia, acute caesarean section 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 a low birth weight, said Dr. Willibald Zeck, maternal and neonatal health coordinator for the United Nations Population Fund, who often gave birth to babies for young mothers while working as a gynecologist in Tanzania and later monitored. maternal health programs in Nepal and the Philippines.
While a pregnant 10-year-old in Ohio may have access to antenatal care and a cesarean section that will reveal the effects of a premature birth, the experience of pregnancy in a young girl is the same in India as in the United States, said Dr. Dyalchand. “The girls would go through more or less exactly the same type of complication: the only difference is due to access to better health care that they may not have the same type of horrible outcome. But that does not mean that the girl’s body and life do not get scars.”
Dr. Shershah Syed, a gynecologist and expert on maternal mortality in Pakistan, provides regular care to pregnant girls as young as 11. He said that good maternity care can prevent the development of a gap between the wall of the bladder or rectum and vagina – called a fistula – which causes leakage of urine or feces which is not only painful (the leaked urine causes burning wounds) but also a source of immense shame and humiliation.
But even good prenatal care can not prevent hypertension or urinary tract infections that are common in very young mothers, he 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. Syed, adding: “And the the mental torture she will go through, it is not measurable. ”
In the cases he has seen, early pregnancy stops the very young mother’s physical growth, and also often her mental development because many girls leave school and lose normal social contact with peers, he said. But while an anemic mother struggles to carry the pregnancy, the fetuses receive appropriate nutrients and continue to grow, until they have surpassed what a young mother’s pelvis can deliver.
“They go to birth for three days, four days, five days, and after that birth the baby is usually dead. And then when the head collapses, the baby is born,” said Dr. Syed, one of South Asia’s foremost experts. on repair of obstetric fistula, a common result of prevented birth in pregnant girls.
In almost all of these cases, the girl has developed vesicovaginal fistula, a hole between the wall of the bladder and the vagina. In a quarter of the cases, the prolonged birth will also cause a fistula in the rectum, so that the girl constantly leaks both urine and feces.
If the fistula sufferer finds out that treatment is available and takes the road to his clinic, Dr. Syed said he can repair the condition. But the process requires a long recovery: the fistula in the bladder takes about five weeks to heal, while a rectal fistula needs four or 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. During the first week, two young pregnant girls bled to death – one while giving birth, the other at the entrance to the hospital, before ever recovering. It started him on a long career working with communities to convince them to postpone the age of marriage and first conception in girls.
This intervention has shown considerable success, and, noted Dr. Dyalchand, India has also steadily expanded access to abortion. The procedure is legal up to 24 weeks of pregnancy.
In Gambia, Bass Gomez said her clinic is able to offer good maternity care to pregnant girls, but it does little to dull the greater trauma of the experience. Her clinic is designed to serve adults, she said. “But when you have a baby that goes in just as pregnant, it’s really traumatic for the baby,” she said. “It’s not comfortable, that environment, it’s not set for them. You can see that they are struggling. It’s a lot of shame and disgrace. “