What Pregnancy and Childbirth Do to Girls’ Bodies

After the account of a 10-year-old Ohio girl who crossed state lines to have an abortion drew national attention last week, some prominent abortion opponents suggested that the child should have carried the pregnancy to term.

But midwives and doctors working in countries where pregnancy is common among teenagers say those pushing for very young girls to carry pregnancies to term may not understand the brutal toll of pregnancy and childbirth in a child’s body.

“Their bodies are not ready for childbirth, it’s very traumatic,” said Marie Bass Gomez, a midwife and senior nurse at the reproductive and child health clinic at Bundung Maternal and Child Health Hospital in The Gambia (West Africa).

The critical issue is that a child’s pelvis is too small to allow even a small fetus to pass through, said Dr. Ashok Dyalchand, who has worked with pregnant teenagers in low-income communities in India for more than 40 years.

“They have prolonged labor, obstructed labor, the fetus puts pressure on the bladder and urethra,” sometimes causing pelvic inflammatory disease and tissue breakdown between the vagina and the bladder and rectum, he said. Dyalchand heads a public health organization called the Institute of Health Management Pacod, which serves marginalized communities in central India.

“It’s a pathetic situation, especially for girls under 15,” he added. “Complications, morbidity and mortality are much higher in girls under 15 years of age than in girls aged 16 to 19, even though they have a mortality rate twice as high as women aged 20 and over.”

The phenomenon of girls having babies is relatively rare in the United States. In 2017, the last year for which data were available, there were 4,460 pregnancies among girls under age 15, with just under half ending in abortion, according to the Guttmacher Institute, which supports abortion rights and regularly oversees clinics. .

Globally, complications related to pregnancy and childbirth are the leading cause of death for girls aged 15 to 19, according to the World Health Organization.

Young maternal age is associated with an increased risk of maternal anemia, infections, eclampsia and preeclampsia, 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 weights, said Dr Willibald Zeck, coordinator of maternal and newborn health at the United Nations Population Fund, who often delivered to young mothers while working as a gynecologist in Tanzania and later oversaw maternal health programs in Nepal and the Philippines.

While a 10-year-old pregnant woman in Ohio might have access to antenatal care and a cesarean section that would lessen the effects of obstructed labor, a young woman’s experience of pregnancy is the same in India and the United States, Dyalchand said. “Girls would go through more or less exactly the same kind of complications: the only difference is that, due to access to better health care, they might not have the same kind of terrible results. But that doesn’t mean the girl’s body and your life will not be marked.”

Dr Shershah Syed, a gynecologist and specialist in maternal mortality in Pakistan, regularly sees pregnant girls as young as 11. He said good prenatal care can prevent the development of a hole between the wall of the bladder or rectum and the vagina, called a fistula, which causes painful urine or stools to leak (leaked urine causes burning sores) and is also a source of enormous shame and humiliation.

Not even good prenatal care can prevent the hypertension or urinary tract infections that are common in very young mothers, he said.

“In normal physiology, a 10-year-old shouldn’t get pregnant. The point is, she’s a child, and the child can’t give birth, she’s not ready,” Syed said, adding, “And the mental torture that she will pass is immeasurable.”

In the cases he saw, early pregnancy stops the mother’s physical growth at a very young age and also often stops her mental development, because many girls drop out of school and miss normal social interaction with peers, he said. As an anemic mother struggles to carry the pregnancy, fetuses appropriate nutrients and continue to grow until they far outstrip what a young mother’s pelvis can provide.

“They go into labor for three, four, five days, and after that the baby is usually dead. Then when the head collapses, the baby is born,” said Syed, who is one of the leading experts in southern India. Asia in the repair of obstetric fistula, a common result of obstructed labor in pregnant girls.

In almost all of these cases, the girl developed a vesicovaginal fistula, a hole between the wall of the bladder and the vagina. In a quarter of cases, prolonged labor also causes a fistula from the rectum, so the girl constantly leaks urine and feces.

If fistula sufferers know treatment is available and go to his clinic, Syed said it can cure the problem. But the process requires a long recovery: a bladder fistula takes about five weeks to heal, whereas a rectal fistula needs four or five months.

In 1978, Dyalchand began his career in public health at a small district hospital in rural Maharashtra, on India’s west coast. In their first week, two young pregnant women bled to death — one in labor, the other at the hospital entrance, even before admission. This launched him on a long career of working with communities to convince them to delay the age of marriage and first conception in girls.

This intervention has had considerable success and, as Dyalchand noted, India has also been steadily expanding access to abortion. The procedure is legal until the 24th week of pregnancy.

In The Gambia, Bass Gomez said her clinic is able to provide good antenatal care to pregnant girls, but that does little to alleviate the greater trauma of the experience. Her clinic is designed to serve adults, she said.

“But when you have a child that comes in, also pregnant, it’s really traumatizing for the child,” she said. “It’s not comfortable, that environment isn’t made for them. You can see they’re struggling. There’s a lot of shame and disgrace.”

Translated by Luiz Roberto M. Gonçalves