Prevent teen pregnancies

India is one of the ten countries with the largest number of teenage pregnancies in the world. The latest National Family Health Survey reveals that 17.5 % of urban women and 31.5% of rural women are married before the age of 18. State-wise data reveals that four out of 10 girls in West Bengal are married before 18 years. Despite a substantial reduction in the prevalence of early marriage nationally, childbearing at this age has declined only marginally— that is, from 35.7% to 31%.

A vast majority of these young married girls come from lower socio-economic backgrounds. They are often neither physically nor psychologically mature and lack decision-making power and freedom of mobility. They are unable to make choices on self-care, including access to food. Such girls are often not allowed to complete school education, which impinges on their ability to become economically empowered and socially adjusted. The man in the household is often given priority in meals, receiving maximum nutrition.

In such situations, teen girls are not able to gain optimum height and weight and enter pregnancy with higher chances of having poor height with poor reserves of essential nutrients. Moreover, social pressure and expectation to prove fertility leads to early childbearing.

This adds to another dimension of deprivation with young mother and foetus competing for available nutrients for growth, leading to much higher chances of poor birth outcome, inadequate growth in early childhood and stunting.

Short mothers are three times more likely to have a child who is stunted at two years of age. The national demographic survey reveals a significant decrease in relative risk of stunting in children for every 5 cm increase in maternal height. Anaemia and undernourishment among mothers are also likely to cause of poor foetal growth, low birth weight, and undernourished adolescent girls. Setting in motion, a vicious cycle of malnutrition across generations.

A recent study published in The Lancet presents evidence linking adolescent marriage and child stunting in India. The study reveals that the prevalence of malnutrition in children is 11% higher in children born to adolescent mothers than in other children. Such mothers also are noted to be poorer in seeking appropriate healthcare during pregnancy and in following the recommended complementary or semi-solid child feeding practices.

Besides reproductive factors, the study stresses on social factors and calls for subnational policies and programmes that are cognizant of the cultural differences that enable child marriage across states. Understanding these factors can draw attention to the interventions required at the political and societal levels for increasing age of marriage and first birth.

Continued investments in girl children’s education, and human capital can help reduce early childbearing in the country. Investing in education and enabling girl children to complete at least ten years of school, can also be an effective enabler.

Currently, many states in the country have launched various cash transfer schemes, to help retain girls in schools. Additionally, social mobilisation aimed at changing strong traditional mindsets of getting girls married young is crucial but complex, despite the “Prohibition of Child Marriage Act 2006” that prohibits child marriage for girls below 18 years. Women’s self-help groups, who form a large network under the National Rural Livelihood (NRLM) programme, could also be involved to help reach more families with out-of-school adolescent girls.

The involvement of Panchayat functionaries and leaders can turn this into a people’s movement. If influencers at the local and district administration level are mobilised to raise awareness against early marriage, it will significantly improve maternal and child health outcomes and break the intergenerational cycle of malnutrition, poverty.

Besides prevention, both adolescent girls and the spouse must be enabled to make informed choices on sexual, reproductive and nutritional behaviours. The government’s family planning programme for newly married couples and adolescent health programme - RKSK – is a great opportunity to provide proper counselling and health services to address all aspects of physical, mental and reproductive health.

Moreover, special care of adolescent girls in the post-conception period cannot be ignored. Special effort is crucial to ensure teens who enter motherhood are motivated and supported to regularly subscribe to antenatal services, consumption of supplementary nutrition provided to pregnant and lactating women under the Integrated Child Development Scheme (ICDS), and are counselled on appropriate health, nutrition sanitation and hygiene for infants, with special attention to child feeding practices.

Adolescent girls are a key demographic that are essential to address India’s burden of malnutrition. Intervention to prevent early marriage and early conception combined with measures to ensure appropriate care of newborns is essential towards reaching the malnutrition target of Mission POSHAN.

(The writer is the founder-director of the Public Health Nutrition and Development Centre)