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Pregnancy: The leading cause of death for teenage girls in the developing world

96493512 1 200x300 Pregnancy: The leading cause of death for teenage girls in the developing world

A pregnant fifteen-year old girl from Malemba who was raped 3 times, shows her belly to the photographer as she poses at her attacker's home. (Getty Images)

The family planning world is meeting in London this week to make one straightforward request – give 120 million women in the world’s poorest countries access to contraception.  Their reasoning is basic: ‘It’s mortality, stupid’.  Pregnancy is the leading cause of death for teenage girls in the developing world.

Most people would agree they are making a fair and simple ask: Give girls a choice and help save lives.  But, while increasing access to contraception is vital, it is only one piece of a complex puzzle needed to reduce early pregnancy.  There are a number of critical issues to address – including rape, lack of access to appropriate health care and lack of knowledge about contraceptives.  However, the elephant in the room is surely early and forced marriage – one of the primary reasons young girls in the developing world end up in sexual relationships in the first place.

Take the case of Nargis.   She was married in rural Bangladesh when she was 12 years old.  She became pregnant soon afterwards.   In labour before her body was properly developed, she suffered serious trauma.  Her baby died soon after it was born.  She has never fully recovered, leaving her in daily, excruciating pain.

Girls aged 15-19 are twice as likely to die in childbirth as women aged over 20, while girls aged 10-14 face five times the risk.  What’s more, babies born to mothers under 18 are 60 per cent more likely to die before their first birthday than babies born to older mums.

Access to contraception would have certainly helped Nargis and other girls like her.  However, equally importantly, we need to address why a 12-year-old ended up in a marital bed.

Poverty, gender discrimination, the impact of disasters:  All of these are tricky and sticky reasons why girls like Nargis become child brides.  Often girls in some of the world’s poorest countries are only valued in their roles as wives or mothers.  Some families even try to protect their daughters from the risks of pre-marital sex and pregnancy, by securing them a husband, and preserving their ‘honour’, as early as possible.

In Nargis’ case, her family said they simply had no means to look after her any more.  Her family was so desperate that the village matchmaker was given 24 hours to find her a husband.  She had no say in the process and was terrified on the day itself.

If we want to stop child marriage and the resulting risky early pregnancies, we need to invest in long-term community programmes.  At Plan, we start with children themselves.  We support children in the slums of Dhaka who decided to take action after seeing too many of their friends married off.  Through raising awareness of the problems and identifying kids at risk, local people claim to have cut the rate of child marriage by half.  Elsewhere, Imams in Niger (the country with the most child brides in the world), MPs in Kenya and filmmakers in Pakistan are campaigning against the practice.

Contraception is important – but child brides need sensitive and targeted help.  They are triply disadvantaged by their age, their sex and their marital status.  Married girls with little or no schooling often have a limited awareness of their rights and simply lack the knowledge and power to negotiate safer sex.

Girls who marry young are commonly isolated in their own homes, meaning they can’t access sexual health services that do exist.  Social stigma and a lack of age-appropriate services also stop them getting the guidance they need.  We are currently working with AstraZeneca and John Hopkins Bloomberg School of Public Health on the Young Health Programme, which includes specialist projects to give young women, including child brides, a safe place to learn about their rights and sexual health.

International leaders must take heed of the calls from the Family Planning Summit and extend the reach of contraception.  However, the work cannot end there.  Without tackling the root causes of early and forced marriages and gender inequality, we cannot hope to end the horror of the fifty thousand teenage girls who die every year because of pregnancy or childbirth.

Marie Staunton is chief executive of Plan UK

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