Adolescent Girls Health Risks

According to Family Health international thousands of adolescent women die each year around the world from complications due to an unplanned pregnancy. And in 18 African countries a third of today's 15 year olds will become infected with HIV during their adult lives. An unplanned pregnancy is a serious reproductive health risk for many adolescent girls. In addition to disease and possibly death, other severe consequences for an unmarried adolescent with an unplanned pregnancy include expulsion from school, loss of job or dishonour for her family and herself. Because they are afraid, ashamed or desperate, many young women are willing to risk their lives to end an unplanned pregnancy. They seek an illegal abortion, often from an untrained person under unsafe conditions, or they try dangerous ways to induce an abortion.

Ashley Montage, a programme associative for the US based IPAS, a reproductive health organisation that concentrates on preventing unsafe abortion says, "Adolescents are more likely than adults to deny they are pregnant, not recognise the signs of pregnancy, delay decision making and seek abortion later in the pregnancy, which puts them- at greater risks.

"Clandestine abortion is associated with high rates of illness and death. Unsafe abortion can result in haemorrhage, infection and cuts or chemical burns. Treatment can require hospitalisation, blood transfusions, antibiotics and other drugs.

It is interesting to note that beside unintended pregnancies or unmarried pregnancies, of the 15 million young women aged 15 to 19 who give birth every year, 13 million live in less developed countries. Thirty three per cent of women in less developed countries give birth before age of 20, ranging from a low of 8 per cent in East Asia to 55 percent in West Africa. In more developed countries, about 10 percent of women give birth by age 20; however, in the United States, the level of teen age childbearing is significantly higher, at 19 percent. Early pregnancy and child bearing are typically associated with less education and lower future income for young mothers. For unwed teens in some countries, motherhood can result is social ostracism. In other settings, teens may choose to become pregnant to gain status with their peers, improve their relationship with family members, or because they have few other life opportunities outside of motherhood.

Young women and their children face serious health risks from early pregnancy and child bearing. More adolescent girls die from pregnancy related causes than from any other cause. In fact, maternal mortality among 15 to 19 year old women is twice as high as for women in their 20s. Because adolescent women have not completed their growth, particularly in height and pelvic size, they are at greater risk of obstructed labour, which can lead to permanent injury or death for both the mother and the infant. Infants of young mothers are also more likely to be premature and have low birth weights. In many countries, the risk of death during the first year of life is 1.5 times higher for infants born to mothers under age 20 than for those born to mothers aged 20 to 29. For all women, first births are higher risk than subsequent births and for teens, the risks are greater still. Because adolescents have less experience resources and knowledge about pregnancy and childbirth than older women, they and their children suffer when obstetric emergencies occur.

About youth and the HIV/AIDS crisis it is to be noted that about half of all people infected with HIV are under age 25, according to WHO estimates, and in less developed countries, up to 60 percent of all new infections are among 15 to 24 years olds. In this group of newly infected people, there are twice as many young women as young men. Adolescents are at high risk of contracting HIV and other STIs because, among other reasons, they often have multiple short-term sexual relationships and do not consistently use condoms. They also tend to lack sufficient information and understanding of HIV/AIDS: their vulnerability to it, how to prevent it and the self-confidence necessary to protect themselves.

Young people face special obstacles in obtaining diagnosis and treatment of HIV/AIDS and other sexually transmitted infections (STIs), even where services are available. They usually lack information about STIs, their symptoms, the need for treatment and where to obtain services.

They are also reluctant to seek care, and providers may be hesitant to treat them, because females with eclampsia and gonorrhoea, the most common STIs, often do not show symptoms, and because having another STI increases an individual's susceptibility to HIV, young people are at high risk of contracting and spreading these infections.

Additionally, young people often believe that STIs will simply go away if untreated or that they will not recur if treated. Young women are particularly Vulnerable to STIs for both biological and cultural reasons.

Adolescents women have fewer protective antibodies than do older women and the immaturity of their services increases the likelihood that exposure to infection will result in the transmission of the disease. Sexual violence and exploitation, back of formal education (including sex education), inability to negotiate with partners about sexual decisions, and lack of access to contraception and reproductive health services work together to put young women at especially high risk. Additionally, women in many societies are not accustomed to discussing issues of reproductive health and sexuality with others, which further increases their vulnerability.

Health experts say, "For developing countries, if adolescents are to avoid unplanned pregnancies, diseases and other serious reproductive health problems, they need accurate information and services."

"Preventing HIV infections among adolescents is an excellent strategy for slowing AIDS pandemic," says Dr. Ward Cates, Jr, President of FHI and an expert on sexually transmitted diseases (STDs). "Younger people are more likely to adopt and maintain safe sexual behaviours than are older people with well-established sexual habits, making youth excellent candidates for prevention efforts," he says "Reducing adolescent infections will ultimately result in fewer infections among all age groups.

However, many inter-related and complex factor that put adolescents at risk of HIV and other STDs will not be changed easily or quickly, he and other experts say. In many settings, these include poor education, unemployment and poverty. Also urbanisation can disrupt family relationships, social networks and traditional moves while generating more opportunity for sexual encounters.

Effective strategies and programmes to protect the reproductive health of adolescents and young adults are needed in every country, but are urgent for youth in developing countries.

"Young adults need a basic understanding of how their bodies work and the reproductive health concerns they face, as can be provided through family life education," says Dr. Nancy Williamson, senior associate for frontiers in Reproductive Health - a project of the population council, Tulane University and FHI to evaluate reproductive health programmes, including programmes for youth in Mexico, Bangladesh, Kenya and Senegal. She cautions, however, that reproductive health programmes for adolescents should be carefully designed and evaluated before expanding on a large scale. Difficult decisions must be made about allocating limited resources wisely.

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