By Arindam Biswas
There is a time and place for everything. And teenage is not the time to get pregnant or be a parent. According to the National Family Health Survey 5 (NFH 5), 7.2% of all women between the ages of 15-19 years in Meghalaya were pregnant during the survey period of 2019-2020. However, rural Meghalaya had 8.4% and urban areas had 3.2% of teenage pregnancies. Compared to that, the average teenage pregnancy rate in India stood at 6.8%.
According to ICRW (International Centre for Research on Women), there were approximately 119 million adolescent girls in India in 2019. That translates to about 8.6 million pregnant teenagers in that year in India. Several states in India are grappling with a high teenage pregnancy rate. According to NFH-5, Tripura had the highest percentage of teenage pregnancy at 22%. The other states with high pregnancy rates included West Bengal 16%, Andhra Pradesh 13%, Assam 12%, Bihar 11%, and Jharkhand 10%. However, a percentage is only the proportion of the subgroup of interest in the total population. Instead to understand the magnitude of a health issue, we must consider the absolute number of individuals.
In 2011 (census 2011), Meghalaya had 350,605 females within the age bracket of 10-19 years. Hence, an average teenage pregnancy rate of 7.2% would translate to about 25,000 plus pregnant adolescents during the NFHS-5 survey. That’s because the population of adolescent women would have grown by the time of the survey.
Teenage pregnancies lead to several life-threatening and lifelong issues for both the mother and the child. It also hampers the prospect of a female’s livelihood and the chance to live her life to its full potential. Adolescence is a transformative state from childhood to adulthood. It encompasses multi-dimensional changes starting from biological, social, and psychological changes. That makes it crucial to design health interventions that have lifelong benefits. With teenage pregnancy, reaping these benefits becomes compromised.
Teenage pregnancy predisposes a girl to anemia. According to NFHS-5, in Meghalaya, 52.5% of the women between 15-19 years were anemic. It is a condition where there is less hemoglobin content in the blood. Babies born to teenage anemic mothers suffer from many health complications.
Also, teenage mothers are at a higher risk of preterm birth. It leads to premature birth and low birth weight of babies and a higher risk of infant death. Many children born to teenage mothers develop impaired cognitive and motor movements. Several reports highlighted teenage pregnancies as a leading cause of death among girls (15-19 years), globally.
A study by the CDC (Centers for Disease Control and Prevention) has shown that teenage mothers suffer from depression after giving birth. That interferes with the upbringing and care of the newborn. Moreover, teenage mothers remain susceptible to a higher rate of depression in general.
According to Meghalaya Youth Policy 2021, the state’s vision for the decade, 2020-2030 ‘is to become one of the Top Ten States in the country in terms of per capita income and achievement of Sustainable Development Goals.’ To achieve its decadal goal, Meghalaya would need healthy adolescents and a young cohort who can contribute to the growth of the state. Teenage pregnancy and poor nutritional profile (anemic & micronutrient deficiencies) make them less productive. Moreover, several studies highlight that teenage pregnancies lead to school dropout. A study by Population Foundation India revealed that one year of additional education leads to a 7.02% increase in monthly income. Hence, teenage pregnancy impacts the quality of the workforce of a state. That is a key factor in determining the competitiveness of a state.
Like everything else in life, there is a time to be a girl and a time to be a woman. A girl becomes a woman through early marriage and pregnancy. That doesn’t put society in a competitive spot. ‘When girls are allowed to be girls, everybody wins.’ UNICEF. Reduction in teenage pregnancies requires a multifaceted approach. It includes education, access to contraception, and parental and societal involvement.
As per NFHS-5, in Meghalaya, 27.4% of people used some contraceptive during the survey. It is low compared to other states and India, where 66.7% of people used contraceptives. Having access to contraceptives is beneficial for health. It empowers a girl to remain protected from unwanted pregnancy and plan her pregnancy according to her choice. But, having access may not be enough to encourage use of contraceptives. Having knowledge and awareness about the benefits and side effects of contraceptives is crucial. So are cultural norms and access to quality healthcare services. According to NFHS-5, 26.9% of the fecund women in Meghalaya needed contraceptives. That is one of the highest numbers of women among the Indian states. But as far as contraceptive use is concerned, only 27.8% of couples and individuals of reproductive age use contraceptives. That is one of the lowest in India. Hence, there is a lot of scope to increase the use of contraceptives in Meghalaya.
The Government of India launched the Rashtriya Kishor Swasthya Karyakram (RKSK) or National Adolescent Health Programme on January 7, 2014. In Meghalaya, the RKSK campaign was officially launched at the state and district level on January 14, 2019. The program aims to address several health issues among adolescents. That includes Sexual and Reproductive Health; Drug Abuse; HIV/STD; Mental Health; Non-communicable diseases; Gender Equality; Gender Violence; Injuries; and Nutrition. During the NFHS- 4 survey (2015-2016), Meghalaya had a teenage pregnancy rate of 8.6%. But within 4-5 years, that rate came down by about 17% (7.2%) by the time of the NFHS- 5 survey (2019-2020).
Public Health Systems are complex. Factors like socio-political-economic policies and culture play crucial roles. That makes implementing public health programs and its outcome a slow process. Hence, despite a lot of effort, there remains a significant gap. However, there needs to be a continuous effort to address these challenges. That will reduce the incidence of teenage pregnancies in Meghalaya. Families in Meghalaya consider children as a ‘gift of God.’ But it may not be as good a gift if it arrives too early in teenage life.
(The writer is with Indian Institute of Public Health (IIPH) Shillong)