By Dr Kerlin Mihsill
The Outpatient department was closing for the day. It was a Saturday, a half working day at the mission hospital in Bangalore. As a first year post graduate student, I longed for the weekend, knowing this would be my chance to catch up on some much-needed sleep and some therapeutic window-shopping. But that afternoon, about 15 years ago, I vividly remember, my afternoon being delayed by a teenage girl, barely 17 years of age. She came out positive on the pregnancy test kit and to make matters worse, the ultrasound showed an ectopic pregnancy. I had the responsibility of counselling her on the diagnosis. An ectopic pregnancy is one that is lodged outside its normally assigned place (the uterus). It could be located in the Fallopian tubes ( tubes that connect the uterus to the ovaries), the ovaries or even in the abdominal cavity close to the intestines. An ectopic pregnancy can have catastrophic results. If the pregnancy is not intervened on time, it is bound to grow and rupture leading to massive internal haemorrhage, sometimes resulting in death. As I sat with this young girl, I called her boyfriend as well and explained in detail the need for hospitalization to further monitor and treat her. Alas! This was never in their plans. Being a minor, and an immigrant student there were other challenges. Her parents would have to be informed. Their written consent would be required for any further management. The girl was distraught. Her boyfriend, helpless.
This scenario, as heart wrenching as it is, is not a rare occurrence anymore. Young unmarried women, if not teenagers, find themselves with an “unplanned pregnancy”. The immediate reaction is panic, fear and anxiety. As reality seeps in, questions like “What do I do now?” “What do I tell my parents?” “What’s going to happen to my education?” “Will my boyfriend disown me?” And the oh very famous and unavoidable question – “What are people going to think of me?” The reflex answer – “Get rid of it!!” What one must realize is that this is the exact frame of mind to avoid while making life impacting decisions. Some face it alone, while others call on friends for support. It is not uncommon that few will help themselves to over-the-counter pills. Needless to say, this could turn out to be fatal. The right way would be to consult a health practitioner and make it to a hospital. The MTP Act, 1971, provides for the termination of certain pregnancies by registered medical practitioners and under defined conditions, each according to the duration of pregnancy. But is abortion the answer to every unintended pregnancy?
On a particularly busy night duty, a 19-year-old girl was wheeled into the labour room. She had been referred to the tertiary hospital I worked in as she had been found to have large growth of vulval warts, making a normal delivery impossible. We rushed her to the OT for an emergency Caesarean section as she was in labour and the baby needed to be out as soon as possible. Once the surgery was done, mother and baby settled, we were informed that the patient was HIV positive. A 19-year-old with HIV infection- this is so not right! Her life seemingly over before it had even begun. The prevalence rate of HIV in Meghalaya is 0.40 per cent, higher than the national average of 0.21 per cent- Meghalaya Aids Control Society (MACS) Thankfully, centers for treatment and monitoring are very accessible to our patients. They can enjoy a relatively good life provided they stick to their regimes.
So why am I talking about these – the unplanned pregnancies, the teenage pregnancies complicated with HIV? I speak about these because I see and feel the brokenness in the lives of women I meet within our society. Young women, who are only just beginning their lives. Young, beautiful women with hearts filled with dreams and aspirations but futures snatched from their very hands and ambitions cut short. So, what happened? Where did things go so awry ? Quite obvious here is the practice of casual and unsafe sex. Complicated further with multiple sex partners and complete ignorance of its consequences.
Let’s look further into the implications of casual sex. To start with- unplanned pregnancies, worse, teenage pregnancies. India’s average teenage pregnancy rate was 6.8% ( NFH 5, 2019-2020 survey). In comparison, in Meghalaya, 7.2% of all women between the ages of 15-19 years were pregnant during the survey period of 2019-2020, of which, rural Meghalaya had 8.4% and urban areas had 3.2% of teenage pregnancies. According to the state’s data, the number reflected 10% of all pregnancies. Teenage pregnancies come under the aegis of the POCSO act. All teenage pregnancies must be reported to the police at the first point of contact. The stress of a teenage pregnancy can leave a young girl with mental health issues and challenges. Certain studies (BMC Psychiatry volume 23, Article number: 786 (2023) have shown PTSD like symptoms in women who have undergone abortions. This has been termed “Post Abortion syndrome”. Illegal abortions can result in septic abortions, leading to hospitalization, ICU admissions and even worse, death.
Thankfully though, with family support, girls find the means to keep their babies and manage timely treatment. However, pregnancy, labour and delivery in a teenage girl are not without complications. Because, her body isn’t fully mature, she is susceptible to complications such as Intra-uterine growth restriction of the baby, Anemia, Preeclampsia (a hypertensive syndrome that can lead to convulsions in the mother and consequent fetal brain asphyxia and fetal death), pre-term labour and delivery. Delivery itself can be difficult through an underdeveloped pelvis, resulting in a higher incidence of instrumental deliveries and Caesarean sections.
Post delivery, the teenage mother is forced to take on the role of mother, that, might I say, she hasn’t fully comprehended yet. With a baby at her breast, she is overwhelmed with this premature responsibility; while also realizing, her life has come to a standstill. This can lead to depressive thoughts, low self-esteem and loss of motivation to care for the baby. In extreme cases, we may encounter postpartum depression or even psychosis. The family must be alert for self-harm and tendency to harm the baby as well. This brings to mind a 21-year-old who found herself pregnant in the middle of her undergraduate studies. Though disappointed, she kept the pregnancy, safely delivered her baby and when I met her a year later, she was back to college pursuing her studies.
Having said this, when a girl finds herself with an unintended pregnancy, I encourage her to open up to her parents. It’s amazing what parental love and support can do in such a situation. I would encourage parents who are faced with the news of an unintended pregnancy, as heartbreaking and difficult as it is for you, to stand by your daughter and stay positive and supportive as you navigate this journey together. The outcomes are far more positive for both mother and baby.
The heart of the problem is a lack of understanding on the effects of casual sex among the majority of our younger generation. The reasons are many. To begin with, a healthy discussion of sex must begin at home, but does it? The uncensored influence of Hollywood and social media on our children is overwhelming. Postmodern ideas and trends have thrown basic moral standards out the window.
Here’s my perspective as a parent and a gynaecologist. I implore upon parents to prioritise spending dedicated, quality time with their children in the first 12 years of their lives, building a strong bond of love and trust, through time spent in fun and games and meaningful conversations. Begin talking about adolescence and the changes it brings with it as the 12th year approaches, or even earlier in kids showing signs of early onset of puberty. The age of onset of puberty in girls has been pushed to an average of 9 years in recent times. Make efforts to read up and educate yourself on what’s happening around them and discuss friends and their conversations together. You will know your child and when best to talk about sex. Because when they hit 13, the teenage years have officially arrived.
The teen years are probably the most confusing years in a person’s life. They are suddenly exposed to a behemoth of information. A surge of hormones brings about changes in their bodies, affecting their physical appearance and emotional status. Their expanding minds are rapidly beginning to think for themselves and bear an opinion of their own. With so much happening, the lines between right and wrong become blurred. They groan under peer pressure. Teenagers are known to have risk taking behavior because of a brain that hasn’t fully matured. They need a home where they are nurtured and confident that they can discuss and confide in their parents anytime. A discussion should include- what is sex, when is one ready for it and how must one define boundaries in a relationship. One can’t expect a child to figure these out on their own. If we neglect these, they will pick up as much information as misinformation from their equally ignorant friends, from the very deceptive internet and God forbid, from child predators themselves. Worse, some will be challenged to experiment on sex, drugs and pornography. Limiting screen time and filtering the kind of content kids are exposed to can’t be over-emphasized. In no way must social media and movies be allowed to set the moral standard of living for your child. Over the years there has been a distortion of the value of sex. Casual sex has been glorified and normalized and made to look fun and harmless.
The fineprint which includes STIs, HIV, emotional and mental effects and the trauma of an unintended pregnancy and the pain that follows it are barely mentioned. Clearly, there are zero benefits to casual sex. Keep communication open and clear. Discourage sex before or outside the confines of marriage. Children who grow up with healthy relationships at home, with boundaries well defined, tend to be more secure and happy and make wiser choices as they grow up. Really, the fact doesn’t change- It all begins at home.