Adolescent mothers 20 percent of maternal deaths

At age 16, Bagerhat girl Moushumi Akter Bithi was forced to enter a child marriage – using a fake birth certificate – in 2017. Bithi's older brother married a seventh-grader – Rimi, 14 – the same year. Both girls conceived in 2018 but though Bithi survived childbirth, her sister-in-law, Rimi, died.          

As many as 59 percent of adolescents in Bangladesh are becoming wives before their 18th birthday. Among them, 28 percent of girls conceive and many of the young mothers die maternity-related complications.         

A survey found that 134 adolescent mothers per 1 lakh live births died as a result of complications during pregnancy or childbirth. The deaths amount to 20 percent of the total maternal deaths in the three years preceding the 2016 survey.

At present, the rate of total maternal deaths in Bangladesh is 169 per 1 lakh live births. As a signatory of the Sustainable Development Goals (SDGs), the country will have to reduce the number to less than 70 per 1 lakh live births by 2030.

The survey titled "Bangladesh Maternal Mortality and Health Care Survey" calculated the ratio of deaths per one lakh live births. Maternal mortality is defined as deaths associated with complexities during delivery or within 24 days following delivery.

Professor Sayeba Akhter, prominent obstetrics and gynaecology specialist, told The Business Standard, "When an adolescent girl conceives, she suffers from pregnancy-related problems like: anemia, high blood pressure, pre-eclampsia, eclampsia, bleeding, and obstructed delivery."

According to the United Nations Children's Fund, the risk of death during pregnancy, or delivery, among girls between 15 and 19 years of age is double than that of those who are above 20.

Also, the risk of death for girls below 14 is five times higher.

Dr Jaynal Haque, programme manager of adolescent and reproductive health at the Directorate General of Family Planning, said, "In Bangladesh, the adolescent girls marriage rate is 59 percent." 

"A total of 113 adolescent girls out of every 1,000, who are between 15 and 19 years of age, become pregnant," he said.

"The rate of deaths of adolescent mothers was high in the past due to child marriage," he added.

Health experts said the maternal mortality rate could not be slashed due to child marriage.

Professor Mohammad Bellal Hossain, of Dhaka University's Population Science Department, has been undertaking research on child marriage.

"Girls are becoming mothers at an age when they are not even supposed to be wives," he told The Business Standard.

The professor elaborated and said, "Child marriage is more common in the marginalized class. The mothers conceive before their bodies are ready. They also do not get proper medical treatment during pregnancy and delivery care. These factors contribute to maternal mortality."   

Challenges grip Child Marriage Restraint Act

The Child Marriage Restraint Act makes it mandatory for documents to be submitted as evidence of the marriage age. In many cases, child marriages take place with forged birth certificates.

On top of that, parents secretly marry off their children, evading the law.             

According to the Act, there will be Child Marriage Prevention Committees at the local level comprising of government officials and local representatives.

However, Professor Bellal was critical of the role of the committees. "Parents are yet to be aware of the legal age for marriage. Others arrange weddings secretly, in different areas, fearing the constraints [on child marriage] of their locality."

The professor said, "The committees basically raise awareness and prevent child marriage after being tipped-off. In many cases, they remain in the dark about the child marriage taking place in their locality."

Mofidul Islam, Rajshahi's Harian union parishad chairman, echoed the Dhaka University professor's statement.

"Many poor families opt to marry off their children secretly at remote areas here. Some arrange the weddings in other places altogether," he said.

"People in char areas cannot bear their children's' education costs. They marry off their daughters in sixth to seventh grade," he said adding, "The remote char areas remain largely out of prevention committee surveillance."       

In the meantime, experts say some religious and cultural issues are also challenging for the Restraint Act.    

They said, "A child marriage cannot be annulled once it is done. Parents are often penalised for child marriage but the marriage itself remains valid. This is a psychological trait – to marry them off any way possible and end the hassle."

Govt working to reduce maternal deaths among adolescents

Dr Mohammad Sharif, director of Maternal Child Health Services unit at the Directorate General of Family Planning, said the directorate is working on school-based healthcare programmes.

"Community medical officers at the union level visit schools and give advice on child marriage and various aspects of reproductive health," he said.

He said further, "For those who do not go to school, there are adolescent-friendly health corners in at least two Union Health and Family Welfare Centres of every upazila. Until now, 603 adolescent-friendly health corners have been set up.

"This year, another 300 such corners will be set up. At the centres, the privacy of adolescent girls and boys will be maintained. They will be counselled on the bad effects of adolescent pregnancy. The environment in Mother and Child Centres at the district level is friendly." 

Gynaecologist Professor Sayeba said, "There is no alternative to education, health education and awareness-building to reduce death rates among adolescent mothers. Child marriage must be stopped. If one conceives, one must be provided regular maternity care. Additionally, delivery – by an expert hand at a health centre – must be ensured."