Teen pregnancies fuelling maternal, child mortality

Arusha. There is no doubt that some teenage girls who are forced into marriages in the Maasai community die while giving birth.

Others develop obstetric fistula, a serious and debilitating complication of childbirth affecting millions of women in the developing world. It changes their lives completely.

According to the maternity and child health coordinator for the Arusha Region, Belinda Mumbuli, 9.6 percent of wom-en who gave birth in the region in 2022 were girls under the age of 20.

The girls experience many complications before and during birth, including obstructed labour, whereby some end up developing fistulas, hypertensive disorders, anaemia, and postpartum haemorrhage that sometimes leads to death.

“Their bodies are not well prepared for pregnancy; therefore, some of these girls die from haemorrhage and hyper-tensive disorders,” she said.

The main causes are uterine atony, retained placenta, genital tract lacerations, and coagulation disorders.

According to the World Health Organisation (WHO), maternal mortality is unacceptably high.

About 287,000 women died during and following pregnancy and childbirth in 2020.

Almost 95 percent of all maternal deaths occurred in low and lower-middle-income countries in 2020, and most could have been prevented.

According to the UN’s Sustainable Development Goal (SDG) regions and sub-regions, Sub-Saharan Africa and Southern Asia accounted for around 87 percent (253,000) of the estimated global maternal deaths in 2020.

Sub-Saharan Africa alone accounted for around 70 percent of maternal deaths (202 000), while Southern Asia account-ed for around 16 percent (47 000).

Women in low-income countries have a higher lifetime risk of maternal death.

A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a ma-ternal cause.

In high-income countries, this is 1 in 5300, versus 1 in 49 in low-income countries.

Given the situation, a midwife from the Oltetesi area of Longido District, Anna Simeil, who has for years carried out mutilations, has stopped doing the practice after undergoing training. She said she now focuses more on midwifery.

Ms Simeil said people from the community shun hospitals and therefore do not take their wives to clinics or even the hospital during birth.

“I perform midwifery services in my village because a majority of the people don’t go to hospitals, but if I detect a complication, I advise the family to take the mother to a hospital for safe delivery,” she said.

She also used to accompany hospital mothers who had developed complications to ensure their safe delivery.

The WHO report recommends that it is vital to prevent unintended pregnancies in order to avoid maternal deaths.

Most maternal deaths are preventable, as healthcare solutions to prevent or manage complications are well known.

All women need access to high-quality care in pregnancy and during and after childbirth.

Maternal health and newborn health are closely linked.

All births must be attended by skilled health professionals, as timely management and treatment can make the differ-ence between life and death for the woman as well as for the newborn.

Severe bleeding after birth can kill a healthy woman within hours if she is unattended.

Injecting oxytocin, a natural hormone that manages key aspects of the female reproductive system, including labour and delivery, immediately after childbirth effectively reduces the risk of bleeding.

Infection after childbirth can also be eliminated if good hygiene is practiced and if early signs of infection are recog-nised and treated promptly.

Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications.

Administering drugs such as magnesium sulphate for pre-eclampsia can lower a woman’s risk of developing eclampsia.

Seconding the report, the executive director of MWO, Rose Njiro, whose organisation works in the Manyara and Arusha regions, helping Maasai girls and women fight against abuse, said girls lose their lives when giving birth, mostly due to excessive bleeding.

“Just the other day, we lost a 14-year-old girl; she bled a lot when giving birth at home, and by the time she was rushed to Mt. Meru hospital, she had lost her life together with the baby.

“This follows my experience after I was married as a third wife at 13 years old to a 62-year-old man.

“We had four beautiful girls after having passed through a difficult period in my marriage because I was married very young and not aware of the responsibilities facing me as a married woman,” she said.

Ms Njiro suffered a fistula after her first delivery because her body was not well prepared for pregnancy and giving birth.

She said no woman should go through the pain and suffering associated with a fistula. Thanks to medication, she was cured.

She noted that after undergoing the difficult period, her mother-in-law was angry with her for failing to behave like a married woman.

“I stayed in the marriage for 10 years; I was taken out of the marriage and helped to go to court,” she said.

According to her, the woman who helped her gave her shelter, food, and clothing until she could support herself.

She later opened an NGO to help girls and women who were going through what she had also experienced.

”Remember, I am doing this because I also went through the same challenges. So far, I have been able to save at least 37 girls from ages 10 to 20.

“Don’t be surprised if Masaai marry their girls at the tender age of 10 years,” she said.

According to her, the girls are married off and have the responsibility of providing for the family financially as well as taking care of the family.

“The girls are married off and get pregnant; they give birth at home and face many risks, and some die due to severe bleeding, which the community believes is caused by the mother’s curse,” she said.