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Married adolescent girls are perhaps the most vulnerable of all segments of the sexually active population—exposed at a young age to the risks of infection, pregnancy, and childbirth and yet mostly without the protection afforded by education, economic security, social networks, and a mature body physiologically ready to bear children. Early marriage (defined here as before age 18) is especially common among girls in West Africa, South Asia, and in some countries in Latin America.
Married adolescent girls have many profound needs, and yet they have little power to meet those needs and to make autonomous decisions affecting their own welfare. Avoiding early childbearing is one of the most acute needs of married adolescent girls, and strengthening family planning programs and policies to help married girls—and their spouses—postpone first births and space subsequent births should be a high priority for reproductive health programs.
Family Planning Needs
Childbearing
during the early adolescent years harms both mother and child. The risks of
maternal morbidity (including obstetric fistulas), maternal mortality, and
infant mortality are much greater than for mature women. Nevertheless,
adolescent childbearing is common in large parts of the developing world. In
sub-Saharan Africa the majority of women have given birth at least once by the
time they reach age 20. Research shows that most young married girls in
developing countries do not want to bear children at such early ages. Nor do
they want to bear the burden of repeated pregnancies and large families while
they are themselves still children. Yet, in many situations young married girls
are under pressure to demonstrate their fertility soon after marriage, and they
lack the autonomy to make decisions about contraception and other aspects of
their reproductive lives. 1 The
pressure to bear children soon after marriage frequently comes from the husband
and/or mother-in-law and has obvious implications for both the decision to use
contraception and the type of contraceptive to use.
In such an environment a young married girl faces many challenges in order to postpone her first pregnancy and space subsequent pregnancies (ideally at least three years between pregnancies). These obstacles are not unique to married adolescents, but in many ways they are accentuated in this group. These hurdles include:
Special Considerations When Counseling
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Although these obstacles are difficult to overcome, program interventions can address them by focusing on the needs of individual clients, including quality and access issues.
Contraceptive Options
A married
adolescent girl has many contraceptive options to help her postpone her first
birth and space subsequent births. The World Health Organization’s Medical
Eligibility Criteria do not rule out any method on the basis of age alone.
2
Nevertheless, some methods are likely to be more appropriate than others, based
on the personal characteristics of the client. For example, female sterilization
is rarely, if ever, appropriate for married girls (although medically eligible)
because most girls want children in the future.
In developing countries overall, oral contraceptives (OCs) are the method that married girls age 15-19 most commonly use. (In contrast, condoms are more popular among unmarried girls.) As use of injectables continues to grow, this method is beginning to supplant OCs in some countries as the preferred method among this age group.
Program Implications
The most important
way that a program can reduce the risks associated with early childbearing is to
work with communities, policy makers, and families to change community norms,
enhance education for girls, and take other steps to help delay early
marriage.3 To meet
the family planning needs of adolescent girls already married, programs can
address needs at multiple points:
1Mathur S, Greene M and Malhotra A. Too
Young to Wed: The Lives, Rights, and Health of Young Married Girls. Washington,
DC: International Center for Research on Women, 2003.
2Medical Eligibility Criteria for Contraceptive Use. Third
Edition. Geneva, World Health Organization, 2004. Available at: http://www.who.int/reproductive-health/publications/mec/index.htm
3Haberland N, Chong EL, and Bracken HJ. Early
Marriage and Adolescent Girls. YouthLens No. 15. Arlington, VA: FHI/YouthNet,
2005