Breaking the cycle of teenage pregnancy

The fifth series of National Family Health Survey has revealed an alarming picture on prevalence of child marriage and teenage pregnancy in Assam. Bringing down the maternal mortality rate and infant mortality rate of the state will remain an unachieved reality if the twin problem of child marriage and teenage pregnancy remain unaddressed. The survey data show that even though there has been decline in teenage pregnancy from their previous survey in 2015-16 it is still estimated at 11.7 per cent during the survey year 2019-20. Rural areas accounted for 12.5 per cent while urban areas account for 5.8 per cent. Percentage of women in the age group of 15-19 years who were already mothers or pregnant at the time of the previous survey was 13.6. The NFHS-5 survey also registered increase in percentage of mothers in the age group of 20-24 years who were married before 18 years to 31.8 from 30.8 in 2015-16. Percentage of women in this category is as high as 33.4 in rural areas and it is 22.3 per cent in urban areas which indicate high rate of prevalence of early marriage. The minimum age of marriage for women in India is 18 years and for men it is 21 years. Percentage of men in the age group of 25-29 years who were married before the minimum age of marriage has registered significant increase to 21.8 per cent against 15 per cent in 2015-16. Such rising trend of early marriage does not bode well for overall demography of the state and calls for immediate intervention by the government and all stakeholders. Infant and child mortality figures have come down significantly but are still high in the state. The Infant Mortality Rate (IMR) which is defined as number of infants dying before one year of age per 1000 live births has significantly declined to 31.9 in 2019-20 against 47.6 in 2015-16 but in rural Assam the IMR is 33.1. The under-five mortality rate is found to be 39.1 while neonatal mortality rate per 1000 live birth is estimated at 22.5. Teenage pregnancy leads to poor nutritional status of children as such young mothers belonging to poor and underprivileged sections often suffer from nutritional deficiencies during pregnancy due to poor access to healthcare. The data reveal that 35.3 per cent of children under 5 years are stunted, 21.7 per cent are wasted, 9.1 per cent children in the category are severely wasted and 32.8 per cent are under weight in the state. Low level of education of parents as well as early married couples is one of the major causes of prevalence of teenage pregnancies. The survey reveals that 54.2 per cent of pregnant women in the age group of 15-49 years in Assam are anaemic. Percentage of women in the age group 15 to 19 years has sharply increased to 67 per cent from 42.7 per cent during the previous survey. Apart from prevention of early marriage better access to family planning and use of contraception of the early married couple play an important role in preventing teenage pregnancies. Community based interventions can help delay the marriage of girls till they attain the minimum age and preferably beyond till completion of their higher education. Such intervention can produce results only if it is complemented by poverty reduction initiatives and measures aimed at supporting girls continuing their education beyond ten years of schooling. Establishment of institutions of education and providing toilet and sanitation facilities within proximities of their residences will go a long way in educating the girls to empower them to resist early marriage by their parents. Successful implementation of adolescent health programmes will reverse the prevailing trend of teenage pregnancies. Often the teenage girl born to teenage parents end up becoming a teenage mother. More emphasis should be laid on implementing the Rashtriya Kishor Swasthya Karyakram (RKSK), a comprehensive programme that includes all those in the age group of 10-19 years, married and unmarried, poor, and affluent boys and girls, those in schools as well as out of school. One of its objectives of enabling sexual and reproductive health (SRH) aims at improving knowledge, attitudes, and behaviour, in relation to SRH, reduce teenage pregnancies and improve birth preparedness, complication readiness and provide early parenting support for adolescent parents. Peer educators groomed under the scheme play the most critical role. Incentives and support system to improve mobility of girls to educational institutions such as providing bicycles, subsidising travel by public transport can prevent dropout. Civil society organizations engaged in Menstrual health hygiene campaign in educational institutions and among communities should leverage the reach out to make girls, their parents as well as boys aware about the consequences of early marriage and adolescent pregnancies. Achieving gender equality is the key to breaking the vicious cycle of teenage pregnancy.