Adolescent women are often overlooked, but they have specific health needs, writes Médecins Sans Frontières’ Women’s Health Advisor, obstetrician Dr Tane Luna.
As a medical humanitarian organisation, Médecins Sans Frontières values International Women’s Day (IWD) as an opportunity to reflect on the medical needs facing women in the countries where we work.
For IWD 2015 we’re focussing on the medical needs of our adolescent patients. Adolescent girls, who fall into the age range of 10 to 19 years, are often overlooked within the maternal and child health sector. Yet as they become sexually active they face a higher risk than adults of complications related to pregnancy and childbirth, and of sexually transmitted infections including HIV.
The teenage years can be a difficult time as young people negotiate their identity, their place in society and their physical development. But in many countries adolescents face another level of difficulty. Girls and young women especially, often miss out on basic sexual and reproductive health education, and face considerable barriers to accessing healthcare. Gender roles can mean that women lack power to make their own decisions about healthcare, but this is exacerbated for adolescents who may also lack the financial power to access the healthcare they need.
When it comes to family planning, younger women may lack the partner, parental and social support to participate—or it may not be offered at all. Perhaps not surprisingly, in countries where family planning coverage remains low, early pregnancy is extremely common—and unsafe. Worldwide, 95 per cent of births to adolescents occur in developing countries.
In projects worldwide, Médecins Sans Frontières provides crucial medical care to adolescent girls. Furthermore, all Médecins Sans Frontières medical services are free and confidential, overcoming some of the barriers that prevent young women from seeking care.
In Kibera, in Kenya, for example, Médecins Sans Frontières provides family planning information and counselling to young women and couples struggling with early parenthood and a lack of appropriate support. I In Dhaka, Bangladesh, Médecins Sans Frontières recently reoriented its project to meet the educational and nutritional needs of pregnant and lactating girls up to age 19. Many of the girls did not know how to prevent pregnancy, and were equally unaware of pregnancy care and its complications.
Pregnancies during adolescence can be particularly dangerous. In fact, maternal causes are the second highest killer of 15–19 year olds, according to the World Health Organization. For many years now Médecins Sans Frontières has prioritised emergency obstetric care to treat the life-threatening complications that arise during pregnancy, delivery, or the postpartum period. In comprehensive Emergency Obstetric and Newborn Care centres in Afghanistan, Nigeria and Haiti, Médecins Sans Frontières manages complications including eclampsia (hypertensive disorder), obstructed labour, and post-partum haemorrhage.
Obstructed labour in younger women typically associates with their lack of physical development and can have devastating and disabling outcomes such as obstetric fistula. Jahun in northern Nigeria is one project where we concentrate on fistula repair – specialised surgery accompanied by months of treatment and rehabilitation without which a young woman may be ostracised for life.
In general, young women are at greater risk of rape than older women. Without appropriate care, as for any woman exposed to sexual violence, this can lead to sexually transmitted infections, HIV, unwanted pregnancy and psychological trauma. The consequences are often far worse for younger women because they may lack the confidence or even the language to explain what happened.
In the slum district of Mathare in Kenya’s capital Nairobi, over 50 per cent of patients at our sexual violence clinic are below the age of 18. A round-the-clock service means psychological and medical care is available. In Tegucigalpa in Honduras, rape is high amongst 10–14 year old girls, who commonly miss out on the limited emergency services available. Médecins Sans Frontières continues to strongly push for better access to care for this vulnerable group.
Adolescence is a time when girls are making choices that will affect the kind of women they will become. How their health needs are met is crucial to their future wellbeing—and their survival.