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MATERNAL MORTALITY IN ADOLESCENTS

Friday, 31st of January 2014

MATERNAL MORTALITY IN ADOLESCENTS COMPARED WITH WOMEN OF OTHER AGES: EVIDENCE FROM 144 COUNTRIES

Original Text

Dr Andrea Nove PhD a , Prof Zoë Matthews PhD b, Sarah Neal PhD b, Alma Virginia Camacho MD c

Background

Adolescents are often noted to have an increased risk of death during pregnancy or childbirth compared with older women, but the existing evidence is inconsistent and in many cases contradictory. We aimed to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15—19 years by country, region, and worldwide, and to compare these ratios with those for women in other 5-year age groups.

Methods

We used data from 144 countries and territories (65 with vital registration data and 79 with nationally representative survey data) to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each 5-year age group from 15—19 to 45—49 years. We adjusted these estimates to take into account under-reporting of maternal deaths, and deaths during pregnancy from non-maternal causes. We then applied the adjusted PMDFs to the most reliable age-specific estimates of deaths and livebirths to derive age-specific maternal mortality ratios.

Findings

The aggregated data show a J-shaped curve for the age distribution of maternal mortality, with a slightly increased risk of mortality in adolescents compared with women aged 20—24 years (maternal mortality ratio 260 [uncertainty 100—410] vs 190 [120—260] maternal deaths per 100 000 livebirths for all 144 countries combined), and the highest risk in women older than 30 years. Analysis for individual countries showed substantial heterogeneity; some showed a clear J-shaped curve, whereas in others adolescents had a slightly lower maternal mortality ratio than women in their early 20s. No obvious groupings were apparent in terms of economic development, demographic characteristics, or geographical region for countries with these different age patterns.

Interpretation

Our findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of womens educational, social, and economic development.

Funding

WHO, UN Population Fund.

a Evidence for Action, Options Consultancy Services, London, UK

b Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK

c United Nations Population Fund, Latin America and the Caribbean Regional Office, Panama City, Panama

Correspondence to: Dr Andrea Nove, Evidence for Action, Options Consultancy Services, London E1W 1LB, UK