‘Adolescent, pregnant and forgotten’ – new research identifies maternal healthcare gap for millions of adolescent girls

New research, published in The Lancet and launched at the Scientific Meeting of the International Federation of Obstetricians and Gynecologists in Paris, found that the healthcare needs of pregnant adolescents will continue to be ignored in low and middle-income countries (LMIC) unless there are major changes to healthcare delivery and frameworks.

The study by Murdoch Children’s Research Institute in collaboration with University College London (UCL) in the UK, found that public health policies for adolescents in LMICs focused on pregnancy prevention and did not target crucial areas like childbirth, postnatal care, abortion, mental health, violence or substance misuse.

Murdoch Children's Adolescent and Global Health researcher and General Practitioner, Dr Farnaz Sabet said that while 21 million girls aged 15-19 years become pregnant annually in LMICs (where 97 per cent of global adolescent births occur), there were almost no high-quality services or support for them.

“Pregnancy and motherhood are new and daunting experiences for anyone, let alone for adolescents, yet we see this group missing from global health research – the focus needs to extend beyond reducing teenage pregnancy to providing quality, stigma-free support for those who do become pregnant,” she said.

“We also know that babies born to adolescent mothers in LMICs have a higher chance of being born early, underweight and dying young, while their mothers face humiliation, physical abuse and greater disease risk.”

Utilising global talent, researchers across adolescent and maternal health analysed 20 years of data, focusing on LMICS – where health interventions for pregnant adolescents were found in just 29 of some 140 nations. Some of these LMICs included Mexico, Brazil, Indonesia, China, Nepal, India, Pakistan, Bangladesh, Ghana, Uganda, Tanzania, Nigeria, Burkina Faso and South Africa.

“While we identified useful interventions for pregnant adolescents, including nutritional supplements, complex structural and cultural issues remain – and these do impact the level of care these young people receive,” said Dr Sabet.

She said that without specific and improved research, informing policy frameworks across these nations (and more broadly), higher risks to both babies and their young parents remained.

Co-author and Murdoch Children's Director of the Centre of Adolescent Health Professor Susan Sawyer said that further research, and specific data, is also needed.

“In much-existing research, adolescents aged 15-19 years old have been labelled as ‘women of reproductive age’ and assumed to have the same outcomes as pregnant women in older age groups – which our study found was not the case,” she said.

Professor Sawyer also noted that most studies on pregnancy and maternal outcomes excluded 10 to 14-year-old pregnant girls, who remain the most vulnerable group in this area.

“We cannot allow pregnant girls to continue to be so clearly forgotten – we need global leaders to enact deliberate change, especially those from the fields of obstetrics, gynaecology and adolescent health,” she said.

Additional co-author and co-supervisor Professor Audrey Prost, Co-Director of Centre for the Health of Women, Children and Adolescents at UCL said the needs and rights of these young people matter.

“Pregnant adolescents can and must be included in the global movement for respectful maternity care,” she said.

“Encouragingly, some studies in this review also found that offering pregnant adolescents a space to share challenges, be heard and exercise agency can make a real difference to the quality of their experience.”

Publication

Farnaz Sabet, Audrey Prost, Sadaf Rahmanian, Heba Al Qudah, Mauro Nogueira Cardoso, John Carlin, Susan M Sawyer, George C Patton, ‘The forgotten girls: the state of evidence for health interventions for pregnant adolescents and their newborns in low-and middle-income countries'. The Lancet, 2023.

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Dr Farnaz Sabet, Adolescent Health researcher, Murdoch Children’s Research Institute
Professor Susan Sawyer, Director, Centre for Adolescent Health, Murdoch Children’s Research Institute

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About Murdoch Children’s Research Institute

Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.

Funding

Dr Farnaz Sabet was supported by an NHMRC Postgraduate Scholarship (GNT 1150879) and Clifford Family Scholarship. GP, SS and FS are researchers in the NHMRC-funded Centre of Research Excellence in Driving Global Investment in Adolescent Health (GNT 1171981). GP was supported by an NHMRC Investigator Grant (GNT 1196999).*

*The content of this communication is the sole responsibility of Murdoch Children’s Research Institute and does not reflect the views of the NHMRC.