Prioritising The Safety Of India's Young Mothers: A Call To Action

According to the fifth round of the National Family Health Survey (NFHS 5, 2019-21), conducted by the Ministry of Health and Family Welfare, Government of India, the Total Fertility Rate (TFR, defined as the average number of children born to a woman of reproductive age during her lifetime) has declined to an average of 2.0 children per woman. A recent study published in the Lancet indicates that this declining trend in TFR is expected to continue over the next few decades, coming down to a projected TFR of 1.2 by 2050. This trend can be attributed to several factors such as overall socioeconomic development, a rise in women’s literacy, workforce participation and improvements in other empowerment indicators. 

Extending Beyond The Physical Health Of The Mother

Today, India has the largest adolescent population in the world, and almost half of this young and vibrant group comprises adolescent girls filled with hopes and dreams. Unfortunately, the aspirations of most of them remain largely unfulfilled due to the multifaceted challenges they face that impede their overall health and well-being. Child marriage remains a significant contributing factor to early pregnancies, robbing young girls of their childhood and subjecting them to premature motherhood. The ramifications are far-reaching, extending beyond the physical health of the mother and child to social, emotional, and economic dimensions.

Despite the declining trend in TFR, teenage pregnancies continue to be a prevalent phenomenon in many parts of the world today. The statistics present a stark reality. According to UNICEF, globally, an estimated 13 per cent of adolescent girls and young women gave birth before the age of 18 in 2022. Maternal conditions are among the top causes of disability-adjusted life years and death among girls aged 15-19 in the world. Almost one in every two girls in the South Asia region is married before the age of 18, and one in every five becomes a mother before reaching that age. According to NFHS 5, 2019-21, around 8% of currently married girls aged 15–19 years in India were pregnant at the time of the survey.

Early pregnancies not only endanger the health of young mothers but also curtail their educational pursuits, perpetuating a cycle of limited opportunities and diminished prospects. Education is a cornerstone for empowerment, enabling girls to make informed choices about their bodies, health, and future aspirations. However, early motherhood often hinders educational pathways, exacerbating inequalities and hindering socio-economic progress.

Moreover, the intersecting vulnerabilities faced by young mothers extend beyond reproductive health to encompass heightened risks of HIV transmission and gender-based violence (GBV). Lack of access to comprehensive sexual and reproductive health services further compounds these risks.

Concerted efforts are required on multiple fronts to safeguard the well-being of India's young mothers. Firstly, there is an urgent need to strengthen legislative frameworks and enforce laws that prohibit child marriage and protect the rights of adolescent girls. Robust mechanisms for implementation and monitoring must accompany legal reforms to ensure compliance and accountability.

Secondly, comprehensive sexuality education should be integrated into school curricula to equip adolescents with knowledge and skills to make informed decisions about their sexual and reproductive health. By promoting gender-sensitive and empowerment-based approaches, such initiatives can enable young girls to assert their agency and autonomy.

Furthermore, expanding access to adolescent-friendly health services is essential to address the unique needs of young mothers and mitigate the risks associated with early pregnancies. This entails ensuring the availability of contraceptives, antenatal care, and postnatal support services tailored to the needs of adolescent girls, along with providing psychosocial support and counselling. Front-line health workers also need to be re-oriented to overcome their reluctance to provide sexual and reproductive health information and services to adolescents. 

In addition to targeted social and behavioural change communication interventions, addressing the structural determinants of adolescent health requires a comprehensive approach that addresses underlying socio-economic inequities. Investments in education, employment opportunities, and social protection mechanisms can empower adolescent girls, enabling them to realize their full potential and break free from the cycle of poverty and marginalization.

How Women-Led Development Comes Into Play

During its G20 Presidency in 2023, India emphasised the concept of 'women-led development,' recognizing the profound impact empowering women and girls can have on the nation's development. By addressing the underlying determinants of adolescent health and well-being, we can create an enabling environment where every girl has the opportunity to thrive and fulfil her potential. 

Annu Kumari, a young woman from Amawan in the Rajauli subdivision of Nawada district, Bihar, was raised in a community where early marriage was the norm. Her trajectory changed when she crossed paths with Sheela Devi, a mentor at Kishori Samooh (adolescent girls’ group), a programme initiated by the Population Foundation of India, a national NGO working on women’s and young people’s health and well-being. Through Kishori Samooh, Annu received training in menstrual hygiene management, nutrition, and health, coupled with invaluable mentorship aimed at empowering young women to pursue their goals. Through her mentors’ guidance, Annu not only persuaded her family to redirect dowry funds towards her education but also defied societal pressures of early marriage to enrol in Bihar's police academy.

Annu's remarkable achievement is a beacon of hope and a story of resilience and empowerment. We must pledge to champion adolescent girls and ensure a brighter, healthier future for generations to come.

Authored by Sanghamitra Singh, Chief of Programmes at the Population Foundation of India.