“It’s about time we make the well-being of our young people more important than ideology and politics. As a country, we benefit from investing in their future by investing in teen pregnancy prevention.” – Jane Fonda
During the past three weeks in my Obstetrics and Gynaecology rotation, I’ve seen a lot of pregnant women. Some, first time mothers, excitedly asking us to record the sound of their baby’s heartbeat and others, mothers many times over, sighing to us, “This is the fifth one.”
I’ve also seen some very young mothers – teenagers – still in school. Some of them with their family supporting them, others very much alone. In Guyana, it was clear that I possibly lived a sheltered life since I remember being surprised when a few years ago (2013), I’d read that according to a report by the United Nations Population Fund (UNFPA), Guyana had the second highest rate of adolescent pregnancy in both the Caribbean and South America: 97 out of every 1000 girls between the ages of 15 and 19 were giving birth. I hadn’t seen this either in my village or at QC. Recently, I read of a 17-year-old Guyanese girl giving birth to her third child!
But here at Port of Spain General Hospital, at least the teen age mother-to-be’s I was seeing were those that made it to clinic for their antenatal checkups. Going by the figures of teenage pregnancies, it would seem like there are so many more pregnant teens that never get to go to those checkups. Trinidad reported that they had 2500 teenage pregnancies in 2014, compared with our 3000 (with half of Trinidad’s population!) for 2013.
And missing those checkups is dangerous for both the mother and her baby. As I’d mentioned before, it’s incredibly important for pregnant women to have regular antenatal checkups so that the doctors will be able to deal with any of the myriad complications that can arise during pregnancy. And it’s doubly important for teenage mothers to get those checkups because there are so many extra complications that can happen due to their age.
Pregnant teenagers are at a higher risk of developing pre-eclampsia, a condition with high blood pressure, kidney damage, liver damage and a host of other complications that can progress to eclamptic seizures. They are also more likely to go into pre-term labour and deliver premature babies. Since teens often become pregnant before their bones are finished growing, their pelvises (‘hips’) aren’t usually wide enough, and a c-section often becomes necessary.
One of the requirements for this rotation was for us to accompany a patient to the Medical Social Worker. And after our visit, it was patently obvious why it was necessary. It was eye-opening and it certainly put things into perspective for us: suddenly complaining about the trials and travails of medical school seemed petty compared to those of several of our patients. We were forced to confront the harsh reality of abuse and incest that some young women have to face. And according to the social worker, those aren’t rare cases.
She explained to us that as doctors, we’re not just supposed to treat the patient and move on – we’re supposed to be advocates for our patients. And in cases where the patient is a pregnant minor, we’re expected to call the Child Protective Unit right away. The state and nation must move away from the “blame the girl” syndrome and recognise its duty to protect its girls. They are people too.
The report cited above has some good advice for us in the Caribbean: it called for a “…new approach (which) must target the circumstances, conditions, norms, values, and structural forces that perpetuate adolescent pregnancies on the one hand and isolate and marginalise pregnant girls on the other. Girls need to have access to both sexual and reproductive health services and to information.”