A woman holds her baby in Nepal
Lisa Shannon
Pregnancy and childbirth are risky, even in wealthy countries. In the world’s least developed regions, they are outright dangerous due to insufficient health infrastructure and services. For adolescent girls in particular, complications from pregnancy or childbirth are still the leading cause of mortality globally. Early and frequent childbearing also negatively impacts infant and child survival. The areas with the fastest growing populations tend to also have the highest rates of maternal and child morbidity and mortality.
Every year, nearly 260,000 women die from pregnancy-related causes. That’s equivalent to over 700 maternal deaths every day — about one every two minutes. Nearly 92% of these deaths occurred in low- and lower-middle-income countries in 2023.
The situation is even worse for teenage girls, whose bodies often haven’t developed enough to safely accommodate a pregnancy or to endure childbirth. Tragically, complications from pregnancy and childbirth are the leading cause of death worldwide for girls ages 15-19.
In addition to early childbearing, frequent childbearing takes its toll. This is the reason birth spacing is encouraged by reproductive health professionals, especially in low-resource settings. The Mayo Clinic recommends waiting 18 to 24 months after giving birth before becoming pregnant again. Of course, for most couples, this will mean they need to use contraception during that time to avoid pregnancy sooner than is safe.
Three-quarters of maternal deaths are due to severe bleeding, infections, high blood pressure, delivery complications, and unsafe abortion. While deaths from safe abortions are extremely rare — fewer than 1 per 100,000 procedures — in regions where unsafe abortions are common, mortality rates can exceed 200 per 100,000. This is especially tragic because most of these deaths could be prevented with the care during pregnancy and childbirth of skilled providers who have access to appropriate medicines and sterile equipment. The World Health Organization (WHO) stresses:
“To avoid maternal deaths, it is also vital to prevent unwanted pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.”
Also according to WHO:
“Women in less developed countries have, on average, many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5,400, versus 1 in 45 in low-income countries.”
Pregnancy and childbirth, even when they don’t cause death, often lead to illness, injury, and disability. The United Nations estimates that for every woman who dies of pregnancy-related causes, 20 women experience pregnancy-related morbidity. One of the main types of maternal morbidity is obstetric fistula—an injury that can occur during obstructed labor wherein a tear occurs between the reproductive tract and either the urinary tract or rectum. This causes urine or feces to leak out through the vagina, which often leads to infection, chronic pain, and community shunning. Up to 100,000 women a year develop this traumatic birth injury.
Early childbearing isn’t only risky for mothers — it also increases risks to newborns, including low birth weight, preterm delivery, and severe neonatal conditions. Frequent childbearing is dangerous to children as well—high fertility and poverty are closely correlated with infant and child death. The countries with the highest infant mortality rates have some of the highest fertility rates and lowest per capita incomes in the world. The primary causes of infant and child death are infectious diseases, diarrhea, and preterm birth, with malnourishment exacerbating the risk of death from these causes.
Improving and expanding health services in low-income settings and making safe abortion care and family planning accessible to all are essential to ending preventable maternal and child mortality and morbidity. In addition, enabling girls to attend school and cracking down on child marriage will go a long way towards protecting teens. These actions also slow population growth, which reduces poverty and thereby indirectly improves maternal and child health as well.
