MILLENNIUM DEVELOPMENT GOAL 5: Improve Maternal Health
Reduce the maternal mortality ratio by three quarters between 1990 and 2015


“For too long, when an adolescent becomes pregnant, we have pointed the finger at her. It is time we pointed the finger at ourselves. If a girl gets pregnant that is because we have not provided her with the information, education, training and support she needs to prevent herself becoming pregnant.”
                                   (Dr.Pramilla Senanayake, Former Assistant Director, International Planned Parenthood Federation)


More than 14 million adolescent girls give birth each year.  More significantly 90% of these births occur in developing countries with the highest levels of adolescent pregnancy being in Africa. More than half of women in Sub-Saharan Africa give birth before the age of 20. Even within developed countries, there is a wide variation: The 15 – 19 year old birth rate in the USA, is 14 times higher than in Japan, and twice as high as in Australia and Canada.


Early births around the world

In Malta, 6% of births in 2007 were to mothers under the age of 20. In addition, statistics show that fewer than 10% of girls have a baby before the age of 18 in countries such as: Japan, Germany, Poland, France, China, Tunisia, Sri Lanka, Great Britain,Morocco, Burundi, Philippines, Rwanda, United States of America, Thailand.

10-20% of girls have a baby before the age of 18 in: Turkey, Peru, Trinidad,Tobago, Egypt, Indonesia, Paraguay, Brazil, Ecuador, Sudan, Pakistan,Dominican Republic, Colombia, Namibia, Bolivia, Zambia, Mexico 20%-30% of girls have a baby before the age of 18 in: Zimbabwe, Ghana,Botswana, Yemen, Kenya, Guatemala, India, United Republic of Tanzania, TogoThese numbers significantly increase in countires such as Madagascar, Burkina Faso, Senegal, Nigeria, Malawi, Central African Republic, Uganda with 30% - 40% of young women having babies before the age of 18 and up to 40% - 50% of girls have a baby before the age of 18 in countries such as Cote DÍvoire, Liberia, Mali, Cameroon and Bangladesh.More than 50% of girls have a baby by the age of 18 in Niger.

Unwanted and early pregnancy at a very young age reflects failure to provide a safe environment that allows young girls to reach adulthood with education, prospects and hope. Most childbearing amongst adolescents is in the context of marriage or other forms of union, and the highest rates to under 18-year-olds are in countries with a high rate of child marriage.  Where is Malta looking when it matters most?In Malta, an increasing number of teenage mothers attend the educational support service for schoolgirl mothers. The unit Ghozza provides guidance and counseling to adolescent mothers as young as 12 years who are often at risk of poverty and the benefit trap as a result of a sudden halt in school attendance and no training skills to support them later on in their working life when they need to be financially independent of their family and the State. For too long we have pointed a finger at teenage pregnancies, yet the sexual health policy remains in the pipeline, and sex education in schools is still a far cry from the exigencies of today’s youth culture.  Teenage girls need targeted attention and together with teenage boys need to be more responsible and involved in sexual health programmes, where they exist. Adolescent boys need to engage more in sexual health programmes, and to end violence against their partners.

Why reduce teenage pregnancies?
• teenage pregnancy increases the risk of HIV infection. Biological factors seem to lead to higher rates of HIV transmission among young girls, but there is also evidence that the physiological condition of pregnancy and lactation may predispose to HIV transmission.

• We need to keep teenage girls in school. Again, the most compelling reason is to avoid the spread of the HIV infection and other sexually transmitted diseases.

Education has proven to reduce the spread of HIV amongst youth and accentuates the importance of sexual health. In addition, young women who stay in school are much less likely to become pregnant at a young age. In the context of high unemployment, it is difficult to make the case that school completion confers economic advantage for the individual. At the same time, economic growth and redistribution both depend on a more educated population.Ways to reduce teen pregnancy. Sub Saharan Africa accounts for two-thirds of HIV-positive persons in the world. Food and clean water are inaccessible to people with a low income which makes up more than half the African population. Teenage girls and young women are in some places five times more likely to become infected than men in the same age group, largely due to gender inequality and lack of education and low socio-economic status. A targeted multi-sectoral approach is required to address the underlying root causes of gender inequality that fuel the spread of the epidemic. 

In the face of a massive HIV epidemic, the following target should be taken up with urgency:
• keep young people in school and get drop-outs back into the system as quickly as possibleIt is known that school leavers tend to have more unprotected sex. This change in sexual behaviour is not adequately explained by the desire to have a child, the length of relationship with partners or marriage. The likely answer is that a significant proportion of girl drop-outs succumb to a set of social pressures and expectations that prevail when they leave school. In a situation of unemployment and insecurity compliance with economic pressures and social expectations is very likely to take the form of sexual partnership with a man who can provide physical and material protection. However, ‘protection’ is often in exchange for unprotected sex. Despite the general expression of optimism about their long-term future, the social and individual sexual behaviour of young women is shaped by the constraints of day-to-day reality. Trying to break out of the constraints has penalties with no guarantee of reward. Most young people feel they just have to settle for what they have. Such a mentality increases risk tolerance.

Action areas
• Adolescent pregnancy is a societal responsibility that needs to be recognized as a link to poverty
• Pregnancy in adolescence should be recognized as a male and female issue
• Pregnant adolescents need protection from discrimination and abuse
• Sexual and reproductive services protect the health of mothers and children, through antenatal and obstetric care
• It is important to involve communities and families in planning, implementing and evaluating activities to reduce maternal mortality in adolescents
• Research gaps in relation to pregnant girls need to be addressed with urgency
• Identify whether and how the role of the media can become more positive