New Delhi: Researchers at International Food Policy Research Institute (IFPRI), a global research centre, through a recent study have linked stunted growth among children with adolescent pregnancy. The study suggests that one in every four women who have given birth between 2010 and 2016 has been a mother in her teenage.
The report also found that stunted growth and underweight prevalence were 11 percentage points higher in children born to adolescent mothers (10-19 years) than in children born to adult mothers. The teenagers have got married even earlier at a mean age of 16.4 years.
At all ages till five years, the children born to adolescent mothers had lower height and weight as per their age, than the children born to young adults or adult women, the study says. The teen mothers were shorter, underweight and anaemic, with poorer access to health services during the crucial first 1000-day period; and had poorer complementary feeding practices as compared to the adult mothers. Citing a study from Bangladesh, the report reasoned the finding as pregnancy and lactation ceases the linear growth of the infants. It happens due to a ‘concurrent competition’ for nutrients between both the growing mother and foetus.
Further, it’s not the children who alone get impacted. Pregnancy and childbirth complications lead to deaths of the adolescent women also.
India is home to the largest number of stunted and wasted (lower weight for height) children. One in almost every three children under five in India, is stunted. Pakistan fares better, at third with 10.7 million stunted children.
As per the Global Nutrition Report (GNR) 2018, about half of all Indian girls including the teenagers have been underweight for over a decade now. Despite that, NFHS-4 found eight percent of the teenagers bearing child; a decline from 12 percent as in NFHS-3. Five percent of the teenagers have had a live birth.
Pregnancy among teenage girls is relatively high in rural areas and among the scheduled tribes (11%), stated the NFHS-4. Nearly one in every 10 women in rural areas within the adolescent age group has begun childbearing. By religion, the ratio has been high among Hindus, Muslims and Buddhists. Twenty percent of the teenage girls with no schooling have already begun childbearing. The IFPRI report also found out that the adolescent mothers were from disadvantaged groups, had lower education, less bargaining power and lived in poorer households with poorer sanitation.
As per a 2012 World Bank report, adolescent pregnancy cost India 12% of its GDP, which equals nearly 400 billion USD, i.e. Rs 28 lakh crore as per today’s rate. Among the leading states are Tripura, West Bengal, Assam, Bihar, Jharkhand and Andhra Pradesh – whose contribution is more than the average of India (7.9%).
All the other states were among the top outlier states in the NFHS-3 (2005-6) report too, except Assam that replaced Karnataka. West Bengal, Bihar, Jharkhand and Andhra Pradesh have collectively reduced the ratio of adolescent pregnancy by over 10 percent. Bihar and Jharkhand had achieved a significant drop.
Credits can be given to the government for its intervention. The Union government has come up with several programmes to address the health emergency as well as the population burden. Reproductive Child Health Phase-II (RCH-II) was introduced in 2005 and it looked into the Adolescent Reproductive Sexual Health (ARSH), which aimed at reorganising existing public health facilities and introducing sex education in school curriculum.
A 2012 report of Overseas Development Institute and Save the Children undermines the condition of sex education in schools. “Since 2007, six states have banned the co-curricular sex education programme that had been implemented in 150,000 schools across the country – a worrying development given that less than 20% of Indian teens were aware of at least one method of contraception,” said the report adding that the non-specialist teachers found the subject uncomfortable and avoided it. About 61% of girls did not have access to awareness programmes on contraception and sexual health. Family planning policies, messages and clinics emphasised on female sterilisation when all these females wanted was to delay their first pregnancy; very limited adolescents had access to contraceptive measures, the report added.
The Union government in 2004-05 formed National Population Stabilization Fund, which later came to be known as Jansankhya Sthirta Kosh (JSK). A body to take measures for population control, the JSK launched ‘Prerna’ strategy to push the girls’ marriage age among other aims. Focusing on the highly populated states like Bihar, UP, MP, Rajasthan, Jharkhand, Chhattisgarh and Odisha, new mothers were monetarily incentivised if they were married after 19 years of age.
The JSK website was not working at the time of filing this report and the last mention of the scheme appeared in an answer in the Rajya Sabha in 2016.
Under Kanyashree scheme, the West Bengal government since 2013, is also giving away cash incentives to girls of 18 years, provided they are unmarried and remain in education. On the contrary, teenage pregnancy ratio in Tripura has in fact fractionally increased.
Notably, adolescent pregnancy is not solely responsible for malnourished children. The states that lead in stunting, underweight, wasting and anaemia are not necessarily the ones that lead in teenage pregnancy. Only Jharkhand and Bihar are among the top five outlier states for stunting and underweight as well as for childbearing teenagers.
Noteworthy, several of the leading malnourished states also appear in the list of top contributors of child marriages.
Except Rajasthan, all the BIMARU states — Bihar, Madhya Pradesh and Uttar Pradesh — are among the top contributors of malnourished children. All these appear in the list of leading states with childbearing teenagers. Coincidentally, most states with malnourished states are also the states with maximum number of child marriages.
India is among the top 10 countries with the largest burden of teenage pregnancy. While marriage of under-18 girls is illegal, the 2016 National Family and Health Survey (NFHS-4) revealed that 27 percent of girls are married before their eighteenth birthday; and 31 percent of the married Indian women gave birth by the age of 18 years.
The Teenage Girls Survey 2018 (TAG Survey) by Naandi Foundation indicates towards a contradictory will of the girls. Through a direct conversation with 74,000 girls across India, the survey found that 73.3 percent of teenage girls want to marry only after the age of 21. “Unfortunately, in India, early marriage and subsequent pregnancy is often not a deliberate choice, but rather the result of an absence of choices, and of circumstances beyond a girl’s control,” said Purnima Menon, IFPRI senior research fellow and co-author of the study.
“Unfortunately, in India, early marriage and subsequent pregnancy is often not a deliberate choice, but rather the result of an absence of choices, and of circumstances beyond a girl’s control. Despite a legal framework against child marriages, if it continues to take place, then apart from policy implementation, the challenge is more local. Both needs to be addressed,” IFPRI senior research fellow and co-author of the study, Purnima Menon told this reporter.
Additionally, the 2012 report highlights the lack of access for family planning options among the young women. The report quotes, “only 6.9% of married teens reported using contraceptives in the 2006 DHS; this is compared with 25.3% of unmarried teens.”
For the country that still struggles to establish Right to Food for all, the GNR flagged that India does not have ‘presence of policy, legislation and institutional arrangement’ for stunting, nor a multi-sectoral comprehensive nutritional plan. In 2018, the Union government has launched the POSHAN Abhiyaan to parliamentary constituency-wise address the malnourishment with help of multiple ministries.
An analysis of the focus on ‘adolescent education, diet and age of marriage’ under the scheme for a year (April 1, 2018 to April 30, 2019) shows that the performance has been ‘below average’ in outlier states like West Bengal, Jharkhand and the north-eastern states.