Health risks from premature birth high as child marriage continues

By Radha Luitel,Phidim, June 5: Samjhana (name changed),  a resident of Phalelung Rural Municipality in Panchthar district, eloped when she was only 14 years old and got pregnant immediately. 

She got into preterm labour in the seventh month and gave birth to a daughter at the Panchthar District Hospital in March 2023.

The infant weighed 900 grams and died within 12 hours of her birth.

According to the hospital, even the mother's weight was only 41 kilograms when she was brought to the hospital. 

Two months after she gave birth, Samjhana still has a poor health condition.

Likewise, 18-year-old Kalpana (also name changed), a resident of Yangwarak Rural Municipality in Panchthar, gave birth to her third child at the district hospital recently.

As doctors found it difficult to conduct delivery, Kalpana's third child was delivered through the caesarean section.

Kalpana had also eloped when she was in school. She became the mother of her first child when she was only 14. Her first child is now three-and-a-half-year-old. The very next year, she gave birth to her second child, who is now two-year-old. The first two children are skinny, she said.

In the final week of February 2023, a 14-year-old girl, a tenth grader at a school in Phidim, gave birth to a daughter whose weight was 1,600 grams. Likewise, a 16-year-old girl from Phidim had also given birth to a child weighing 1,700 grams at the Panchthar District Hospital in March 2023. 

According to the Panchthar District Hospital, around 100 females arrived at the hospital for child delivery in a month and around 35 per cent of them were aged below 20 years. 

"A total of 835 females visited the hospital for child delivery in the first nine months of the current fiscal year 2022/23. Among them, 145 were aged below 20 years. Of the 145 cases of early pregnancy, 19 females gave preterm birth. Three of the premature children died within 24 hours of their birth," the hospital's data showed.

Complications of early pregnancy 

Dr. Arun Agrawal, a paediatrician at the district hospital, said that the children born prematurely, which means in less than 37 weeks of pregnancy, have poor health and need to be treated seriously with oxygen support.

"It is complicated to treat a child with serious health conditions. It is more complicated to treat a premature child," said Dr. Agrawal.

According to doctors, preventing early pregnancy is the best option to reduce the premature birth rate and neonatal mortality rate.

"Other than early pregnancy, preterm labour can be a result of having a second child in less than 18 months of the first one, lack of nutritious diet and consumption of tobacco and alcohol products during pregnancy," said Dr. Buddhi Bahadur Thapa, an MD in General Practice deployed at the Panchthar District Hospital.

According to Laxmi Joshi, nursing inspector at the district hospital, both the mother and child have high chances of health complications when they give birth before reaching 20.

"There is a long list of problems such as uterine prolapse and urine leakage that occur in mothers after premature delivery. A premature child will have problems in breathing and maintaining body temperature and infection in blood and other parts of the body," said Joshi.

Strict laws, but unimplemented

Section 173 of the National Penal (Code) Act, 2017, prohibits marriage before one becomes 20 years old.

Doctors said that the age restriction for marriage if implemented strictly would help reduce the cases of early pregnancy to a great extent.

Meanwhile, the Nepal Demographic and Health Survey (NDHS) 2022 report shows that 14 per cent of women aged between 15 and 19 years were pregnant, and 10 per cent of them had live births, two per cent had a pregnancy loss, and four per cent were pregnant.

The rate of early pregnancy came down by 3 per cent compared to the NDHS 2016 report.

According to another report prepared by the Paropakar Maternity and Women's Hospital, one of the five pregnant women in Nepal are aged less than 20 years old.

Health experts argued that early pregnancy was a result of child marriage, unawareness and social stigma related to safe abortion among others. Many underaged females also suffer from post-partum depression.

Some under-aged females in Panchthar district were also found not consuming iron supplements due to fear of shame leading to anaemia. 

Since the uterus of a female aged below 20 years is not mature enough to give birth to a child, such mothers can hardly give birth through normal delivery.

Way forward

Health experts suggested the need for providing broader knowledge regarding sexual health in schools. 

Similarly, the government has been requested to inspect the rural areas as child marriage is still prevalent there.

"If the trend of using contraceptives increases, there will be less chance of early pregnancy. We could reduce maternal mortality rate by 30 per cent and infant mortality rate by 10 per cent with the proper use of contraceptives," said Kabita Aryal, chief of the Family Planning and Reproductive Health Section under the Department of Health Services (DoHS).

Aryal argued that despite several stakeholders working in the sector of women and children, coordination among them is missing.

"Through the provincial and local governments, nutritious food should be ensured to the pregnant women and child marriage practices should be restricted," said Aryal.

"There is also misinformation and stereotypes related to reproductive health. There are different sectors that need improvement before bringing the infant and maternal mortality rates down," said Dr. Pawan Jung Rayamajhi, director at the Kathmandu-based Paropakar Maternity and Women's Hospital.