Building futures two generations at a time: Introducing Action for Adolescent Maternal and Newborn Health

Picture a pregnant mother, or a mother of a young child. What comes to your mind? What support does she need from her partner, family and community? What questions and concerns does she have? And—this is important—how old is she?  

Often, we assume that a mother is an adult with a loving spouse and a whole network to help keep her and her child healthy. Yet the reality is that many pregnancies and births are to adolescents, who rarely receive the support they need. 

Pregnant and parenting adolescents and their newborns: Two generations of children whose unique needs are neglected

Globally, adolescent pregnancy rates have declined but remain worryingly high. Around 12 million girls ages 15-19 and 2.5 million under age 16 give birth annually in low- and lower-middle income countries (LMICs). (1) Pregnancy and childbirth are especially risky for adolescents and their newborns, leading to poor health outcomes for both. For example: 

• Complications of pregnancy and childbirth are the leading cause of death for girls ages 15-19 in LMICs. (2)  

• Perinatal deaths, including stillbirths, are 50% higher among babies born to mothers under age 20 compared to those ages 20-24. (3)  

And yet, in a literature review and landscape analysis led by Save the Children,(4) we found very few interventions to improve maternal and newborn health (MNH) outcomes for adolescents. MNH interventions have largely assumed that a general package of care and support would meet the needs of both adolescent and adult women. However, we now understand that is not the case: adolescents have unique, unaddressed vulnerabilities that make pregnancy and childbirth inherently riskier. This calls for tailored support. 

Catalyzing action for pregnant and parenting adolescents in Nepal 

In Nepal, although child marriage is illegal, 35% of girls are married before age 18.(5) Adolescent pregnancy is high and usually occurs in the context of child marriage.(6) Pregnant and parenting adolescents are more likely to access antenatal care late, make fewer visits during pregnancy, and less likely to receive postnatal care.(7) 

Adolescents’ access to health services is impeded by: 

• Social and gender norms that limit girls’ decision-making 

• Limited information to help girls understand the importance of health services and where to access them 

• Health facilities that do not offer privacy and are not prepared to tailor counseling and care to adolescents’ needs, and may even treat adolescents with disrespect 

• Few mechanisms to bring adolescents’ voices into discussions to design and improve services to meet their needs.  

In response to these realities, Save the Children is proud to launch a new project, Action for Adolescent Maternal and Newborn Health (aMNH) to be implemented with partners Panchtara Yuwa Samrkshyak (PTYSM), Village Development and Save the Environment Forum (VDSEF) and Karnali Integrated Rural Development and Research Cente (KIRDAC). We will work in Karnali, the largest province in Nepal, where 20.5% of girls ages 15-19 have been pregnant —the highest rate in the country—compared to 13.6% nationally.(8)  

Over three years, Action aMNH will design and implement tailored approaches to support pregnant and parenting adolescents in Karnali. Here is what most excites us about this work: 

• We are leveraging momentum: Our earlier work in Nepal, including the Healthy Transitions for Nepali Youth Project, provides a foundation of how-to insights and tested strategies.(9) We will build on existing Healthy Transitions groups to reach more pregnant and parenting adolescents, incorporate content addressing their needs, and provide home visits to build family support and address adolescents’ questions in a private setting.  

• We are confronting disrespectful health care: To understand the complex, multifaceted factors driving disrespectful care for adolescents, we will use participatory methods to co-design key approaches with adolescents, healthcare providers and a youth-led partner to be identified 

• Adolescents are taking the lead: We will explore creative, anonymous approaches to gather pregnant and parenting adolescents’ feedback on experience of care to feed into existing social audits and quality improvement processes. Voices of pregnant and parenting adolescents are usually missing from these mechanisms; many are scared to contribute because these forums are not anonymous, and they are concerned that it is illegal for them to be married before age 20. 

• We are filling in the data gaps: Through a robust learning agenda, our hope is this work will narrow critical evidence gaps and inform efforts to better support pregnant and parenting adolescents. 

We must also accelerate our efforts to help adolescents delay pregnancy until they are ready. At the same time, the 12 million adolescents who do become mothers each year urgently need support. We have a long way to go in closing the gap, but we look forward to sharing what we learn along the way. 

Citations:

[1] WHO. (2018) Adolescent Pregnancy Fact Sheet. Geneva: Switzerland

[2] Global Health Estimates (GHE). Causes of death among adolescents. In: Maternal, newborn, child, and adolescent health. Geneva: World Health Organization; 2016 (https://www.who.int/maternal_child_ adolescent/data/causes-death-adolescents,

[3] World Health Organisation. (2016) Global health estimates: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: Switzerland,

[4] Save the Children (2024). Young, vulnerable and unattended. What we know about adolescent maternal and newborn health, and opportunities for learning

[5] https://www.girlsnotbrides.org/learning-resources/child-marriage-atlas/regions-and-countries/nepal/

[6] NHRC and UNICEF (2024), Behavioural Determinants of Child Marriage and Adolescent Pregnancy in Nepal: A qualitative study. Kathmandu, Nepal: Nepal Health research council (NHRC) & United Nations Children’s Fund.

[7] Ministry of Health and Population, Nepal; New ERA; and ICF. 2022. Nepal Demographic and Health Survey 2022: Key Indicators Report. Kathmandu, Nepal: Ministry of Health and Population, Nepal.

[8] Ministry of Health and Population, Nepal; New ERA; and ICF. 2022. Nepal Demographic and Health Survey 2022: Key Indicators Report. Kathmandu, Nepal: Ministry of Health and Population, Nepal.

[9] Bhandari, R., Malakoff, S., Thakuri, D.S. et al. Findings from a mixed-methods evaluation of a multi-level adolescent and youth reproductive and maternal health intervention in Karnali Province, Nepal. BMC Women’s Health 23, 269 (2023https://doi.org/10.1186/s12905-023-02425-w).