Keeping girls in school cuts child, maternal mortality


“Educate them [girls] and empower them and keep them in school as long as you can and those women are the best agents of change. No question about it,” said Margaret Chan, Director-General of WHO answering a question on how to reduce teenage pregnancy at a recently concluded Partners’ Forum conference in Johannesburg.

Despite the pivotal role of education in improving health outcomes in children, delaying marriage and avoiding teenage pregnancy, there are currently about 60 million school-age children out of school across the world.

In India, nearly eight million children have never stepped inside a school and the dropout rate is about 80 million, UNICEF noted.

“When you educate a girl, you educate a nation,” Erna Solberg, Prime Minister of Norway said while addressing the delegates. “I see education as a prime mover for long-term, home-grown sustainable development. Access to quality education, as well as health, is important for human development.”

The Norwegian government has recently committed to doubling its contribution to the global partnership for education for the next three years bringing it up to $100 million per year. “We know [that] increasing awareness about health among teens through education can have life-saving and life-changing consequences,” she said.

Driving home the important message of educating girls, Ms. Solberg said that if all women were to complete primary education in the low- and middle-income countries, there would be a 50 per cent drop in mortality of children aged under five years. And if they were to complete secondary education, a 40 per cent reduction in child mortality could be achieved. “This means preventing 2.8 million child deaths a year,” she said.


Margaret Chan, Director-General of WHO. – Photo: R. Prasad

According to a 2013 UNFPA report, globally, India has the largest number (95 million) of adolescent girls aged 10-17 years. And not surprisingly, in 2010, India had the highest number — 47 per cent (about 12 million) — of adolescent pregnancies in the world. Globally, child marriage is an important driver of early pregnancies; about 90 per cent of such pregnancies occur within marriage.

A 2009 PLoS ONE study found 44·5 per cent of women aged 20-24 years in India were married as a teenager; 22·6 per cent of them were married before age 16 years. A third of them had no formal education and more than two-thirds resided in rural areas.

Child marriage in India had all the well-documented problems — “no contraceptive use before first childbirth, high fertility (three or more births) a repeat childbirth in less than two years, multiple unwanted pregnancies, and abortion.”

Having a baby much earlier in life combined with multiple pregnancies within a short span of time exponentially increases the risk of child death. Adolescent pregnancy is often associated with premature delivery, stillbirth, foetal distress, birth asphyxia, low birth weight, and miscarriage.

There is a 50 per cent likelihood of stillbirth and death in the first week of life in babies born to mothers younger than 20 years than in those aged 20-29 years. There is also about 20 per cent risk of maternal mortality in adolescent mothers. According to the WHO, 14 per cent (2.5 million) of all unsafe abortions in low- and middle-income countries are among mothers aged 15-19 years.

A multi-pronged approach is needed to reduce the number of teenage pregnancies. First, increasing school enrolment even while reducing the dropout rate. Second, improving the quality of education. Third, providing girls with the much needed sex and reproductive education. Fourth, providing access to child-friendly health services. Finally, reducing the prevalence of child marriage.

(The Correspondent participated in the Partners’ Forum in Johannesburg at the invitation of Global Health Strategies, New Delhi.)

Published in The Hindu on July 9, 2014