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Millennium Development Goal 5 and Adolescents: Looking Back, Moving

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Millennium Development Goal 5 and Adolescents: Looking Back, Moving Progress reports Arch Dis Child: first published as 10.1136/archdischild-2013-305514 on 22 January 2015. Downloaded from Millennium Development Goal 5 and adolescents: looking back, moving forward Joshua P Vogel,1 Cynthia Pileggi-Castro,2,3 Venkatraman Chandra-Mouli,1 Vicky Nogueira Pileggi,2,3 João Paulo Souza,3,4 Doris Chou,1 Lale Say1 1UNDP/UNFPA/UNICEF/WHO/ ABSTRACT HOW IS MDG5 MEASURED? World Bank Special Programme Since the Millennium Declaration in 2000, Global progress on MDG5 is measured through six of Research, Development and Research Training in Human unprecedented progress has been made in the reduction global indicators that were selected through inter- Reproduction (HRP), of global maternal mortality. Millennium Development national consultative processes (summarised in Department of Reproductive Goal 5 (MDG 5; improving maternal health) includes two table 1), including the MMR, the proportion of Health and Research, World primary targets, 5A and 5B. Target 5A aimed for a 75% births attended by skilled personnel, the adolescent Health Organization, Geneva, reduction in the global maternal mortality ratio (MMR), birth rate, the contraceptive prevalence rate, ante- Switzerland 2Department of Paediatrics, and 5B aimed to achieve universal access to reproductive natal care coverage and unmet need for family 1 Ribeirão Preto Medical School, health. Globally, maternal mortality since 1990 has planning. For the period 1990–2012, in all devel- University of São Paulo, nearly halved and access to reproductive health services oping countries, the skilled birth attendance rate Ribeirão Preto, SP, Brazil in developing countries has substantially improved. In increased from 56% to 68% and antenatal care 3GLIDE Technical Cooperation setting goals and targets for the post-MDG era, the coverage (four or more visits by a skilled provider) and Research, Ribeirão Preto, 1 SP, Brazil global maternal health community has recognised that has increased from 37% to 52%. The unmet need 4Department of Social ultimate goal of ending preventable maternal mortality is for contraceptives has dropped from 16% to 12% Medicine, Ribeirão Preto now within reach. The new target of a global MMR of and the contraceptive prevalence has risen from Medical School, University of <70 deaths per 100 000 live births by 2030 is 52% to 63%.1 Globally, rates of adolescent preg- São Paulo, Ribeirão Preto, SP, — Brazil ambitious, yet achievable and to reach this target a nancy appear to be declining over time the ado- significantly increased effort to promote and ensure lescent birth rate (number of births to women aged Correspondence to universal, equitable access to reproductive, maternal and 15–19 years, per 1000 women) decreased from 64 Dr Joshua Vogel, Department newborn services for all women and adolescents will be per 1000 in 1990 to 54 per 1000 in 2011.1 of Reproductive Health and required. In this article, as we reflect on patterns, trends An estimated 16 million adolescents aged 15–19 Research , World Health 1 Organization, Avenue Appia and determinants of maternal mortality, morbidity and years give birth every year. While data on child- 20, Geneva 1205, Switzerland; other key MDG5 indicators among adolescents, we aim bearing girls below the age of 15 years is scarce, a [email protected] to highlight the importance of promoting and protecting recent review of birth rates among girls aged 12–15 the sexual and reproductive health and rights of years in low-resource countries estimated that as Received 12 August 2014 Accepted 31 October 2014 adolescents as part of renewed global efforts to end many as 2.5 million births occur each year to girls preventable maternal mortality. under 16 years of age, up to 50% of which occur in girls under 15 years of age.6 http://adc.bmj.com/ ADOLESCENCE AND PREGNANCY GLOBALLY The number of adolescents (defined as those between GLOBAL PROGRESS ON MILLENNIUM the ages of 10 and 19 years) currently living world- DEVELOPMENT GOAL 5 wide is estimated at 18% of the world population.7 The latest global maternal mortality estimates have This proportion varies between regions, accounting demonstrated a 45% reduction in the global average for 12% of the population in developed countries – maternal mortality ratio (MMR)1 4 compared with and reaching 23% of the total population in the least- on September 28, 2021 by guest. Protected copyright. 1990 levels, from 380 deaths per 100 000 live developed countries.7 While this proportion has births (1990) to 210 deaths per 100 000 live births reduced over time worldwide (due to more general- (2013; figure 1).2 Furthermore, the average annual ised improvements in survival across age groups), in rate of reduction is accelerating, from −2.2% (for sub-Saharan Africa it has increased, a trend that is the period 1990–2005) to −3.3% (for the period predicted to continue.7 The absolute number of ado- 2005–2013).2 Eleven countries have already lescents living worldwide has steadily risen—there is Open Access Scan to access more reached their Millennium Development Goal currently an estimated 1.2 billion boys and girls free content (MDG) 5A maternal mortality targets, and a further worldwide, 90% of whom are living in developing 63 countries have made substantial progress, achiev- countries.7 ing an average annual decline of −2.0% in 1990 to The proportion of adolescent girls (15–19 years −5.5% in 2013.2 While other social, demographic old) who are married or in a union in developing and economic trends (such as improved education, countries (excluding China) is 22%.7 Approximately delayed childbirth and greater economic opportun- 11% of global births occur in adolescent mothers, ities) have contributed to maternal health gains in with 95% occurring in developing countries.8 Half many countries,5 marked improvements in quality of the world’s adolescent births occur in just seven To cite: Vogel JP, Pileggi- of and access to reproductive and maternal health countries (India, Nigeria, Democratic Republic of Castro C, Chandra-Mouli V, services globally as part of the MDG initiative have Congo, Brazil, Bangladesh, China and Ethiopia).9 In et al. Arch Dis Child had a substantial impact on reducing maternal developing countries, evidence suggests that most – 2015;100(Suppl 1):s43 s47. deaths over the past two decades. births to adolescent women occur within marriages Vogel JP, et al. Arch Dis Child 2015;100(Suppl 1):s43–s47. doi:10.1136/archdischild-2013-305514 s43 Progress reports Arch Dis Child: first published as 10.1136/archdischild-2013-305514 on 22 January 2015. Downloaded from Figure 1 Map with countries by category according to their maternal mortality ratio (MMR, death per 100 000 live births), 2013 (reprinted with permission from ref. 2). The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. Dotted lines and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. and are wanted.9 However, these figures must be interpreted with pregnancies in some countries.911Furthermore, a lack of repro- caution due to considerable international variation—in many ductive healthcare services for adolescents (particularly a lack of countries, a significant proportion of adolescent pregnancies are contraceptive education and affordable, available contraceptive neither planned nor wanted. Furthermore, while a pregnancy may commodities) means contraceptive use among married and be wanted by an adolescent’s community, family or partner, the unmarried adolescents is generally low in developing individual adolescent may not wish to become pregnant and may regions,912even while contraceptive use in women of repro- have been pressured into pregnancy. ductive age appears to be increasing globally.1 FACTORS INFLUENCING ADOLESCENT PREGNANCY RISKS OF ADOLESCENT PREGNANCY A range of factors have been implicated in how and why Adolescent pregnancy, especially for younger adolescents, can adolescent pregnancies occur, and while many adolescents carry increased risks of a range of pregnancy and childbirth may wish to fall pregnant, many pregnancies occur in the complications due to underlying biological factors, such as http://adc.bmj.com/ context of human rights violations such as child marriage, gynaecological immaturity and incomplete pelvic growth. coerced sex or sexual abuse.10 Broader socioeconomic factors, However, risks of adverse outcomes among pregnant adoles- such as poverty, lack of education and limited economic oppor- cents can be further magnified by a higher prevalence of risk tunities for girls may also contribute to adolescent pregnancy factors compared with older women, such as malnutrition, rates.9 Other factors, including rurality, ethnicity and cultural smoking, substance abuse, anaemia, malaria, HIV/AIDS and norms have also been associated with higher rates of adolescent sexually transmitted infections.913In addition, of the estimated on September 28, 2021 by guest. Protected copyright. Table 1 Trends in Millennium Development Goal 5 Indicators, developing regions only* 1990 2000 2012† Maternal mortality ratio 380 330 210 (2013) (maternal deaths per 100 000 live births) Proportion of births attended by skilled health personnel (%) 56% 57% 68% Contraceptive prevalence rate‡§ 51.8% 59.8% 62.5% (percentage of women who are using any method of contraception among women aged 15–49 years, married or in union) Adolescent birth rate‡§ 63.7 56.1 54.3 (2011) (number of live births per 1000 adolescent women aged 15–19 years) Antenatal care coverage: 65% 71% 83% At least one visit¶ (%) 37% 44% 52% At least four visits¶ (%) Unmet need for family planning‡§ 16.5% 13.5% 12.4% (percentage of women who have an unmet need for family planning among women aged 15–49 years, married or in union) *Table adapted from Statistical Annex: Millennium Development Goals, Targets and Indicators, 2104.
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