Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries

This Lancet paper sets out to quantify the risk of maternal death in adolescents by estimating maternal mortality ratios for women aged 15–19 years by country, region, and worldwide. It further aims to compare these ratios with those for women in other five year age groups.Adolescents are often thought to be at greater risk of death during pregnancy or childbirth than women in other age groups.But mortality risks to adolescent mothers have not been accurately quantified, and most studies tend to calculate single mortality figures for women and girls across all age groups. This paper therefore seeks to provide separate estimates of mortality risks faced by adolescent mothers.The authors used vital registration data (when available) or nationally representative surveys from 144 countries and territories, to calculate the proportion of maternal deaths among deaths of females of reproductive age (PMDF) for each five year age group (from 15-19 to 45-49).These estimates were adjusted to account for under-reporting of maternal mortality and deaths during pregnancy from non-maternal causes. The authors then applied the adjusted PMDFs to age-specific estimates of deaths and livebirths to calculate age-specific maternal mortality ratios (MMRs) across age groups.An annex to the main paper provides age-specific maternal mortality estimates for all 144 countries.  This paper concludes that the excess mortality risk to adolescent mothers may be less than previously expected, and highlights the very high mortality ratios for women aged 35 and above. It, however, insists that these findings should not divert focus away from efforts to address adolescent pregnancy.Key findings:

• 10% of maternal deaths in the 144 countries included are to adolescents (15-19 years old)
• The 20 countries with the largest number of adolescent maternal deaths account for 82% of the world’s total
• In most regions, the age distribution of maternal mortality follows a J-shaped curve, with a slightly increased risk of death in adolescents as compared to women between 20 and 24 years old
• However, overall, in most countries the adolescent maternal mortality ratio is low compared with women above 30
• There are significant variations across countries, with the J-shaped curve being more or less pronounced depending on settings
• In addition, adolescents in some countries were found to be at lower risk of death than women in their early 20s and even than women in all other age groups
• Differences amongst countries did not seem to follow obvious patterns in terms of economic development, demographics, or geography - they may however reflect a range of underlying socio-economic, biodemographic and physiological factors

Country-specific findingsEthiopiaLike the overall results, there was a J-shaped curve in Ethiopia, with the MMR for 15-19 year-olds 25% higher than for 20-24 year-olds, and much lower than for women aged 30 and over. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Ethiopia, for which the estimates were calculated from the 2011 DHS. GhanaLike the overall results, there was a J-shaped curve in Ghana, but unusually, the maternal mortality ratio for adolescents in Ghana was almost four times as high as the MMR for 20-24 year-olds and 65% higher than the MMR for 25-29 year-olds. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Ghana, for which the estimates were calculated from the 2007 Maternal Health Survey. MalawiIn contrast to the overall results, the MMR for 15-19 year-olds in Malawi was virtually the same as for women aged 20-24, and much lower than for women aged 25 and over, indicating that there is no excess risk of maternal death associated with adolescent pregnancy. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Malawi, for which the estimates were calculated from the 2010 DHS.  It is therefore possible that adolescents are actually at higher risk of maternal death when compared with women aged 20-24.NigeriaIn contrast to the overall results, the MMR for 15-19 year-olds in Nigeria was the same as for women aged 20-24, and much lower than for women aged 30 and over, indicating that there is no excess risk of maternal death associated with adolescent pregnancy. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Nigeria, for which the estimates were calculated from the 2008 DHS.  It is therefore possible that adolescents are actually at higher risk of maternal death when compared with women aged 20-24.Sierra LeoneLike the overall results, there was a J-shaped curve in Sierra Leone, with the MMR for 15-19 year-olds 23% higher than for 20-24 year-olds. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Sierra Leone, for which the estimates were calculated from the 2008 DHS. TanzaniaIn contrast to the overall results, the MMR for 15-19 year-olds in Tanzania was the same as for women aged 20-24, and much lower than for women aged 25 and over, indicating that there is no excess risk of maternal death associated with adolescent pregnancy. It should be noted that the uncertainty estimates are wide, especially for countries reliant on survey data, such as Tanzania, for which the estimates were calculated from the 2010 DHS.  It is therefore possible that adolescents are actually at higher risk of maternal death when compared with women aged 20-24.To read this article for free, click here>Nove A., Matthews Z., Neal S., & Camacho A.V. (2014). Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. The Lancet Global Health. 2(3): e155-e164.