1. Teenage Pregnancy: Risk and Consequences among Adolescent Women in Rural Haryana Presented by Purva Rai Dwivedi INDEPTH Network Fellow Ballabgarh HDSS Haryana, India Authors: Purva Rai Dwivedi*, Ravinder Bisla, Anand Krishnan

2. Introduction  It has been associated with maternal complications, pregnancy wastage, premature birth, low birth weight, perinatal mortality and increased infant mortality.  One fourth of teenage girls had married by reaching at legal marriageable age i.e., 18 years.(RGI, 2008)  In Rural India early childbearing is common especially, in the states like Rajasthan, Haryana, Uttar Pradesh, Bihar, Karnataka.  Teenage pregnancy is an important public health problem worldwide as it often occurs in the context of poor social support.

3. Objectives  To study the prevalence of teenage pregnancy.  To study the trend in the teenage pregnancy for year 2004 to 2008.  To study the socio-economic determinants of teenage pregnancy.  To study the consequences associated with the teenage pregnancy in Ballabgarh, HDSS.

4. Figure : Geographical map of Ballabgarh HDSS

5. Methods and Materials  Source of Data: Health Management Information System (HMIS) maintained data of intensive field of Comprehensive Rural Health Services project (CRHSP), Ballabgarh, Haryana.  Population : Women of aged 15-49 years at the time of termination of pregnancy during the period 2004-2008 (11,942).  Study Variables: Date of birth of women Date of termination of pregnancy Caste Education of pregnant women Outcome of pregnancy

6.  Date of birth of women was reported at the time of reporting of their marriage by their own or by any other family member.  Age of women may not be exact, it may be overestimated or underestimated.  Education and Caste were used as measures of Socio-economic Status. Measurements  Teenage Pregnancy: Women whose pregnancy was terminated at the age less than 20 years  The age of women at the time of pregnancy was computed by using date of termination of pregnancy and date of birth of the women.

7. Cont…  Caste was classified in five groups Jat: Most prosperous groups in India on a per-capita basis, largely agriculturalists and members of the military. Rajput: Warrior group enjoy a reputation as formidable soldiers. Scheduled Caste and Tribes (ST/SC): Classified on the basis of their social and economic condition. Other Backward Class (OBCs): In the constitution, described as "socially and educationally backward classes“. Others: Includes Muslim, Brahmin, and other caste

8. Results

9. Table 1: Distribution of teenage women whose pregnancy were terminated during the year 2004-2008 Age of WomenFrequencyPercentage 1310.3 1420.6 1530.9 16421.5 178112.6 188123.7 1920760.5 Total342100.0

10. Results  From 11,942 pregnant women, 342 (2.9 %; 2.75, 3.05 ) women were from the age less than 20 years at the time of termination of pregnancy.  This prevalence is much lower as compared to the NFHS-3 estimates for Haryana of the teenage pregnancy i.e., 7.5% live births (which did not include pregnancy wastage)

12. Table 2 : Caste wise distribution of women whose pregnancy were terminated during the period 2004- 2008 Caste Age Group Confidence Interval (<20 years) <20 years (342) >=20 years (11,600) LowerUpper Rajput4.1(80)95.9(1890)3.24.9 Jat2.5(57)97.5(2252)1.93.1 SC & ST3.1(82)96.9(2561)2.43.8 OBC2.4(62)97.6(2510)1.83.0 Other2.5(61)97.5(2387)1.93.1 Total2.9 (342)97.1(11600)2.73.1 Chi-square = 15.1 and p = 0.004

13. Table 3: Education wise distribution of women whose pregnancy were terminated during the period 2004-2008 Education Age GroupConfidence Interval <20 years (342) >=20 years (11,600) LowerUpper Illiterate2.0(79)98.0(3835)1.92.5 less than Primary School Completed 3.4(68)96.6(1929)2.64.3 Primary School Completed3.4(89)96.6(2507)2.74.1 Middle School Completed3.5(59)96.5(1649)2.64.3 High School Completed2.7(47)97.3(1680)2.03.5 Total2.9(342)97.1(11600)2.83.1 Chi-square = 17.4 and p = 0.002

14. Table 4. Age wise distribution of Pregnancy Outcomes among women whose pregnancy were terminated during year 2004-2008. Age group Pregnancy Outcome Live Birth Still Birth Induced Abortion Spontaneous Abortion Total <20 years 76.92.02.318.7 342 >=20 years 80.52.22.514.8 11600 Total78.4(9624)2.2(261)2.5(293)14.8(1764) Chi-square = 3.4 and p = 0.332

15. Discussion  Lower age at marriage and lesser gap between marriage and pregnancy may be one of the reasons of the high percentage of teenage pregnancies.  However, we have legislation for the age of marriage for both girls and boys (18 years for girls and 21 years for boys) but even then, every year many girls get married and become pregnant or give childbirth before turning 20 (teenage pregnancy).

16. Conclusion  Prevalence of teenage pregnancy in Ballabgarh HDSS (2.9%) is much lower than the Haryana state as per NFHS-3 estimates (7.5%).  However, teenage pregnancy decreased during the period 2004 to 2008.  Socio-economic status (Education and caste of women) are important determinants on the teenage pregnancy, though a gradient was not seen.  Teenage pregnancies had poorer outcomes, mainly in the form of higher spontaneous abortion.

17. Recommendations Our existing legislation needs to be enforced properly. Early marriage is a social evil and needs to be addressed at that level. In the meantime, health system needs to recognize this group as high risk and target special intervention.