Second Opinion

NATURE does not always know best. One clear example is the danger of pregnancy for teenage girls. Just because girls are capable of becoming pregnant does not mean they are physically mature enough for an uncomplicated pregnancy and delivery. In many parts of the world, young girls who become pregnant under the age of 16 face a real risk of death; in Africa, the maternal mortality rate in girls aged 10-14 is five times higher than in women aged 20. In Western countries, teenage pregnancies carry substantial risks for the baby even if the mother's life is not seriously threatened.

The main hazard for the very young mother is that her pelvis will not have finished growing and will not be big enough for the baby to pass through. Most are lucky, but if the baby is too large for the pelvis the mother has to hope she will be able to be delivered using forceps or by caesarean section. Without skilled obstetric care, she will face a long, obstructed labour likely to end with a dead baby and damage to her pelvic organs - even if she escapes with her life. The World Health Organisation is urging governments in Africa, Asia and the Amer-icas to "ensure that their populations are aware of the need for both parents to be fully grown, adequately nourished, and disease-free before conception". At present, says a report in the Lancet, in countries such as Niger nearly half the women are married by 15 and 40 per cent have a child by 17.

The teenage mother in the West is likely to be better nourished and physically more mature, but prospects for her baby are still worse than for an older woman. Babies born to teenagers are smaller, more likely to be premature and more likely to die during the first year of life. Until recently the assumption was that these risks were linked to the social deprivation of many teenage mothers, who are more likely than the rest of the pregnant population to be unmarried, less well educated, and (in the US and Britain) non-white. Yet research in Utah shows that white, married women in their teens who receive quality care during their pregnancies have poorer outcomes than older wom-en. Their babies are twice as likely to be premature and undersized. Teenagers who had sub-standard care in pregnancy had even poorer outcomes, but the striking finding was the increased risk for mothers under 20, one that continues into the next pregnancy; a second baby born to a teenager is also more likely to be underweight or premature. The explanation for the higher risk of complications in teenage pregnancy in the West is likely to be similar to that in developing countries: a teenager hasn't finished growing. This may lead to both mother and infant competing for nutrients, while the immature uterus may predispose the moth-

er to infective and other complications.

Some politicians are likely to use these statistics to denigrate teenage mothers. The message the WHO wants politicians to ab-sorb is that the next generation of children will be healthier if mothers can choose not to become pregnant until they are mature. That means providing teenagers with the sex education and contraception they need to take control of their reproductive health.