Intended for healthcare professionals


Pregnancy and childbirth are leading causes of death in teenage girls in developing countries

BMJ 2004; 328 doi: (Published 13 May 2004) Cite this as: BMJ 2004;328:1152
  1. Susan Mayor
  1. London

    Complications from pregnancy and childbirth are the leading cause of death in young women aged 15 to 19 in developing countries, warned a report published last week. An estimated 70 000 adolescent mothers die each year because they have children before they are physically ready for parenthood, the report says.

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    The fifth annual State of the World's Mothers report, published by the international charity Save the Children, found that 13 million births (a tenth of all births worldwide) each year are to women aged under 20, and more than 90% of these births are in developing countries.

    Overall, a third of women from developing countries gave birth before the age of 20—ranging from 8% in east Asia to 55% in west Africa. Analysis of the most recent and best quality data from government statistics for different countries or from international surveys showed that complications from pregnancy and childbirth were the leading cause of death for girls aged 15 to 19 years in poorer countries.

    Figures showed that girls in this age group were twice as likely as older women to die from causes related to pregnancy and childbirth. Their babies were 50% more likely to die than children born to women in their 20s. The youngest mothers—those aged 14 and under—faced the greatest risks. Research from Bangladesh showed that the risk of maternal mortality may be five times higher for mothers aged 10 to 14 than for mothers aged 20 to 24.

    Obstructed labour was found to be common in teenage girls, resulting in increased risk of infant death and of maternal death or disability. The report also showed that young mothers and their babies were at greater risk of contracting HIV.

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    The report included an “early motherhood risk” ranking that identified countries where motherhood was most devastating for young girls and their babies. Nine of the 10 highest risk countries were in sub-Saharan Africa, with Niger, Liberia, and Mali topping the list. Countries outside Africa with high risk scores included Afghanistan, Bangladesh, Guatemala, Haiti, Nepal, Nicaragua, and Yemen.

    In the 10 highest risk countries, more than one in six teenage girls aged 15 to 19 gave birth each year and nearly one in seven babies born to these teenagers died before the age of 1 year. The rankings were based on marriage and birth rates among teenage girls in each country as well as on infant mortality for children born to teenage mothers.

    The risk of maternal mortality was one in seven in Niger (at the bottom of the ranking) but only one in 29 800 in the lowest risk country, Sweden.

    Birth rates for adolescent girls in the United States were higher than in any other industrialised country, and in some remote rural communities, adolescent birth rates are higher than in many developing countries.

    State of the World's Mothers is available at

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