Verguet Stéphane, Nandi Arindam, Filippi Véronique, Bundy Donald A P
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Tata Centre for Development, Harris School of Public Policy, University of Chicago, Chicago, Illinois, USA.
BMJ Open. 2016 Sep 26;6(9):e011586. doi: 10.1136/bmjopen-2016-011586.
High levels of maternal mortality and large associated inequalities exist in low-income and middle-income countries. Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty. We examined the distribution across socioeconomic groups of maternal deaths and impoverishment among adolescent girls (15-19 years old) in Niger, which has the highest total fertility rate globally, and India, which has the largest number of maternal deaths.
In Niger and India, among adolescent girls, we estimated the distribution per income quintile of: the number of maternal deaths; and the impoverishment, measured by calculating the number of cases of catastrophic health expenditure incurred, caused by complicated pregnancies. We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year. We used epidemiological and cost inputs sourced from surveys and the literature.
The number of maternal deaths would be larger among the poorer adolescents than among the richer adolescents in Niger and India. Impoverishment would largely incur among the richer adolescents in Niger and among the poorer adolescents in India. Increasing educational attainment of adolescent girls might avert both a large number of maternal deaths and a significant number of cases of catastrophic health expenditure in the 2 countries.
Adolescent pregnancies can lead to large equity gaps and substantial impoverishment in low-income and middle-income countries. Increasing female education can reduce such inequalities and provide financial risk protection and poverty alleviation to adolescent girls.
低收入和中等收入国家存在着高水平的孕产妇死亡率以及与之相关的巨大不平等现象。青少年怀孕仍然很常见，怀孕的青少年女性面临着更高的孕产妇死亡风险和贫困风险。我们研究了在全球总生育率最高的尼日尔以及孕产妇死亡人数最多的印度，15至19岁少女的孕产妇死亡和贫困情况在社会经济群体中的分布。
在尼日尔和印度，我们估计了青少年女性中孕产妇死亡人数以及因复杂妊娠导致的灾难性卫生支出病例数在每个收入五分位数中的分布情况。我们还研究了将青少年女性的教育水平提高1年对孕产妇死亡和贫困可能产生的影响。我们使用了来自调查和文献的流行病学及成本数据。
在尼日尔和印度，较贫困的青少年孕产妇死亡人数会多于较富裕的青少年。在尼日尔，贫困主要发生在较富裕的青少年中；在印度，则主要发生在较贫困的青少年中。提高青少年女性的教育程度可能会避免这两个国家大量的孕产妇死亡以及大量的灾难性卫生支出病例。
在低收入和中等收入国家，青少年怀孕会导致巨大的公平差距和严重的贫困。提高女性教育水平可以减少此类不平等现象，并为青少年女性提供经济风险保护和减轻贫困。
