270868 Young and vulnerable: Comparing delivery care, domestic violence, and child undernutrition between adolescent girls and women in Bangladesh

Sunday, October 28, 2012

Kavita Sethuraman, PhD , FANTA-3 Project, FHI 360, Washington, DC
A. Elisabeth Sommerfelt, MD, MS , FANTA-3 Project, FHI 360, Washington, DC
Tara Kovach, MPH , FANTA-3 Project, FHI 360, Washington, DC
Ferdousi Begum, MBBS, MS , FANTA-3 Project, FHI 360, Dhaka, Bangladesh
BACKGROUND: While maternal and child undernutrition are persistently high in Bangladesh, one large underserved sub-group are adolescent mothers and their children – their specific vulnerabilities and needs are poorly understood. OBJECTIVE: This paper examines linkages between age at first birth, domestic violence (DV), women's empowerment, maternity care, and children's/women's nutritional status. METHODS: The nationally representative Bangladesh 2007 DHS survey included questions on women's empowerment, physical/sexual DV from husband (subsample), age at first birth, delivery care (last 5 years), and nutritional status of women and children under-five. Using Stata, the analysis focused on women who were teenagers at first birth (FB-teen) versus women who were 20+ years (FB-20+). RESULTS: Almost 60% of all 19 year olds have initiated childbearing. Facility delivery for first birth was less common for FB-teen women (18%) than FB-20+ women (41%) (p<0.001). DV from husband was more common among FB-teen women (54%) than FB-20+ women (37%) (p<0.001). FB-20+ women were marginally more involved in household decision making than FB-teen women. Stunting levels were higher among first-born children of FB-teen mothers (42%) than of FB-20+ mothers (30%) (p<0.001). Wasting levels were equal (15-16%). Women's height was no different between FB-teen and FB-20+ women. DISCUSSION: Adolescent mothers have specific vulnerabilities and this has programmatic implications: they are at greater risk of experiencing DV and unskilled home births, and having undernourished children. Adolescent-friendly services are urgently needed to address these vulnerabilities. Advocacy involving government and non-government stakeholders is needed to re-orient service provision for Bangladeshi adolescent mothers and their children.

Learning Areas:
Advocacy for health and health education
Program planning
Public health or related public policy
Public health or related research

Learning Objectives:
1. Describe the magnitude of the problems of teenage pregnancy, domestic violence, and children’s undernutrition (stunting and wasting) in Bangladesh. 2. Discuss associations between age at first birth (teenage years vs. 20+ years) and delivery in a health facility, experience of physical/sexual domestic violence, and children’s nutritional status. 3. Discuss programmatic implications and needed changes to provide adolescent-friendly services 4. Formulate key concepts for policy advocacy on the special needs of adolescent mothers and their children promoting wellness across the lifespan.

Keywords: Teen Pregnancy Prevention, Domestic Violence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a pediatrician and public health expert, an advisor on the USAID-funded FANTA-3 Project, who has worked internationally for over 25 years with colleagues in Africa and Asia on topics related to evidence-based advocacy to improve nutrition, reduce maternal mortality, increase newborn survival, and decrease the malaria burden; written on child health and nutrition; and domestic violence against women. Carried out the data assessment and analyses. Have no conflict of interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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