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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