DMH-1 Pregnancies in adolescents year olds
Pregnancies in adolescents (10–19-year-olds) and in older women (≥35 years) are hazardous for the mother and the child. Despite an almost universal decline in the adolescent DMH-1 since 1990, adolescent fertility still accounts for 11% of all births worldwide, with 95% of these births occurring in low-income and middle-income countries (LMICs). In 2014, the average global birth rate among 15–19-year-olds was 49 per 1000 girls (1 in 20), with startling differences in rates between countries (from 1 to 299 per 1000), the highest rates occurring in sub-Saharan Africa. Early marriage remains a strong factor underlying adolescent fertility, with most adolescent childbearing (90%) occurring within marriage, although premarital conception for first births that occur within marriage is common. Recently, attention has shifted towards identifying adverse outcomes in older mothers. In the USA, first-birth rates for women aged 35–39 years increased by nine times from the mid-1970s to 2012 (from 1·7 to 11·0 per 1000). Similar temporal trend data in LMICs are lacking.
As described in , the COHORTS Collaboration was able to muster the enhanced statistical power of pooling data from 19 403 participants located in five birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa, to identify an increased risk of low birthweight, preterm birth, stunting at 2 years, failure to complete secondary schooling, and lower adult height in children of young mothers (≤19 years) compared with mothers aged 20–24 years. Although mothers aged ≥35 years had an increased risk of preterm birth, their children had less stunting and better school progression and adult height attainment, the latter two being novel findings in LMIC settings.
This new evidence is both timely and important. Timely, because it comes at a moment when international mobilisation around the “first 1000 days of life” concept is gaining momentum. Young mothers stand to gain the most from the initiative aimed at improving pregnancy and young child outcomes. Important, because it confirms that the adverse outcomes linked to the extremes of maternal age, mostly described in high-income settings, are as relevant in LMIC settings and worthy of serious public health intervention given their considerable effect on child outcomes. The study makes a strong case for continued and uninterrupted allocation of resources (even in situations of scarcity) through the life cycle, well beyond the current 1000 day focus. As important was the study\'s exploration of adult outcomes—a global first. Adult fasting glucose concentrations were increased in offspring of young and old mothers, but adult blood pressure was unrelated to maternal age.
Violence pervades the lives of children around the world. For too long, society has ignored child violence and failed to hold adult guardians to account for their traumatising actions towards children. The right to be protected from violence is guaranteed by the United Nations Convention on the Rights of the Child, and yet children in many countries are routinely exposed to physical attacks as victims or as bystanders. Moreover, even though children spend more time in school than in any other setting, robust evidence on the prevention of violence in schools outside North America is scarce. The community trial by Karen Devries and colleagues in is therefore a bold and important initiative in the field of paediatric violence. The trial evaluated a complex behavioural intervention—the Good School Toolkit, designed by non-profit organisation Raising Voices—in 42 Ugandan schools. The need for such an intervention is stark. According to a recent UNICEF report on violence, Uganda\'s child homicide rate is 10 per 100 000 annually—one of the highest in the world—with 36% of 13–15-year-olds having been in a physical fight during the past year and 54% of 15–19-year-olds having experienced physical violence since age 15 years. Anecdotal reports suggest that most students have experienced physical punishment at school at the hands of school staff, including caning and slapping. Such experiences are shared equally between boys and girls and track strongly into adult life in experiences involving forced sexual acts and attitudes towards intimate partner violence and using physical discipline with children.