Adolescent maternal health, a subject of renewed international and national concern, took the spotlight in Mexico City earlier this month. In a two-day meeting, “Towards Better Adolescent Maternal Health in Mexico: Challenges and Opportunities,” 43 academics, civil society representatives, and state and federal policymakers focused on three aims:
- Analyze the state of adolescent maternal health in Mexico
- Identify needs and opportunities for policy and public programs
- Identify gaps in knowledge and priorities for future research on this subject
Financed by the John D. and Catherine T. MacArthur Foundation, the meeting was organized jointly by the Women and Health Initiative and Mexfam, an International Planned Parenthood Federation (IPPF) affiliate.
Analyze the state of adolescent maternal health in Mexico
Contrary to previous thinking, the maternal mortality ratio (MMR) among 15-19 year olds is not higher than that of women aged 20-29 years in Mexico. However, the MMR is significantlyhigher among 10-14 year olds when compared to 15-24 year olds.
One of the most notable themes that emerges when assessing adolescent maternal health in Mexico is socioeconomic disparity. Adolescents living in poorer, more disadvantaged municipalities—where a higher proportion of indigenous and illiterate residents live and where the Human Development Index is lower—MMR is higher. Not only do rates differ, but so do the causes. In disadvantaged municipalities, post-partum hemorrhage remains the leading cause of death, whereas in the country as a whole, indirect causes, such as diabetes and obesity-related conditions, play a larger role.
Other disparities among adolescents exist in terms of abortions, post-abortion care, and antenatal care (ANC). Adolescent girls in Mexico experience a very high rate of hospitalization for abortion complications. In addition, only 64% of pregnant adolescents aged 15-19 years old receive ANC, compared to 80% of 20-24 year olds.
The adolescent birth rate (ABR) in Mexico is relatively high; equal with Guatemala at 57 births per 1000 adolescent women, it is higher than the average ABR in Central America (56), and much higher than the average ABR in South America (38). Inequity and limited life opportunities were identified as contributing factors that need to be addressed through multisectoral and sustained public policy and programs to address the high ABR.
Identify needs and opportunities for policy and public programs
So what can we do? We know that keeping girls in school can help prevent pregnancy in the first place. Adolescent girls may face disruptive life events during the school years—moving, losing a parent, etc.—and those of better socioeconomic status often have the resources to cope with these events more effectively and stay in school, but disadvantaged girls do not. Scholarships and action to make education systems more flexible could have an impact on not only keeping girls in school, but in preventing adolescent pregnancy.
In Mexico, many of the existing policies are progressive and high quality. Therefore, the issue is not developing new policies but enhancing managerial and leadership capacity to improve implementation of existing policies and programs. Efforts to build managerial and leadership capacity should focus at the state-level, especially those with a high MMR.
One area that does need attention is the current policy around service delivery. The publication of new legislation governing adolescent sexual and reproductive health is an important opportunity to ensure that adolescents can access information and services without the necessity of parental presence or consent. Parental consent has been shown to be a significant barrier to promoting adolescent sexual and reproductive health. The meeting participants called on the Ministry of Health to ensure that the new legislation allows adolescents to access the care they need without the consent of their parents.
In addition, strategies moving forward should be multidisciplinary—housing, education, livelihood— to ensure comprehensive adolescent health is protected and promoted.
Identify gaps in knowledge and priorities for future research on this subject
As we move forward on improving adolescent maternal health in Mexico, meeting participants shared two key take away messages. First, when it comes to measuring many relevant indicators of adolescent maternal health, Mexico does well with good national health surveys and vital statistics. So the first priority is to analyze the available data and use the evidence better and more. Second, there are knowledge gaps, such as reproductive health among 10-14 year olds, the perspectives and reproductive health needs of male partners and male adolescents, the evaluation of scalable and sustainable approaches for service delivery, and human rights issues such as child marriage.