Motherhood in Childhood

Developing regions
woman—or girl—living with obstetric fistula is
ostracized from her home and her community
and is at risk of poverty and marginalization.
The persistence of obstetric fistula is a reflection
of chronic health inequities and health-care
system constraints, as well as wider challenges,
such as gender and socio-economic inequality,
child marriage and early child bearing, all of
which can undermine the lives of women and
girls and interfere with their enjoyment of their
basic human rights.
In most cases, fistula can be repaired through
surgery, but few actually undergo the procedure,
mainly because services are not widely available
or accessible, especially in poor countries lacking
quality medical services and infrastructure,
or because the surgery, which can cost as little as
$400, is prohibitively expensive for most women
and girls in developing countries. Of the 50,000
to 100,000 new cases per year, only about 14,000
undergo surgery, so the total number of women
living with the condition rises every year.
While a skilled birth attendant and emergency
Caesarean section can help an adolescent avert
obstetric fistula, the best way to protect a girl
ESTIMATES OF UNSAFE ABORTIONS AND UNSAFE
ABORTION RATES FOR GIRLS, AGES 15 TO 19, 2008
Annual number
of unsafe
abortions to
girls 15–19
Unsafe abortion
rate (per 1,000
girls 15–19)
Developing countries 3,200,000 16
Africa 1,400,000 26
Asia excluding East Asia 1,100,000 9
Latin America and the Caribbean 670,000 25
Source: Shah and Ahman, 2012.
from the condition is to help her delay pregnancy
until she is older and her body matures. Often
this means protecting her from early marriage.
Unsafe abortion
Unsafe abortions account for almost half of
all abortions (Sedgh et al., 2012; Shah and
Ahman, 2012). According to the World Health
Organization, an unsafe abortion is “a procedure
for terminating unwanted pregnancy either
by persons lacking the necessary skills or in an
environment lacking minimal medical standards
or both” (World Health Organization, 2012c).
Almost all (98 per cent) of the unsafe abortions
take place in developing countries, where abortion
is often illegal. Even where abortion is legal,
adolescents may find it difficult to access services.
Data on abortions, safe or unsafe, for girls
between the ages of 10 and 14 in developing
countries are scarce but rough estimates have
been made for the 15 to 19 age group, which
accounts for about 3.2 million unsafe abortions
in developing countries each year (Shah and
Ahman, 2012).
This study covers Africa, Asia (excluding
East Asia) and Latin America and the Caribbean
(Shah and Ahman, 2012). Rates of unsafe abortions
per 1,000 are similar for sub-Saharan
Africa and Latin America and the Caribbean:
26 versus 25, respectively; however, the total
number of unsafe abortions in sub-Saharan
Africa is more than double that of Latin America
and the Caribbean, because of the former’s larger
population size. Sub-Saharan Africa accounts
for 44 per cent of all unsafe abortions among
adolescents between the ages of 15 and 19 in the
developing world (excluding East Asia), while
Latin America and the Caribbean account for
23 per cent.
20 CHAPTER 2: THE IMPACT ON GIRLS' HEALTH, EDUCATION AND PRODUCTIVITY