In today’s world of independency with rapid improvement in health-quality, health-consciousness and awareness, it is dejected to note that very 5th child is born by adolescent mothers (< 19 years) and around eighty percentages of such early pregnancies occur in third-world countries as per the data provided by the United Nations International Children’s Emergency Fund (UNICEF) (1). Meanwhile, cesarean section (CS) is a surgical procedure conducted to deliver the babies by performing an incision on the mother’s abdomen in order to reduce complications that may arise in the course of vaginal delivery and improve the health outcomes in both the mother and neonate. However, rate of CS has continued to rise dramatically in past 30 years (2).
There has been an upsurge in the rate of CS all over the world, data from 2016 showed that currently 18.6% births occur by CS, which is far greater than the optimum rate mentioned by WHO. The rate of CS is rising by 4.4% every year with highest being in Asia and lowest in North-America (3). Similarly, early pregnancies are also considered as a universal burden covering all countries irrespective of their economic status (4). It has been estimated that around sixteen million girls between the age of 15–19 years give birth each year globally and babies delivered from theses teen-age mothers occupies 11% of total birth worldwide. It is staggering to note that highest numbers (around 95,153) of such early pregnancies occurs in Eastern-Asia (5). Furthermore, ninety-five percentages of such birth happen to be from developing countries like Nepal (6).
WHO statistics of 2014 shows that among the cause of mortality of young mothers, complications during pregnancy and delivery is the second leading factor which is highly associated with unfavorable perinatal and obstetric outcomes (7, 8). Moreover, finding has represented that early pregnancies are at risk of CS nearly by 80% in comparison to older women due to reasons like biological immaturity, fetal distress, poor nutritional status, disproportion between fetus and maternal pelvis size, failure of induction and oxytocin augmentation (9, 10, 11). Sadly, early pregnancies among such young population are not a product of voluntarily choice and decision but lack of access to proper education and existing stereotype and prejudice in the communities (12).
Speaking about Nepal, it is already fighting burden of Maternal Mortality Rate (MMR) of 281 deaths per 100,000 live births which is highest in comparison to other South-Asian countries and home delivery in unhygienic environment is another load in its back. Multi-parity, teen-age pregnancy, less or no antenatal visits being some of the basic key indicators of the vaginal delivery at home (13, 14). In the study conducted in Nepal, finding has shown that nearly 2/3rd of females were married before the age of 19 years in the year 2017/18 (15, 16). Furthermore, this trend was mostly prevalent in families from lower economical groups. On the other hand, it has also been found that women having higher level of educational status have higher preference for CS (17, 18, 19). Thus, attitude and practice of Nepalese society towards child marriage, restriction of individualism and burden of imposed conclusion among girls are the root cause of the soaring rate of early pregnancies in Nepal. Government of Nepal is working vigorously in solving these issues and reducing the burden of early motherhood among adolescents. Family Health Division (FHD) has developed National Adolescent Health Development Strategy (NAHDS) in order to increase the availability with easy access of information along with counseling services for adolescents about their health. Government is playing crucial role in collaboration with various Non-Government Organization (NGO) and different medias to sensitize its population in the topics of child marriage and its complications, women empowerment and decision-making, maternal health and many more.
However, which mode of delivery is more sound and safer for adolescent pregnancy, planned vaginal or planned CS? Well, this is the new milestone and field of many clinical researches as well as the controversies too (20). In light of these growing concerns, our objective was to find the association between adolescent pregnancy and CS and identifying factors contributing to prevalence of CS among adolescent mothers in Nepal.