Excess risk of maternal mortality in adolescent mothers
Authors: Ann K Blanc
Journal: The Lancet Global Health (2014)

Andrea Nove and colleagues (March, 2014)1Nove A Matthews Z Neal S Camacho AV Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries.Lancet Glob Health. 2014; 2: e155-e164Summary Full Text Full Text PDF PubMed Scopus (165) Google Scholar report compelling and much-needed evidence on the global age pattern of maternal mortality. Their analysis concludes that the excess mortality risk faced by mothers aged 15–19 years might be “less than previously believed”. As the authors point out, this evidence is consistent with our own similar analysis of data from a smaller number of countries.2Blanc A Winfrey W Ross J New findings for maternal mortality age patterns: aggregated results for 38 countries.PLoS One. 2013; 8: e59864Crossref PubMed Scopus (72) Google Scholar During our analysis, we sought to uncover the source of the oft-cited so-called fact that the risk of maternal mortality of women aged 15–19 years is twice that of women aged 20–24 years (and that the risk for those younger than 15 years is five-times higher). We identified dozens of instances over the past 25 years in which these figures were cited, often without any reference. Although we cannot be sure, the original source seems to be a study done in the late 1960s in rural Bangladesh.3Chen L Gesche M Ahmed S Chowdhury A Mosley W Maternal mortality in rural Bangladesh.Stud Fam Plann. 1974; 5: 334-341Crossref PubMed Scopus (97) Google Scholar This early study was based on surveillance data collected in Matlab Thana and showed that the maternal mortality rate for mothers aged 15–19 years was 7·4 per 1000 livebirths whereas for mothers aged 20–24 it was 3·8. For mothers younger than 15 years, the rate was 17·7. These ratios were subsequently cited in a 1989 WHO volume4Royston E Armstrong S Preventing maternal deaths. World Health Organization, Geneva1989Google Scholar and then repeated many times in journal articles, reports, and policy documents without reference to the original data. A compilation of age-specific maternal mortality data from 40 countries during roughly the same period as the Bangladesh study suggested a much more moderate excess risk for young mothers, but the findings were mostly ignored in the scientific literature.5Nortman D Parental age as a factor in pregnancy outcome and child development. Reports on population/family planning, no 16. Population Council, New York, NY1974Google Scholar Until very recently, little research has re-examined these early findings on the basis of the more comprehensive data now available. This is an interesting story but, more importantly, a cautionary tale for the maternal health community. As intense policy discussions occur around the appropriate allocation of human and financial resources for reproductive health, it is a powerful reminder that the evidence for evidence-based policymaking should hold up under scrutiny and that facts are not facts by virtue of frequent repetition. I declare that I have no competing interests. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countriesOur findings suggest that the excess mortality risk to adolescent mothers might be less than previously believed, and in most countries the adolescent maternal mortality ratio is low compared with women older than 30 years. However, these findings should not divert focus away from efforts to reduce adolescent pregnancy, which are central to the promotion of women's educational, social, and economic development. Full-Text PDF Open AccessExcess risk of maternal mortality in adolescent mothers – Authors' replyWe strongly agree with Ann Blanc, who clearly highlights the dangers of so-called accepted wisdom based on limited or flawed evidence, and the need to question and probe the provenance of data used to direct resources and plan policies. This is indeed an important lesson for the maternal health community as we move forward with setting priorities for national and global maternal health agendas. Full-Text PDF Open Access