Beyond mores and morals

Umesh N. Jindal

Life is moving in the fast lane. Urbanisation is going on at an unprecedented pace. There is exposure to world-class cinema and TV and explosion of social media. Amid all this, sexuality is not a taboo and pre-marital sex is not perceived as sin. That sounds like a lot of freedom, but a lack of understanding about where it could lead is compromising young lives.

The risk

The lack of sex education leads to unplanned pregnancies in relationships involving the young. Besides the risk of pregnancy, there is an increased risk of sexually transmitted diseases such as syphilis, gonorrhoea, the HIV and the HPV. It may sound far-fetched, but the HPV is a known causative agent in the development of cancer of the cervix.

Out of the available contraceptives, condoms are the safest and easily available. These not only protect against pregnancy, but also against the STDs. However, it requires a will and knowledge of their proper use.

Oral contraceptive pills may be used by girls, who are older than 18 years. Used regularly under proper medical supervision, these give almost fool-proof protection against pregnancy. Contrary to common belief, the pill is perhaps the safest and most reliable method at this age and devoid of long-term side effects. However, it does not prevent against sexually transmitted diseases. The HPV vaccine is the latest development in the field. It prevents from the HPV infection and cancer of the cervix. 

Why must we care?

With almost 30 to 60 girls per 1,000 conceiving before 20 years of age, teenage pregnancies are a major concern worldwide. According to the National Family Health Survey (2012), seven in 100 women are still getting married before the age of 18 in India. The good news is that there has been a 50 per cent decline in this number in the last decade. An early pregnancy due to early marriage is still the most common reason behind teenage pregnancy in India.

Teenage pregnancies are associated with lower socio-economic strata, lack of education, pre-marital relationships, sexual abuse and a lack of knowledge regarding appropriate contraception.

Conception is possible once menstruation is established. However, a girl is not physically and mentally mature to handle a baby before she is 18. A pregnancy between the ages of 15 and 18 years has higher chances of medical complications such as anaemia, pre-eclampsia, premature labour, etc. Infants born to such mothers suffer from low-birth weight, nutritional deficiencies, etc.

More often than not, these pregnancies land in problems because of lack of social and financial support. Despite the availability of legal ways under the MTP Act 1972, many of these unwanted pregnancies end up in illegal abortions. In case these pregnancies continue, such infants may be abandoned. It is pertinent to note here that illegal abortions are associated with many complications such as infections, injuries to the genital tract and risk of permanent damage to genital organs, sometimes due to use of improper instrumentation. This may lead to childlessness and sub-fertility later in life. In India, induced septic abortion is still the major cause of maternal mortality and morbidity. These girls are likely to face social stigma, ostracisation and hence face psychological consequences. They drop out from school and suffer long-term disadvantage because of educational and economic deprivation.

Emergency contraceptives

A word of caution against the use of emergency contraceptives, which are freely available over the counter. Some of these are not abortifacients i.e. these do not cause abortion. These drugs prevent pregnancy by disrupting the normal ovulation and related hormonal changes in the body. That leads to menstrual irregularity even after single use. These pills should be used occasionally, like once a year or so, and that too as a backup. Frequent use is likely to upset the menstrual cycles significantly. These drugs become unpredictable and pregnancy may occur during this period without the girl realising it.

Abortion pills, too, must not be popped in just like that. These have to be given after ultrasound confirmation of pregnancy and under medical supervision. However, these tablets, too, come with the risk of incomplete abortion, infection and permanent damage to the uterus.

Pregnancies in young age are disastrous and have long-term medical, social and economic complications. Social awareness and sex education will go a long way in educating youngsters and preventing damage to young bodies and minds.

— The writer is a gynaecologist based in Chandigarh