Is There an Ideal Age For Motherhood? Docs Explain
(Video Editor: Kunal Mehra)
(This article has been republished in light of National Safe Motherhood Day that is observed on 11 April every year.)
Should there be an ideal age of motherhood?
When Prime Minister Modi announced setting up a task force to increase the age of marriage for women (and therefore presumed motherhood) from the current 18 years, to protect their health, he set off an avalanche of opinions. India has a high level of preventable maternal deaths, so can doing so actually reduce our maternal mortality rate? Can the state decide an age? And what about unwed pregnancies?
FIT speaks to renowned gynaecologist and obstetrician Dr Noser Sheriar to understand the complex issue of maternal mortality better.
“First, I believe there has to be parity in everything, including the age of marriage. Both men and women should have the same age - why the difference?”Dr Nozer Sheriar, former secretary general of the Federation of Obstetric & Gynaecological Societies of India (FOGSI)
“The age of adulthood or getting a license is the same, so why can’t we have the same age of marriage?” he says, setting off an interesting tone of discussion. As Dr Sheriar explained, maternal health and mortality is intrinsically tied to women's equality - in healthcare, nutrition, education and status.
So to have a separate age just for them seems counter-productive to the overall goal of equality.
“Education is intimately tied to maternal mortality,” he reiterates.
Haemorrhage, Hygiene and Unsafe Abortions: 3 Most Common Causes of MM
What about health? What are the primary causes of MMR?
“The most common cause of maternal mortality still is haemorrhage or bleeding after she delivers, something called POST-PARTUM HEMORRHAGE. This is impacted by many things, her health,her nutrition. The condition of anaemia, that’s low haemoglobin.”
He adds, “The second cause of MM is infections which boils down to hygiene and cleanliness. The third cause is abortions and miscarriages. India has done great in terms of maternal mortality but we have a lot more to achieve.”
India is a vast country, with great diversity and Dr Sheriar says that the most underprivileged women are obviously most at risk. “For the more privileged folk, there are newer complications coming in like liver disease, hypertension and other non-communicable diseases that are growing in India and impacting maternal health as well.”
Addressing health and infrastructure issues can go a long way to save Indian mothers from preventable deaths
Will Changing the Age Help?
Yes and no. Dr Nozer says.
The risks are most potent for the very young or the very old.
Firstly, the very young. “Someone under the age of 15 was 5 times more likely to die of pregnancy than someone over the age of 20.”
“A person under the age of 20 was twice as likely to die of pregnancy as someone over the age of 20.Dr Nozer Sheriar, former secretary general of the Federation of Obstetric & Gynaecological Societies of India (FOGSI)
Why does this happen? “Well for the very young, it is because they are not ready physically, physiologically for a pregnancy,” explains Dr Sheriar. He adds that the lack of autonomy, the lack of care, the lack of proper medical attention will put them at risk.
The older you are, generally, the more in control of yourself and your health you are.
He says that for the very young there is a biological risk, but once you get past adolescence that kind of evens out
Having a pregnancy at 19 or 20 is not going to be any more high-risk than having a pregancy at 25 or 30
Dr Sheriar says, “Where it would make a difference is that, and older woman, and her partner, will have more capacity, more confidence, more resources to take care of themselves better.”
The issue here is more of autonomy and equality than health or safety. In this sense, would increasing the age from 18 to 21 really help?
“I would like to focus on making the age of marriage the same for men and women, and on plugging the causes of maternal mortality. No, I don't have a magic number of marriage.”
Improving maternal mortality is more about improving equality,access to healthcare, nutrition, education and access than about a specific number.
He adds that he gets clients who are pregnant in their late 40s or 50s, and adds, “I don't think we have any right to talk about their decision, so long as they are not putting themselves at risk.”
However, for the very old, like women who get pregnant in their 70s or 80, there needs to be “a cut-off age, because a very elderly woman is a tremendous risk when she goes through what pregnancy does to a woman.”
Most arguments for very old pregnancies speak of the child and the quality of care they would receive, but Dr Sheriar puts the woman’s health first. I ask him about maternal healthcare, where often the focus shifts entirely to the newborn and he says the same, “Women, once they deliver, are put on a pedestal and simultaneously have to forgo their needs. It’s important to focus on the new mom too, her nutrition, her health and her mental health.”
Improving Maternal Healthcare: Contraception, Affordable & Non-Judgemental Care
“It’s important for new moms to be aware of contraception as well.”
Dr Sheriar says that one of the most foundational steps to reducing maternal mortality is investing in adolescent health.
“If women are aware of their contraceptive options, and men too, they will make smarter choices and avoid unwanted pregnancies and unsafe abortions which are the third most common reason for maternal deaths.”
Women in India need more access to affordable care, but Dr Sheriar adds that we as a country need to make it lucrative for healthcare workers to go to underserved areas. “We need to protect our healthcare workers so that they are incentivised and excited to work in remote areas.”
He also focusses on patient care - women in particular, are often at a disadvantage with doctors who are abrasive with sensitive questions, dismissive of pain or judgemental.
“We need to instill a quality of care, I know doctors are busy but how difficult is it to take that time out for a patient. It can really help them.”Dr Nozer Sheriar, former secretary general of the Federation of Obstetric & Gynaecological Societies of India (FOGSI)
For Dr Nozer, who has worked on India’s Medical Termination of Pregnancy Act, 1971, a vital step is improving our abortion laws and reducing the number of unsafe abortions.
He quotes a study by The Guttmacher Institute published by The Lancet which says,”
“In India, we had almost 48.1 million pregnancies, out of which almost half were unintended. If we prevented those unintended pregnancies, we would have fewer unsafe abortions, which is the third most common form of death.”Dr Nozer Sheriar, former secretary general of the Federation of Obstetric & Gynaecological Societies of India (FOGSI)
“This is an entirely preventable way to die,” he laments.
Dr Sheriar concludes, “Contraception is live saving,”
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