Public health department has prepared teenage pregnancy reporting guideline

Health: To help outline a reporting mechanism for incidences of teenage pregnancies in the country, the health ministry’s Department of Public Health (DoPH) has prepared a teenage pregnancy reporting guideline.

The department is waiting for government directives on further course of action on the guideline.

The guideline states that village health workers shall line list all pregnant women and girls and report to the health facilities. The basic health unit and community health unit in-charges shall also compile a list of teenage pregnancies and submit it to Dzongkhag Health Officers (DHO) on a monthly basis.

The DHOs shall compile the list of teenage pregnancies in the dzongkhag and submit to the reproductive, maternal and neonatal health programme on a quarterly basis. Similarly, community health department or unit of Thimphu referral hospitals, regional referral hospitals, and Gidakom, Dewathang, and Phuentsholing general hospitals shall report to the reproductive health programme on a quarterly basis. Accordingly, the reproductive, maternal and neonatal health programme shall analyse the data and share with relevant agencies.

Confidentiality shall be maintained by all health workers at all levels, the guideline states further.

According to DoPH’s director, Dr Pandup Tshering the guideline was prepared in consultation with relevant stakeholders.

“Through the implementation of the reporting guideline we’ll be able to understand the actual burden of teenage pregnancy in the country,” he said. “That’ll help us develop appropriate public health and other intervention for health and well being of the teenage mother and her child.”

In absence of a mechanism to report teenage pregnancy so far, there are no statistics on the teenage pregnancy rates. However, a one-year report of antenatal visits to Thimphu referral hospital showed 26 cases of teenage pregnancy.

Complications of teenage pregnancy

According to DoPH officials, teenage pregnancy leads to several complications on the mother’s and child’s health.

Officials said that a teenage mother, compared to older age groups, are at a greater risk of having medical complications like anaemia, nutritional deficiency, pregnancy induced hypertension, preterm baby, inadequate weight gain and obstructed labour. Besides, teens are more likely to smoke, drink, or take drugs during pregnancy.

Health officials said that if pregnancy is out of wedlock, they may not avail antenatal services or come late to the health facilities when they develop pregnancy/delivery complications endangering their lives. Some may also seek unsafe abortions that might lead to long-term morbidity or mortality. Given the non-use of contraceptives there is no birth spacing, which adds to malnourishment and anaemia.

Socioeconomic effect on mothers such as teenage mothers dropping out of school, remaining unmarried or unemployed and living in poverty are also associated with teenage pregnancy.

Negative health impacts on babies born to teenage mothers include preterm or of low birth weight, according to health officials. In addition, due to emotional immaturity of the mother, the baby is more likely to be neglected and abandoned or abused. These babies are often sick, malnourished, underweight and anaemic. Psychosocial effects on the baby such as higher risk of long-term problems are also expected. Health officials also said that babies born to teenage mothers are more likely to be impulsive or overactive and suffer from anxiety, loneliness, low esteem and depression.

“With drug, alcohol and tobacco use in pregnancy, some babies may have low birth weight with malformed faces, heart problems and mental retardation,” Dr Pandup Tshering said.

WCYC report on teenage pregnancy

Findings and implementation status of the National Assembly’s women, children, and youth committee (WCYC) states that at least two to three teenagers delivered in a year in the dzongkhags the committee visited. The committee observed that although most of the pregnancy was consensual and teenagers were married, some were reportedly caused by abuse and rape.

The report states that health workers do not choose to report teenage pregnancy cases to the police fearing that law-enforcing agencies would take legal action if reported. As a result teenage pregnant girls would not come to hospitals for antenatal care or delivery in future. “It would ultimately lead to drop in institutional delivery causing risk to both the young mother and child,” the report stated. “It was also reported that there is no clear guideline to follow in such situation.”

Therefore, the health ministry was directed to develop guidelines on reporting teenage pregnancies and at the same time considering adequate protection of health workers while providing services. The committee recommended the Assembly provide directions on the endorsement of the teenage pregnancy reporting mechanism.

Issues 

According to health officials, there is no specific provision in the Penal Code of Bhutan requiring medical and health professionals to report on teenage pregnancy. Weak multisectorial collaboration on prevention and routine reporting of teenage pregnancies is also an issue. Besides, there is no legal definition on teenage pregnancy and the health system follows the World Health Organisation’s definition of adolescent pregnancy, which is between 10-19 years.

Considering the legality issue, if teenage pregnancies are reported to law enforcement authorities, consequences such as low health seeking behaviour, illegal abortions, low performance in schools, drop outs, stigma, maternal and child mortality and morbidity could increase. Health officials also expect a drop in antenatal coverage and institutional delivery coverage while health worker’s involvement in legal proceedings may hamper their performance besides lack of trust and confidence in health system.

Sections 15 and 17 of the Penal Code of Bhutan 2011 states that a defendant shall be guilty of the offence of statutory rape if the defendant engages in any act of sexual intercourse with a child below 12 years, or incompetent person, either with or without knowledge of the other person being a child or incompetent person. Section 17 states that a defendant shall be guilty of the offence of rape of a child above the age of 12 years if the defendant commits any act of sexual intercourse against a child between the ages of 12 to 18 years. However, consensual sex between children of 16 years and above shall not be deemed to be rape.

On the other hand, section 430 of Penal Code of Bhutan 2004 states that the defendant shall be guilty of offence of failure to report a crime, if the defendant, who witnesses any person committing a crime, does not report to the lawful authority.

The Bhutan Medical and Health Council Regulation 2005, however, mandates medical and health professionals to respect and protect confidential information.

Kinga Dema