Impact of adolescent pregnancy on maternal morbidity

1. Introduction

1.1 Background:

Pregnancy, generally in our country, is accepted after marriage. And marriage is almost
universal in Bangladesh and in many other countries. The early the marriage, the early the
pregnancy might be. The early pregnancy which is simply called adolescent marriage makes
trouble maternal life. Even this pregnancy makes unnecessarily maternal death as well as child
death. According to WHO, (world health organization) every day, approximately 800 women
die from preventable causes related to pregnancy and childbirth (2012). 99% of all maternal
deaths occur in developing countries like Bangladesh as it’s argued. In Bangladesh, the
maternal morbidity as well as maternal death is slightly higher than that of other areas of the
world due high rate of early marriage as well as early pregnancy. Maternal morbidity is
especially increasing in Bangladesh as maternal morbidity includes any kinds of illness or
injuries caused or aggregated by, or associated with pregnancy (WHO). However as health
practitioner tells that adolescent girls are not enough mature to bear a child. It might be very
high the girl is illiterate.

1.2 Justification:
1.2.1 Statement of the problem or research issue:

Adolescents are not fully physically developed to overcome the health complications
related to childbirth. A general statement is that if a fruit is low in quality then it might provide
less and low quality of result. Like this, if the mother is small as well as young, she is more
likely to give birth to a small, weak baby whose chances of survival are equally small. Many
children of adolescent mothers have higher incidence rate of low birth weight, still birth or any
other birth related complications. In Bangladesh, the % of underweight children is near about
41.5% of all birth. And most of them are from adolescent mother as UNFPA and WHO argued.
With child mortality there is a good number of maternal mortality due to adolescent
pregnancy.In 2012, WHO specially shows that maternal mortality due to morbidity by
pregnancy is higher in women living in rural areas and among poorer communities in
developing countries e.g. Bangladesh. They also argued that young adolescents face a higher
risk of complications and death as a result of pregnancy than older women. Maternal mortality
is unacceptably high. About 800 women die from pregnancy- or childbirth-related
complications around the world every day. In 2010, 287 000 women died during and following
pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings like
Bangladesh. All these death occurred due to morbidity. Adolescent marriage greatly exists in
rural area in Bangladesh. Adolescents age 15 through 19 are twice as likely to die during
pregnancy or child birth as those over age 20; girls under age 15 are five times more likely to
die (BDHS 2007). With maternal mortality due to morbidity, infants of adolescents are at
increased risk for death. In fact, the infants of adolescent mothers are more likely to die before
their first birthday than are the infants of older mothers.
As the adolescent are more at risk of maternal morbidity. And this maternal morbidity
is a crucial issue which may influence by early pregnancy from early marriage. Most the of the
NGOs as well government agencies are concerned about maternal mortality there has been a
little or no research on maternal morbidity in Bangladesh resulting this problem as severe for
Bangladesh.

1.2.2 Possible findings

By this research, the result might be like this….

1. Adolescent marriage is caused by poorness of rural people. It makes more early

pregnancy.
2. It makes a girl’s life in unsafe and insecurity.
3. A large number of mother & children suffer a lot of trouble due to adolescent
pregnancy.
4. The impact of this pregnancy on children’s health is very bad.
5. More mother and children died by early pregnancy.
6. It is a great problem to development. And it increases more population and so on.

1.2.3 Possible impact of the findings:

After assessing the causes & impact of adolescent marriage which makes adolescent
pregnancy, this problem can be solved by implicating new policies which will be helpful
for our development. As knowing the impact of adolescent pregnancy on maternal
morbidity, policy makers and govt. can take new decision about this adolescent. If Govt.
is able to do it, then it helps the country to develop.

1.3 Study goal:

This study will be conducted with a view to increase and accelerate understanding of
the maternal health of adolescent mother who falls more health related complications due early
pregnancy from early marriage which increases maternal and child morbidity as well as
maternal and child mortality. There is a strong relation between adolescent pregnancy and
maternal morbidity and has a tremendous impact of adolescent marriage on maternal
morbidity. In order to obtain this goal, the following objectives are selected:

1.4 Objectives:
 To know the causes of adolescent marriage in rural area.
 To identify the impact of adolescent pregnancy on maternal and child morbidity
mortality.
 To identify the impact of adolescent pregnancy on maternal and child mortality.

1.5 Research questions:

1. What are thecauses of getting married of rural girls in adolescent stage?
 2. What are the effects of adolescent pregnancy on maternal morbidity and
mortality?
3. What are the effects of adolescent pregnancy on child morbidity and mortality?
1.6 Research gap:

There have been a large number of valuable studies of adolescent pregnancy using
cross-section data in outside of Bangladesh. All of which present evidence on a trend and
relationships of adolescent pregnancy and maternal morbidity. However, none of these studies
provides a comprehensive picture of impact adolescent pregnancy on maternal health. And
none of these identifies the causes of early marriage. And this research will suggests these
issues.

1.7 Limitation of the research:

This research would be conducted by a cross-sectional study. And the causality

couldn’t be ensured. It is the most important limitation of this research. The majority of
outcomes would be based on “self report” of the respondents, which is vulnerable to social
desirability and recall biases.

2. Literature review: In order to achieve the objective, there should have to be done a
comprehensive literature review to have a clean overview about adolescent pregnancy and its
influence on maternal morbidity. Some reviews discussed below…..

Ahmed (1998) stated in “Maternal Morbidity in Rural Bangladesh: Where do women

go for care?” that most women who had complications consulted untrained service providers.
41% consulted village practitioners, 11% went to homeopaths, and 6% went to kabiraj or other
healers. Only 34% sought help from medically trained personnel. 19% didn’t seek any care.
The use of medical facilities for obstetric complication was positively associated with women’s
age, education and many other issues.

Rehaman (2001) stated in “Maternal health review Bangladesh” that the situation of
maternal morbidity in Bangladesh is considered unacceptable. It was appeared in general, to
be higher prevalence of morbidity among women than that of male counterparts. This
morbidity is basically due to the early age pregnancy. Older women suffered less morbid
condition that of younger.

Sarkar (2007) sated in “Determinants and effect of early marriage in Bangladesh” that
early marriage is a complex issue in Bangladesh due to various factors. It was found that early
marriage brings early pregnancy which led to many children. But in this early age, women
didn’t prepare and aware about pregnancy as they were less educated and less mature. As a
result, it brought women’s life in danger.

3. Concept, variable and its level of measurement:

 Concept Variable and Operational definition Level of
indicator Measurement

Demographic Maternal morbidity Any diseases related to Nominal

characteristics pregnancy

Adolescent marriage Marriage bellow age 19 interval

Early marriage Marriage below 18 Interval

Age at marriage Age of mother when became Ratio

married

Age at first Age of mother when became Ratio

pregnancy mother

Social Education Completed year of schooling Ratio

characteristics
Place of residence The place where they live nominal

Economic Occupation The main profession one’s do Nominal

characteristics
Family income Total income from various Ration
sources

Asset of the family Family’s asset e.g. land, pond etc Nominal

Health issues Disease pattern Types of diseases e.g. fistula Nominal

Frequency of disease How much suffers from illness Interval

Health care Nominal

4. Methodology:

4.1 Study Design: The study follows a cross sectional study design where interview schedule
was constructed to collect data based on conceptual framework established after reviewing
literature.
 4.2 Study Area and Population: Selection of study area is very much crucial issue for any
study. The accomplishment of any study depends upon the selection of a study area. Hence,
the study area was selected as word no. 3, 5, 6, and 8 (selected area) in Sylhet district’s sadar
pourashava because of…….

 It represents the activities of adolescent marriage prevalence area in

Bangladesh.
 It is also a high maternal morbid and death area.
 It can be fulfilled all requirements of the research work.
 And easy access to and collect information.

1. Conceptualization and conceptual framework:

2. Types of research/ research strategy: The research strategy for the above research
problems is quantitative strategy. As quantitative strategy, we know that it tests the existing
theory; positivism & objectivism are the epistemological as well as ontological position of
this strategy. On the other hand, it rejects the interpretivism & objectivism. If we deepen the
problems which have been taken, we could know issues that related with quantitative
strategy. For example, the problem is “what are the causes of getting married of rural girls
in adolescent stage” which don’t have needed any interpretive issues i.e. no need social
reality which is influenced by social action.

3. Research Design: The research problem fits ideally experimental design; it doesn’t fit for
practically as we can’t select two groups for my experiment which isn’t ethically right. On the
other hand, we have limited resources as well as time. For experimental design, we need a long
time & large money. Thus we take “cross-sectional design” for research.

6. Sampling strategy:

Although my targeted population is adolescent girl which is not hidden but practically
probability sampling is not possible. As our population are fully conservative. They don’t want
to give any information about their personal issues. If a part of the population are interested to
this but number of population is very small. Thus I should take a non-probability sampling
strategy specially convenience sampling. As it is hardly possible to take information from
randomly assigned population, thus available person’s interview is easy. Since selecting who
are available for the study easy to participate and it saves my both time & money.

Sample size:

4. Data collection: Both primary as well as secondary data has been collected for this
research. Data gathering and analysis will occur simultaneously. To carry out the research,
systemic actions are taken step by step. Like
  Collection of information
 Data analysis and interpretation

Primary and secondary data has different step as both are different. This two is given bellow.

4.1. Primary data source: Primary data will be collected from field survey with
structured questionnaire.

4.1.1. Data type: It is basically quantitative data.

4.1.2. Instrument: Many instruments will be used. Like

 Recorder, pen, pencil, questionnaire and camera

4.1.3. Tools and techniques: For collecting data, above instrument will have been
used. Besides these, structural questionnaire will be used for this research. The data
collection technique will be interview; specially structured interview while the tool will be
used to collect data in this study will be questionnaire with some open ended questions to
fulfill the exploratory inquiry involved with research topic.

4.2. Secondary data source: Secondary data, which need to collect from

 Bangladesh Bureau of Statistics

 Bangladesh Demographic health Survey
 Official reports
 Book, Newspaper; national and international journals and so on.

5. Data Entry, Data analysis plan and Preparation for Analysis:

After the completion of editing and recoding collected data are entered using SPSS.
The rearranging of data, collapsing of data, creating new variables, scaling of variables,
recoding and necessary merging the categories with negligible frequency are also conducted
to prepare data for the final analysis.

Data analysis is done using statistical software SPSS and MS Excel Analysis was done
in three levels:

1. Univariate analysis: At univariate analysis, frequency of distribution, percentage

of relevant variables of both dependent and independent variables were presented in both
tabular and graphical form. In separate chapters the univariate analysis is shown by
background, socio-economic, social contact of respondent’ sand some other variables.
2. Bivariate analysis: At the bivariate analysis, the relationship is observed between
conceptually related independent and dependent variables. The variables used in the study
are mostly categorical. For this reason, cross tabulation are conducted with chi-square test.
3. Multivariate analysis: At multi-variate analysis, logistic model are fitted for
dependent variable and multiple cross tabulation to find out the impact of forces for migration
5. Study plan or activity plan: For my research, I will study step by step. For this, an
activity wise flow diagram is given bellow.

Conclusion:

References:

TABLE OF CONTENT

Abstract iv

Contents vi

List of Tables ix

List of Figure xiii

Chapter 1 Introduction

1.1 Background 2

1.2 Statement of the Problem 2

1.3 Rationale of the Study 5

1.4 Objective of the Study 6

1.5 Scope of the Study 7

1.5 Organization of the Study 7

Chapter 2 Conceptualizing Migration

2.1 Defining Migration 10

2.2 Different Forms of Mobility 12

2.3 Theories of Migration 15

2.4 Typologies in Migration Study 21

Chapter 3 Conceptual Framework of the Study

3.1 Petersen’s Typology of Migration 31

3.2 Applicability of Petersen’s Typology in Bangladesh 33

 3.3 Determinants of Internal Migration in Bangladesh

3.3 Conceptual Framework for the study 37

Chapter 4 Methodology

4.1 Study Design 40

4.2 Study Area and Population 40

4.3 Source of Data 41

4.4 Determination of Sample Size 42

4.5 Data Collection Techniques and Tools 42

4.6 Sampling Technique 43

4.7 Data Collection 44

4.8 Data Editing and Coding 45

4.9 Data Entry and Preparation for Analysis 45

4.10 Data Analysis 45

4.11 Operationalization of Variables and Their Indicators 46

4.12 Hypothesis of the study 49

4.13 Ethical Consideration 49

Conceptual Framework:

Contextual Situation of the Characteristics of the

area: respondents: Age at Pregnancy
 Socio-economic marriage
 Age
conditions  Sex
 Employment  Marital Status
opportunity  Family Type and size Maternal and child morbidity
 Climatic and  Education as well as mortality
 Occupation
Environmental  income
condition  Health and nutrition
Source: Modified from different sources

Flow diagram:

Identification of the problem

Topics selection Objective selection Conceptualization

Literature Review Indicator selection

Primary Data Study Area selection

Secondary data

Questionnaire Data collection

BBS, BDHS,
Books,
Newspaper,
Survey interview Data processing Journals etc

Data analysis

Data presenting

Draft submission

Final submission

Figure: Flow chart of the study

 3.10 Hypotheses

i. There is difference between income, in the place of origin and in Dhaka.

ii. There is difference between employment facilities, in the place of origin and in Dhaka.
iii. There is difference between educational facilities, in the place of origin and in Dhaka.
iv. There is difference between family size of the migrants before and after migration.
v. There is a relationship between migration and possession of asset.
vi. There is difference between food consumption by the migrants before and after
migration
vii. There is association between level of education and income.
viii. There is association between income and wealth of the family.
ix. There is association between income and food consumption.
x. There is association between family size and wealth of the family.

3.11 Ethical Consideration

Informed consent was obtained from all the respondents by describing them about the identity
of the researcher, purpose of the study, necessity of their valuable response and comments.
Their right to deny answering some or all the questions is respected throughout the data
collection procedure. Sensitivity towards the respondent is maintained throughout the
interview process as questions asked about past may bring memories of their distress,
especially in case of people who came for environmental reason, economic insecurity, social
or political conflict at place of origin. Careful progression with questionnaire was followed so
that good data come out as well as the respondents do not feel threaten when income, land and
asset related questions come. No force is applied to the respondent for drawing the information
necessary for this study. Gender bias is omitted during study by interviewing both male and
female migrants. Although the target respondent is head of the family most of the respondents
are male. In order to maintain highest level of confidentiality, instead of name, unique
identification number is used. Finally the collected data is only used to fulfill the research
objective other than any purpose.
4.1. Introduction
Demographic and background characteristics of the migrants plays a major role in the process of
migration. Therefore, before going to detail analysis, it is necessary to skim through the
demographic and background characteristics of the migrants. This chapter provides the frequency
and percent distribution of the social-demographic and economic characteristics of the migrants
before and after the migration. The socio-demographic characteristics include background
characteristics, age and sex of the respondents, family type and size, marital status and educational
attainment of the respondents before and after the migration. Economic characteristics include
occupation, income, food consumption, health seeking behavior and so on.