The US House of Representatives has voted to restore abortion rights nationwide in Democrats' first legislative response to the Supreme Court’s landmark decision overturning Roe v. Wade. Video / AP
Warning: This story discusses sexual abuse of young girls
The account of a 10-year-old rape survivor from Ohio being forced to cross state lines to get an abortion has gripped the attention of Americans and the world in the weeks since the US Supreme Court overturned Roe v Wade.
Her story, first published on July 1 by the Indianapolis Star, laid bare the grim reality of millions of US women losing their constitutional right to an abortion.
The image of a pregnant, primary-school-aged child being forced to carry a child herself proved a powerful one for both pro- and anti-choice advocates: US President Joe Biden cited the girl while announcing his executive order on abortion access, while prominent abortion opponents clung on, arguing that she should have carried the pregnancy to term.
US President Joe Biden has cited the story of the 10-year-old rape victim. Photo / AP
But when it comes to the deeply-held views of the latter group, midwives and doctors who work in countries where pregnancy is common in young adolescent girls told The New York Times they may not understand the brutal toll of pregnancy and delivery on the body of a young girl.
The phenomenon of girls in America getting pregnant is relatively rare – in 2017, according to research from the Guttmacher Institute, there were 4460 pregnancies among those under the age of 15, just under half of which ended in abortion.
Globally, however, the World Health Organisation cites that complications relating to pregnancy and childbirth are the leading cause of death for girls aged 15 to 19.
"Their bodies are not ready for childbirth and it's very traumatic," midwife and senior nursing officer at Gambia's Bundung Maternal and Child Health Hospital's reproductive and child health clinic, Marie Bass Gomez, told The Times.
Dr Ashok Dyalchand, who has worked with pregnant adolescent girls in low-income communities in India for more than 40 years, explained to the publication that the critical issue is that the pelvis of a child is too small to allow the passage of even a small foetus.
They have long labour, obstructed labour, the foetus bears down on the bladder and on the urethra," he said, sometimes causing pelvic inflammatory disease and the rupture of tissue between the vagina and the bladder and rectum.
"It is a pathetic state particularly for girls who are less than 15 years of age. The complications, the morbidity and the mortality are much higher in girls under 15 than girls 16 to 19 although 16 to 19 has a mortality twice as high as women 20 and above."
Per a 2014 evaluation published in the Journal of Neonatal-Perinatal Medicine, young maternal age is associated with an increased risk of maternal anaemia, infections, eclampsia and pre-eclampsia, the need for an emergency caesarean delivery, and post-partum depression.
While a pregnant 10-year-old in America might have access to better prenatal care or a C-section than a girl in the same situation in India, Dyalchand said the experience would be "more or less" identical, down to the possible complications.
"The only difference is because of access to better health care, they may not have the same kind of terrible outcomes," he added.
"But that doesn't mean that the girl's body and her life doesn't get scarred."
The story of a 10-year-old rape survivor in Ohio has shocked the US. Photo / AP
Gynaecologist and expert on maternal mortality in Pakistan, Dr Shershah Syed, agreed, telling The Times that even good prenatal care could not prevent hypertension or urinary tract infections in young mothers.
"They go to labour for three days, four days, five days, and after that labour, usually the baby is dead. And then when the head is collapsed, then the baby is delivered," Syed, who regularly provides care to pregnant girls as young as 11, said.
In "nearly all" cases in South Asia, he said the girls also developed a vesicovaginal fistula – a hole between the wall of the bladder and the vagina. In a quarter of cases, the prolonged labour resulted in a fistula of the rectum – so that the girl constantly leaks both urine and faeces.
"In normal physiology, a 10-year-old child is not supposed to be pregnant," Syed said.
"The point is, she's a child and the child cannot deliver a child, she's not ready. And the mental torture she will go through, that is not measurable."
Sexual harm - Where to get help If it's an emergency and you feel that you or someone else is at risk, call 111. If you've ever experienced sexual assault or abuse and need to talk to someone, contact Safe to Talk confidentially, any time 24/7: • Call 0800 044 334 • Text 4334 • Email support@safetotalk.nz • For more info or to web chat visit safetotalk.nz Alternatively contact your local police station - click here for a list. If you have been sexually assaulted, remember it's not your fault.
