Women's Age	Maternal Deaths/1,000 Births	Average Birth Weight	Premature Births (%)	Perinatal Deaths/1,000 Births
12 to 19	3.80	1.9 kg	20	29.6
20 to 30	2.55	2.5 kg	16	18.4
31+	1.07	2.65 kg	11	4.3
Source: Mishra & Dawn 1986 (329)

The life-threatening complications of pregnancy that women under age 20 face are the same risks that all other woman face: hemorrhage, sepsis, pregnancy-induced hypertension including preeclampsia and eclampsia, obstructed labor caused by cephalopelvic disproportion, complications of unsafe abortion, and iron-deficiency anemia. Young women face greater risks than older women of hypertension, cephalopelvic disproportion, iron-deficiency anemia, and unsafe abortion (7, 275, 281, 293, 330, 432, 451). These risks are higher for young women not only because of their age but also because births to younger women often are first births, which are riskier than second, third, or fourth births. Socioeconomic factors, including poverty, malnutrition, lack of education, and lack of access to prenatal care or emergency obstetrical care can further increase a young woman's risk of pregnancy-related complications (19, 212, 428). Among the young, as with older women, risks are greatest for poor women, who are most malnourished and have the least opportunity for prenatal care.

Untreated pregnancy-induced hypertension can cause heart failure or stroke and result in the death of both the mother and infant. Hypertension occurs most often among women having their first child and accounts for a large proportion of maternal deaths in women under age 20 (293, 451).

Cephalopelvic disproportion—meaning that the woman's pelvic opening is too small to allow the infant's head to pass through during delivery—can slow or prevent vaginal delivery. In some cases, if cesarean section cannot be performed, the woman's uterus ruptures, and both mother and infant die. Cephalopelvic disproportion is common in very young women whose pelvic growth is not complete and women of any age who are of small stature because childhood malnutrition stunted their growth (281, 330). The prolonged labor associated with cephalopelvic disproportion increases the risk of fistula—a tear between the vagina and the urinary tract or rectum, which allows urine or feces to leak out through the vagina. In many African countries fistula injuries occur most commonly in women under age 20, and obstructed labor causes most of these injuries (394, 490, 538). Fistula is reparable through surgery. For women who cannot get proper care, however, it often leads to lifelong disability and ostracism.

In many regions iron-deficiency anemia is a factor in almost all maternal deaths. An anemic woman is five times more likely to die of pregnancy-related causes than a woman who is not anemic (510). Anemic women are less able to resist infection and less able to survive hemorrhage or other complications of labor and delivery. Anemia also contributes to premature delivery and low birth weight (47).

Iron-deficiency anemia is particularly common among pregnant women, and young pregnant women are more likely than older women to be anemic, even in developed countries. For example, an analysis of eight US clinical studies found that pregnant women under age 20 were twice as likely to be anemic as older women (432). A US study of pregnant teenagers attending a prenatal clinic found that 70% lacked enough iron (47). Normal menstrual bleeding, a diet lacking absorbable iron, and malaria cause most anemia in pregnant women. To avoid anemia during adolescence, young people need twice as much iron as adults of the same weight (66, 537).

Lack of prenatal care. Adequate prenatal care can reduce pregnancy-related mortality and complications, especially among very young women (19, 161, 314, 353, 432). In developing countries, however, many women get no prenatal care (417), and young women are least likely to get care, even in developed countries (248, 460). When they do so, it is often late in pregnancy (293). Even where available, prenatal care services may not be used because child-bearing is considered normal for young women and thus is seen to require no medical attention.

Higher risks for infants. Pregnancy before age 20 also poses risk to the young woman's infant. Data from Demographic and Health Surveys (DHS) and other studies show that mortality and morbidity rates are higher among infants born to young mothers (468). Young mothers, especially those under age 15, have higher rates of premature labor, spontaneous abortion, stillbirth, and low birth weight infants (161, 314, 329, 353, 394, 428, 432, 434, 464, 493, 538). For the infant who survives, the higher risk of death persists throughout early childhood (32, 56, 113, 314, 329, 432, 464, 468, 490, 493).