Start Ddating girl direct 206 txt 206

Ddating girl direct 206 txt 206

We also examined the potential impact on maternal deaths and poverty of increasing adolescent girls' level of education by 1 year.

Further detail is given in the online supplementary appendix section 1.2.

Third, medical impoverishment was quantified by the estimated number of cases of catastrophic health expenditure incurred, which depended on assumed individual income and OOP costs.

Assuming an association with the adolescent pregnancy rate, we estimated the potential reduction in adolescent maternal-related deaths and impoverishment.

We calculated the number of maternal deaths averted due to a decrease in adolescent pregnancies, the amount of OOP costs averted due to the prevented complicated deliveries, and subsequently the number of cases of catastrophic health expenditure averted.

For example, by increasing education levels of young girls, pregnancies could be reduced and their associated risks of mortality and impoverishment, especially among the poorest, could be decreased.

Health economic evaluations have mostly focused on estimating the cost of an intervention per health gain (eg, cost per disability-adjusted life year averted).20 Extended cost-effectiveness analysis (ECEA)21–23 supplements such traditional economic evaluations with equity (eg, distribution of health outcomes per socioeconomic group) and financial risk protection (prevention of medical impoverishment) evaluation.

In this respect, it can address questions related to policies to be implemented for increasing financial risk protection, promoting poverty alleviation and equity, and improving the distribution of health in countries.

In this paper, consistent with ECEA, we first quantified the maternal-related deaths and medical impoverishment consequences of adolescent pregnancies in two countries: Niger, with the highest total fertility rate worldwide; and India, with the largest number of maternal deaths globally.

We relied on secondary data extracted from estimates from international agencies, surveys and the published literature.

We used country maternal mortality and population estimates from the United Nations for the year 2015.2–4 The percentage of women aged 15–19 who were pregnant per income quintile and skilled birth attendance coverage (proxy for healthcare usage) per income quintile were obtained from Niger's 2012 Demographic and Health Survey and India's 2007–2008 District Level Household Survey and 2005–2006 National Family Health Survey.26–28 We used an estimated relative risk (compared with 20–24 years old women) of maternal mortality among adolescents (15, 16, 17, 18, 19 years old)7 and data on OOP costs for complicated deliveries and transportation costs which were extracted from the literature for Niger15 We simulated the hypothetical impact of a 1-year increase in the education level of young girls.

It was based on the occurrence of complicated deliveries (15%; table 1), the relative risk of maternal mortality among adolescents, and the per cent of women aged 15, 16, 17, 18 and 19 pregnant.