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A review of the literature on the health consequences of adolescent sexual behavior and childbearing in sub-Saharan Africa reveals substantial contextual variation. Among the more general factors impacting on early sexual onset and childbirth are younger age at menarche, erosion of social and cultural controls on premarital sex, the abandonment of pubertal rites of passage, and more widespread schooling. Childbearing at young ages has been associated with pregnancy-induced high blood pressure, anemia and hemorrhage, obstructed and prolonged labor, infection, and higher rates of infant morbidity and mortality. Both cultural and biologic factors elevate the likelihood of transmission of sexually transmitted diseases, including HIV, among female adolescents. Many sequelae common to all adolescents are exacerbated by cultural practices such as genital mutilation. It is often assumed that the health problems of adolescent females will be addressed by general improvements in women's health services. However, the level of care required by adolescents who are delivering a first child is considerably greater than that required by healthy adult women. Moreover, may women's health services are hostile to teens who initiate coitus out of wedlock and may even deny treatment. Ultimately, prevention may depend more on changes in public policy and consideration of cultural context than upon specific programs.
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