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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 then estimated the potential reduction in adolescent maternal-related deaths, and equity and financial risk protection benefits that could be gained through increased educational attainment of young girls in these two countries.We considered the population of adolescent women, aged 15–19 years, in two countries, namely, Niger and India.Complicated deliveries included assisted vaginal deliveries with obstetric complications (eg, haemorrhage, eclampsia) and caesarean sections.

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Adolescent pregnancies remain common, and pregnant adolescent women face elevated risks of maternal mortality and poverty.

Further detail is given in the online supplementary appendix section 1.1.

Second, we estimated the amount of OOP costs related to complicated deliveries and associated transportation costs per income quintile.

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.

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