YAISHWARYAJ: {Awareness} Teenage Pregnancies: An Issue Calling for Closer Attention

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Teenage Pregnancies: An Issue Calling for Closer Attention

Submitted by JPMS Blogs Admin on December 21, 2015 – 8:54 PM Be the first to comment

Teenage is the period of transition from childhood to adulthood that in girls aids in physical, functional and psycho-social development to prepare for motherhood. According to WHO, teenage pregnancy is the conception of an unplanned fetus during adolescence (Acharya, Bhattaria, Poobalan, Teijlingen, & Chapman, 2010). This can often have severe consequences for both mother and neonate. In my reproductive health clinical, I encountered a 13 year old girl from a low socioeconomic background, who had just completed her 7th class in school and had been forced by her family to marry.

During the first year of marriage, this girl was in no way ready to have a child but due to societal pressure and her husband's dominating role in the household, she got pregnant. She was malnourished, and in the 30^th week of gestation, gave birth via C-section to a premature baby girl weighing 1.2 kg. The teenage mother was neither able to continue her education, nor was she prepared for a child, and so she losing interest in the infant's care, she fell into depression.

According to UNFPA (2013), 15 million adolescents globally get pregnant each year and 529000 die of ensuing complications of pregnancy. In Pakistan, the overall adolescent birth rate is 51.1 per 1000 women; with specific figures of 63, 46, 34 and 57 per 1000 women in Sindh, Punjab, Balochistan and Khyber Pakhtunkhwa respectively. This has increased the maternal mortality ratio to 190/100,000 births. Moreover, 49% of reported cases of child mortality are seen in relation with teenage pregnancies.

Many socio-cultural factors lead to teenage pregnancies. According to Acharya et al. (2010), the root cause is a tradition of early marriages. In Pakistan, 30% of girls are forcefully married in adolescence because parents believe this will save their daughters from unacceptable relationships and sexual abuse. Secondly, poverty and low literacy rates prompt early marriages (and consequent teenage pregnancies) since families view girls as a financial liability. Thirdly, Pakistani society being patriarchal, females are excluded from decision making, and the husband has the authority over conception. There are also social expectations to meet by having a child during the first year of marriage (Banerjee et al., 2009).

Moreover, teenagers are less informed about sexual health and contraceptive measures because sexual health education is still yet a cultural taboo. Somewhat paradoxically, hypersexualization in the media may increase early sexual desires; this may partly be to blame for a rise in sexual abuse and rape cases (Kirven, 2014). Furthermore, inappropriate parenting can neglect a teenager's behavior and he/she may become involved in unsafe sexual intercourse with multiple partners. Lastly, alcoholism, smoking and peer pressure also draw teenagers towards risky sexual behavior because teenagers consider smoking and alcoholism to be socially fashionable, and a gateway to acceptability (Lavin & Cox, 2012).

Teenage pregnancy has untoward consequences for both mother and child. The mother's body is not physically developed for child bearing and often among the lower social class, teenage girls especially are malnourished and anemic. This can result in low birth weight infants leading to the vicious cycle of malnutrition (Banerjee et al., 2009). Moreover, teenage mothers have 2.5% more chance of maternal mortality and maternal morbidities like PIH, pre-eclampsia, postpartum hemorrhage and post-natal depression.

Due to their immature physiological condition, teenage mothers run a higher risk for spontaneous abortions, and also unsafe abortions if the pregnancy is unplanned and unwanted (Kirven, 2014). Most teenage pregnancies result in preterm birth, stillbirth, perinatal and neonatal mortality, thereby increasing the infant mortality rate to 63/1000 live births in Pakistan.
Teenage pregnancy also has its own plethora of emotional and social consequences. The teenager is over-strained with the additional responsibility of a child, and vulnerable to depression due to which the adolescent mother may neglect her infant's care, thus denting the trusting mother-child relationship. Teenagers also lack the knowledge about parenting skills, which adds to their own psychological stress and affects the growth and developmental milestones of their child (Frances, 2011).

Additionally, it reduces access to higher education and decreases work opportunities for females, thereby decreasing the literacy level, increasing poverty and socioeconomic dependence on others. This comes in the way of women empowerment, making teenagers potential victims of domestic violence and coerced sex. Teenage pregnancies due to sexual abuse cut off the girl from the society. This lowers her self-esteem and leads to mental health issues (Acharya et al., 2010).

The Johnson Behavioral System (JBS) Model can be used to solve this issue (Oyedele, Wright & Maja, 2013). This model works for prevention of teenage pregnancies and improving consequences of teenage pregnancies. For the prevention, there are two subsystems:

(i) The dependency subsystem, in which a health care provider can counsel parents about the importance of female education, prevention of early marriages, complication of early pregnancy and the significance of parent-child relationship in order to understand teenager's sexual drives.

(ii.) The sexual subsystem, where the health care provider can arrange sex education programs in collaboration with reproductive health services for teenagers, including information about the human rights, gender equity, sexual relations, risks of unprotected sex and early pregnancy and guidance about the use of contraceptive measures. Moreover, advice can be given on the dangers of substance abuse, lifestyle modification and resisting peer pressure to curtail risky sexual behaviour.

Two subsystems are also present for alleviate negative consequences of teenage pregnancies:

(i) Supportive peer group subsystem, in which the healthcare team can provide parenting classes for teenage parents to prepare them for parenting and teach effective coping strategies to cope with the physical and emotional disturbance. Additionally, referral and psycho-social support are provided to women who have suffered sexual/domestic abuse. (ii) The Achievement subsystem, in which the health care personnel can collaborate with the government and policy makers. The aim is to initiate career skill programs and virtual academic learning for teenage mothers so that they could continue their education and have a self-sustaining future. This would empower women and reduce socioeconomic burden.

In conclusion, teenage pregnancy is an issue which has a negative socio-cultural and health impact. To achieve all the Millennium Development Goals it is necessary to solve this issue at individual, community and governmental levels. By working on the above mentioned strategies, we can eliminate this issue from our society.

References
Acharya, D., Bhattaria, R., Poobalan, A., Teijlingen, E., &
Chapman, G. (2010). Factors associated with teenage pregnancy in South Asia: a systematic review. Health Science Journal, 4(1), 3-14.

Banerjee, B., Pandey, G., Dutt, D., Sengupta, B., Mondal, M., & Deb, S. (2009). Teenage pregnancy: a socially inflicted health hazard. Indian Journal Of Community Medicine: Official Publication Of Indian Association Of Preventive & Social Medicine, 34(3), 227.

Frances, G. (2011). Teenage pregnancy: successes and challenges. Practice Nursing, 22(1), 12-13.

Kirven, J. (2014). Maintaining their future after teen pregnancy: Strategies for staying physically and mentally fit. International Journal Of Childbirth Education, 29(1), 57-61.

Lavin, C., & Cox, J. (2012). Teen pregnancy prevention: current perspectives. Current Opinion In Pediatrics, 24(4), 462–469.

Oyedele, O., Wright, S., & Maja, T. (2013). Prevention of teenage pregnancies in Soshanguve,South Africa: using the Johnson Behavioural System Model. Africa Journal of Nursing
and Midwifery, 15(1), 95-108.

UNFPA. (2013). Adolescent Pregnancy: A Review of the Evidence (pp. 3-55). NewYork:UNFPA.

About the Author: Afsheen Hirani, completed her Bachelors in Science of Nursing with honors from Aga Khan University School of Nursing and Midwifery. She is currently working as a nursing intern at Aga Khan University Hospital, Karachi, Pakistan. Public health, Mental health, Child health and Nursing research are her major interests. She can be reached atafsheenhirani11@gmail.com

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