Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review

[Teenage pregnancy: when digital social networks support becoming a mother]

The onset of pregnancy during adolescence brings with it upheavals for the body, identity, family and society. This particular context can make some teenagers psychopathologically fragile, while others adapt perfectly. When these mothers-to-be receive support, their adjustment to pregnancy seems to be facilitated. At present, it seems easy for teenagers to maintain contacts and thus benefit from a form of support on digital social networks. Recently discussed in the literature, the latter could represent a source of social support in this type of pregnancy, but also of support for the identity process of becoming a mother.

"The ones at the bottom of the food chain": structural drivers of unintended pregnancy and unsafe abortion amongst adolescent girls in Zambia

BACKGROUND

Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia.

METHODOLOGY

This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis.

RESULTS

Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers.

CONCLUSION

The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school.

Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses

BACKGROUND

Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern.

METHODS

Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant.

RESULTS

Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood.

CONCLUSION

Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.

Pooled prevalence and associated factors of teenage pregnancy among women aged 15 to 19 years in sub-Saharan Africa: evidence from 2019 to 2022 demographic and health survey data

BACKGROUND

Teenage pregnancy is becoming one of the most common social and public health problems worldwide, with the highest prevalence in sub-Saharan Africa. Health risks and adverse outcomes of pregnancy and childbirth among adolescent girls are the commonest cause of the global burden of maternal morbidity and mortality. This study is intended to determine the pooled prevalence and determinants of teenage pregnancy in sub-Saharan Africa using the most recent demographic and health survey data (2019-2022).

METHODS

A cross-sectional study was conducted using data from the most recent demographic and health surveys of four countries (Kenya, Tanzania, Gabon, and Cameroon) in sub-Saharan Africa conducted between 2019 and 2022. A total weighted sample of 12,829 teenagers aged 15 to 19 years was included in the study. Data extracted from demographic and health survey data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value ≤ 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

The pooled prevalence of teenage pregnancy among women aged 15 to 19 years was 18.15% (95% CI: 17.49, 18.83). Teenage pregnancy was positively associated with the respondent's age [AOR = 2.97; 95% CI (2.55, 3.46)], educational status [AOR = 2.21; 95% CI (1.62, 3.03)] and [AOR = 1.80; 95% CI (1.54, 2.12)], wealth status [AOR = 2.61; 95% CI (2.12, 3.22)] and [AOR = 1.65; 95% CI (1.33, 2.05)], relation to the household head [AOR = 2.09; 95% CI (1.60, 2.72)], and unmet need for contraception [AOR = 14.3; 95% CI (11.5, 17.8)]. On the other hand, it was negatively associated with marital status [AOR = 0.08; 95% (0.07, 0.10)], working status [AOR = 0.75; 95% CI (0.64, 0.88)], age at first sex [AOR = 0.68; 95% CI (0.58, 0.80)], contraceptive use [AOR = 0.25; 95% CI (0.20, 0.30)], contraceptive knowledge [AOR = 0.27; 95% CI (0.19, 0.40)], and community contraceptive utilization [AOR = 0.85; 95% CI (0.73, 0.99)].

CONCLUSION

In the current study, one out of six young women aged 15 to 19 experienced teenage pregnancy. Therefore, addressing unmet needs for family planning, improving women's educational status, and giving special attention to teenagers with low educational and economic status are recommended.

Prevalence and Factors Associated With Adolescent Pregnancy Among an Indigenous Ethnic Group in Rural Nepal: A Community-based Cross-sectional Study

OBJECTIVES

The Chepang people, an indigenous ethnic group in Nepal, experience substantial marginalization and socioeconomic disadvantages, making their communities among the most vulnerable in the region. This study aimed to determine the prevalence and factors associated with adolescent pregnancy in the Chepang communities of Raksirang Rural Municipality, Makwanpur District, Bagmati Province, Nepal.

METHODS

A cross-sectional study was conducted from October 2022 to April 2023 among 231 Chepang women selected using simple random sampling from Raksirang Rural Municipality. A semi-structured questionnaire was used for interviewing the mothers. Bivariate and multivariate logistic regression analyses were performed, using odds ratios with 95% confidence intervals (CIs). Variables with a variation inflation factor of more than 2 and a p-value of more than 0.25 were excluded from the final model.

RESULTS

The study revealed that the prevalence rate of adolescent pregnancy among Chepang women was 71.4% (95% CI, 65.14 to 77.16). A large percentage of participants (72.7%) were married before the age of 18 years. Poor knowledge of adolescent pregnancy (adjusted odds ratio [aOR], 10.3; 95% CI, 8.42 to 14.87), unplanned pregnancy (aOR, 13.3; 95% CI, 10.76 to 19.2), and lack of sex education (aOR, 6.57; 95% CI, 3.85 to 11.27) were significantly associated with adolescent pregnancy.

CONCLUSIONS

The prevalence of adolescent pregnancy among the Chepang community was high. These findings highlighted the importance of raising awareness about the potential consequences of adolescent pregnancy and implementing comprehensive sexuality education programs for preventing adolescent pregnancies within this community.

Health and well-being of young mothers displaced by conflict: Experiences from South Sudan and the Kurdistan Region of Iraq

Giving birth during adolescence is linked to a variety of negative outcomes, including poor health and well-being. Girls who have been displaced by conflict are at increased risk for becoming young mothers. While prevalence rates and health outcomes have been documented, rarely have the complex personal narratives of early motherhood been examined from the perspectives of mothers themselves, particularly in the Global South. This study relies on in-depth, inductive, narrative analysis of qualitative interviews with 67 young mothers and 10 relatives in South Sudan and the Kurdistan Region of Iraq (KRI) who had been displaced by conflict. This study provides deep insights into the contributing circumstances and consequences of young motherhood from sexual and reproductive health and well-being perspectives, with additional insights on mothering in humanitarian crisis.

A qualitative analysis of adolescent motherhood within the broader family context in Peru

Objective

The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets.

Background

Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group.

Method

This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed.

Results

The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy.

Conclusion

Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy.

Implications

Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

Mechanisms behind gender transformative approaches targeting adolescent pregnancy in low- and middle-income countries: a realist synthesis protocol

INTRODUCTION

Adolescent pregnancy is defined as pregnancy at the age of 19 or below. Pregnancy and childbirth complications are the most significant cause of death among 15-19-year-old girls. Several studies have indicated that inequitable gender norms can increase the vulnerability of adolescent girls, including violence exposure, early marriage, and adolescent pregnancy. To address these disparities, gender transformative approaches aim to challenge and transform restrictive gender norms, roles, and relations through targeted interventions, promoting progressive changes. This realist review aims to synthesise existing evidence from a broad range of data sources to understand how, why, for whom, and in what contexts gender transformative approaches succeed in reducing adolescent pregnancy in low- and middle-income countries.

METHOD AND ANALYSIS

We employ a five-step realist synthesis approach: (1) clarify the scope of review and assessment of published literature, (2) development of initial programme theories, (3) systematic search for evidence, (4) development of refined programme theories, and (5) expert feedback and dissemination of results. This protocol presents the results of the first three steps and provides details of the next steps. We extracted data from 18 studies and outlined eight initial programme theories on how gender transformative approaches targeting adolescent pregnancy work in the first three steps. These steps were guided by experts in the field of sexual and reproductive health, implementation science, and realist methodology. As a next step, we will systematically search evidence from electronic databases and grey literature to identify additional studies eligible to refine the initial programme theories. Finally, we will propose refined programme theories that explain how gender transformative approaches work, why, for whom, and under which circumstances.

ETHICS AND DISSEMINATION

Ethics approval is not required because the included studies are published articles and other policy and intervention reports. Key results will be shared with the broader audience via academic papers in open-access journals, conferences, and policy recommendations. The protocol for this realist review is registered in PROSPERO (CRD42023398293).

Family planning saves maternal and newborn lives: Why universal access to contraception must be prioritized in national maternal and newborn health policies, financing, and programs

We highlight why integrating contraceptive services within maternal and newborn health programs is essential for improving outcomes. We offer effective, actionable recommendations that can be implemented easily.

Adolescent child custody loss and substance use treatment as predictors of young adult substance use trajectories among females with foster care and juvenile justice involvement

This study aimed to identify trajectories of substance use from adolescence to young adulthood among 166 females with dual child welfare and juvenile justice system involvement, and to explore the influence of adolescent child custody status and substance use treatment on substance use trajectories. Results identified four substance use trajectory groups (stable moderate substance use, decreasing substance use, increasing substance use, stable high substance use). Custody loss during adolescence predicted membership in the stable high substance use trajectory group (log odds estimate = 2.99, p = < 0.01). No significant associations were found with adolescent substance use treatment. The findings can inform policymakers, foster care professionals, and law enforcement officers to promote the delivery of timely and appropriate substance use services that respond to the unique needs of females across the child welfare and juvenile justice system populations.

Gender role beliefs and adolescent pregnancy in Colombia: findings from the 2015 DHS survey

This study investigated the association between gender role beliefs and the prevalence and likelihood of experiencing pregnancy among 8525 young women and girls aged 13-19 years in Colombia. The primary outcome of interest was adolescent pregnancy. Retrospective cross-sectional analysis utilised data from the 2015 Demographic and Health Survey (DHS) in Colombia, which included an add-on questionnaire on gender relations. Our analysis measured both pregnancy prevalence and pregnancy likelihood in relation to gender role beliefs. With one exception, young women who disagreed with traditionally conforming gender roles had a lower prevalence of pregnancy and were less likely to experience pregnancy than those who agreed with them. The highest likelihood of pregnancy prevalence and likelihood was found among those who agreed with statements suggesting male dominance and those who agreed with women's homemaking responsibilities. The greater the adherence to traditionally conforming gender role beliefs, the higher the likelihood of experiencing pregnancy during adolescence. Girls' and young women's adherence to traditional gender role beliefs appeared to be a risk factor for adolescent pregnancy. Our findings support Colombia's current sex education policies and practices within the framework of gender equity, and evidence the link between gender equity and girls' and young women's reproductive health.

Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d'Ivoire: triangulation of three independent evaluations

Merci Mon Héros (MMH) is a youth-designed multi-media campaign seeking to improve sexual and reproductive health and family planning (SRH/FP) outcomes among youth living in nine francophone countries. A mixed methods approach was implemented to assess the MMH campaign progress and impact in Côte d'Ivoire. Three data sources were triangulated to evaluate the campaign: social media listening (October 2019-January 2021); a quantitative cross-sectional monitoring survey (September 2020) with 412 youth (aged 16-24) and 597 adults (aged 25-49); and a qualitative study using a Most Significant Change approach (March 2021), including a total of 24 focus group discussions with youth (aged 15-24) and adults (aged 25+) exposed to the MMH campaign. Data from all three studies were analysed independently and then brought together through a triangulation workshop where the study team compared findings to achieve convergence in evaluation results. Social listening results showed topic-specific online conversations related to MMH campaign spiked significantly during the two-week period after topic-specific campaign posts (p < .05), suggesting potential campaign impact. Survey results showed both adults and youth were more likely to have spoken with someone about FP in the past five months if exposed to the campaign (p < 0.01). Qualitative findings support the campaign's effect on shifting attitudes and behavioural uptake of intergenerational communication among adults and youth. This evaluation shows evidence of MMH's strong potential for impact in encouraging communication and the need to focus efforts on strategies to strengthen supportive adults' communication competencies and redefine what it means to act in support of SRH/FP for youth.

Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis

BACKGROUND

Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea.

METHODS

Data for this cross-sectional study were obtained from the 2016-2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15-19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality.

RESULTS

Weighted ECI for teenage pregnancy was - 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy.

CONCLUSIONS

A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.

Nurturing care among adolescent mothers

Many studies show the impact of adolescent mothers on child development. To prevent the impact of adolescent pregnancy, nurturing care is needed to support optimal children's development. This study aims to identify comprehensive nurturing care among adolescent mothers. This study used secondary data in the integration of the 2018 National Socioeconomic Survey and Basic Health Survey. To measure nurturing care, 5 components were used: health, adequate nutrition, security and safety, responsive caregiving, and opportunities for early learning with latent class analysis. The results of the analysis showed that 62% of adolescent mothers provided uncompleted nurturing care. About 21% of adolescent mothers need assistance in improving nurturing care related to adequate nutrition and learning opportunities, and 17% need assistance to improve health, nutrition, responsive caregiving, and opportunities for early learning. Adolescent mothers are in need of comprehensive nurturing care for their children. Practice is needed in order to enhance nurturing care initiatives, particularly for teenage mothers.

Maternal mortality in adolescents and young adults: temporal trend and correlation with prenatal care coverage in the state of Bahia, Brazil, 2000-2020

MAIN RESULTS

From 2000 to 2020, maternal mortality among adolescents and young adults showed a decreasing trend in the state of Bahia. It could be seen an inverse and significant correlation between the highest number of prenatal care visits and maternal mortality in the studied groups.

IMPLICATIONS FOR SERVICES

The study suggests the importance of quality obstetric care during prenatal, childbirth, and postpartum period for reducing maternal mortality among adolescents and young adults, especially from preventable causes.

PERSPECTIVES

Improving the records of causes of death on information systems, enhancing obstetric care, and investing in sexual and reproductive health policies aimed at adolescents may contribute to the reduction of maternal deaths.

OBJECTIVE

to analyze the temporal trend of maternal mortality and correlate it with prenatal care coverage among adolescents and young adults, state of Bahia, Brazil, 2000-2020.

METHODS

this was an ecological time-series study and correlation between maternal deaths and prenatal care visits in 10-19 and 20-24 age groups, using the Mortality Information System; the trend analysis was performed by means of Prais-Winsten regression, according to race/skin color, timing and causes of death; and Spearman coefficient was used for correlation.

RESULTS

in the study period, 418 deaths among adolescents and 574 among young adults were recorded; maternal mortality ratio was 59.7 and 63.2 deaths/100,000 live births, with a significant decreasing trend (-2.2% and -2.9% respectively); it could be seen an inverse correlation between a higher number of prenatal care visits and maternal mortality in the age groups.

CONCLUSION

maternal mortality showed a decreasing trend in the study period, but with high proportions of death; there was a significant correlation between prenatal care coverage and maternal mortality among adolescents and young adults.

Social-psychological determinants of hormonal contraceptive use intentions among adolescent girls in the Bono East Region of Ghana

Introduction

The correct and consistent use of hormonal contraceptive (HC) methods by sexually active adolescent girls can prevent pregnancy and avert the health and social consequences of unwanted pregnancy for both the mother and her child. Despite these benefits, research shows that HC use is rather low among adolescent girls globally and especially among those in low and middle-income countries. This study was carried out to assess the social-psychological determinants of HC use intentions among adolescent girls and young women.

Methods

A cross-sectional survey was conducted among 1,203 young women aged 15-24 years from 70 communities within the Kintampo North Municipality and Kintampo South District in the Bono-East Region of Ghana from April 2021 to September 2021. Multiple linear regression analysis was used to identify factors associated with the intention to use HC among the entire sample of 1,203 respondents and among two sub-samples of young women based on HC use experience.

Results

Attitude toward personal HC use (β = 0.268; p < 0.001), self-efficacy toward access and use of HC (β = 0.341; p < 0.001), and HC use experience (β = 0.647; p < 0.001) were found to be significant and unique correlates of HC use intention among the entire sample of adolescent girls. Attitude toward personal HC use and self-efficacy toward access and use of HC were also associated with HC use intention in the two sub samples significantly (p's < 0.001). In addition, among participants with no HC experience, being a Christian as opposed to participants that affiliate themselves with Islam, Traditional religion or being non-religious positively predicts future HC use (β = 0.230; p < 0.01).

Conclusion

Our results demonstrate that different groups of adolescent girls need different interventions, focusing on different determinants for the motivation to use HC. Comprehensive sexuality education, informing all adolescent girls about the personal benefits of HC use and enhancing their skills in accessing and using HCs, can support their HC use intentions to promote their reproductive health and general wellbeing.

Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis

BACKGROUND

Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC.

METHODS

Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies.

RESULTS

Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs.

CONCLUSION

Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately.

PROSPERO REGISTRATION NUMBER

CRD42019139183.

Growth failure among children of adolescent mothers at ages 0-5 and 6-12 years in India

Adolescent motherhood has been linked with poor health outcomes at birth for children, including high neonatal mortality, low birthweight, and small-for-gestational-age rates. However, longer-term growth outcomes in the children of adolescent mothers in low-resource settings remain inadequately studied. We used longitudinal data from the India Human Development Surveys, 2004-2005 and 2011-2012 (n = 12,182) and employed regression and propensity score matching analysis to compare the following growth indicators of children born to adolescent mothers (ages 19 years or below) with those born to older mothers. Growth indicators included height and weight during ages 0-5 years and 6-12 years and change in height and weight between the two periods. In regression-based estimates, children born to adolescent mothers were 0.01 m shorter and weighed 0.2 kg less than children of older mothers at ages 0-5 years. At ages 6-12 years, those born to adolescent mothers were 0.02 m shorter and weighed 0.97 kg less. The height difference between the two groups increased by 0.01 m and the weight difference grew by 0.77 kg over time. Height and weight difference between the two groups worsened among boys over time, while for girls, only the weight gap worsened. The results were similar when using propensity score matching methods. Public policies for reducing child marriage, combined with targeted health, nutrition, and well-being programs for adolescent mothers, are essential for both preventing adolescent childbearing and reducing its impact on growth failure among children in India.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022

BACKGROUND

Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia.

METHODS

This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies.

RESULTS

Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment.

CONCLUSION

From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

Accuracy of Sexual and Reproductive Health Information among Adolescent Girls: A Cross-Sectional Study

BACKGROUND

The leading cause of death for girls aged 15-19 years globally is complications from pregnancy and childbirth. Girls have poor access to sexual and reproductive health (SRH) services, including information.

STUDY OBJECTIVE

To describe the accuracy of SRH information (SRHI) and its associated factors among adolescent girls in Uganda METHODS: We conducted a cross-sectional study among girls aged 13-19 years in an urban district and a rural district. The accuracy of SRHI was assessed using a set of 13 questions covering "sex and reproduction," "condom use," and "HIV and other sexually transmitted diseases." Accuracy was categorized as low (≤7 items correct), moderate (8-11 items correct), and high accuracy (≥12 items) according to the number of correct answers. Poisson regression analysis was used to determine factors associated with accurate SRHI using STATA version 14.

RESULTS

Of the 600 girls (mean age: 16.9 years; SD = 3.84), 75.3% were in school. The mean SRHI knowledge score was 9.9. The SRHI accuracy score was low among 6.3% of adolescents, moderate among 80.7%, and high among 13%. Parents with permissive parenting styles had adolescents with low SRHI accuracy compared with disciplinarian/authoritarian parents (IRR = 0.93 [0.885-0.987]; P = .004), whereas parents talking about sex with their adolescents was associated with accurate SRHI (IRR = 1.1 [1.051-1.153]; P < .001). Adolescents who had ever been pregnant had low SRHI accuracy (0.98 [0.911-0.989]; P = .019). There was no difference in SRHI accuracy between the urban and rural districts (P = .45).

CONCLUSION

The low accuracy of SRHI calls for interventions aimed at engaging and training parents, who are considered to be the first in line to provide accurate information to adolescents irrespective of their location. The interventions and training should be culturally appropriate, and parents need to be supported with skills aimed at demystifying SRHI.

Juvenile incarceration in an adult correctional facility as a risk factor for adolescent childrearing?

INTRODUCTION

Recent trends in reproductive rights have contributed to lasting concerns about adolescent childrearing in American society. Beyond being generally unprepared when raising a child, having a child during adolescence is associated with a variety of environmental, social, and psychological consequences for both the parents and the child. It is important to understand the factors contributing to adolescent childrearing. Although research has identified many factors that contribute to adolescent childrearing, a notable gap remains when considering the role of the correctional system and, in particular, the age-specific effects of confining adolescents in adult correctional facilities.

METHODS

The current study examined the age-specific effects of time spent in adult correctional facilities from 13 to 34 years of age on childrearing between 14 and 35 years of age using the National Longitudinal Survey of Youth-1997 (NLSY97). The NLSY97 is a nationally representative sample of Males (51%) and Females (49%) born in the United States. Respondents of the NLSY97 were interviewed about life events beginning at age 7 and continued to participate in the study as recently as 2021.

RESULTS

The results of the lagged growth curve models suggest that the time spent incarcerated between 13 and 17 years of age heightens the risk of childrearing between 14 and 18 years of age, an effect that is not observed during adulthood.

CONCLUSION

Overall, the results suggest that the conditions adolescents are exposed to during incarceration in an adult correctional facility could contribute to a heightened likelihood of adolescent childrearing.

A, Diez Roux AV. Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities

BACKGROUND

Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries.

METHODS

We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics.

RESULTS

We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores.

CONCLUSION

Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.

Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review

Background

Adolescent pregnancy is a public health challenge that has well-defined causes, associated health risks, and social and economic consequences for adolescent, their families, communities, and society. The purpose of this scoping review is to summarize studies published on socio-cultural determinants of adolescent pregnancy in Ghana.

Methods

Search for records was done in four major databases, including PubMed CENTRAL, Science Direct and JSTOR. Records from Google and Google Scholar were also added, and results and findings from published and unpublished studies were included. All the 22 studies that met the eligibility criteria, were critically appraised. The guidelines for conducting scoping reviews by Arksey and O’Malley were followed.

Results

The result revealed that poverty, peer influence, low level of education, dysfunctional family, lack of communication between parents and their daughters, lack of sexual and reproductive health education, child marriage, coerced sex, misconception and non-usage of contraceptives, and decline in cultural values such as puberty rites and virginity inspection are some of the determinants of adolescent pregnancy in Ghana. The study also showed that there is a lack of high-quality observational studies that adjust for confounding variables.

Conclusion

Interventions and policies should be designed to take into consideration the needs, context, and background of adolescents. Programmes to enhance adolescent reproductive health need to consider multilevel factors such as person, family, community, institutions, national, and global issues that affect such programmes.

Adolescent experiences of pregnancy in low-and middle-income countries: a meta-synthesis of qualitative studies

Background

Fertility rates among adolescents have fallen globally, yet the greatest incidence remains in low-and middle-income countries (LMICs). Gaining insight into adolescents needs and experiences of pregnancy will help identify if context specific services meet their needs and how to optimise pregnancy experiences. A meta-synthesis of qualitative studies considering adolescent experiences of pregnancy in LMICs has not yet been published.

Aim

To synthesise available qualitative evidence to provide greater understanding of the needs and experiences of adolescents who become pregnant in low-and middle-income countries.

Methods

An extensive search utilised six databases and citations searching. Studies were included if they were of a qualitative or mixed methods design. Participants lived in LMICs and were adolescents who were pregnant, had experienced pregnancy during adolescence or were an adolescent male partner. Relevant studies were assessed for quality to determine suitability for inclusion. A meta-ethnography approach was used to generate themes and a final line of argument.

Results

After screening and quality assessment 21 studies were included. The meta-ethnography generated four themes, A wealth of emotions, I am not ready, Impactful relationships and Respectful and disrespectful care. Unplanned, unwanted and unacceptable pregnancies were a source of shame, with subsequent challenging personal relationships and frequently a lack of needed support. Even when pregnancy was wanted, adolescents faced the internal conflict of their desires not always aligning with socio-cultural, religious and family expectations. Access, utilisation and experiences of care were significantly impacted by adolescents’ relationships with others, the level of respectful care experienced, and engagement with adolescent friendly services.

Conclusions

Adolescents who experience pregnancy in LMICs deserve support to meet their personal and pregnancy needs; efforts are needed to tailor the support provided. A lack of a health care provider knowledge and skills is an obstacle to optimal support, with more and better training integral to increasing the availability of adolescent friendly and respectful care. Adolescents should be involved in the planning of health care services and supported to make decisions about their care. The diversity across countries mean policy makers and other stakeholders need to consider how these implications can be realised in each context.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-05022-1.

"Now, I have my baby so I don't go anywhere": A mixed method approach to the 'everyday' and young motherhood integrating qualitative interviews and passive digital data from mobile devices

The impacts of early pregnancy and young motherhood on everyday life, including interpersonal and individual behavior, are not well-known. Passive digital sensing on mobile technology including smartphones and passive Bluetooth beacons can yield information such as geographic movement, physical activity, and mother-infant proximity to illuminate behavioral patterns of a mother's everyday in Nepal. We contribute to mixed-methods research by triangulating passive sensing data (GPS, accelerometry, Bluetooth proximity) with multiple forms of qualitative data to characterize behavioral patterns and experiences of young motherhood in the first year postpartum. We triangulated this digital information in a constant comparative analysis with in-depth interviews, daily diaries, and fieldnotes. We reveal typical behavioral patterns of rural young mothers and highlight opportunities for integrating this information to improve health and well-being.

Maternal and Neonatal Outcomes of Adolescent Pregnancy: A Narrative Review

Adolescent pregnancy is the pregnancy of girls aged 10-19 years, leading to many maternal and neonatal adverse effects. These pregnancies have been a global concern for many decades and yet are still prevailing. This article has reviewed the significant determinants of adolescent pregnancy and various maternal adverse effects, including preeclampsia, preterm premature rupture of the membrane (PPROM), maternal anemia, sexually transmitted diseases, postpartum depression, and maternal deaths, and adverse neonatal outcomes, including low birth weight (LBW), prematurity, stillbirths, early neonatal demise, and low Apgar score. Various pathophysiologic events that lead to such adverse consequences have been briefly discussed in the article and how such occurrences can be overcome. This article has also emphasized the need to implement various modalities such as sex education, availability of contraceptives, and bringing community-level awareness to lower the prevalence of adolescent pregnancy.

Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries

CONTEXT

Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above.

METHOD

Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630).

RESULTS

Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics.

CONCLUSION

Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

Transition in social risk factors and adolescent motherhood in low- income and middle- income countries: Evidence from Demographic and Health Survey data, 1996-2018

Understanding the dynamics of social risk factors in the occurrence of adolescent motherhood is vital in designing more appropriate prevention initiatives in low-income and middle-income countries (LMICs). We aimed this study to examine the transition of social risk factors and their association with adolescent motherhood in LMICs since the initiation of the MDGs. We analysed 119967 adolescent girls (15-19 years) from 40-nationally representative Demographic Health Surveys in 20 LMICs that had at least two surveys: a survey in 1996-2003(baseline, near MDGs started) and another in 2014-2018(endline). Adolescent motherhood (having a live birth or being pregnant before age 20) was the outcome of interest, whereas social risk factors including household wealth, girls' level of education, and area of residence were the exposures. The association between adolescent motherhood and the social risk factors, as well as changes in the strength of the association over time were observed using multilevel logistic regression analysis. On an average, the proportion of adolescent mothers without education decreased by -15·61% (95% CI: -16·84, -14·38), whereas the poorest adolescent mother increased by 5·87% (95% CI: 4·74, 7·00). The national prevalence of adolescent motherhood remained unchanged or increased in 55·00% (11/20) of the studied countries. Comparing baseline to endline, the overall adjusted odds ratio (AOR) of adolescent motherhood increased for both poorest (AOR = 1·42, 95% CI: 1·28, 1·59) and rural residences (AOR = 1·09, 95% CI: 1·01, 1·17), and decreased, but not statistically significant for the low level of education (AOR = 0·92, 95% CI: 0·84, 1·01 for no education). Our study concludes that social risk factors of the adolescent mother had shifted in different directions during MDGs and SDGs eras, and adolescent mothers remained more disadvantaged than non-mothers in LMICs. Efforts need to be enhanced to improve adolescent girls' education. Intervention should be prioritised in disadvantaged communities to delay adolescent first birth and prevent adolescent motherhood in LMICs.

Which factors affect postpartum educational enrollment of adolescent mothers in South Africa? A latent class analysis

Interrupted education of adolescent mothers remains a major concern, but limited evidence-based programming exists to support postpartum schooling of this group. This study aimed to better understand the factors that render some adolescent mothers vulnerable to school non-enrollment, and how to reduce these risks. Data from 1,046 adolescent and young mothers (10-24 years) from rural and urban communities in South Africa's Eastern Cape was obtained through a questionnaire containing validated and study-specific measures relating to sociodemographic characteristics, schooling, relationships, violence exposure, and health. Using latent class analysis, we explored emerging latent groups and their relationship to mothers' enrollment in school, college, or tertiary education. The analyses revealed three distinct groups of mothers: The 'most disadvantaged' subgroup (39%) experienced multiple risks, including food insecurity, living in informal housing, lacking positive relationships with their caregiver, and the highest distance to school; The 'disadvantaged' subgroup (44%) did not experience food insecurity whilst reporting better caregiver relationships and lower distance to school. However, this group still showed high probabilities of residing in informal housing and in communities that expose them to violence; A 'least disadvantaged' subgroup (17%) was largely unaffected by economic and community risks and experienced good caregiver relationships. Compared to the most disadvantaged mothers, the least disadvantaged mothers showed the highest probability of being enrolled in education (65% versus 45%). Adolescent motherhood can impede continued enrollment in education and individual-centered interventions alone might not be sufficient to mitigate the risks for non-enrollment. Services and provisions that address severe poverty and improve family relationships might provide an opportunity to positively influence schooling among adolescent mothers.

The Influence of Parenting and Friendship on Self-Esteem in Adolescents

BACKGROUND: Studies in psychology often discuss adolescents with their strong self-esteem as individuals who know themselves. Self-esteem development in adolescents. These adolescents begin to understand the changes of personality development starting from the cognitive aspect or thoughts, emotion, feeling, social, and physical aspects. AIM: This study consistently aimed at finding comprehensive evidence that positive parenting and friendship affect self-esteem in adolescents. METHODS: The population of this study was adolescents, namely 173 senior high school students consisting of 72 males and 100 females who were involved and participated in this study. The data analysis, in this study, was the 2 predictors for linear regression analysis. RESULTS: The results showed that parenting and friendship simultaneously influenced self-esteem formation in adolescents. Partially, the result of this study also showed that parenting affected self-esteem formation in adolescents. CONCLUSION: In conclusion, friendship showed a significant effect on self-esteem formation in adolescents. Thus, the hypotheses in this study were accepted.

Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals

Objective

To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals.

Materials and Methods

Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified.

Results

The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years.

Conclusions

It is advisable to develop education strategies, strengthen group care and involve the teenager’s support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.

"… I would have left that man long time ago but, …" exploring circumstances of and motivators for repeat adolescent birth in Eastern Uganda

BACKGROUND

First birth before 18 years has declined in Uganda unlike repeat adolescent birth (=second or more births before age 20 years). We explored the circumstances of and motivators for repeat adolescent birth in Eastern Uganda.

METHODS

Between January and March 2020, we conducted a qualitative study involving 70 individual in-depth interviews with purposively selected respondents - 20-25-year-old women with and without repeat adolescent birth, their partners, and parents, in the communities of Teso sub-region. We conducted latent content analysis.

RESULTS

Four major themes emerged: poverty, vulnerability, domestic violence, and demotivators. Sub-themes identified under poverty were: "limited provisions", "peasantry", "large families", "dropping out of school", "alcohol abuse", and "broken family structure". Vulnerability included "marital entrapment" and "partner coercion". Demotivators included: "abandonment", "stern warning", "objection to marriage", and "empowerment". Extreme poverty resulted in inadequate provision of basic needs leading to unprotected sexual activity in a bid to secure financial support. Following the first birth, more than three quarters of the women with repeat adolescent birth reported increased economic distress that forced them to remain in unwanted marriage/union, often characterized by partner coercion, despite wanting to delay that repeat birth. Women without repeat adolescent birth avoided a second birth by empowerment through: an economic activity, contraception use, and resumption of schooling.

CONCLUSION

Repeat adolescent birth in Uganda is premised around attempts to address the economic distress precipitated by first birth. Many women want to delay that repeat birth but the challenges robbed them of their reproductive autonomy. Beyond efforts to prevent first birth, programs need to address economic empowerment, ensure contraceptive access, and school re-integration for adolescent mothers in order to prevent shortly-spaced repeat births.

The body cannot be cheated: sexual practices and modern contraceptive use among street-involved young people in two South West States in Nigeria

Background: Young people aged 10-24 years constitute about one-third of the total population of Nigeria. Street-involved young people (SIYP) face a double burden of living condition instability and lack of adequate parental monitoring. This leaves them vulnerable to poor sexual and reproductive health (SRH) choices and behaviour. Risky sexual behaviour with poor access to SRH information and interventions increases their vulnerability to adverse SRH outcomes. This study explored the use of modern contraceptives and sexual practices among male and female SIYP (10-24 years) in Nigeria. Methods: This qualitative study used an exploratory research design to guide the development of the focus group discussion (FGD) and in-depth interview (IDI) guides. Participants were asked questions on background information, lived experiences and SRH practices. The FGDs were stratified by sex and age. Both FGD discussions and IDI interviews were recoded; transcripts were transcribed and translated from local dialect into English language. Content analysis was conducted thematically with the aid of NVivo. Results: In total, 17 IDIs and 11 FGDs were conducted among SIYP aged 10-24 years. The total number of respondents interviewed was 109. There is high awareness of modern contraceptives among SIYP; the commonly known method was condom with a few also aware of emergency contraceptives pills. However, participants reported low use of modern contraceptives. The common reasons alluded for not using condoms were reduced sexual pleasure, cost and associated myths. The five themes that emerged under sexual practices of SIYP included early age at first sexual encounter, multiple sex partners, transactional sex, same-sex relationships, and transactional sex. Conclusions: There is low utilization of contraceptives by SIYP against the background of their high-risk sexual practices. SIYP would benefit from free contraceptive education, social safety nets and interventions to dissuade them from transactional sex and other unhealthy sexual practices.

Assessing the Vulnerability and Risks of Adolescent Girls and Young Women in East and Southern Africa: A Preliminary Review of the Tools in Use

The sexual and reproductive health (SRH) needs of adolescent girls and young women (AGYW) aged 10–24 years remain a cause for concern in the countries of East and Southern Africa (ESA). High rates of adolescent pregnancy and HIV prevalence prevail, and prevention programmes are challenged to identify those at greatest risk. This review aimed to identify tools being used in ESA countries that support the recording of factors that make AGYW vulnerable to SRH risks and document their use. A mixed-methods approach was used to find available English language tools that had been designed to assess the vulnerability of AGYW SRH risks including literature reviews and key informant interviews with thirty-five stakeholders. Twenty-two tools were identified, and experiences of their use obtained through the interviews. All but one tool focused on HIV prevention, and most aimed at establishing eligibility for programmes, though not aligned with programme type. Analyses of the content of seventeen tools showed information collection related to behavioral, biological, and structural risk factors of HIV and other aspects of AGYWs’ lives. There was considerable diversity in the ways in which these questions were framed. Aspects of the processes involved in undertaking the risk and vulnerability assessments are presented.

Norms and sexual relations among adolescents in the context of an intervention trial in rural Zambia

High levels of adolescent pregnancy and child marriage rates in low- and middle-income countries is an issue of concern to many stakeholders, including in Zambia where almost one-third of women give birth before age 18. The aim of this paper is to explore and analyse social norms concerning adolescents' sexual behaviour within the context of an intervention trial in rural communities in southern Zambia. It is based on a qualitative study applying individual interviews, focus group discussions and participatory research methods. We apply the distinction between injunctive and descriptive norms to demonstrate that adolescent girls are caught between conflicting norms. Injunctive norms express that premarital sex, contraceptive use, and discussions about sex between adults and youths are socially condemned. At the same time poor girls are reported to feel pressure towards having sexual relations for the economic benefits such relations can bring, and this practice is considered so common that it amounts to a descriptive norm. Norms and structural conditions combine to create a disabling and disempowering environment for adolescent sexual and reproductive health, which limits girls' agency and exposes them to unwanted pregnancies.

A qualitative study of risks and protective factors against pregnancy among sexually-active adolescents in Soweto, South Africa

Risky sexual behaviors contribute to increased risk of adolescent pregnancy. This qualitative study sought to understand risks and protective factors against pregnancy amongst sexually-active adolescents in Soweto, South Africa. We used purposive sampling to recruit women at age 24 years from Soweto, who self-reported having sexual debut by age 15 years. Twenty women were recruited: (i) women who did not become pregnant before 18 years (n = 10) and (ii) women who became pregnant before 18 years (n = 10). In-depth interviews were conducted to understand their family backgrounds, conversations about sex, sexual behaviors, and initiatives taken (or not) during adolescence to prevent pregnancy. Both groups of women reported predisposing risks to early pregnancy including influence from peers to engage in early sex, unstable family relationships and limited conversations about sex. We found that the family is a key institution in supporting adolescents' decisions regarding their behaviors and choices, as are peers and exposures to information. Community Youth Centers, high schools and Youth Friendly Health Services should ensure that adolescents have access to relevant information, including sex education and contraceptives.

Adolescents' narratives of coping with unintended pregnancy in Nairobi's informal settlements

Aim

This study explored adolescent experiences and coping strategies for unintended pregnancy in two informal settlements—Viwandani and Korogocho—in Nairobi, Kenya.

Methods

Forty-nine in-depth-interviews and eight focus group discussions were conducted with male and female adolescents aged 15–19 years from households in two informal settlements. Participants were purposively selected to include adolescents of varying socio-demographic characteristics, including the married and unmarried, and adolescents who had never/ever been pregnant. Data were transcribed, translated verbatim and analyzed thematically.

Results

Adolescents attributed unintended pregnancy to poverty, sexual violence and inconsistent contraceptive use. Lack of parental support and guidance, as well as household conflicts also exposed girls to early sexual debut and risky sexual behavior. Decisions about pregnancy management centered on carrying the pregnancy to term or terminating it. Deciding to terminate a pregnancy was not always straightforward and was motivated by concerns about stigma or shame, and school disruption. Participants reiterated that carrying an unintended pregnancy to term disrupts adolescents’ schooling, with few girls returning to school after childbirth. Upon deciding to carry a pregnancy to term, adolescents used several coping strategies such as relocating from usual residence, hiding until delivery and planning to put up the child for adoption upon delivery.

Conclusions

Early interventions to provide adolescents with comprehensive pregnancy prevention information and to address sexual violence and poverty can prevent unintended pregnancy in adolescents. Efforts to support adolescents to positively cope with unintended pregnancy and facilitate re-entry to school are also warranted.

Adolescent pregnancy and social norms in Zambia

Early pregnancy occurs frequently in Zambia and is considered a public health issue. The aim of this study was to improve understanding of how gendered sexual norms make young unmarried girls vulnerable to unintended pregnancies in a specific context. It combined individual interviews and focus group discussions with girls and boys aged 13-18 years and the parents of other young people of this same age, with peer interviews with girls aged 13-20 years at four sites in the southern province of Zambia. For girls, sexual relationships and early pregnancies were at odds with dominant norms and were consistently met with disapproval because they led to economic difficulties for young women and their parents, school dropouts and health problems for the young woman and her baby. Lack of resources and insufficient knowledge about sexuality and reproduction, together with gender norms governing sexual behaviour and contraceptive use, combine to place adolescent girls in a vulnerable position with respect to unintended pregnancy.

Trends and determinants of adolescent childbirth in Uganda- analysis of rural and urban women using six demographic and health surveys, 1988-2016

Introduction

Uganda has high adolescent pregnancy. The details of adolescent childbirth and urban/rural patterns are scarce. We investigated the levels, time trends and determinants of adolescent childbirth in Uganda separately for urban and rural women.

Methods

We estimated the percentage of women 20–24 years at each of the six Uganda Demographic and Health Surveys (1988/89, 1995, 2000/01, 2006, 2011 and 2016) who reported a live childbirth before age 20 years (“adolescent childbirth”), and examined change over time using t-test. A modified multivariable Poisson regression was used to examine determinants of having adolescent childbirth on the 2016 survey.

Results

Among these women, 67.5, 66.4, 70.1, 62.3, 57.3 and 54.1% reported an adolescent childbirth in 1988/89, 1995, 2000/01, 2006, 2011 and 2016 surveys, respectively. Between 1988/89 to 2000/01, there was no evidence of change (+ 2.6% point (pp), p = 0.170), unlike between the 2000/01 and 2016 surveys when a significant decline occurred (− 16.0 pp., p < 0.001). First childbirth < 18 years of age declined by − 13.5 pp. (p < 0.001) between 2000/01 and 2016. There was no change over time in the percentage of adolescents 18–19.9 years of age having first childbirth. Among rural residents, childbirth < 18 years declined from 43.8% in 1988/89 to 32.7% in 2016 (− 11.1 pp., p < 0.001), in urban it declined from 28.3 to 18.2% (− 10.1 pp., p = 0.006). There was an increase over time in the percentage of women, both rural and urban, who wanted to delay their first pregnancy. Independent determinants of reporting an adolescent childbirth in both urban and rural residents were: no education/incomplete primary and younger age at first sex. Additional determinants for rural women were residence in Eastern region, Muslim religion, and poor household wealth index.

Conclusion

In the 30-year period examined, adolescent childbirth in Uganda declined from highs of 7 in 10 to approximately 5 in 10 women, with more wanting to delay the pregnancy. The decline started after the 2000/01 survey and affected predominantly younger adolescent childbirth < 18 years among both rural and urban residence women. Efforts need to be intensified to sustain the decline in adolescent pregnancies. Targeted and specific strategies for urban and rural areas might be required.

Fertility knowledge, contraceptive use and unintentional pregnancy in 29 African countries: a cross-sectional study

OBJECTIVES

We examined the association between incorrect knowledge of ovulation and unintentional pregnancy and child among young women in sub-Saharan Africa countries.

METHODS

Using Pearson's Chi-square, t test, multiple logistic regression, and likelihood ratio test, we analyzed Demographic and Health Survey data (2008-2017) of 169,939 young women (15-24 year).

RESULTS

The range of prevalence of incorrect knowledge of ovulation was 51% in Comoros and 89.6% in Sao Tome and Principe, while unintentional pregnancy ranged between 9.4% in the Republic of Benin and 59.6% in Namibia. The multivariate result indicates a strong association between incorrect knowledge of ovulation and unintentional pregnancy (OR = 1.17; p < 0.05) and unintentional child (OR = 1.15; p < 0.05).

CONCLUSIONS

Adolescent women (15-19) generally have poor knowledge of ovulation and are more likely to report an unintentional pregnancy/child than women between ages 20-24. To reduce the burden of unintentional child/pregnancy in Africa, fertility knowledge should not only be improved on but must consider the sociocultural context of women in different countries that might affect the adoption of such intervention programs. Pragmatic efforts, such as building community support for young women to discuss and share their experiences with professionals and educate them on fertility and sexuality, are essential.

Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys

Background

Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors.

Methods

We analyzed Uganda Demographic and Health Survey data of women age 20–24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression.

Results

At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth.

Conclusion

Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.