Factors influencing repeated teenage pregnancy: a review and meta-analysis

Engaging Community Health Workers to Enhance Modern Contraceptive Uptake Among Young First-Time Parents in Five Cities of Uttar Pradesh

INTRODUCTION

Young newly married women and first-time parents (FTPs), particularly those living in slum settlements, have a high unmet need for modern contraceptive methods to limit and space births. We describe an intervention in which adolescents and youth sexual and reproductive health (AYSRH) services tailored to FTPs were incorporated into the government's existing family planning (FP) program in 5 cities of Uttar Pradesh. We examined the effect of this intervention on modern contraceptive use among FTPs aged 15-24 years.

METHODS

To assess the effect of this pilot, in 2019, 1 year after the implementation of the program, we analyzed community-based output tracking survey data on 549 married women who are FTPs in the pilot cities. These FTPs were compared with 253 women who were FTPs from other cities where the program was implemented without a specific focus on FTPs. Descriptive statistics and multivariate logistic regression analysis were applied to understand the association between exposure to FP information, either through accredited social health activists or through service delivery points, and use of modern contraceptives.

RESULTS

Use of modern contraceptives was higher among FTPs in the 5 pilot cities than non-pilot cities (39% vs. 32%; P<.05). The interaction effect of city type and exposure to the information showed a positive association between modern contraceptive use and program exposure, greater in pilot cities than non-pilot cities.

CONCLUSIONS

Higher uptake of modern contraceptives among young women may be achieved when an FTP-focused intervention is layered on the government's existing FP programs. Future studies with a longer duration of implementation, in a wider geography, and with longitudinal design are recommended to provide more robust measures of high impact intervention/practices in urban areas.

Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis

Background

Short birth interval is associated with an increased risk of adverse health outcomes for mothers and children. Despite this, there is a lack of comprehensive evidence on short birth interval in the Asia-Pacific region. Thus, this study aimed to synthesise evidence related to the definition, classification, prevalence, and predictors of short birth interval in the Asia-Pacific region.

Methods

Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, and Web of Science) were searched for studies published between September 2000 and May 2023 (the last search was conducted for all databases in May 2023). We included original studies published in English that reported on short birth interval in the Asia-Pacific region. Studies that combined birth interval with birth order, used multi-country data and were published as conference abstracts and commentaries were excluded. Three independent reviewers screened the articles for relevancy, and two reviewers performed the data extraction and quality assessment. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The findings were both qualitatively and quantitatively synthesised and presented.

Results

A total of 140 studies met the inclusion criteria for this review. About 58% (n = 82) of the studies defined short birth interval, while 42% (n = 58) did not. Out of 82 studies, nearly half (n = 39) measured a birth-to-birth interval, 37 studies measured a birth-to-pregnancy, four measured a pregnancy-to-pregnancy, and two studies measured a pregnancy loss-to-conception. Approximately 39% (n = 55) and 6% (n = 8) of studies classified short birth intervals as <24 months and <33 months, respectively. Most of the included studies were cross-sectional, and about two-thirds had either medium or high risk of bias. The pooled prevalence of short birth interval was 33.8% (95% confidence interval (CI) = 23.0-44.6, I2 = 99.9%, P < 0.01) among the studies that used the World Health Organization definition.

Conclusions

This review's findings highlighted significant variations in the definition, measurement, classification, and reported prevalence of short birth interval across the included studies. Future research is needed to harmonise the definition and classification of short birth interval to ensure consistency and comparability across studies and facilitate the development of targeted interventions and policies.

Registration

PROSPERO CRD42023426975.

Childhood adversity and accelerated reproductive events: a systematic review and meta-analysis

OBJECTIVE

Accelerated female reproductive events represent the early onset of reproductive events involving puberty, menarche, pregnancy loss, first sexual intercourse, first birth, parity, and menopause. This study aimed to explore the association between childhood adversity and accelerated female reproductive events.

DATA SOURCES

PubMed, Web of Science, and Embase were systematically searched from September 22, 2022 to September 23, 2022.

STUDY ELIGIBILITY CRITERIA

Observational cohort, cross-sectional, and case-control studies in human populations were included if they reported the time of reproductive events for female individuals with experience of childhood adversity and were published in English.

METHODS

Two reviewers independently screened studies, obtained data, and assessed study quality, and conflicts were resolved by a third reviewer. Dichotomous outcomes were evaluated using meta-analysis, and pooled odds ratios and 95% confidence intervals were generated using random-effects models. Moderation analysis and meta-regression were used to investigate heterogeneity.

RESULTS

In total, 21 cohort studies, 9 cross-sectional studies, and 3 case-control studies were identified. Overall, female individuals with childhood adversity were nearly 2 times more likely to report accelerated reproductive events than those with no adversity exposure (odds ratio, 1.91; 95% confidence interval, 1.33-2.76; I2=99.6%; P<.001). Moderation analysis indicated that effect sizes for the types of childhood adversity ranged from an odds ratio of 1.61 (95% confidence interval, 1.23-2.09) for low socioeconomic status to 2.13 (95% confidence interval, 1.14-3.99) for dysfunctional family dynamics. Among the 7 groups based on different reproductive events, including early onset of puberty, early menarche, early sexual initiation, teenage childbirth, preterm birth, pregnancy loss, and early menopause, early sexual initiation had a nonsignificant correlation with childhood adversity (odds ratio, 2.70; 95% confidence interval, 0.88-8.30; I2=99.9%; P<.001). Considerable heterogeneity (I2>75%) between estimates was observed for over half of the outcomes. Age, study type, and method of data collection could explain 35.9% of the variance.

CONCLUSION

The literature tentatively corroborates that female individuals who reported adverse events in childhood are more likely to experience accelerated reproductive events. This association is especially strong for exposure to abuse and dysfunctional family dynamics. However, the heterogeneity among studies was high, requiring caution in interpreting the findings and highlighting the need for further evaluation of the types and timing of childhood events that influence accelerated female reproductive events.

Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews

Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.

Associations of age at first birth and lifetime parity with weight and adiposity across midlife in women from Project Viva

OBJECTIVE

This study aimed to evaluate the associations of age at first birth and parity with weight, waist circumference (WC), and body fat across midlife.

METHODS

A secondary data analysis was conducted with 735 participants from Project Viva who reported their age at first birth and lifetime parity at a midlife study visit. Weight, WC, and body fat were measured up to four times after the participants' final birth, and associations were examined using linear mixed-effects regression models.

RESULTS

Participants' mean (SD) age was 32.6 (4.9) years at enrollment and 30.4 (5.5) years at their first birth, and they had 2.4 (0.9) lifetime births. In adjusted models, women who had their first birth at age <23 or ≥40 years, versus age 30 to 34 years, had a higher trajectory of weight, WC, and body fat after their final birth (i.e., mean differences in weight 8.38 kg [95% CI: 4.13-12.63] for age <23 years and 6.54 kg [95% CI: 0.64-12.45] for age ≥40 years). Women with four or more births, versus two, had a higher trajectory of adiposity after accounting for covariates.

CONCLUSIONS

Women who have a first birth before age 23 years or after age 40 years and those with multiple births may benefit from more intensive monitoring for excess adiposity gain.

Development of pregnancy class with husband's assistance on the outcome of teenage pregnancy

Background

Teenage pregnancy is an international phenomenon without a definite solution to date. Globally, an estimated 16 million girls aged 15-19 give birth each year. Husbands need to play their assistance role in order to thwart the negative impact of the outcome of teenage pregnancy.

Research objective

To identify the effect of the development of Pregnancy Classes with the Husband's Assistance on the Outcome of Teenage Pregnancy in the Dayak community, Central Kalimantan.

Research methods

This was a quasi-experimental study with the posttest-only non-equivalent control group design involving the husband's assistance in pregnancy classes. The respondents were 60 individuals where 30 of them were given the pregnancy class assistance intervention while the other 30 were not given any intervention (control group).

Results and discussion

Pregnancy class with Assistance by the husband increases positive pregnancy outcomes 2.4 times compared to without the husband's assistance. Family support increases positive pregnancy outcomes 2.5 times compared to pregnant women without support from the family. Pregnant women that are highly motivated regarding antenatal care are likely to have positive pregnancy outcomes 5.4 times greater than pregnant women with low motivation. Based on the analysis, then the variables that have no effect are the history of antenatal care, frequency of antenatal care, and support from health workers.

Conclusions

Pregnancy class with husband's assistance affects positive outcomes of teenage pregnancy. Other factors with meaningful influence on pregnancy outcomes include family support and motivation to seek teenage antenatal care. Furthermore, other factors that have no influence include the teenager's age, history of antenatal care, frequency of antenatal care, and support from health workers. An intervention is needed that involves the husband/partner in the form of active assistance.

Complications of Long-Acting Reversible Contraceptive Modalities

ABSTRACT

Long-acting reversible contraception has risen in popularity in recent decades and is becoming one of the more common modalities of contraception in the United States, with a growing adolescent population among its users. The 2 modalities of long-acting reversible contraception-intrauterine devices and subcutaneous hormonal implants/etonogestrel implants (referred to as Nexplanon in the US)-are beneficial for their excellent effectiveness, ease of use, and safety profile. This article reviews the pharmacology of these modalities, common complications and their presentations, and the initial evaluation and management in the pediatric emergency department setting. Where applicable, attention will be paid to problems unique to the adolescent population.

Repeated adolescent pregnancy in Brazil from 2015 to 2019

OBJECTIVE

The aim of this study was to assess the rate of repeated pregnancy in adolescence and its association with early marriage and education level.

METHODS

This is a cross-sectional study conducted by searching the Live Births Data System. The study included all adolescents in the age group 10-19 years with live births from 2015 to 2019 (n=2,405,248), divided into three groups: G1: primiparas; G2: with 1 previous pregnancy; and G3: with two or more previous pregnancies.

RESULTS

Total repeated pregnancies remained stable, along the years. In the age group 10-14 years, the decrease in the period was from 5.0 to 4.7%, whereas in the age group 15-19 years, it was from 27.8 to 27.3%. Being married or in a stable union increases by 96% the chance of repeated pregnancy in the age group 10-14 years (p<0.001; OR=1.96; 95% confidence interval [CI] 1.85-2.09). In the age group 15-19 years, the chance of repeated pregnancy among the married or in stable union increased 40% (p<0.001; OR=1.40; 95%CI 1.39-1.41)). Girls aged 10-14 years with an education level of<8 years had a 64% higher chance of repeated pregnancy (p<0.001; OR=1.64; 95%CI 1.53-1.75), and among those aged 15-19 years, there was a 137% higher chance of repeated pregnancy (p<0.001; OR=2.37; 95%CI 2.35-2.38).

CONCLUSION

Repeated pregnancy in adolescence in Brazil remains very high over the years. There is an association between low education level and early marriage with repeated pregnancies in adolescence.

Associations between the use of insecticide-treated nets in early childhood and educational outcomes, marriage and child-bearing in early adulthood: evidence from a 22-year prospective cohort study in Tanzania

BACKGROUND

The effectiveness of insecticide-treated nets (ITNs) in preventing malaria in young children is well established. However, the long-term effects of early childhood ITN use on educational outcomes, fertility, and marriage in early adulthood are not well understood.

METHODS

This study uses 22 years of longitudinal data from rural Tanzania to investigate the associations between early life ITN use and educational attainment, fertility and marriage in early adulthood. Unadjusted and adjusted logistic regression models were used to estimate the associations between early life ITN use and early adult outcomes (education, childbearing, and marriage), controlling for potential confounders, such as parental education, household asset quintiles, and year of birth. Analyses were conducted separately for men and women.

RESULTS

A total of 6706 participants born between 1998 and 2000 were enrolled in the study between 1998 and 2003. By 2019 a total of 604 had died and a further 723 could not be found, leaving 5379 participants who were interviewed, among whom complete data were available for 5216. Among women, sleeping under a treated net at least half of the time during early childhood ["high ITN use"] was associated with a 13% increase in the odds of completing primary school (adjusted odds ratio (aOR) 1.13 [0.85, 1.50]) and with a 40% increase in the odds of completing secondary school (aOR 1.40 [1.11, 1.76]) compared with women sleeping less frequently under ITNs in early life (< age 5 years). Among men, high ITN use was associated with a 50% increase in the odds of completing primary school (aOR 1.50 [1.18, 1.92]) and a 56% increase in the odds of completing secondary school (aOR 1.56 [1.16, 2.08]) compared to men with low ITN use in early life. Weaker associations were found between ITN use in early life and both adolescent childbearing (aOR 0.91 [0.75, 1.10]) and early marriage (aOR 0.86 [0.69, 1.05]).

CONCLUSION

This study found that early life use of ITNs was strongly associated with increased school completion in both men and women. More marginal associations were found between early-life ITN use and both marriage and child-bearing in early adulthood. ITN use during early childhood may have long-term positive effects on educational attainment in Tanzania. However, further research is needed to understand the mechanisms behind these associations and to explore the broader impacts of ITN use on other aspects of early adult life.

A phenomenological study on recurrent teenage pregnancies in effutu municipality- Ghana.the experiences of teenage mothers

BACKGROUND

Generally, recurrent teenage pregnancies are public health menaces that impede the quality of life of teenage mothers, their offspring, and society as a whole. However, there is paucity of information regarding factors influencing this social issue especially, in developing countries where Ghana is no exception. Moreover, this menace has been least investigated from the perspective of the teenager with multiple pregnancies. Hence, this study aimed at identifying the factors influencing recurrent teenage pregnancies and the challenges confronted by these teenage mothers.

METHOD

This study is a phenomenological qualitative study that was conducted in the Effutu Municipality in the Central Region of Ghana. Employing convenience and snowball sampling, 40 participants who were residents of the study area, had a child each, and were pregnant at the time of the study were included. Other participants included teenage mothers who had at least two (2) children. A face-to-face in-depth interview with the help of an interview guide was conducted. Proceedings were recorded, transcribed, and analysed using thematic analysis. Quotations were used in the result presentation.

RESULTS

The results of the study revealed that factors influencing recurrent teenage pregnancies are multifactorial. It includes peer pressure, parental neglect, poverty, living with a partner, and inadequate knowledge of family planning. The teenager with recurrent pregnancy is confronted with financial difficulties and is faced with stigmatisation in the society where she finds herself.

CONCLUSION

To this effect, it is important to intensify education on family planning and good parental practices among parents with teenage mothers while providing a similar form of sensitization for members of the society about the harmful effects of stigmatisation on the teenage mother and her children. Again, a social support network for teenagers with recurrent pregnancies could be formed to help curb this public health menace.

Contraceptive methods in adolescence: a narrative review of guidelines

PURPOSE

Adolescent pregnancy, while recently in decline, remains a matter in need of addressing. Education and counselling are deemed crucial and this review aims at comparing published contraceptive guidelines, thus resolving any surrounding misconceptions.

MATERIALS AND METHODS

Recently published contraception guidelines regarding adolescent pregnancy were retrieved. In particular, guidelines and recommendations from ACOG, RCOG, SOCG, AAP, CPS, NICE, CDC, and WHO were compared and reviewed based on each guideline's method of reporting.

RESULTS

Three categories of contraceptive methods are available for adolescents and recommendations on their initiation should be made based on their efficacy, according to all guidelines. Therefore, long acting reversible contraceptives (LARCs) should be highly recommended as the most effective method (typical use failure rate: 0.05%), followed by short-acting hormonal contraceptives (typical use failure rate: 3-9%). The third contraceptive option includes contraceptives used in the moment of intercourse and displays the lowest effectiveness (typical use failure rate: 12-25%), mostly due to its dependence on personal consistency, however offers protection against STI transmission.

CONCLUSION

Adolescents should be encouraged to initiate contraception, with LARCs being the primary choice followed by short-acting hormonal contraception. However, regardless of the chosen effective contraceptive method, the use of condom is necessary for STI prevention.

Predictors of underage pregnancy among women aged 15-19 in highly prevalent regions of Ethiopia: a multilevel analysis based on EDHS, 2016

Under age (teenage) pregnancy is a pregnancy that occurs under the age of 20 years old. Its magnitude is increasing globally. It is much higher in low-income countries compared to high-income countries. Teenage pregnancy exposed teenagers to various obstetric and perinatal complications. However, its predictors are not well investigated in highly prevalent regions of Ethiopia. Therefore, this study assessed individual and community-level predictors of teenage pregnancy using a multi-level logistic regression model. An in-depth secondary data analysis was performed using the fourth Ethiopian Demographic and Health Survey (EDHS) 2016 data set. A weighted sample of 2397 teenagers was included in the final analysis. Multi co linearity and chi-square tests were checked and variables which did not fulfill the assumptions were excluded from the analysis. Four models were fitted. Variables with p value ≤ 0.2 in the bi-variable multilevel logistic regression were included in the multivariable multilevel logistic regression. The adjusted odds ratio (AOR) with a 95% confidence interval (95% CI) was computed. Variables with a p value of less than 0.05 in the multi-variable multilevel logistic regression were declared as statistically significant predictors. A total of 2397 weighted participants aged from 15 to 19 were involved. About 15% of teenagers were pregnant. Age [17 (AOR = 9.41: 95% CI 4.62, 19.13), 18 (AOR = 11.7: 95% CI 5.96, 23.16), 19 (AOR = 24.75: 95% CI 11.82, 51.82)], primary education (AOR = 2.09: 95% CI 1.16, 3.76), being illiterate (AOR = 1.80: 95% CI 1.19, 2.73), religion [being Muslims (AOR: 2.98:95% CI 1.80, 4.94), being Protestants (AOR = 2.02: 95% CI 1.20, 3.41)], contraceptive non use (AOR = 0.18: 95% CI 0.11, 0.31), a high proportion of family planning demand (AOR = 3.52: 95% CI 1.91, 6.49), and a high proportion of marriage (AOR = 4.30: 95% CI 2.25, 8.21) were predictors of teenage pregnancy. Age, educational status, religion, contraceptive non-use, literacy proportion of marriage and proportion of demand for family planning were the most significant predictors of teenage pregnancy. The ministry of education shall focus on universal access to education to improve female education. The government should work in collaboration with religious fathers to address reproductive and sexual issues to decrease early marriage and sexual initiation. Especial attention should be given to teenagers living in a community with a high proportion of marriage.

Associations between sexual and reproductive health knowledge, attitude and practice of partners and the occurrence of unintended pregnancy

Background

Although global contraceptive coverage has increased significantly, high rates of unintended pregnancy remain the current global status quo. A comparative analysis of the differences and correlations of knowledge, attitude and practice (KAP) of sexual and reproductive health (SRH) of both partners will help guide public health work according to gender characteristics and needs, and reduce the occurrence of unintended pregnancy.

Methods

A questionnaire survey of people with unintended pregnancies including women and their male partners (n = 1,275 pairs) who sought help from the Shanghai General Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from October 2017 to October 2021. Data were collected on sexual and reproductive health knowledge, attitudes, and practices in both partners who had unintended pregnancies. Chi-square test and Logistic regression were used to analyze the relationship between the occurrence of unintended pregnancy and KAP and its influencing factors. Paired odds ratio and McNemar's test were used to estimate the difference and concordance of KAP between partners.

Results

This study included 1,275 partners with a mean age of 30.0 years. The partner's overall level of KAP is good. Compared with women, men had better knowledge (χ2 = 3.93, p = 0.047) and more active contraceptive practices (χ2 = 19.44, p < 0.001). In the analysis of partner concordance, male contraceptive intention was found to be better than female [matched pairs odds ratio (ORMP) = 2.56, p < 0.001], and the concordance of positive contraceptive practice between partners increased with male education [adjusted odds ratio (aOR) = 1.556, 95% confidence interval (CI) = 1.185-2.044, p = 0.001]. In partner-paired regression analysis, compared with good contraceptive knowledge in both men and women in the partner, the risk of negative contraceptive practice was 1.7 times (aOR = 1.721, 95% CI = 1.234-2.400, p = 0.001) higher with good contraceptive knowledge in women but negative in men, while women with poor contraceptive knowledge but men with good knowledge are 1.3 times (aOR = 1.349, 95% CI = 1.000-1.819, p = 0.05) more likely to have negative contraceptive practices. In addition, compared with partners with positive contraceptive attitudes, women with positive attitudes but negative men and women with negative attitudes but positive men had 1.7 and 1.4 times the risk of negative contraceptive practices, respectively.

Conclusion

The study found that unintended pregnancy occurs mainly in young people, and the younger age of first sexual intercourse, the low education background and the lack of discussion of contraception between partners are risk factors for not taking contraceptive measures. Men's better knowledge and contraceptive practices compared with female partners, and poor male contraceptive knowledge and attitudes may lead to a higher risk of negative contraceptive practices, the results suggest that male KAP plays an important role in promoting contraceptive use and reducing unintended pregnancy.

Longitudinal associations between academic achievement and depressive symptoms in adolescence: Methodological considerations and analytical approaches for identifying temporal priority

Failure to meet educational expectations in adolescence can derail an individual's potential, leading to hardship in adulthood. Lower academic achievement is also associated with poorer mental health, and both share common pathways to adult functional outcomes like employment status and economic security. Although linked in adolescence, and predictive of similar outcomes in adulthood, methodological and analytical limitations of the literature do not permit the assessment of the temporal priority between academic achievement and mental health. This omission of directionality hampers intervention and prevention efforts. In this narrative review, we summarize the literature on the temporal ordering between academic achievement and depressive symptoms in adolescence, a particularly vulnerable developmental period. We propose methodological and analytical strategies to guide future research to disentangle the chronological ordering between academic achievement and depressive symptoms-recommendations that can be used to examine other sets of correlated variables over time. Specifically, we highlight methodological issues that require attention such as the need to understand reciprocal and cascading influences over time by attending to repeated measures and timing, measurement consistency, reporter effects, examination of processes and mechanisms, and missing data. Finally, we discuss the need to embrace analytical methods that separate within-person from between-person effects; account for heterogeneity in associations using person-centered approaches; and use the two approaches as complementary, rather than competing, for a more holistic examination of temporality.

Adolescent pregnancy: An important issue for paediatricians and primary care providers-A position paper from the European academy of paediatrics

Adolescent pregnancy and childbearing, remain a widespread health-related problem with potential short and long-term consequences. Comprehensive social, economic, environmental, structural, and cultural factors heavily impact on adolescents' sexual and reproductive health and early pregnancy. Health professionals can play a pivotal role in the prevention of unplanned pregnancy. Improved access to family planning, sexuality education in schools, community-based interventions, and policies contribute greatly to reduce the risk of adolescent pregnancy and the adoption of respectful and responsible sexual behaviour. Additionally, health care professionals can support pregnant adolescents in making decisions under these circumstances and provide adequate health care. This review highlights actions that can guide healthcare professionals in empowering young adolescents to become more aware and capable of making informed decisions about their sexual life, health, and future.

Epidemiology of birth defects in teenage pregnancies: Based on provincial surveillance system in eastern China

Background

Healthcare for adolescents and birth defects (BD) prevention are highlighted public health issues. The epidemiology of birth defects in teenage pregnancies has not been studied extensively.

Objectives

To investigate the prevalence trend and spectrum of BDs among teenage mothers.

Methods

This observational study covered all births registered in the BD surveillance system in Zhejiang Province, China, during 2012-2018. The annual change in the prevalence of BDs among adolescent mothers was estimated. Crude relative ratios using the BD categories in teenage pregnancies were calculated and compared with those in women aged 25-29 years.

Results

Overall, 54,571 BD cases among 1,910,977 births were included in this study, resulting in an overall prevalence of 234.64 to 409.07 per 10,000 births from 2012 to 2018 (P _trend < 0.001) in total population. The prevalence of birth defects in teenage pregnancies increased from 247.19 to 387.73 per 10,000 births in 2012-2018 (P _trend = 0.024). The risks of neural tube defects (relative risk [RR] = 3.15, 95% confidence interval [CI] 2.56, 3.87), gastroschisis (RR = 7.02, 95% CI 5.09, 9.69), and multiple birth defects (RR=1.27, 95% CI 1.07, 1.52) were higher in teenage pregnancies than those in women aged 25-29 years.

Conclusions

We found a distinctive spectrum of BDs, with higher proportions of fatal or multiple anomalies in infants born to teenage mothers than in those born to adults aged 25-29 years. These results emphasize the importance of providing adolescents with better access to reproductive and prenatal care.

Individual and Social Level Factors Influencing Repeated Pregnancy among Unmarried Adolescent Mothers in Katavi Region-Tanzania: A Qualitative Study

Adolescents’ pregnancy rates are still high in Tanzania, despite the efforts made by the national campaign. Within two years after the first pregnancy, adolescent mothers are more at risk of repeat conception. Repeated pregnancies are associated with increased maternal and perinatal outcomes. Katavi is a leading region in the country, with 45% adolescent pregnancy. Studies are scarce on factors influencing repeated pregnancy among unmarried adolescent mothers in the region. Therefore, this study explored the individual and social level factors influencing repeated pregnancy among unmarried adolescent mothers in the Katavi Region. An exploratory qualitative study, using key informant interviews (KIIs) was adopted for 16 participants. The study participants were unmarried adolescent mothers, aged 15–19 years, who were purposively sampled. Thematic analysis was used to analyze qualitative data. QSR Nvivo version 14 was used to analyze these data. The study established the individual factors influencing repeated pregnancy, which were inadequate sexuality knowledge, individually perceived barriers to contraceptive use, and the guarantee for marriage. Furthermore, the social factors identified were the power of decision-making, peer pressure, and the parent–child relationship. Inadequate education on sexuality is observed as a crucial factor influencing repeated pregnancy. Parents as primary educators should be encouraged to talk with their children, especially adolescent girls about sexual education.

Factors influencing contraception choice and use globally: a synthesis of systematic reviews

BACKGROUND

Unintended pregnancy has a huge adverse impact on maternal, child and family health and wealth. There is an unmet need for contraception globally, with an estimated 40% of pregnancies unintended worldwide.

METHODS

We systematically searched PubMed and specialist databases for systematic reviews addressing contraceptive choice, uptake or use, published in English between 2000 and 2019. Two reviewers independently selected and appraised reports and synthesised quantitative and qualitative review findings. We mapped emergent themes to a social determinants of health framework to develop our understanding of the complexities of contraceptive choice and use.

FINDINGS

We found 24 systematic reviews of mostly moderate or high quality. Factors affecting contraception use are remarkably similar among women in very different cultures and settings globally. Use of contraception is influenced by the perceived likelihood and appeal of pregnancy, and relationship status. It is influenced by women's knowledge, beliefs, and perceptions of side effects and health risks. Male partners have a strong influence, as do peers' views and experiences, and families' expectations. Lack of education and poverty is linked with low contraception use, and social and cultural norms influence contraception and expectations of family size and timing. Contraception use also depends upon their availability, the accessibility, confidentiality and costs of health services, and attitudes, behaviour and skills of health practitioners.

INTERPRETATION

Contraception has remarkably far-reaching benefits and is highly cost-effective. However, women worldwide lack sufficient knowledge, capability and opportunity to make reproductive choices, and health care systems often fail to provide access and informed choice.

Pregnancy and miscarriage predict suicide attempts but not substance use among dual-systems involved female adolescents

Background

To examine the associations between adolescent pregnancy and pregnancy outcomes on substance use and suicide attempts in a sample who is at greater risk for substance use and suicide attempts - those who have been involved with the uvenile justice and child welfare systems.

Methods

Using a prospective, longitudinal design, we examined the role of adolescent pregnancy outcomes on risk for suicide attempts and substance use among a sample of 166 female adolescents with juvenile justice system and child welfare involvement.

Results

Of participants, 36% (n = 60) reported at least one adolescent pregnancy with a total of 109 pregnancies reported. Adolescent pregnancy was associated with an increase in later suicide attempts (aOR = 1.68, 95% CI 1.06-2.72). Miscarriage was associated with a 2-fold increase in the likelihood of later suicide attempts, (aOR = 2.12, 95% CI 1.10-4.12). No participants who reported induced abortion (n = 13) reported suicide attempts. Adolescent pregnancy, miscarriage, and abortion were not significantly associated with later substance use (Ps > 0.05).

Conclusions

Healthcare professionals should conduct routine screening for suicidality in the months following a miscarriage, offer education to caregivers about how to support youth who experience pregnancy loss, provide additional social supports and familiarize themselves with local and virtual behavioral health resources to prevent suicide attempts among female adolescents who are at high risk and experience miscarriage.

Teenage pregnancies in Western Greece: experience from a university hospital setting

PURPOSE

Teenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies.

METHODS

This retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January-December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20-34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected.

RESULTS

Teenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups.

CONCLUSIONS

The findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.

Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis

Background

Unintended pregnancies (UPs) are a global health problem as they contribute to adverse maternal and offspring outcomes, which underscores the need for prevention. As psychiatric vulnerability has previously been linked to sexual risk behavior, planning capacities and compliance with contraception methods, we aim to explore whether it is a risk factor for UPs.

Methods

Electronic databases were searched in November 2020. All articles in English language with data on women with age ≥ 18 with a psychiatric diagnosis at time of conception and reported pregnancy intention were included, irrespective of obstetric outcome (fetal loss, livebirth, or abortion). Studies on women with intellectual disabilities were excluded. We used the National Institutes of Health tool for assessment of bias in individual studies and the Grading of Recommendations Assessment, Development and Evaluation method for assessment of quality of the primary outcome.

Findings

Eleven studies reporting on psychiatric vulnerability and UPs were included. The participants of these studies were diagnosed with mood, anxiety, psychotic, substance use, conduct and eating disorders. The studies that have been conducted show that women with a psychiatric vulnerability (n = 2650) have an overall higher risk of UPs compared to women without a psychiatric vulnerability (n = 16,031) (OR 1.34, CI 1.08–1.67) and an overall weighed prevalence of UPs of 65% (CI 0.43–0.82) (n = 3881).

Interpretation

Studies conducted on psychiatric vulnerability and UPs are sparse and many (common) psychiatric vulnerabilities have not yet been studied in relation to UPs. The quality of the included studies was rated fair to poor due to difficulties with measuring the outcome pregnancy intention (use of various methods of assessment and use of retrospective study designs with risk of bias) and absence of a control group in most of the studies. The findings suggest an increased risk of UPs in women with psychiatric vulnerability. As UPs have important consequences for mother and child, discussing family planning in women with psychiatric vulnerabilities is of utmost importance.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04452-1.

Trends and factors associated with repeated adolescent pregnancies in Tanzania from 2004-2016: evidence from Tanzania demographic and health surveys

Introduction

a repeated pregnancy represents a failure of health and social systems to educate and provide the necessary services and skills to ensure adolescent girls do not experience any further unwanted pregnancies during this young age. We aimed to determine trends and factors associated with repeated adolescent pregnancies in Tanzania 2004-2016.

Methods

an analytical cross-sectional study was conducted using secondary data from Tanzania demographic and health surveys of the years 2004-2005, 2010 and 2015-2016 among adolescent mothers aged 15 to 19 years. Data analysis was performed using STATA version 15 and considered the complex survey design. The Poisson regression model was used to estimate prevalence ratios (PR) and 95% confidence intervals for factors associated with repeated adolescent pregnancy.

Results

the proportion of repeated adolescent pregnancies increased from 15.8% in 2004/2005 to 18.6% in 2010, then to 18.8% in 2015/2016. Adolescents who delivered their first pregnancy at home (APR: 1.36, 95% CI: 1.03, 1.78) and who started sexual activity before 15 years of age (APR: 1.80, 95% CI: 1.40, 2.31) were likely repeated adolescent pregnancy. In contrast, adolescents who used contraception (APR: 0.52, 95% CI: 0.34, 0.81) had a lower prevalence of repeated adolescent pregnancies.

Conclusion

the prevalence of repeated adolescent pregnancies has increased and remains unacceptably high. Adolescents who had low education delivered their first pregnancy at home and were non-contraceptive users need to be targeted in policies and programs for the prevention of repeated adolescent pregnancies.

Reproductive Life Planning in Adolescents

Unplanned pregnancy in adolescents contributes to the burden of disease, mortality, and health and educational disparities experienced by young people during this vulnerable period between childhood and adulthood. Reproductive life planning (RLP) is an approach that has been endorsed and adopted internationally, which prompts individuals and couples to set personal goals regarding if and when to have children based on their own personal priorities. This review discusses RLP tools, their acceptability, effectiveness, and issues in implementation across different contexts, with a specific focus on how RLP has been applied for adolescents. While a range of RLP tools are available and considered acceptable in adult populations, there is minimal evidence of their potential benefits for adolescent populations. Online platforms and information technology are likely to promote reach and implementation of RLP interventions in adolescents. Consideration of the socioecological contexts where adolescent pregnancies are more common should be integral to much needed future work that explores RLP interventions in adolescents.

Determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle: a case-control study

Background

Adolescent pregnancy carries a high risk of severe health issues for both the mother and the newborn. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America. Most of the risk factors are met in indigenous communities, which is an underrepresented and poorly studied population. We aimed to assess the determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle.

Methods

Through a case–control study, female adolescents aged 13 to 19 years old from seven indigenous communities of the Peruvian central jungle were interviewed. Adolescents with (cases) and with no (controls) pregnancy history, such as current pregnancy, children and abortion, fulfilled our eligible criteria. Our instrument explored: sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. We performed a penalized maximum likelihood logistic regression analysis to obtain Odds Ratios (OR) and their 95% confidence intervals (95% CI).

Results

We enrolled 34 cases and 107 controls. Overall, 53.9% were 15 to 19 years old. We found a significant association of being 15–19 years old (OR = 6.88, 95% CI 2.38–19.86, p < 0.0001) and an elementary school level of instruction (OR = 5.59, 95% CI 1.95–16.06, p = 0.001) with the risk of adolescent pregnancy. A marginal statistical significance between having five to six siblings and adolescent pregnancy was also reported (OR = 2.70, 95% CI 0.85–8.61, p = 0.094). Furthermore, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy (OR = 0.17, 95% CI 0.06–0.47, p = 0.001).

Conclusion

Our results suggest that public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health topics with adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01247-z.

Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America and rural areas. Indigenous communities are mainly located in rural areas and are exposed to multiple risk factors of adolescent pregnancy. We aimed to find the factors that have an influence on adolescent pregnancy in indigenous communities from the Peruvian central jungle. We conducted a case–control study identifying female indigenous adolescents from the Peruvian central jungle with or without pregnancy history. Our survey explored sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. Being 15 to 19 years old, having an elementary educational level, and five to six siblings increased the risk of adolescent pregnancy. On the other hand, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy. Furthermore, eight out of ten adolescents opposed to sexual intercourse at an early age. Public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health with adolescents.

Trends in teenage delivery and abortion rates in Estonia over more than two decades: a nationwide register-based study

BACKGROUND

In the last 30 years, Estonia has undergone major socio-economic changes, including profound educational and healthcare reforms. The study aimed to analyse trends in teenage delivery and induced abortion rates among younger and older teens, including Estonians and non-Estonians, and to study trends in repeat teenage pregnancies in more detail.

METHODS

The register-based study included data on 29 818 deliveries (1992-2019) and 25 865 (1996-2019) induced abortions among 15-19-year-old girls. Delivery and abortion rates per 1000 girls were calculated by age group, ethnicity and reproductive history. Poisson regression models were applied to estimate average annual percentage changes in delivery and abortion rates over the whole period and in two sub-periods with change points in the trend in 2007.

RESULTS

The delivery rate decreased by 5.3% per year, from 49.9 in 1992 to 8.4 in 2019; the abortion rate decreased by 6.0% per year, from 42.4 in 1996 to 8.6 in 2019. A faster decline in delivery rates took place among Estonians than non-Estonians, but the opposite trend occurred in abortion rates. Delivery rates for first and repeat pregnancies decreased nearly at the same pace, while abortion rates for repeat pregnancies decreased faster than those for first pregnancies.

CONCLUSIONS

A decreasing trend in teenage births is evident in parallel with society becoming wealthier. A remarkable decline in teenage abortions occurs when young people's rights to safe abortion, contraception, mandatory sexuality education and youth-friendly services are ensured. There always remains a small group of adolescents who repeatedly become pregnant.

"… 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.

"What Are You Looking For?" Investigating the Association Between Dating App Use and Sexual Risk Behaviors

Introduction

Literature on the association between dating app use and sexual risk behaviors is still scant and inconclusive.

Aim

To investigate the association between dating app use and sexual risk behaviors, considering the role of motives for using them.

Methods

1,278 Italian respondents completed an online questionnaire assessing demographics, motives and patterns of dating app use, sexual behaviors and sexually transmitted infections (STIs) diagnoses. One-way ANOVA and Chi-squared analyses were used to investigate differences among the three subsamples (active vs former vs non-users). Multiple linear and logistic regression analyses were run to investigate the role of demographics, motives and patterns of dating app use on sexual risk taking and sexual health.

Main outcome measures

Number of protected and unprotected full sexual partners in the last year; frequency of hook-ups in the last year; STIs lifetime.

Results

Active users, even more than former app users, were more likely to report risky behaviors and STI diagnoses than non-users (χ² = 26.37, P < .001). Installing the apps to find friends or romantic partners was associated with less protected (find friends B = −0.364, P = .015; find romantic partners B = −0.300, P = .006) and unprotected (find friends B = −0.346, P = .016; find romantic partners B = −0.360, P < .001) sexual intercourses. Installing the apps to find sexual partners predicted higher odds of unprotected sexual activity (B = 0.193, P = .048), hook-ups (B = 0.496, P < .001) and STIs diagnoses (OR = 2.835, P = .025). Accessing apps more frequently and more years of usage was associated with reporting risky sexual behaviors and STI diagnoses among active users (app access frequency OR = 1.461, P = .003; usage years OR = 1.089, P = .013).

Conclusion

Installing the apps to search for sexual partners, using them at length since first installation and accessing them frequently are significant factors in influencing the association between dating app use and sexual risk behaviors. Flesia L, Fietta V, Foresta C, Monaro M. “What Are You Looking For?” Investigating the Association Between Dating App Use and Sexual Risk Behaviors. Sex Med 2021;9:100405.

Early Pregnancy Risk Among Adolescents With ADHD: A Nationwide Longitudinal Study

Objective: ADHD potentially leads to risky sexual behaviors, and is considered a major risk factor for early pregnancy (EP). However, the association between ADHD and subsequent EP remains unknown. Method: Seven thousand five hundred five adolescents with ADHD and 30,020 age- and sex-matched individuals without ADHD were enrolled from 2001 to 2009 and were followed until the end of 2011. Adolescents who developed any pregnancy (at age ≤30 years) or EP (at age <20 years) during the follow-up period were identified. Results: Adolescents with ADHD were found to be prone to pregnancy (hazard ratio [HR] = 1.27) and EP (HR = 2.30) compared with those without ADHD. Long-term ADHD medication use was related to a lower risk of subsequent any pregnancy (HR = 0.72) and EP (HR = 0.69). Conclusion: Adolescents with ADHD had an increased risk of any pregnancy and EP compared with their non-ADHD counterparts. Long-term ADHD medication use was associated with a lower subsequent EP risk.

The role of multiparity and maternal age at first pregnancy in the association between early menarche and metabolic syndrome among middle-aged and older women

OBJECTIVE

To analyze whether maternal age at first pregnancy and parity are mediators of the association between early menarche and metabolic syndrome in a sample of middle-aged and older women.

METHODS

Cross-sectional study of 428 women (40 to 80 y), who had experienced a pregnancy in their lifetime, was performed between 2014 and 2016. Age at first pregnancy, parity, and early menarche were self-reported. Metabolic syndrome was assessed using the criteria described by the National Cholesterol Education Program's Adult Treatment Panel III. The association between metabolic syndrome and early menarche was assessed by logistic regression analysis. The mediating role of age at first pregnancy and multiparity in the relationship between early menarche and metabolic syndrome was assessed through mediation analysis, adjusted for covariates.

RESULTS

According to adjusted logistic regression models, early menarche was associated with higher odds of prevalent metabolic syndrome (OR: 2.26; 95% CI: 1.15-4.46). Mediation analysis showed a significant direct effect of early menarche on metabolic syndrome (β: 0.808; 95% CI: 0.107-1.508). Of the two mediators tested, age at first pregnancy was significant (β: 0.065; 95% CI: 0.004-0.221), ie, participants with and without early menarche differ, on average, by 0.879 SDs in the log odds of MetS (total effect), of which 0.065 SDs (8%), on average, would be attributable to the effect of early menarche on age at first pregnancy (indirect effect), which, in turn, affects MetS.

CONCLUSIONS

Age at first pregnancy may partially contribute to the association between early menarche and metabolic syndrome among middle-aged and older women who had experienced a pregnancy over their lifetime.

A Systematic Review of Programs to Promote Aspects of Teen Parents' Self-sufficiency: Supporting Educational Outcomes and Healthy Birth Spacing

Introduction

Expectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children’s healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents’ self-sufficiency by promoting their educational outcomes and healthy birth spacing.

Methods

We conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review’s eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies’ findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence.

Results

We identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs.

Discussion

Effective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens’ education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness.

Electronic supplementary material

The online version of this article (10.1007/s10995-019-02854-w) contains supplementary material, which is available to authorized users.

Pregnant again? Perspectives of adolescent and young mothers who and do not experience a repeat pregnancy in adolescence

Introduction: Teen pregnancy remains a major social and public health issue in developing countries. Each additional child compromises the development of both the mother and children. Scarce studies have been performed in Latin America.

Purpose: This study explores and analyzes individual and family factors associated with repeat pregnancies during adolescence to better elucidate the phenomenon.

Methods: Qualitative-descriptive study. Thirty semi-structured interviews were conducted with mothers 20 years of age or younger from urban areas of Santiago, Chile. Participants were divided into Repeat Pregnancy (RP) and No Repeat Pregnancy (NRP) groups. Qualitative data analysis was based on elements of grounded theory.

Results: The RP group generally related life stories reflecting greater psychosocial vulnerability. Most of the RP group dropped out of school after their first pregnancy to focus on parenting and had a passive attitude towards contraception. In contrast, members of the NRP group actively sought long-term contraceptive methods, motivated largely by the desire to continue their education to improve their living conditions and achieve greater personal fulfilment. They tended to have family support networks that facilitated school retention.

Conclusion: Key differences between groups included use of contraception, focus on life projects, and motivation to finish school. Prevention strategies should promote long-term contraceptive methods, offer strategies to help young mothers continue their education, facilitate achievement of personal projects, and provide support for parenting.

Suspected Nonfatal Drug-Related Overdoses Among Youth in the US: 2016-2019

BACKGROUND AND OBJECTIVES

During the current drug overdose crisis, the United States is experiencing a significant number of overdose deaths, hospitalizations, and emergency department visits. Given the vulnerability of young persons to substance use, it is important to assess how this crisis affects the nation's youth. In this study, we investigate trends in suspected nonfatal drug-related overdoses (all-drugs, opioids, heroin, and stimulants) among youth using syndromic surveillance data from 2016 to 2019.

METHODS

A retrospective analysis of emergency department syndromic surveillance data were used to detect quarterly trends in suspected drug overdoses from April 2016 through September 2019 among youth aged 0 to 10, 11 to 14, and 15 to 24 years. Syndrome definitions were developed using chief complaint free-text and discharge diagnosis codes to identify overdoses involving all-drugs, opioids, heroin, and stimulants. Pearson χ² tests detected quarter-to-quarter changes, and joinpoint regression analysis assessed trends over time.

RESULTS

On average, there was a 2.0% increase for youth aged 0 to 10 years and a 2.3% increase for youth aged 11 to 14 years for suspected all-drug overdoses. Suspected heroin overdoses decreased by an average of 3.3% per quarter for youth aged 15 to 24 years. Among all age groups, suspected stimulant overdoses increased across the study period, 3.3% for 0 to 10-year-olds, 4.0% for 11- to 14-year-olds, and 2.3% for 15- to 24-year-olds.

CONCLUSIONS

Suspected stimulant-involved drug overdoses appear to be rising among youth. These findings could inform targeted interventions, such as stimulant-focused prevention, and comprehensive approaches, including school-based prevention and other strategies to lower morbidity and mortality.

Lactational amenorrhoea among adolescent girls in low-income and middle-income countries: a systematic scoping review

Introduction

Fertility levels among adolescents remain high in many settings. The objective of this paper was to review the available literature about postpartum and lactational amenorrhoea among adolescents in low-income and middle-income countries (LMICs).

Methods

We searched Medline, Embase, Global Health and CINAHL Plus databases using terms capturing adolescence and lactational or postpartum amenorrhoea. Inclusion criteria included publication date since 1990, data from LMICs, and topic related to lactational amenorrhoea as a postpartum family planning method or as an effect of (exclusive) breast feeding among adolescents. Thematic analysis and narrative synthesis were applied to summarise and interpret the findings.

Results

We screened 982 titles and abstracts, reviewed 75 full-text articles and included nine. Eight studies assessed data from a single country (three from India, two from Bangladesh, two from Turkey, one from Nigeria). One study using Demographic and Health Survey data included 37 different LMICs. The five studies measuring duration of postpartum or lactational amenorrhoea reported a wide range of durations across the contexts examined. Four studies (from Bangladesh, Nigeria and Turkey) examined outcomes related to the use of lactational amenorrhoea as a family planning method among adolescents. We did not find any studies assessing adolescents’ knowledge of lactational amenorrhoea as a postpartum family planning method. Likewise, little is known about the effectiveness of lactational amenorrhoea method among adolescents using sufficiently large samples and follow-up time.

Conclusion

The available evidence on lactational amenorrhoea among adolescents in LMICs is scarce. Given the potential contribution of lactational amenorrhoea to prevention of short interpregnancy intervals among adolescents and young women, there is a need for a better understanding of the duration of lactational amenorrhoea, and the knowledge and effective use of lactational amenorrhoea method for family planning among adolescents in a wider range of LMIC settings.

Not all the same: Swedish teenage mothers' and fathers' selection into early family formation trajectories

Previous research has focused on teenage parenthood as a single outcome, and has overlooked the wider family formation trajectory in which it is situated. In this paper, using Swedish register data and sequence analysis tools, we explore the diversity in timing and ordering of childbearing and (re)partnering events among teenage parents. We identify trajectory clusters of traditional family patterns, modern family patterns, single parenthood and re-partnering patterns. We also examine the role of resources in the family of origin for the probability of following the different types of family formation trajectories among teenage parents. Where economic resources in the family of origin is related to the type of trajectory teenage fathers follow, family structure is of greater importance for teenage mothers. The family formation trajectories of teenage parents display substantial heterogeneity, which contradicts a view that a person who has a child early in life suddenly has their life's script written.

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.

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.

Teen pregnancy in Chicago: Who is at risk?

BACKGROUND

Teenage pregnancy, with its associated health and social consequences for young people and society as a whole, is one of the nation's most important public health issues. The purpose of this study was to use Youth Risk Behavior Survey (YRBS) data describe self-reported, pregnancy experiences in 9-12th grade Chicago Public Schools (CPS) students and identify teens at highest risk based on gender, grade-level, race, ethnicity, and sexual orientation.

METHODS

Secondary data analysis of the 2017 CPS high school Youth Risk Behavior Survey was conducted.

RESULTS

The survey response rate was 73% (n = 1,883). 4.9% (n = 91) of CPS students in grades 9 - 12 reported a pregnancy experience, and 1.9% (n = 34) reported being "unsure" of a pregnancy experience. Statistically significant differences in the likelihood of self-reporting a pregnancy experience were found based on grade level (p = .000), race (p = .023), and sexual orientation (p = .000).

CONCLUSION

While risk for a teen pregnancy experience varies across all groups, public health nurses can use YRBS data to better understand pregnancy risk in the populations they serve and can leverage core competencies, and robust community relationships to adapt, implement and evaluate evidence-based teen pregnancy prevention programs for maximum impact on teens at greatest risk.

Managing adolescent pregnancy: The unique roles and challenges of private general practitioners in Malaysia

INTRODUCTION

Managing adolescent pregnancy in the primary care setting is complex, as it requires doctors to navigate through a combination of medical, social, financial and legal needs. Objective: This study explores the perspectives of private general practitioners on their roles and challenges in managing adolescent pregnancy in Malaysia.

METHODS

Nineteen private general practitioners in Selangor and Kuala Lumpur participated in in-depth interviews in 2015. A topic guide was used for interview navigation. Participants were asked to discuss their experiences and approaches in managing pregnant adolescents. We used purposive sampling to recruit consenting private general practitioners who had experience in managing adolescent pregnancy. The verbatim transcripts of the audio-recorded interviews were analyzed using thematic analysis. Data reached saturation at the nineteenth in-depth interview. Results: Two themes emerged. Under the theme 'inadvertent advocator,' participants described their tasks with regards to building trust, calming angry parents and delivering comprehensive counseling and care related to the sexual and reproductive health of adolescents, including requests for abortions. Theme two, 'challenges of private general practitioners,' refers mainly to personal and religious conflicts arising from a request for an abortion and deficiencies in support and multidisciplinary integration within their practice settings.

CONCLUSION

General practitioners practicing in the private sector identify themselves as active players in supporting pregnant adolescents but face many challenges arising from the personal, religious, professional and community levels. Addressing these challenges is important for optimal care delivery to pregnant adolescents in this community.

The State of Adolescent Sexual and Reproductive Health

In the 25 years since the 1994 International Conference on Population and Development, significant progress has been made in adolescent sexual and reproductive health and rights (ASRHR). Trend analysis of key ASRHR indicators at global, national, and subnational levels indicates that adolescent girls today are more likely to marry later, delay their first sexual experience, and delay their first childbirth, compared with 25 years ago; they are also more likely to use contraceptives. Despite overall progress, however, unequal progress in many ASRHR outcomes is evident both within and between countries, and in some locations, the state of adolescents' lives has worsened. Population growth in countries with some of the worst shortfalls in ASRHR mean that declining rates, of child marriage, for example, coexist with higher absolute numbers of girls affected, compared with 25 years ago. Emerging trends that warrant closer attention include increasing rates of ovarian and breast cancer among adolescent girls and sharp increases in the proportion of adolescents who are overweight or obese, which has long-term health implications.

Structure and content of the maternal representations of Mexican teenagers during their first pregnancy

Abstract Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations.

Exploring the Risks of Repeated Pregnancy Among Adolescents and Young Women in the Philippines

Objective Knowledge of the factors which influence repeat pregnancy can inform much needed evidence-based prevention programs. This study aims to identify correlates of repeat pregnancy in the Philippines. Methods We used data from five Philippine Demographic and Health Surveys (1993-2013). A total of 4757 women 15-24 years old who had experienced ≥ 1 pregnancy were included. Individual and partner-related factors were fitted into a series of logistic regression stepwise models with deformalized survey weights. Stratified analyses using two age groups (15-19, 20-24) were also conducted. Interaction terms were included to test for statistical differences between the groups. Results Lower wealth quintiles [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.17-2.49] and partner characteristics such as age of ≥ 30 years (OR = 1.99, CI = 1.41-2.82), multiple partners (OR = 4.19, CI = 1.57-11.19) and live-in status (OR = 1.38, CI = 1.02-1.87) were found to be highly correlated with repeat pregnancy in fully adjusted analysis. Receiving prenatal care from traditional healers (OR = 1.93, CI = 1.02-3.63) during the first pregnancy and giving birth for the first time before 18 years of age (OR = 1.12, CI = 1.04-1.20) showed increased risks among 15-19 years old compared to 20-24 years old in stratified analysis. Conclusions for practice In general, partner characteristics were associated with repeat pregnancy among young women suggesting male involvement, especially older partners, in family planning. High risks for repeat pregnancy were observed among adolescent women who reported younger age at first birth and received prenatal care from a traditional healer which entail promotion of trained prenatal care. Further analysis is needed to validate these findings in other developing countries.

Modern contraceptive use among sexually active women aged 15-19 years in North-Western Tanzania: results from the Adolescent 360 (A360) baseline survey

OBJECTIVES

To describe differences in modern contraceptive use among adolescent women aged 15-19 years according to their marital status and to determine factors associated with modern contraceptive use among sexually active women in this population.

DESIGN

Cross-sectional analysis of Adolescent 360 evaluation baseline survey.

SETTING

The 15 urban and semiurban wards of Ilemela district, Mwanza region, North-Western Tanzania.

PARTICIPANTS

Adolescent women aged 15-19 years who were living in the study site from August 2017 to February 2018 and who provided informed consent. Women were classified as married if they had a husband or were living as married. Unmarried women were classified as sexually active if they reported having sexual intercourse in the last 12 months.

OUTCOME MEASURE

Prevalence of modern contraceptive among adolescent women aged 15-19 years.

RESULTS

Data were available for 3511 women aged 15-19 years, of which 201 (5.7%) were married and 744 (22.5%) were unmarried-sexually active. We found strong evidence of differences in use of modern contraceptive methods according to marital status of adolescent women. Determinants of modern contraception use among unmarried-sexually active women were increasing age, increasing level of education, being in education, hearing of modern contraception from interpersonal sources or in the media in the last 12 months, perceiving partner and/or friends support for contraceptive use, as well as higher knowledge and self efficacy for contraception.

CONCLUSIONS

Sexual and reproductive health programmes aiming to increase uptake of modern contraceptives in this population of adolescent women should consider the importance of girl's education and social support for contraceptive use particularly among unmarried-sexually active women.

Clinical practice guidelines for contraception by the French National College of Gynecologists and Obstetricians (CNGOF)

The French College of Obstetrics and Gynecology (CNGOF) has released its first comprehensive recommendations for clinical practices in contraception, to provide physicians with an updated synthesis of the available data as a basis for their practice. The organizing committee and the working group adopted the objective methodological principles defined by the French Authority for Health (HAS) and selected 12 themes relevant to medical professionals' clinical practices concerning contraception. The available literature was screened through December 2017 and served as the basis of 12 texts, reviewed by experts and physicians from public and private practices, with experience in this field. These texts enabled us to develop evidence based, graded recommendations. Male and female sterilization, as well as the use of hormonal treatments not authorized for contraception ("off-label") were excluded from the scope of our review. Specific practical recommendations are provided for the management of contraception prescription, patient information concerning effectiveness, risks, and benefits of the different methods, patient follow-up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers, in women after 40, for women at high thromboembolism or cardiovascular risk, and for those at of primary cancer or relapse. The short- and mid-term future of contraception depends mainly on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, regardless of their social and clinical contexts. The objective of these guidelines is to aid in enabling this improvement.

Sociodemographic Factors Associated with the Knowledge and Use of Birth Control Methods in Adolescents before and after Pregnancy

Adolescent pregnancy rates are high worldwide. However, insufficient information exists regarding the frequency of birth control methods used before the first pregnancy and postpartum. In the current study, we analyzed the association of sociodemographic factors with the knowledge of birth control methods and their use before and after pregnancy in a sample of adolescents in Mexico City. A cohort study was conducted on 600 pregnant adolescents in Mexico City, from 2013 to 2017, at a health care institution providing prenatal care. Participants were assessed during the second trimester and four months postpartum. The questionnaire explored the knowledge of birth control methods, their use, and other associated factors. Two logistic regression models were implemented to identify potential variables associated with the lack of birth control method use before and after pregnancy. The mean age of participants was 15.4 + 1 years, of which, 48% and 65.2% used a birth control method before pregnancy and postpartum, respectively. We found that the main factors associated with increased risk of not using any birth control method before pregnancy included being under the age of 15 years, school dropout, having an educational lag, initiation of sexual life before the age of 15, and having a mother who did not inform their child about contraceptives. By contrast, variables associated with a higher risk of not using any contraceptive methods after pregnancy included educational lag, lower level of education, and the fact that the adolescent had not used any birth control prior to the pregnancy.

[Intrauterine contraception: CNGOF Contraception Guidelines]

OBJECTIVE

To provide national clinical guidelines focusing on intrauterine contraception.

METHODS

A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.

RESULTS

Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).

CONCLUSION

Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.

[Contraception: CNGOF Guidelines for Clinical Practice (Short Version)]

The French College of Obstetrics and Gynecology (CNGOF) releases its first global recommendations for clinical practice in contraception, to provide physicians with an updated synthesis of available data as a basis for their practice. The French Health Authority (HAS) methodology was used. Twelve practical issues were selected by the organizing committee and the task force members. The available literature was screened until December 2017, and allowed the release of evidence-based, graded recommendations. This synthesis is issued from 12 developed texts, previously reviewed by experts and physicians from public and private practices, with an experience in the contraceptive field. Male and female sterilization, as well as the use of hormonal treatments without contraceptive label were excluded from the field of this analysis. Specific practical recommendations on the management of contraception prescription, patient information including efficacy, risks, and benefits of the different contraception methods, follow up, intrauterine contraception, emergency contraception, local and natural methods, contraception in teenagers and after 40, contraception in vascular high-risk situations, and in case of cancer risk are provided. The short/mid-term future of contraception mostly relies on improving the use of currently available methods. This includes reinforced information for users and increased access to contraception for women, whatever the social and clinical context. That is the goal of these recommendations.