Social disadvantage as a risk for first pregnancy among adolescent females in the United States

Perinatal outcomes of socially disadvantaged women in Australia: A population-based retrospective cohort study

OBJECTIVE

To examine the perinatal outcomes of women who experience social disadvantage using population-based perinatal data collected between 1999 and 2016.

DESIGN

Population-based, retrospective cohort study.

SETTING

Victoria, Australia.

POPULATION OR SAMPLE

A total of 1 188 872 singleton births were included.

METHODS

Cohort study using routinely collected perinatal data. Multiple logistic regression was performed to determine associations between social disadvantage and adverse maternal and neonatal outcomes with confidence limits set at 99%. Time-trend analysis for perinatal outcomes was performed in relation to area-level disadvantage measures.

MAIN OUTCOME MEASURES

Incidence of maternal admission to intensive care unit (ICU), postpartum haemorrhage (PPH) and caesarean section, perinatal mortality, preterm birth, low birthweight (LBW), and admission to special care nursery/neonatal intensive care unit (SCN/NICU).

RESULTS

Social disadvantage was associated with higher odds of adverse perinatal outcomes. Disadvantaged women were more likely to be admitted to ICU, have a PPH or experience perinatal mortality (stillbirth or neonatal death) and their neonates were more likely to be admitted to SCN/NICU, be born preterm and be LBW. A persistent social gradient existed across time for the most disadvantaged women for all outcomes except caesarean section.

CONCLUSIONS

Social disadvantage has a marked negative impact on perinatal outcomes. This aligns with national and international evidence regarding the impact of disadvantage. Strategies that improve access to, and reduce fragmentation in, maternity care in addition to initiatives that address the social determinants of health may contribute to improving perinatal outcomes for socially disadvantaged women.

Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA

Background

The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model’s ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative’s implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery.

Methods

Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI.

Results

Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures.

Conclusions

Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12482-1.

Understanding the Psychological Impacts of Teenage Pregnancy through a Socio-ecological Framework and Life Course Approach

The relationship between mental health and teenage pregnancy is complex. Mental health can be both an antecedent and contributing factor to teenage pregnancy and a concurrent factor wherein pregnancy itself can contribute to depression. Expectant and parenting teens (EPT) are faced with the simultaneous challenges of pregnancy and parenting while navigating the developmental tasks of adolescence which increases their risk for mental health problems. In addition, adolescents growing up in stressful community or home situations where their parents experienced depression, further places them and their children at greater risk of repeated patterns over time. However, adverse mental health outcomes are not inevitable. The socio-ecological model combined with a life course perspective provides a framework for understanding the complexity of risk and protective factors at multiple levels that influence knowledge, attitudes, behaviors, and other health outcomes later in life and across generations. This approach has important implications for reducing adolescents' risk of an unintended/mistimed pregnancy and improving mental health and other outcomes for EPT. This paper describes the prevalence of mental health problems in EPT and using a socio-ecological framework and life course perspective explains variations in mental health outcome among EPT. Implications for interventions and innovative approaches are also discussed.

Adolescent Fertility Attitudes and Childbearing in Early Adulthood

Teens' attitudes about adolescent childbearing predict childbearing in the short term. If these attitudes reflect persistent goals and values, they may also be linked to later outcomes. To test long-term linkages, we analyze the association of adolescent fertility attitudes with actual and prospective fertility in adulthood using Waves I (1994-95) and IV (2007-08) of the National Longitudinal Study of Adolescent to Adult Health and focusing on men (N = 4,275) and women (N=4,418) without a teen birth. For women, we find that more negative teen attitudes predict lower hazards of a first birth up to around age 30 but that teens' attitudes are unrelated to planned childlessness among those who have not yet had children. Men's adolescent attitudes are unrelated to actual fertility or prospective intentions. For both men and women, more advantaged individuals are less likely to have had a child by around age 30; socioeconomic advantage is also related to postponement of childbearing rather than planned childlessness, though more so for women than men. We interpret the findings as evidence that, for girls, teens' attitudes toward adolescent childbearing capture an internalization of social schema about childbearing, childrearing, and sequencing with other life outcomes but do not reflect overall preferences about having children. More work is needed to understand the psychosocial factors that influence men's fertility.

Pregnant adolescent women's perceptions of depression and psychiatric services in the United States

PROBLEM

Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.

BACKGROUND

However, few pregnant adolescent women with depression receive psychiatric services, especially low-income or racial/ethnic minority adolescent women.

AIM

This qualitative study explores perceptions of depression, psychiatric services, and barriers to accessing services in a sample of low-income, pregnant racial/ethnic minority adolescent women. Our goal was to better understand the experiences of depression during pregnancy for these vulnerable adolescent women, and thereby improve their engagement and retention in services for perinatal depression.

METHODS

We recruited 20 pregnant adolescent women who screened positive for depression from 2 public health prenatal clinics in the southeastern United States. Participants were low-income and primarily racial/ethnic minority women between 14 and 20 years old. Data were collected through individual in-depth, ethnographically informed interviews.

FINDINGS

Generally, participants lacked experience with psychiatric services and did not recognize their symptoms as depression. However, participants perceived a need for mood improvement and were interested in engaging in services that incorporated their perspective and openly addressed stigma.

DISCUSSION

Participants reported practical and psychological barriers to service engagement, but identified few cultural barriers. Family perceptions of psychiatric services served as both a barrier and support.

CONCLUSION

Adolescent women are more likely to engage in psychiatric services if those services reduce practical and psychological barriers, promise relief from the symptoms perceived as most meaningful, and address underlying causes of depression. Culture may affect Latina adolescent women's perceptions of depression and services.

The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?

In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.

Follow-up and outcomes of pregnancies in French Guiana: the part of teenage pregnancies

OBJECTIVE

Describe the part that teenage pregnancy plays in overall pregnancies in French Guiana.

METHODS

Descriptive and retrospective study of the medical records of 25,343 women who delivered in French Guiana from January 1, 2009 to December 31, 2012. The study displays and compares several indicators of follow-up visits, pregnancy-linked disorders, delivery and birth outcomes between the years and between minors and adult women.

RESULTS

The proportion of teenage pregnancies was 6.8%; it decreased significantly from 7.2% in 2009 to 6.1% in 2012 (p=0.01). The number of antenatal visits was <7 and the visits were mainly provided by the Mother and Child Health ("Protection Maternelle et Infantile", PMI) services (38.6%). The mean (±SD) gestational age at first antenatal visit was 14.1±6.5 weeks. In comparison with adult pregnancies, teenage pregnancies were more frequently concerned with preterm labour (4.6% vs. 2%; p<0.01) but less concerned with gestational diabetes (0% vs. 2.2%; p<0.05) or pregnancy-induced hypertension (2.2% vs. 4.2%; p<0.05).

CONCLUSION

Teenage pregnancies are still frequent in French Guiana, especially in the Eastern and Western communes, where first visits are often delayed by mothers who are minors and take place in PMI services, which offer less clinical, and paraclinical examinations than other settings.

Knowledge, attitudes and practices of adolescents in Upper Egypt on gender-based violence, with a focus on early girls' marriage

BACKGROUND

A large proportion of the female population all over the world, particularly in developing countries, experience some form of gender-based violence (GBV) during their life. Early marriage, a form of GBV, is particularly highly prevalent in rural Upper Egypt.

OBJECTIVES

The aim of the current study was to assess the knowledge, attitudes and practices (KAP) of adolescents in Upper Egypt on domestic GBV, with a focus on early girls' marriage.

PARTICIPANTS AND METHODS

The study was a cross-sectional descriptive household survey targeting 400 randomly selected adolescent boys and girls aged 11-16 years from five villages of Minya Governorate in Upper Egypt.

RESULTS

The proportion of interviewed adolescents who could identify certain practices as forms of GBV was relatively low: the identified practices were mainly deprivation of work (9.0%), deprivation of inheritance (3.3%), arbitrary neglect and desertion (2.8%), and preventing from visiting relatives (0.5%). Abusive sexual behavior was not identified by any of the study participants as a form of domestic GBV. A total of 112 boys (56.0%) reported that they have been perpetrators in domestic GBV events at least once and 118 girls (59.0%) reported that they have been actual victims of domestic GBV. An overall 65.6% of study participants could correctly identify the legal age of marriage as 18 years, yet only 22.0% identified earlier ages of marriage as a form of domestic GBV. The vast majority of girls and boys reported that they would not agree to get married before the age of 18 years (91.0 and 87.0%, respectively).

CONCLUSION AND RECOMMENDATIONS

Adolescents in Upper Egypt demonstrated a less than satisfactory knowledge about the forms of GBV. Although early girls' marriage was not universally recognized by adolescents as a form of domestic GBV, they demonstrated satisfactory knowledge about the legal age of marriage, as well as a tendency to abandon the practice. Establishing a community-based awareness program for adolescents of both sexes about GBV with a focus on early girls' marriage is highly recommended.

Changing Sociodemographic Factors and Teen Fertility: 1991-2009

This study analyzed the roles of trends in sociodemographic factors known to be related to the risk of a teen birth. The goal was to analyze the roles of these trends in maternal education, family structure and mother's age at first birth in the likelihood of adolescents becoming teen mothers across multiple birth cohorts of women covering the years since 1991. Data are from the 1995, 2002, 2006-2010 and 2011-2013 National Surveys of Family Growth (NSFG). Consecutive birth cohorts of female respondents were constructed and retrospectively followed to estimate the risk of a teen birth for each cohort. Logistic regression models estimate the odds of a teen birth across cohorts and within strata of the predictors across cohorts. Maternal education rose across cohorts; the proportion who were non-Hispanic white declined. In general, the likelihood of an adolescent birth did not change within categories of the predictors that are considered at higher risk for a teen birth across birth cohorts. Specifically, there was no change in the odds of a teen birth among women whose mothers did not finish high school, those born to teen mothers and those not from two-parent families. The odds of a birth declined across cohorts for black women. The findings suggest that much of the decline in teen birth rates is due to declines in the proportion of teens in higher risk categories, rather than to declines within those categories.

Long-term consequences of adolescent parenthood among African-American urban youth: a propensity score matching approach

PURPOSE

The aim of this study was to improve understanding of long-term socioeconomic consequences of teen parenting for men and women.

METHODS

Analysis is based on the Woodlawn Study, a longitudinal study of an African-American cohort from a socially disadvantaged community in Chicago; data were collected at childhood (N = 1,242), adolescence (N = 705), young adulthood (age 32 years, N = 952), and midlife (age 42 years, N = 833). This analysis focused on the 1,050 individuals with data on teen parenting. We used propensity score matching to account for differences in background characteristics between teenage parents and their peers and used multiple imputation to account for differential attrition.

RESULTS

The regression models after propensity score matching showed that at the age of 32 years, in comparison to nonteen mothers, teenage mothers were more likely to be unemployed, live in poverty, depend on welfare, and have earned a GED or completed high school compared to finishing college. At the age of 32 years, teen fathers were more likely to be without a job than nonteen fathers. At the age of 42 years, the effect of teen parenting for women remained statistically significant for education and income. There were no significant associations between teen parenting and outcomes for men at the age of 42 years.

CONCLUSIONS

Socioeconomic consequences of teenage parenting among African-Americans from disadvantaged background seem to be primarily concentrated in women and persist throughout adulthood. In addition to promoting the delay of parenting after the teenage years, it is critical to provide programs at early stages in the life course to mitigate the negative socioeconomic consequences of teenage motherhood as effects for women are broad.

Long-term consequences of adolescent parenthood among African-American urban youth: a propensity score matching approach

PURPOSE

The aim of this study was to improve understanding of long-term socioeconomic consequences of teen parenting for men and women.

METHODS

Analysis is based on the Woodlawn Study, a longitudinal study of an African-American cohort from a socially disadvantaged community in Chicago; data were collected at childhood (N = 1,242), adolescence (N = 705), young adulthood (age 32 years, N = 952), and midlife (age 42 years, N = 833). This analysis focused on the 1,050 individuals with data on teen parenting. We used propensity score matching to account for differences in background characteristics between teenage parents and their peers and used multiple imputation to account for differential attrition.

RESULTS

The regression models after propensity score matching showed that at the age of 32 years, in comparison to nonteen mothers, teenage mothers were more likely to be unemployed, live in poverty, depend on welfare, and have earned a GED or completed high school compared to finishing college. At the age of 32 years, teen fathers were more likely to be without a job than nonteen fathers. At the age of 42 years, the effect of teen parenting for women remained statistically significant for education and income. There were no significant associations between teen parenting and outcomes for men at the age of 42 years.

CONCLUSIONS

Socioeconomic consequences of teenage parenting among African-Americans from disadvantaged background seem to be primarily concentrated in women and persist throughout adulthood. In addition to promoting the delay of parenting after the teenage years, it is critical to provide programs at early stages in the life course to mitigate the negative socioeconomic consequences of teenage motherhood as effects for women are broad.

Disparities in abortion rates: a public health approach

Women of lower socioeconomic status and women of color in the United States have higher rates of abortion than women of higher socioeconomic status and White women. Opponents of abortion use these statistics to argue that abortion providers are exploiting women of color and low socioeconomic status, and thus, regulations are needed to protect women. This argument ignores the underlying causes of the disparities. As efforts to restrict abortion will have no effect on these underlying factors, and instead will only result in more women experiencing later abortions or having an unintended childbirth, they are likely to result in worsening health disparities. We provide a review of the causes of abortion disparities and argue for a multifaceted public health approach to address them.

A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups

OBJECTIVE

To determine the risk factors of adolescent pregnancies and to ascertain the effects of this condition on the maternal and infant outcomes.

METHODS

The study was carried out on 100 adolescent mothers less than 20 years of age and on a same number of adult mothers between 22 and 32 years of age and their infants. A socio-demographic attributes questionnaire form, a pregnancy follow-up and birth history form, and a mother and infant follow-up form were used.

RESULTS

The mean age of the adolescent mothers was 17.8 ± 0.7 years and that of the adult mothers was 26 ± 0.3 years. Income level of 83% of the families of adolescent mothers and 69% of the families of adult mothers was below the poverty line (p < 0.05). Dropout rate (i.e. rate of those not attending any school) was 36% in the adolescent group and 21% in the adult group. Rate of exclusively breastfeeding during the first 2 months was 40% in adolescents and 62% in adults (p < 0.01). Higher rates of adolescent mothers felt themselves inadequate infant care and with 7% of them experiencing problems in accessing a healthcare institution.

CONCLUSIONS

Properly following up adolescent pregnancies during prenatal and postnatal periods may be helpful for preventing the negative impacts on mother and infant health.

Perinatal characteristics among early (10-14 years old) and late (15-19 years old) pregnant adolescents

BACKGROUND

Pregnancy in adolescents is a worldwide health problem and has been mostly common in poor populations. It is not clear if socioeconomic or biological factors are the main determinants of perinatal adverse outcomes in pregnant adolescents. Adolescents under 15 years old may present a high growth rate which may contribute to impair fetal growth. Our aim is to compare perinatal characteristics among early (aged 10 to 14 years) and late (aged 15 to 19 years) pregnant adolescents.

METHODS

A cross-sectional study was performed using data from Pernambuco State 2009, obtained from DATASUS/SISNAC, a Brazilian Government, open-access public health database. Maternal and neonatal outcomes were compared between early (aged 10-14 years) and late (aged 15-19 years) pregnant adolescents. Family income was compared between early and late pregnant adolescents using a sample of 412 subjects evaluated at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during 2011. Statistical comparisons were made using the chi-square test was used with a significant level of 0.05; bivariate and multivariate analysis were performed. This project was approved by the Institutional Ethics Review Board.

RESULTS

Data from 31,209 pregnant adolescents were analyzed. 29,733 (95.2%) were aged 15 to 19 years and 1,476 (4.7%) were aged 10 to 14 years. There were significant differences with respect to marital status, education level and number of prenatal visits of mothers aged 10 to 14 years compared to 15 to 19 years. Of importance, early adolescents had a greater rate of neonates born premature and with low birth weight. Prematurity and low birth weight remained statistically significant after multivariate analysis.

CONCLUSIONS

Early aged adolescents may have an increased risk of prematurity and low birth weight. These findings highlight the potential role of biological factors in newborn outcomes in pregnant adolescents.