Ambivalent messages: adolescents' perspectives on pregnancy and birth

Teaching About Contraception: Adolescent Attitudes Surrounding Sexual Education

Purpose

Adolescent pregnancy remains an important public health issue in the United States as it has profound health consequences for both mother and child. Evidence shows that improved contraception use is a critical factor in decreasing rates of adolescent pregnancy. In order to provide effective and engaging contraception education, it is important to understand adolescents' attitudes, questions, and misconceptions around the topic and its delivery.

Methods

Two searches were conducted using PubMed. Articles were limited to those published in the last 10 years that were written in English. The first search was completed using the search terms "Adolescent attitudes on sex education in the United States", and resulted in 688 articles. The second search was completed using the search terms "Adolescent attitudes on contraception in the United States", and resulted in 840 articles. Articles including contraception but focusing more on HIV, pre-exposure prophylaxis (PrEP), LGBTQ+ health and practices, human papillomavirus (HPV) vaccination, and studies completed in other countries were excluded. Remaining articles were screened by the authors for inclusion, and articles were included if they addressed information on adolescent attitudes on both contraception for pregnancy prevention and sex education, including education by schools, community organizations, the media, peers, parents, and physicians. A total of 56 articles were included in the review.

Results

The overwhelming theme that emerged from the review is that adolescents prefer comprehensive sex education in a safe space that allows for exploration and questioning. Adolescents want to ask their parents questions about sexual health without fear of punishment, and they desire the opportunity to learn from their physicians in a confidential environment.

Conclusion

The foundation of effective sex education is a non-judgmental, confidential, and safe space where adolescents can ask questions. There are multiple resources that adolescents use to gather information and establish their preferences and attitudes.

The paradox of acceptance: A content analysis of Iranian married female adolescent in confronting pregnancy

Adolescent pregnancy is a major health problem significantly associated with adverse effects on the health of both adolescents and their newborns. However, there is a lack of clarity over adolescent pregnancy from adolescents' perspective, particularly in the low- and middle income countries including Iran. This study aimed to explore the experiences of Iranian married female adolescent in confronting pregnancy. This qualitative research was conducted using conventional content analysis approach. Unstructured interviews with 24 female adolescents (aged 14–18 years) were used for data collection, and data analysis was done simultaneously. In this study, the participants were recruited from urban and rural primary healthcare centers (PHCs). The PHCs were selected randomly from several towns and villages of Guilan Province, Iran. The participants were recruited through a purposive sampling method. After data analysis, four categories were extracted from 24 interviews, including "actively accepting pregnancy", "passively accepting pregnancy", "hope and satisfaction" and "frustration and regret". These categories formed the main theme of "paradox of acceptance" in confronting pregnancy. The concepts that have emerged based on the results of the study can potentially help develop comprehensive and age-tailored health promotion programs to confront pregnancy more successfully for female pregnant adolescents. Further research, particularly on the long-term effects of teenage motherhood is suggested.

Continuation of Unintended Pregnancy

Background

Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention from clinicians and policy makers, and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature.

Objective

This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy.

Discussion

Clinicians should approach patients with an unintended pregnancy with a sympathetic tone in order to provide the most support and present the most complete options. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately.

Conclusion

Unintentionally pregnant women deserve a supportive and complete response from their clinicians, who should inform about, and sometimes activate, all the resources available for the continuation of unintended pregnancy.

Summary

Forty-four percent of all pregnancies worldwide are unintended. Induced abortion has drawn a lot of attention and the care for women requesting it has been covered in many publications. However, abortion challenges the values of many women, is associated with negative emotions, and has its own medical complications. Women have the right to discuss their unintended pregnancy with a clinician and receive elaborate information about other options to deal with it. Continuing an unintended pregnancy, and receiving the necessary care and support for it, is also a reproductive right of women. However, the provision of medical information and support required for the continuation of an unintended pregnancy has hardly been approached in the medical literature. This review presents a clinical approach to unintentionally pregnant patients and describes the information and support that can be offered for the continuation of the unintended pregnancy. Clinicians should approach patients with an unintended pregnancy with a sympathetic tone. A complete clinical history can help frame the problem and identify concerns related to the pregnancy. Any underlying medical or obstetric problems can be discussed. A social history, that includes the personal support from the patient's partner, parents, and siblings, can be taken. Doctors should also be alert of possible cases of violence from the partner or child abuse in adolescent patients. Finally, the clinician can provide the first information regarding the social care available and refer the patients for further support. For women who continue an unintended pregnancy, clinicians should start antenatal care immediately.

Building Community Support Using a Modified World Café Method for Pregnant and Parenting Teenagers in Forsyth County, North Carolina

STUDY OBJECTIVE

To identify community priorities, foster awareness of existing supports, and recognize barriers and opportunities to enhance support services for pregnant and parenting teens (PPTs).

DESIGN AND SETTING

A modified World Café event incorporated parallel, rotating focus groups with semistructured, case-based discussions of salient issues. The event was organized and took place in Forsyth County, North Carolina.

PARTICIPANTS

Seventy-eight local health and social service professionals and 15 PPT representatives.

INTERVENTIONS AND MAIN OUTCOME MEASURES

Qualitative coding was used to thematically analyze transcript data. Quantitative data pre-/post-event comparisons were made using Fisher exact test.

RESULTS

Key community-based support services for PPTs were identified. Qualitative analysis yielded 10 key codes regarding barriers and opportunities to enhance community-based support services, resulting in 4 themes. Themes included maximizing access and efficient delivery of high-quality health care, engaging a 3-generation approach to meet the current and future needs of at-risk families, focusing efforts to meet the unique needs of each teen and his/her family, and emphasizing teen self-advocacy. Pre/post survey responses were overwhelmingly positive regarding use of the modified World Café format for discussion and network building.

CONCLUSION

The modified World Café Method offered a platform to collaboratively identify challenges and opportunities and to develop networks to improve health and well-being of PPTs. Engaging multiple stakeholders in meaningful dialogue might foster multidisciplinary, cross-sector collaboration that mitigates risk and enhances resilience among PPTs and their children.

Bad girl and unmet family planning need among Sub-Saharan African adolescents: the role of sexual and reproductive health stigma

Adolescent pregnancy contributes to high maternal mortality rates in Sub-Saharan Africa. We explored stigma surrounding adolescent sexual and reproductive health (SRH) and its impact on young Ghanaian women's family planning (FP) outcomes. We conducted in-depth, semi-structured interviews with 63 women ages 15-24 recruited from health facilities and schools in Accra and Kumasi, Ghana. Purposive sampling provided diversity in reproductive/relationship/socioeconomic/religious characteristics. Using both deductive and inductive approaches, our thematic analysis applied principles of grounded theory. Participants described adolescent SRH experiences as cutting across five stigma domains. First, community norms identified non-marital sex and its consequences (pregnancy, childbearing, abortion, sexually transmitted infections) as immoral, disrespectful, and disobedient, resulting in bad girl labeling. Second, enacted stigma entailed gossip, marginalization, and mistreatment from all community members, especially healthcare workers. Third, young sexually active, pregnant, and childbearing women experienced internalized stigma as disgrace, shame and shyness. Fourth, non-disclosure and secret-keeping were used to avoid/reduce stigma. Fifth, stigma resilience was achieved through social support. Collectively, SRH stigma precluded adolescents' use of FP methods and services. Our resulting conceptual model of adolescent SRH stigma can guide health service, public health, and policy efforts to address unmet FP need and de-stigmatize SRH for young women worldwide.

Family context and individual situation of teens before, during and after pregnancy in Mexico City

Background

In the last 20 years, adolescent pregnancy has become one of the most critical problems affecting women in Latin America and the Caribbean.

Methods

This qualitative study was based on in-depth interviews with 29 teen mothers. All of the pregnant teens were from low- to lower-middle-class social strata in the Mexico City metropolitan area. The family (living with the girl) and the individual context of pregnant teens were analysed on the basis of data from at least three interviews: during pregnancy and at approximately 6 and 24 months following delivery. Additionally, six mothers, four fathers, and four partners of the pregnant girls of the group were interviewed. The information on the individual and family situation before, during and after the pregnancy was recorded and transcribed, then analysed in three phases, comprising pre-analysis, exploration and interpretation.

Results

The pregnant teens had a family background of teen pregnancy. The girls disclosed feelings of repression, loneliness and indifference to their parents, leading them to unprotected sexual relations without fear of pregnancy. After the pregnancy, communication improved between the girls and their parents, but became worse with their partner. Consequently, these teens returned to feeling as they did before getting pregnant. They stated that they would make their situation work for the sake of their child, and regretted dropping out of school and getting pregnant so young. Almost all said they were seeking love outside the family, which revealed a scenario of limited communication and unsatisfactory relations within the family.

Conclusions

Understanding how communication works between parents and children is necessary to avoid teenage pregnancy, as well as early marriage or cohabitation, resulting in dropping out of school and financial constraints, which lead to great frustrations between the couple and affects the child. In addition, it is vitally important that adolescents be motivated in the family setting in order for them to continue their studies. There is also an urgent need to implement measures that compensate for educational inequality, as well as to strengthen strategies aimed at adolescent mothers and pregnant teens that encourage their school performance through the support of scholarship programs and day care centres. Many of the problems inherent in adolescence are related to the lack of affection and support, and in many cases are a reaction to authoritarian rules or limits established unilaterally by parents with little or no dialogue involved.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1570-7) contains supplementary material, which is available to authorized users.

Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient

The American Academy of Pediatrics policy statement "Options Counseling for the Pregnant Adolescent Patient" recommends the basic content of the pediatrician's counseling for an adolescent facing a new diagnosis of pregnancy. However, options counseling is just one aspect of what may be one of the more challenging scenarios in the pediatric office. Pediatricians must remain alert to the possibility of pregnancy among their adolescent female patients. When discovering symptoms suggestive of pregnancy, pediatricians must obtain a relevant history, perform diagnostic testing and properly interpret the results, and understand the significance of the results from the patient perspective and reveal them to the patient in a sensitive manner. If the patient is indeed pregnant, the pediatrician, in addition to providing comprehensive options counseling, may need to help recruit adult support for the patient and should offer continued assistance to the adolescent and her family after the office visit. All pediatricians should be aware of the legal aspects of adolescent reproductive care and the resources for pregnant adolescents in their communities. This clinical report presents a more comprehensive view of the evaluation and management of pregnancy in the adolescent patient and a context for options counseling.

Teen Perceptions of Sexual Activity: Influences, consequences, realities, and thoughts on safe sexual health practices

Teens' engagement in sexual activity and safe sexual practices is an important public health issue in the US today. This descriptive survey study explored teens' thoughts about the influences, consequences, and realities associated with teen sexual activity and pregnancy and their perceptions of access to sexual health education and contraception. Surveys were administered to 856 Delaware youth in 39 high school health classes from 16 schools. Of the 31 survey items, 25 offered significantly different responses; participants agreed with 16 and disagreed with 9 items (p < .005), revealing important findings concerning teen perceptions as the basis for meaningful interventions.

Never-pregnant African American adolescent girls' perceptions of adolescent pregnancy

Despite the decrease in adolescent pregnancy rates, rates among African American girls remain higher than other racial/ethnic adolescent groups. This descriptive qualitative study explored never-pregnant African American adolescent girls' perceptions about adolescent pregnancy. Sixty-four participants participated in individual interviews and focus groups. Individual interviews examined beliefs about adolescent pregnancy and perceptions of life changes resulting from becoming pregnant during adolescence. Focus groups were held to validate findings from the interviews. Participants agreed that becoming pregnant during adolescence would negatively impact their education, family, and peers. Participants anticipated feelings of shame and embarrassment in the event that they became pregnant.