Adolescents' pregnancy intentions: relations to life situations and caretaking behaviors prenatally and 2 years postpartum

School girls and childbearing motives: A randomized clinical trial through hidden curriculum

Background

Childbearing motives are considered as the primary stimulus of fertility and the importance of making fertility decisions in humans.

Objective

The aim of this study is to determine the effect of a new form of interactional program on the childbearing motives of students.

Materials and Methods

According to a well-defined, single-blind randomized controlled trial, we selected eight government schools in Tehran. Students in the age range of 7-12 yr and 16-18 yr (130 students in each school with a total number of 260) were selected for a series of intervention from storytelling to free discussion on a special subject through the concept of hidden curriculum. We evaluate the outcome with pretest-posttest based on the Miller childbearing motives questionnaire. One month after the last intervention, final evaluation took place.

Results

The findings showed that after an intervention conducted in the best way, all positive scores were promoted while the negative ones declined. One the other hand, no matter what really the participant's groups were, their total intention score got better. In this way, the total positive scores were significantly increased in the intervention groups (p = 0.000) Also, the students in high school significantly improved in positive scores and the negative score decreased in them.

Conclusion

This study showed that the fundamental childbearing motives even with small interventions can be improved. Our intervention could improve the positive childbearing motives among school girls. In this regard, the role of some confounding factor such as the role of some confounding factors such as religious beliefs in family, maternal education is most important.

A Rare Presentation of the Syndrome of Inappropriate Antidiuretic Hormone in a 12-Year-Old Girl as the Initial Presentation of an Immature Ovarian Teratoma

BACKGROUND

Immature ovarian teratoma is very rare in childhood. We report on a 12-year-old girl with immature ovarian teratoma who presented initially with syndrome of inappropriate antidiuretic hormone.

CASE

A 12-year-old girl presented with acute abdomen and distention. Initial laboratory tests showed hyponatremia (sodium, 123 mmol/L), that did not respond to fluid management. Computed tomography imaging showed a 15 cm × 9 cm × 20 cm mass in the right ovary with multifocal internal fat, and dystrophic calcifications. She underwent exploratory laparotomy with a right salpingo-oophorectomy, omentectomy, and peritoneal stripping. The pathology revealed metastatic immature teratoma. Hyponatremia resolved soon after the surgery.

SUMMARY AND CONCLUSION

Although a rare diagnosis, immature ovarian teratoma must be considered in a girl who presents with abdominal mass and hyponatremia.

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

BACKGROUND

The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions.

OBJECTIVES

To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are.

DATA SOURCES

We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association's electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders.

REVIEW METHODS

To address the topic's complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback.

RESULTS

We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research.

LIMITATIONS

Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations.

CONCLUSIONS

We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Periconceptional Risk Factors for Birth Defects among Younger and Older Teen Mothers

STUDY OBJECTIVES

We sought to determine whether selected periconceptional health behaviors that influence risk for birth defects differ between older and younger adolescents and whether pregnancy intention predicts more positive preconception health behaviors among teens.

DESIGN AND PARTICIPANTS

We analyzed interview responses from 954 adolescent control group participants from the National Birth Defects Prevention Study who delivered live infants during 1997-2007.

MAIN OUTCOME MEASURES

Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated for factors of interest by age categories (13-15, 16-17, and 18 years, relative to 19 years). To construct a composite periconceptional behavior index, we summed the following healthy behaviors: nonsmoker, nondrinker, folic acid supplementation, and eating 5 or more servings of fruits and vegetables per day.

RESULTS

Analyses indicated that women in the youngest group (13-15 years of age) were more likely to be Hispanic (aOR 2.83, 95% CI 1.40-5.70) and less likely to engage in some unhealthy pregnancy-related behaviors compared with 19-year-olds, such as smoking (aOR 0.45, 95% CI 0.20-0.99) and being overweight or obese (aOR 0.32, 95% CI 0.16-0.61). However, they were also less likely to have taken periconceptional folic acid (aOR 0.44, 95% CI 0.21-0.90). About one-third of teen mothers indicated that their pregnancies had been intended. Among 18- and 19-year-olds, this predicted a higher mean value for the composite periconceptional behavior index (2.30 versus 1.94, P ≤ .01).

CONCLUSIONS

Teen mothers are not a homogeneous group. Each age subgroup presents varied demographic and behavioral factors that put them at varying levels of risk for birth defects. Furthermore, caregivers should not assume that teens do not plan pregnancies or that they need not be informed of the importance of periconceptional health.

Fertility among orphans in rural Malawi: challenging common assumptions about risk and mechanisms

CONTEXT

Although a substantial literature suggests that orphans suffer disadvantage relative to nonorphaned peers, the nature of this disadvantage and the mechanisms driving it are poorly understood. Some evidence suggests that orphans experience elevated fertility, perhaps because structural disadvantage leads them to engage in sexual risk-taking. An alternative explanation is that orphans intentionally become pregnant to achieve a sense of normality, acceptance and love.

METHODS

Data from the 2006 wave of the Malawi Longitudinal Study of Families and Health on 1,033 young adults aged 15-25 were used to examine the relationship of maternal and paternal orphanhood with sexual risk indicators and desired and actual fertility. Regression analyses were used to adjust for covariates, including social and demographic characteristics and elapsed time since parental death.

RESULTS

Twenty-six percent of respondents had lost their father and 15% their mother. Orphanhood was not associated with sexual risk-taking. However, respondents whose mother had died in the past five years desired more children than did those whose mother was still alive (risk differences, 0.52 among women and 0.97 among men). Actual fertility was elevated among women whose father had died more than five years earlier (0.31) and among men whose mother had died in the past five years (1.06) or more than five years earlier (0.47).

CONCLUSION

The elevations in desired and actual fertility among orphans are consistent with the hypothesis that orphans intentionally become pregnant. Strategies that address personal desires for parenthood may need to be part of prevention programs aimed at orphaned youth.

Partner support and impact on birth outcomes among teen pregnancies in the United States

PURPOSE

Despite hypothesized relationships between lack of partner support during a woman's pregnancy and adverse birth outcomes, few studies have examined partner support among teens. We examined a potential proxy measure of partner support and its impact on adverse birth outcomes (low birth weight (LBW), preterm birth (PTB) and pregnancy loss) among women who have had a teenage pregnancy in the United States.

METHODS

In a secondary data analysis utilizing cross-sectional data from 5609 women who experienced a teen pregnancy from the 2006-2010 National Survey of Family Growth (NSFG), we examined an alternative measure of partner support and its impact on adverse birth outcomes. Bivariate and multivariable logistic regression were used to assess differences in women who were teens at time of conception who had partner support during their pregnancy and those who did not, and their birth outcomes.

RESULTS

Even after controlling for potential confounding factors, women with a supportive partner were 63% less likely to experience LBW [aOR: 0.37, 95% CI: (0.26-0.54)] and nearly 2 times less likely to have pregnancy loss [aOR: 0.48, 95% CI: (0.32-0.72)] compared to those with no partner support.

CONCLUSIONS

Having partner support or involvement during a teenager's pregnancy may reduce the likelihood of having a poor birth outcome.

Black adolescent mothers' perspectives on sex and parenting in nonmarital relationships with the biological fathers of their children

OBJECTIVE

To understand single Black adolescent mothers' perspectives on the sexual and parenting-related aspects of their relationships with the biological fathers of their children.

METHODS

The study was a qualitative description of perspectives from a convenience sample of Black single (nonmarried) adolescent mothers. Data were generated through focus groups and interviews. Participants were recruited using self-referral and health provider referrals.

SETTING

The study was conducted in a county public health department sexually transmitted diseases clinic in Rochester, New York.

PARTICIPANTS

Single mothers (N = 31) ages 15 to 19 participated in the study. The mean age of participants was 17.5 years (SD = 1.4).

FINDINGS

Four themes were identified that reflected the major characteristics of the relationships between the mothers and the biological fathers of their children: (a) You will always care about your "baby daddy" because of your child, (b) Negative behavior is tolerated to keep the family together, (c) The "baby daddy" can get sex as long as we are not on bad terms, and (d) He will always be part of our lives.

CONCLUSION

Black adolescent mothers have complex relationships with the biological fathers of their children that may include ongoing sexual activity. The intersection of coparenting and sexual health needs among adolescent mothers highlights the importance of integrating sexually transmitted infections prevention with perinatal health programs. It is important to consider this unique coparenting relationship when providing risk-reduction counseling to young mothers.

Preconception reflections, postconception intentions: the before and after of birth control in Australian adolescent females

Background The relationship between pregnancy intentions and contraceptive behaviour is difficult to establish. This study explored the contraceptive histories of teenagers with a recent experience of pregnancy to generate qualitative profiles of pregnancy intentions. Subsequent intentions in relation to birth control were also examined. Methods: A purposive sample of female teenagers aged 14–19 years was recruited from various clinical and community-based antenatal and postnatal services and termination services across the Perth metropolitan area. The current analysis was based on a total of 56 semistructured interviews. A two-staged process of thematic analysis was conducted to identify commonalities emerging from the narrative data. Results: Three pregnancy intention profiles were identified: 1) unplanned, unwanted, unlikely; 2) planned, wanted, likely; and 3) unplanned, ambivalent, likely. Each profile represents variation in pathways to pregnancy based on teenagers’ accounts of pregnancy desires, personal responsibility over contraceptive use, and perceptions of pregnancy risk. Regardless of the way that pregnancy was resolved (i.e. termination or childbirth), similar postconception intentions surrounding birth control emerged through a shared discourse of pregnancy avoidance across the sample. Conclusions: Exploring adolescents’ understandings of the decisions and behaviours that lead to pregnancy will assist in the development of more accurate assessment tools to identify those at risk of unplanned and unwanted pregnancies. Our research also suggests that the provision of contraceptive counselling immediately after conception, followed by ongoing support, may help to maintain strong intentions to delay further pregnancies as identified in our study.

Adolescents' Pregnancy Intentions, Wantedness, and Regret: Cross-Lagged Relations With Mental Health and Harsh Parenting

The authors used cross-lagged analyses to examine the across-time influences on and consequences of adolescents' pregnancy intentions, wantedness, and regret. One hundred pregnant Latina adolescents were studied during pregnancy and at 6 and 12 months postpartum. The results revealed 4 main findings: (a) similar to what has been found in adult women, adolescents' lower prenatal pregnancy intendedness and wantedness predicted initial difficulties in parenting; (b) frequent depression symptoms predicted subsequent lower pregnancy intendedness and wantedness; (c) adolescents' poor mental health and harsh parenting of their child predicted subsequent higher childbearing regret, and (d) high childbearing regret and parenting stress were reciprocally related across time. In addition, adolescents' wantedness of their pregnancy declined prenatally to postbirth, and strong pregnancy intendedness and wantedness were not concurrently related to adolescents' poor prenatal mental health. The findings reveal how adolescents' thoughts and feelings about their pregnancies are influenced by and predictive of their mental health and parenting experiences.

Adolescents' Pregnancy Intentions, Wantedness, and Regret: Cross-Lagged Relations With Mental Health and Harsh Parenting

The authors used cross-lagged analyses to examine the across-time influences on and consequences of adolescents' pregnancy intentions, wantedness, and regret. One hundred pregnant Latina adolescents were studied during pregnancy and at 6 and 12 months postpartum. The results revealed 4 main findings: (a) similar to what has been found in adult women, adolescents' lower prenatal pregnancy intendedness and wantedness predicted initial difficulties in parenting; (b) frequent depression symptoms predicted subsequent lower pregnancy intendedness and wantedness; (c) adolescents' poor mental health and harsh parenting of their child predicted subsequent higher childbearing regret, and (d) high childbearing regret and parenting stress were reciprocally related across time. In addition, adolescents' wantedness of their pregnancy declined prenatally to postbirth, and strong pregnancy intendedness and wantedness were not concurrently related to adolescents' poor prenatal mental health. The findings reveal how adolescents' thoughts and feelings about their pregnancies are influenced by and predictive of their mental health and parenting experiences.

Breast-feeding attitudes and behavior among WIC mothers in Texas

OBJECTIVE

This study explored the influence of demographic characteristics on attitudes toward the benefits of breast-feeding, approval of public breast-feeding, and the use of infant formula. Additionally, the study examined whether attitudes were related to infant feeding practices among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas.

DESIGN

This study used a cross-sectional design.

SETTING

Participants completed questionnaires at WIC clinic sites across Texas.

PARTICIPANTS

Mothers of young children who were receiving WIC benefits.

MAIN OUTCOME MEASURE(S)

Attitudes toward the benefits of breast-feeding, attitudes toward public breast-feeding, attitudes toward infant formula, and the choice of infant feeding practice.

ANALYSIS

Descriptive statistics, multivariate ordinary least squares regression, and multinomial logistic regression.

RESULTS

A key finding was that many Hispanic mothers held favorable attitudes toward both breast milk and infant formula. Younger and less educated mothers were least likely to agree with the benefits of breast-feeding. Mothers with positive attitudes toward the benefits of breast-feeding were likely to exclusively breastfeed and use both formula and breast milk.

CONCLUSIONS AND IMPLICATIONS

Attitudes toward breast-feeding, public breast-feeding, and infant formula and their influence on breast-feeding behavior should inform the curriculum of breast-feeding promotion programs.

Social predictors of repeat adolescent pregnancy and focussed strategies

This article begins with an overview of teenage pregnancy within a social context. Data are then presented on conceptions and repeat conceptions in teenagers. Social predictors of repeat teenage pregnancy are grouped according to social ecological theory. A brief summary of prevention of teenage pregnancy in general is followed by a detailed analysis of studies of interventions designed to prevent repeat pregnancy that reached specific quality criteria. The results of some systematic reviews show no significant overall effect on repeat pregnancy, whereas others show an overall significant reduction. Youth development programmes are shown in some cases to lower pregnancy rates but in other cases to have no effect or even to increase them. Features of secondary prevention programmes more likely to be successful are highlighted.

Motivational intervention to reduce rapid subsequent births to adolescent mothers: a community-based randomized trial

PURPOSE

One-quarter of adolescent mothers bear another child within 2 years, compounding their risk of poorer medical, educational, economic, and parenting outcomes. Most efforts to prevent rapid subsequent birth to teenagers have been unsuccessful but have seldom addressed motivational processes.

METHODS

We conducted a randomized trial to determine the effectiveness of a computer-assisted motivational intervention (CAMI) in preventing rapid subsequent birth to adolescent mothers. Pregnant teenagers (N = 235), aged 18 years and older who were at more than 24 weeks' gestation, were recruited from urban prenatal clinics serving low-income, predominantly African American communities. After completing baseline assessments, they were randomly assigned to 3 groups: (1) those in CAMI plus enhanced home visit (n = 80) received a multi-component home-based intervention (CAMI+); (2) those in CAMI-only (n = 87) received a single component home-based intervention; (3) and those in usual-care control (n = 68) received standard usual care. Teens in both intervention groups received CAMI sessions at quarterly intervals until 2 years' postpartum. Those in the CAMI+ group also received monthly home visits with parenting education and support. CAMI algorithms, based on the transtheoretical model, assessed sexual relationships and contraception-use intentions and behaviors, and readiness to engage in pregnancy prevention. Trained interventionists used CAMI risk summaries to guide motivational interviewing. Repeat birth by 24 months' postpartum was measured with birth certificates.

RESULTS

Intent-to-treat analysis indicated that the CAMI+ group compared with the usual-care control group exhibited a trend toward lower birth rates (13.8% vs 25.0%; P = .08), whereas the CAMI-only group did not (17.2% vs 25.0%; P = .32). Controlling for baseline group differences, the hazard ratio (HR) for repeat birth was significantly lower for the CAMI+ group than it was with the usual-care group (HR = 0.45; 95% CI, 0.21-0.98). We developed complier average causal effects models to produce unbiased estimates of intervention effects accounting for variable participation. Completing 2 or more CAMI sessions significantly reduced the risk of repeat birth in both groups: CAMI+ (HR = 0.40; 95% CI, 0.16-0.98) and CAMI-only (HR = 0.19; 95% CI, 0.05-0.69).

CONCLUSIONS

Receipt of 2 or more CAMI sessions, either alone or within a multicomponent home-based intervention, reduced the risk of rapid subsequent birth to adolescent mothers.

The role of mental health factors, behavioral factors, and past experiences in the prediction of rapid repeat pregnancy in adolescence

PURPOSE

This study investigates the predictors of rapid repeat pregnancy (subsequent pregnancy within 24 months of previous pregnancy outcome) in a sample of urban adolescents.

METHODS

Adolescents aged 12-19 years (N = 354) who were predominantly African-American (94.1%) completed individual interviews during pregnancy and at 24 months postpartum. Logistic regression was used to determine the relationship among mental health factors, behavioral factors, and negative life experiences in the prediction of rapid repeat pregnancy.

RESULTS

Of the adolescents, 42% (n = 147) of adolescents reported a rapid repeat pregnancy. Baseline reports of later age at menarche (12.43 vs. 11.91; p = .003) and a greater likelihood of aggression were significantly associated with having a rapid repeat pregnancy within 24 months. Age at menarche and self-reported aggression contributed independently to the prediction of a closely spaced second pregnancy (p < .05).

CONCLUSIONS

It is suggested that pubertal onset and individual mental health as it relates to measures of aggression should be considered when developing programs targeting adolescents at highest risk for rapid repeat pregnancy.

The effects of unintended pregnancy on infant, child, and parental health: a review of the literature

This article provides a critical review of studies assessing the effects of unintended pregnancy on the health of infants, children, and parents in developed and developing countries. A framework for determining and measuring the pathways between unintended pregnancy and future health outcomes is outlined. The review highlights persistent gaps in the literature, indicating a need for more studies in developing countries and for further research to assess the impact of unintended pregnancy on parental health and long-term health outcomes for children and families. The challenges in measuring and assessing these health impacts are also discussed, highlighting avenues in which further research efforts could substantially bolster existing knowledge.

The impact of pregnancy intention on breastfeeding duration in Bolivia and Paraguay

Research has demonstrated that prolonged duration of breastfeeding promotes child survival. This study examines the impact of unintended--mistimed or unwanted--pregnancy on breastfeeding duration. We use data from the 1990 Paraguay and 1994 Bolivia Demographic and Health Surveys and restrict our analysis to last-born, surviving children younger than 36 months from singleton births. To assess the association, unintended and intended pregnancies are compared by calculating incidence rates and adjusted hazard ratios (aHR) using survival analysis. Most children (approximately 95 percent) were breastfed initially, but the median duration of breastfeeding in Bolivia was five months longer than that in Paraguay (19 versus 14 months). A greater proportion of pregnancies were described as intended in Paraguay than in Bolivia (74 percent versus 45 percent). In adjusted analyses, unwanted and mistimed pregnancies were associated with slightly longer duration of breastfeeding (aHR = 0.9) than were intended pregnancies, but the association was not statistically significant. In this study, therefore, pregnancy intention was not an important factor in duration of breastfeeding in Bolivia or Paraguay.

Social ecological predictors of repeat adolescent pregnancy

CONTEXT

Women with multiple pregnancies in adolescence may experience medical, psychological and social complications. Improved understanding of the individual-, dyad-, family-, peer/community- and social system-level risk factors for repeat pregnancy may lead to the development of more effective prevention strategies for adolescent mothers in a variety of settings.

METHODS

Between 1993 and 1996, white, black and Mexican American adolescent mothers at a labor and delivery unit in Texas were interviewed after delivery and completed written surveys prospectively for up to 48 months. Logistic regression analyses were used to determine predictors of repeat pregnancy within 24 months, using social ecological theory as a guide.

RESULTS

Forty-two percent of adolescent mothers experienced a repeat pregnancy within 24 months; 73% of these delivered a second child. Individual-level predictors were planning to have another baby within five years (odds ratio, 1.6) and not using long-acting contraceptives within three months of delivery (2.4). Dyad-level predictors were not being in a relationship with the father of the first child three months after delivery (2.0), being more than three years younger than the first child's father (1.6) and experiencing intimate partner violence within three months after delivery (1.9). Peer/community-level predictors were not being in school three months postpartum (1.8) and having many friends who were adolescent parents (1.5).

CONCLUSION

Adolescent mothers are at high risk for a rapid subsequent pregnancy. Interventions that address the complex and multifaceted aspects of the lives of adolescent mothers are needed to prevent repeat pregnancy.

Repeat Pregnancy in Adolescence

PURPOSE

To determine the perceptions of young mothers concerning their intentions about repeat pregnancy and to determine shared meanings concerning intentionality and decision making about sexual activity and use of birth control.

DESIGN AND METHODS

Ethnographic, descriptive study with interviews of a purposive sample of young mothers with a repeat pregnancy. Iterative methods, recursive data sifting, and Ethnograph 5.0 were used in data analysis.

RESULTS

All of the mothers stated that their repeat pregnancies were unintended. Regarding decision making about sexual activity, some mothers discussed a conscious, rational decision-making process before sexual activity, whereas others talked about a more impulsive, spontaneous participation in unprotected sexual activity. A key finding in this study was that although mothers did not intend to get pregnant, they also did not intend to prevent pregnancy. Many discussed feeling pressured to have sex, coerced into not using birth control, unable to implement safe sex behaviors, or just "doing it."

CLINICAL IMPLICATIONS

These data suggest that much of teen sexual activity is spontaneous, unplanned, and sometimes involuntary. As such, interventions must be created that take the nature of this sexual activity into account. Consideration of young mothers' thought processes, intentions, and perspectives is integral in the design and implementation of programs and policies to prevent or delay repeat pregnancy during the adolescent years.

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents

PURPOSE

Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy.

METHODS

The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group.

RESULTS

In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy.

CONCLUSIONS

Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Concepts of the advantages and disadvantages of teenage childbearing among pregnant adolescents: a qualitative analysis

OBJECTIVE

We sought to enhance our understanding of pregnant adolescents' concepts of the advantages and disadvantages of teen pregnancy and childbearing.

METHODOLOGY

This is a qualitative study of 247 pregnant adolescents recruited during their first prenatal health care visit to a women's primary care clinic in Providence, Rhode Island. Participants responded in writing to open-ended questions assessing their ideas about what was advantageous and disadvantageous about having an infant during their teen years rather than waiting until they were older. Themes and patterns in responding were coded, and subgroup differences based on age, ethnicity, intendedness of current pregnancy, and pregnancy/parenting history were assessed.

RESULTS

Themes related to advantages of teen pregnancy included enhancing connections, positive changes/benefits, and practical considerations. Themes related to disadvantages included lack of preparedness, changes/interference, and others' perceptions. Differences among groups based on age, ethnicity, intendedness of the current pregnancy, and pregnancy/parenting history were examined and noted.

CONCLUSIONS

Pregnant adolescents do not represent a homogeneous group. Considering differences in how pregnancy and childbearing are conceptualized along developmental, cultural, attitudinal, and experiential lines will strengthen our ability to tailor pregnancy-prevention messages.

A Positive Orientation Toward Early Motherhood Is Associated with Unintended Pregnancy Among New Orleans Youth

OBJECTIVE

Characterizing young women's willingness to enter motherhood is critical to understanding the high rates of unintended pregnancy among women under 20 years. Our objectives were to discuss a measure called Positive Orientation towards Early Motherhood (POEM), and investigate its association with self-reported unintended pregnancy experience.

METHODS

We used data from 332 African-American women 13-19 years old recruited at public family planning and prenatal clinics in New Orleans. Using a series of ANOVAs and multinomial logistic regression, we assessed differences in POEM between four different outcome groups: women who were never pregnant and those who had only intended pregnancies, only unintended pregnancies and both unintended and intended pregnancies.

RESULTS

The data suggested that young women perceive pregnancy as an opportunity to assert responsibility, become closer with their families and achieve greater intimacy with their boyfriends. Multiple regression analysis indicated that this positive orientation toward early motherhood independently raised the likelihood that young women experienced unintended pregnancies. In particular, the perception that a pregnancy makes a young woman feel more responsible was associated with an increased likelihood that a young woman had only unintended pregnancies compared to no pregnancies at all. Interestingly, this perception did not differentiate young women who had only intended pregnancies from those who were never pregnant.

CONCLUSION

When interpreting reports of unintended pregnancy, more attention should be given to young women's orientation toward early motherhood. Doing so will inform policies that address both personal and structural factors that contribute to persistently high rates of unintended pregnancy among adolescents.

Psychosocial correlates of adolescent males' pregnancy intention

OBJECTIVE

To identify psychosocial differences between sexually experienced male adolescents who indicate intentions to get someone pregnant and those who do not.

METHODOLOGY

Cross-sectional study of 101 sexually experienced adolescent males recruited from a sexually transmitted disease clinic in northern California. We used Student's t tests and regressions to examine psychosocial differences between males who reported any intention versus no intention to get someone pregnant in the next 6 months, and we used analyses of variance to examine differences among different combinations of pregnancy plans/likelihood.

RESULTS

Adolescents' reports of their plans for getting someone pregnant differed from their assessments of the likelihood that they would do so (chi2 = 24.33; df = 1). Attitudes toward pregnancy and participants' mothers' educational attainment differentiated those with clear pregnancy intentions (planning and likely) from those with clear intentions to avoid pregnancy (not planning and not likely)

CONCLUSIONS

To reduce the rates of adolescent childbearing, males' pregnancy intentions must be assessed and asked about in multiple ways.

Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy

Behaviors that lead to teen pregnancy also place young women at risk for STDs and repeat pregnancy. Compared to the broad literature on adolescent sexual risk behavior, our understanding of sexual risk in pregnant/mothering teens lags far behind. Primary objectives of this systematic review (1981-2003) of pregnant/mothering teens were to: (1) document rates of STD, repeat pregnancy, condom use, and contraception; (2) identify correlates of these biological and behavioral outcomes; (3) review sexual risk reduction interventions; and (4) discuss directions for future research and implications for clinical care. Fifty-one studies met inclusion criteria. Rates of STD and repeat pregnancy were high, with the majority of teens engaging in unprotected sex during and after pregnancy. An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989) Ecological Systems Theory, was proposed to organize findings on correlates of sexual risk. Improvements in research, including integration of outcomes and risk factors, stronger methodologies, and standardized assessments, are essential. Results suggest that teen pregnancy is a marker for future sexual risk behavior and adverse outcomes, and that pregnant/mothering teens need hybrid interventions promoting dual use of condoms and hormonal contraception. Pregnancy may provide a critical "window of opportunity" for sexual risk reduction.

Adolescent pregnancy intentions and pregnancy outcomes: a longitudinal examination

PURPOSE

(a) To examine different methods of assessing pregnancy intention; (b) to identify psychosocial differences between those who indicate pregnancy intentions and those who do not; and (c) to examine the relationship between pregnancy intentions and subsequent pregnancy at 6-month follow-up in nonpregnant (at baseline), sexually experienced adolescent females.

METHODS

Longitudinal cohort study of 354 sexually experienced female adolescents attending either a STD clinic or HMO adolescent medicine clinic in northern California. Student's t-tests and regressions examined psychosocial differences between females who reported "any" and "no" pregnancy intentions. ANOVAs examined differences among different combinations of pregnancy plans/likelihood. Chi-square analyses assessed associations between baseline pregnancy intentions and subsequent pregnancy.

RESULTS

Adolescents' reports of their pregnancy plans and their assessments of pregnancy likelihood differed from one another (chi2 = 50.39, df = 1, p < .001). Pregnancy attitudes and baseline contraceptive use differentiated those with inconsistent pregnancy intentions (Not Planning, but Likely) from those with clear pregnancy intentions (Planning and Likely, and Not Planning and Not Likely) (Pregnancy Attitudes: F [2,338] = 68.96, p < .0001; Contraceptive Use: F [2,308] = 14.87, p < .0001). Suspected pregnancies and positive pregnancy test results were associated with baseline pregnancy intentions (Suspected: chi2 = 19.08, df = 2, p < .01; Positive Results: chi2 = 8.84, df = 2, p = .015).

CONCLUSIONS

To reduce adolescent childbearing we must assess pregnancy intentions in multiple ways. Information/education might benefit those female adolescents with inconsistent reports of pregnancy intentions.

Perfil de adolescentes com repetição da gravidez atendidas num ambulatório de pré-natal

Este trabalho identificou o perfil biopsicossocial das adolescentes com repetição da gravidez, atendidas num ambulatório de pré-natal. Os dados obtidos através do prontuário médico e entrevista foram analisados quantitativamente. Através dos resultados encontrados e de acordo com a literatura, foram selecionados, do perfil das adolescentes, fatores mais fortemente associados à ocorrência da repetição da gravidez. São eles: menarca precoce, primeira relação sexual após curto intervalo da menarca, repetência escolar, abandono escolar, ausência de ocupação remunerada, baixa renda familiar, envolvimento com parceiros mais velhos, residir com o parceiro, união consensual com o parceiro, um parceiro fixo, baixo uso de condon, história familiar de gravidez na adolescência, ausência do pai por morte ou abandono, reação positiva da família à gravidez anterior, aborto anterior, parto anterior bem conceituado pela adolescente, e ausência à revisão pós-parto anterior.

Parental attitudes about a pregnancy predict birth weight in a low-income population

BACKGROUND

Low birth weight remains the primary cause of neonatal morbidity and mortality in the United States. We examined whether maternal happiness about a pregnancy, in addition to her report of the father's happiness, predicts birth weight and risk for low birth weight (<2,500 g).

METHODS

In this prospective cohort study, the mother's report of her and her partner's happiness about the pregnancy was measured before 21 weeks' gestation on a scale from 1 to 10 (1 to 3 unhappy, 4 to 7 ambivalent, or 8 to 10 happy). "Mother reports partner happier" occurred when the mother perceived the father's happiness score at least 5 points greater than her own. Information on birth weights and maternal sociodemographic, medical, and psychosocial factors were obtained from surveys and medical records.

RESULTS

Of 162 live births, 9 were low birth weight (5.6%). Compared with women who reported happiness with the pregnancy, risk for low birth weight was greater when the mother reported partner happier about the pregnancy (relative risk 10.0, 95% confidence interval, 3.1-32.4). This predictor of birth weight remained significant in multivariate linear regression analyses (coefficient = -472 g, SE = 171 g, P = .007) after adjustment for other known predictors of birth weight.

CONCLUSIONS

Maternal report of greater partner happiness about a pregnancy is associated with birth weight and appears to define low- and high-risk subgroups for low birth weight in a low-income population. Further study in larger samples is needed to confirm our findings and to assess whether maternal report of greater partner happiness is itself a modifiable factor or is a marker for other factors that might be modified with targeted interventions.

Effective prenatal care for adolescent girls

Provision of prenatal care for adolescents requires an understanding of routine prenatal care as well as developmental and psychosocial issues unique to this population. In this article, management of adolescent pregnancy, including the prenatal history, physical examination, diagnostic testing, and follow-up care are presented. Collaboration with other disciplines, which optimizes care, is also discussed.

Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth

PURPOSE

To compare effects of an early intervention program (EIP) of intense home visitation by public health nurses (PHNs) with effects of traditional public health nursing care (TPHN) on infant health and selected maternal outcomes of adolescent mothers.

METHODS

EIP adolescents (N = 102) received preparation-for-motherhood classes and individual home visits (from pregnancy through 1 year postpartum) from PHNs employed in a county health department. Participants were predominantly Latina (64%) and African-American (11%) and from impoverished backgrounds. Infant health outcomes were determined based on medical record data; interviews and standardized questionnaires evaluated other program effects (e.g., maternal educational achievement and psychological status). Data were analyzed using Chi-square and repeated measures ANOVA.

RESULTS

Infants of EIP mothers experienced significantly fewer total days (n = 74) and actual episodes (n = 14) of hospitalization during the first year of life than those receiving TPHN (n = 154, n = 24, respectively). Similarly, positive program effects were found for immunization rates. There were no group differences in emergency room visits or repeat pregnancy rates. Alcohol, tobacco, and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy (lifetime rates).

CONCLUSIONS

These findings demonstrate the positive effects of a PHN home visitation program on health outcomes for children of adolescent mothers. Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers. Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers.

Adolescent parenthood: a costly mistake or a search for love?

Family life is changing worldwide and an increasing number of women are choosing single parenthood. Adolescents who become pregnant and early childbearers do not always become pregnant unintentionally; some actively plan pregnancy while others are ambivalent mainly about the timing. This paper reports on a study using an ethnographic approach that explored the mothering experiences of five sole-supporting Australian teenage mothers who had a child over six months of age. It focuses on the story of one of them, a young woman who gave birth at 16 and set up home for herself and her son. Early childbearing is often a response to adverse social conditions such as poverty or homelessness and is not uncommonly chosen by teenage girls from socially deprived backgrounds. Educational and employment opportunities may be limited, whilst motherhood may provide a purpose in life when few other options are possible. Young women who make this choice need comprehensive services to support them in the parenting role, including appropriate health care, welfare and housing benefits, and support in dealing with parenting, a role which they may greatly desire but are not automatically well prepared for.

Negotiating motherhood: the struggles of teenage mothers

AIMS

This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

BACKGROUND

Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

DESIGN

This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

FINDINGS

The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

CONCLUSIONS

It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.