Trends and factors associated with teenage pregnancy in Ethiopia: multivariate decomposition analysis

Teenage is a time of transition from childhood to adulthood. This stage is a time of change and needs particular care and ongoing support. Adolescent pregnancy remains a common health care problem in low- and middle-income countries, and it is associated with higher maternal and neonatal complications. Thus, this study aimed to determine the trends and factors associated with them that either positively or negatively contributed to the change in teenage pregnancy in Ethiopia. Ethiopian Demographic and Health Survey data from 2005 to 2016 were used for this study. A total weighted sample of 10,655 (3265 in 2005, 4009 in 2011, and 3381 in 2016) teenagers was included. Trends and the proportion of teenage pregnancies for each factor over time were explored. Then, a logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify the factors that contributed to the change in teenage pregnancy. Statistical significance was declared at p-value < 0.05 and the analysis was carried out on weighted data. Teenage pregnancy declined significantly from 16.6% (95% CI: 15.4, 17.9) to 12.5% (95% CI: 11.4, 13.6) in the study period, with an annual reduction rate of 2.5%. About 49.8% of the decrease in teenage pregnancy was attributed to the change in the effect of the characteristics. The compositional change in primary educational status (41.8%), secondary or above educational status (24.55%), being from households with a rich wealth index (1.41%) were factors positively contributed to the decline in teenage pregnancy, whereas being from a Muslim religion (-12.5%) was the factor that negatively contributed to the reduction in teenage pregnancy. This study has shown that teenage pregnancy declined significantly; however, it is still unacceptably high. The changes in compositional factors of teenagers were responsible for the observed reduction in the prevalence of teen pregnancy rates in Ethiopia. Educational status, religion, and wealth index were found to be significant factors that contributed to the reduction in teenage pregnancy. Therefore, intervention programs targeting adolescents should address the socio-economic inequalities of these influential factors to reduce teenage pregnancy and related complications.

Psychological legacies of intergenerational trauma under South African apartheid: Prenatal stress predicts greater vulnerability to the psychological impacts of future stress exposure during late adolescence and early adulthood in Soweto, South Africa

BACKGROUND

South Africa's rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country's long history of political violence during apartheid. Growing evidence suggests that in utero stress exposure is a potent developmental risk factor for future mental illness risk, yet the extent to which the psychiatric effects of prenatal stress impact the next generation are unknown. We evaluate the intergenerational effects of prenatal stress experienced during apartheid on psychiatric morbidity among children at ages 17-18 and also assess the moderating effects of maternal age, social support, and past household adversity.

METHODS

Participants come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto-Johannesburg, South Africa's largest peri-urban township which was the epicentre of violent repression and resistance during the final years of the apartheid regime. Pregnant women were prospectively enrolled in 1990 and completed questionnaires assessing social experiences, and their children's psychiatric morbidity were assessed at ages 17-18.

RESULTS

Full data were available from 304 mother-child pairs in 2007-8. Maternal prenatal stress in 1990 was not directly associated greater psychiatric morbidity during at ages 17-18. Maternal age and past household adversity moderated the intergenerational mental health effects of prenatal stress such that children born to younger mothers and late adolescent/young adult children experiencing greater household adversity exhibited worse psychiatric morbidity at ages 17-18. Social support did not buffer against the long-term psychiatric impacts of prenatal stress.

CONCLUSIONS

Greater prenatal stress from apartheid predicted adverse psychiatric outcomes among children born to younger mothers and adolescents/young adults who experienced greater concurrent stress. Our findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitising effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.

Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana

Globally, an estimated 16 million young women aged 15 to 19 years give birth every year. Most teenage pregnancies are unintended and being pregnant or delivering a baby as a teenager can have serious adverse consequences. Knowledge of the environmental factors and social cognitive determinants influencing young women's failure to protect against unintended pregnancy is necessary to address the high rate of teenage pregnancies. We conducted semi-structured in-depth interviews with 21 young women, who had experience of pregnancy, in Bolgatanga, Ghana. The interview protocol included themes (relationships, sex, pregnancy, family planning) and determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behaviour. Findings show that young women's motivations for sexual relationships are mostly 'beyond love' and seem to focus on economic factors. The main means of sexual protection seems to be condom use. Other forms of contraception were believed to be linked to infertility. Sexuality remains a largely taboo topic for open discussion and sex education in schools seems limited to abstinence-only messages. The need for more open communication on matters of sexuality with young people and the provision of a more comprehensive sexuality education in school to address teenage pregnancies in Ghana, is discussed.

A Decade Later: Follow-Up Review of South African Research on the Consequences of and Contributory Factors in Teen-Aged Pregnancy

In this paper, we review South African research conducted in the last 10 years on the consequences of and contributory factors in teen-aged pregnancy. We discuss research into the rates of teen-aged pregnancy, the intentionality and wantedness of pregnancy, the disruption of schooling, health issues, consequences for the children, welfare concerns, knowledge and use of contraception, timing of sexual debut, age of partner, coercive sexual relations, cultural factors and health service provision. We compare this discussion to the reviews on the same topic appearing in the South African Journal of Psychology a decade ago. We find that there are several changes in focus in the research on pregnancy amongst young women. We conclude that, in general, there has been an improvement in the breadth of data available, mostly as a result of representative national and local surveys. A better teasing out of nuances around particular issues and a grappling with theoretical issues are also evident in recent research.

Behavioural Change vis-à-vis HIV&AIDS Knowledge Mismatch among Adolescents. The Case of Some Selected Schools in Zomba, Malawi

Most researchers on adolescent reproductive health and related susceptibility to contracting HIV&AIDS have highlighted the ironical mismatch preponderant between adolescent knowledge of HIV&AIDS transmission dynamics and behavioural change exemplified in part by abstinence but also condom use. The paradox is compounded by the fact that survey data appear to depict heightened knowledge of the dynamics per se. Empirical data have previously posited variables such as peer pressure and other psychosocial factors as the crisis in adolescence in explaining the anomaly. Results in the current study, however, reveal the culture of silence; the disdain towards AIDS messages and retrogressive cultural practices as alternative explanation. The results were obtained through survey data from adolescent students in selected schools in Zomba, a district in southern Malawi, and are discussed within the larger context of the applicability of cognitive dissonance theory to the AIDS pandemic.

Predicting the Intention of South African Female Students to Engage in Premarital Sexual Relations: An Application of the Theory of Reasoned Action

The Theory of Reasoned Action (Ajzen & Fishbein, 1980) was used to investigate the factors influencing South African female students' decision on whether or not to engage in premarital sexual intercourse. The group of participants consisted of 100 female heterosexual university students who were selected from a larger sample on the basis of sexual inexperience. As anticipated by the theory, both attitudes and subjective norms were found to predict intentions, with attitudes emerging as the stronger predictor. Additional analyses revealed that the hypothesized relationship between attitudes and the cognitive bases, beliefs about the outcome of premarital sexual relations, and the evaluation of these outcomes was supported. However, contrary to the theory, subjective norms were not correlated with motivation to comply with the perceived views of salient referents. The results are discussed in the context of a society in which AIDS is epidemic.