Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia

INTRODUCTION

Despite a decline in unintended teenage pregnancy in Australia, rates remain higher amongst justice-involved adolescent girls, who are more likely to be from disadvantaged socio-economic backgrounds, have histories of abuse, substance use and/or mental health issues. Furthermore, exposure to the criminal justice system may alter access to education and employment and opportunities, potentially resulting in distinct risk-factor profiles. We examine factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland.

METHODS

Data from the Mental Health, Sexual Health and Reproductive Health of Young People in Contact with the Criminal Justice System (MeH-JOSH) Study was analysed on 118 sexually active adolescent girls. Participants were aged between 14 and 17 years, purposefully sampled based on justice-system involvement and completed an anonymous telephone survey. We constructed two multivariate models taking reproductive outcomes as the dependent variables.

RESULTS

Over one quarter (26%, 30/118) reported a past unintended pregnancy, 54 did not use any contraception at their last sexual encounter, and 17 reported LARC use. Following adjustments in the multivariate analysis, lifetime ecstasy use was associated with both unintended pregnancy (aOR 3.795, p = 0.022) and non-contraception use (aOR 4.562, p = 0.004). A history of physical abuse was also associated with both any contraception (aOR 3.024, p = 0.041) and LARC use (aOR 4.892, p = 0.050). Identifying as Aboriginal & Torres Strait Islander, education/employment status and geographic location appeared to have no association.

CONCLUSION

Our findings suggest that justice-involved adolescent girls have distinct risk factors associated with unplanned pregnancy and contraception use compared to the general population, but more research is required to understand the mechanisms and contexts underlying these risk factors. How exposure to physical violence may encourage contraception and LARC use, in particular, warrants further attention as does the association with ecstasy use.

Impact of individual and environmental factors on academic performance of pregnant adolescent

BACKGROUND

Teenage pregnancies continue to disrupt teenage girls' academic development. As a result, teenage mothers are at risk of unemployment, maternal death, and poverty. Previous research, however, has shown that both individual and environmental factors can have a significant impact on the prevalence of adolescent pregnancy. However, there has been little rigorous research on the impact of these factors on pregnant students' academic performance.

OBJECTIVES

The purpose of this study was to determine the relationship between environmental (neighbourhood) and individuals (sexual attitudes, peer attachment) factors. It also examined the influence of individual factors on the academic performance of pregnant teens.

METHODS

The study included a cross-sectional study of 400 pregnant adolescent students aged 15-19 years. The target groups were drawn from three major cities in Nigeria. Respondents were identified through targeted snowballing. Pregnant participants were a combination of married and unmarried girls attending school from home. Data were collected using a structured and self-completed questionnaire. Thus, frequency, mean and standard deviation were used for descriptive analysis. Pearson correlation analysis was applied to show the relationship between variables.

RESULTS

The study found that neighbourhood (r=-.125, p = .12) had a negative and significant relationship with peer attachment. However, there was no significant evidence of a relationship between sexual attitudes and neighbourhood (r=-.040, p = .422). There was, however, a significant relationship between sexual attitudes and academic performance (r = .236, p = .000). There was also a relationship between peer attachment and academic performance (r=-.401, p = < 0.001).

CONCLUSION

This study suggests that the academic performance of pregnant teenagers necessitates a combination of approaches, which includes changes in personal and prosocial behaviour, and environmental reforms. This can be achieved through, peer education, school day-care, subsidised or free contraceptives, free or subsidized education, and community programmes that positively influence young adults in the neighbourhood. These approaches can indirectly boost self-efficacy, motivation, and confidence to achieve higher academic feat, while reducing school dropout rate among the target groups.

Association of pregnancy attitudes and intentions with sexual activity and psychiatric symptoms in justice-involved youth

Context

With over one-third of detained girls experiencing teenage pregnancy, it is critical that the juvenile justice system better addresses the sexual and reproductive health (SRH) needs of youth. Although pregnancy attitudes and intentions (PAI) are associated with pregnancy outcomes among the general adolescent population, this relationship has not been examined among justice-involved youth.

Methods

Participants were drawn from a longitudinal study characterizing trajectories of behavioral and reproductive health and recidivism among newly justice-involved youth in a Northeast family court. Baseline and four-month follow-up data from 288 justice-involved youth (JIY) were analyzed to characterize PAI; examine associations between pregnancy intentions and unprotected sexual activity (i.e., no hormonal, intrauterine, or barrier protection against pregnancy); and explore the relationship between pregnancy intentions and psychiatric symptoms.

Results

At baseline, 39% of JIY youth were sexually active, 44% of these youth reported inconsistent condom use and 14% had not used birth control at last sexual intercourse. Nearly half of sexually active youth reported some intent around pregnancy and those with any pregnancy intentions were more likely to report depression, low self-esteem, substance use, and trauma history. Pregnancy intentions at baseline predicted higher rates of unprotected sexual activity at four months (OR: 16.9, CI = 2.48-115.7).

Conclusions

This study highlights the importance of developing and implementing more comprehensive SRH assessments and brief interventions for youth entering the justice system.

Pregnancy Prevalence and Outcomes in 3 United States Juvenile Residential Systems

STUDY OBJECTIVE

To describe the number of admissions of pregnant adolescents to US juvenile residential systems (JRS) and the outcomes of pregnancies that ended while in custody.

DESIGN

Prospective study.

SETTING

Three nonrandomly selected JRS in 3 US states.

PARTICIPANTS

Designated reporter at each JRS reporting aggregate data on various pregnant admissions, outcomes, and systems' policies.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Monthly number of pregnant people admitted, pregnant people at the end of the month, births, preterm births, cesarean deliveries, miscarriages, induced abortions, ectopic pregnancies, maternal and newborn deaths, and administrative policies.

RESULTS

There were 71 admissions of pregnant adolescents reported over 12 months from participating JRS. At the time of the census, 6 of the 183 female adolescents (3.3%) were pregnant. Eight pregnancies ended while in custody. Of these, 1 pregnancy was a live full-term birth, 4 were miscarriages, and 3 were induced abortions. There were no newborn deaths or maternal deaths. Administrative policies and services varied among the JRS. For example, all JRS had a prenatal care provider on-site, whereas 2 JRS helped cover the costs of abortions.

CONCLUSION

To our knowledge, this study is the first to report the estimates of pregnancy and pregnancy outcomes among justice-involved youth in JRS. Our findings indicate that there are pregnant adolescents in JRS and most return to their communities while pregnant, highlighting the importance of continuity of care. More work is needed to understand the complexities of health care needs of justice-involved pregnant youth during and after their incarceration.

Reproductive Life Goals: A Systematic Review of Pregnancy Planning Intentions, Needs, and Interventions Among Women Involved in U.S. Criminal Justice Systems

Background: Women involved in criminal justice systems (WICJ) are affected by multilevel biological and sociocultural factors that result in adverse health outcomes and health disparities. Criminal justice systems (CJS) must be appropriately resourced to address these issues. Materials and Methods: We developed a systematic review to understand the intentions and needs for pregnancy prevention and planning among WICJ to inform future reproductive health services. We conducted a systematic literature review of epidemiologic and interventional studies that addressed the pregnancy prevention and planning needs of U.S. WICJ (2000-2019). An initial screen identified 7061 articles and 3 independent reviewers determined that 28 articles (16 descriptive studies in adults, 7 descriptive studies in adolescents, and 5 interventional studies) met inclusion criteria. Results: The literature review identified high rates of contraception underutilization and negative attitudes toward pregnancy among WICJ in a wide variety of settings. WICJ described minimal access to reproductive health services, including evidence-based contraception, and experienced high rates of unplanned and undesired pregnancies. Results were interpreted in the context of the reproductive justice (RJ) framework. Conclusions: The CJS, although not designed to provide health care, should dedicate resources to address the multilevel barriers to care experienced by women. WICJ require targeted, gender-responsive, trauma-informed pregnancy prevention and planning interventions that acknowledge the history of reproductive coercion in this population and address key aspects of RJ, including the right to and to not have a child.

Modifying a Risk Assessment Instrument for Youthful Offenders

High rates of incarceration in the United States are compounded by high rates of recidivism and prison return. One solution is more accurate identification of individual prisoner risks and needs to promote offender rehabilitation and successful community re-entry; this is particularly important for youthful offenders who developmentally are in late adolescence or early adulthood, and who struggle to reengage in education and/or employment after release. Thus, this study examined the feasibility of administration and initial psychometric properties of a risk and needs assessment instrument originally created for a juvenile justice population (the Global Risk Assessment Device or GRAD) with 895 male youthful offenders in one adult correctional system. Initial feasibility of implementation within the correctional system was demonstrated; confirmatory factor analyses support the invariance of the modified GRAD factor structure across age and race. Future studies are needed to examine the predictive validity and the sensitivity of the instrument.

Trajectories of Violent Behavior Among Females and Males

Both the psychological and criminological fields have long hypothesized the mechanisms that influence desistance from violent offending, but few studies have focused on violent females. This study identifies patterns of violent behavior across 7 years among 172 females and 172 matched males ages 15-24, testing if heterogeneity in violent offending is linked to (a) developmental change in impulse control and (b) attainment of adult milestones. Fewer females persist in violence (25%) than males (46%); 19% of males increase in violent behavior. Females who develop impulse control and are employed are more likely to desist from violence. Violent offending is unrelated to other adult milestones. Developmental increases in impulse control may trigger desistance, while employment may maintain desistance from violence.

Factors Associated with Pregnancy among Incarcerated African American Adolescent Girls

The purpose of this study was to examine the social and behavioral factors associated with pregnancy history among a sample of African American adolescent girls recruited from a short-term juvenile detention center in order to better understand the needs of this vulnerable population. Data were collected from a sample of 188 detained African American, 13-17-year-old girls in Atlanta, Georgia, who participated in a larger HIV prevention study. An audio computer-assisted self-interviewing survey was completed by participants to obtain information on socioecological factors to include individual, parental/familial, sexual risk, psychosocial, and substance use factors. Among the 188 participants, 25.5 % reported a history of pregnancy. A multivariable logistic regression model showed that girls with a history of pregnancy were more likely to live in a household receiving government aid, use hormonal contraceptives at last sex, participate in sex trading, have casual sex partners, have condomless sex in the past 90 days, and have a history of physical abuse. Girls with no history of pregnancy were more likely to have been incarcerated at least twice and to have previously used alcohol. Detention-based interventions and pregnancy prevention programs for this vulnerable population may benefit by addressing factors related to sexual behavior and development, substance use, individual background, and psychosocial health.

An Exploration of Family and Juvenile Justice Systems to Reduce Youth HIV/STI Risk

Using in-depth interviews with 20 probation youth (60% female; 35% white; 30% Hispanic; mean age 15years, range=13-17), their caregivers (100% female; mean age 44years, range=34-71) and 12 female probation officers (100% white; mean age 46years, range=34-57), we explored how family and probation systems exacerbate or mitigate sexual risk. We conducted thematic analyses of interviews, comparing narratives of families of sexually risky (n=9) versus non-sexually risky (n=11) youth. Family functioning differed by youth sexual risk behavior around quality of relationships, communication, and limit-setting and monitoring. The involvement of families of sexually risky youth in probation positively influenced family functioning. Data suggest these families are amenable to intervention and may benefit from family-based HIV/STI interventions delivered in tandem with probation.

Identity and Agency

Young sexual minority women disproportionately experience pregnancy, repeat pregnancy, and become parents, when compared with their heterosexual peers. Black sexual minority women who are socioeconomically disadvantaged are a part of three demographic groups likely to experience adolescent pregnancy. A paucity of research has examined why these young women become pregnant. The authors begin to address this gap by examining the meaning of pregnancy from young women’s perspective. Modified grounded theory was used to analyze data from interviews with 14 young Black sexual minority women, aged 16–24. Pregnancies, intentional and unintentional, were common among the participants and within their sexual minority community. Pregnancy affirmed sexual identity and same-sex relationships as well as garnered sexual and reproductive agency. Participants’ pregnancy experiences contradicted the belief that young women sought or valued pregnancy because it provided access to heterosexual privilege. Although the main functions of intentional pregnancies did not differ drastically from those of young heterosexual women, we argue that these young women’s pregnancy and parenting desires may be magnified because of the particular realities they face as sexual minority women. Further, we situate our analysis within the context of a Black cultural environment and argue that pregnancy and motherhood may be adaptive subsistence strategies for women who are largely socially devalued.