What they tell you to forget: from child sexual abuse to adolescent motherhood

The Role of Childhood Trauma on Prenatal Attachment: A Cross-Sectional Study

Although the quality of prenatal attachment is a strong predictor of the quality of postnatal mother-infant attachment and mother-child interaction, little is known about the specific impacts of maternal exposure to childhood traumas, and it deserves more attention. This study was conducted to determine whether there is a relationship between childhood traumas and prenatal attachment levels. Prenatal attachment and childhood trauma were evaluated in 104 pregnant women using the Prenatal Attachment Scale and Childhood Trauma Questionnaire. Our results showed that all kinds of childhood traumatic experiences were associated with lower prenatal attachment scores. Also, more severe childhood traumas were strongly associated with weaker prenatal attachment. This study contributes to the very limited literature on the prenatal attachment of expectant mothers with childhood traumas by emphasizing the importance of pregnant women's exposure to childhood traumas as a risk factor for low prenatal attachment.

'There Were Moments We Wished She Could Just Die': The Highly Gendered Burden of Nodding Syndrome in Northern Uganda

Nodding Syndrome (NS) occurs within a wide spectrum of epilepsies seen in onchocerciasis endemic areas of sub-Saharan Africa. It has debilitating consequences on affected individuals and increases the socio-economic, physical and psychological burden on care-givers and their households, diminishing their standing within the community. Social science research on the disproportionate burden of the disease on females is limited. Based on ethnographic research over 3 years in northern Uganda, we explored the burden of being ill and care-giving for persons with NS from a gendered perspective. We found that NS-affected females were at greater risk of physical and psychological abuse, sexual violence, unwanted pregnancies, sexually transmitted infections and stigma, in a context of deteriorating socio-economic conditions. Primary care-givers of the NS-affected, mostly women, struggled to make ends meet and were subjected to stigma and abandonment. Targeted interventions, including legal protection for affected females, stigma reduction, and psycho-social and financial support are needed.

Factors associated with childhood sexual abuse and adolescent pregnancy

BACKGROUND

People who experience childhood sexual abuse (CSA) have a higher rate of adolescent pregnancy than people who do not experience CSA. The purpose of this integrative review was to identify risk or protective factors that are associated with this group to help understand the high rate of adolescent pregnancy in people with CSA histories.

METHODS

This review was conducted using strategies described by Whittemore and Knafl (2005). Five research articles met the following criteria: written in English, published in peer-reviewed journals in the past 10 years, and included the examination of predictors of adolescent pregnancy in any domain of the social ecological model of individual, relationship, community, or societal factors present among girls with CSA histories.

RESULTS

Studies suggest that people who are abused in childhood through adolescence and are not believed when they report abuse may be at greater risk for pregnancy in adolescence. CSA was associated with a range of sexual risk taking behavior (e.g., ineffectual contraception use, drug and alcohol use prior to sex, multiple partners) which could lead to adolescent pregnancy. Individual-level behaviors where predominantly studied. There were no reports at the community or societal level of the model.

CONCLUSIONS

Identifying additional risk or protective factors at the relationship, community, and societal level may prove helpful in developing strategies tailored to this population. The unique characteristics that lead to higher rates of sexual risk-taking behavior that can lead to adolescent pregnancy have not been well documented and deserve further study to guide design and prevention/intervention modalities.

Parenting Among Mothers Who Experienced Child Sexual Abuse: A Qualitative Systematic Review

Child sexual abuse (CSA) represents a significant public health problem. While CSA is associated with several adverse outcomes, recent attention has been given to its effect on maternal parenting. Despite a growing literature on this topic, a comprehensive systematic review has not been conducted. Thus, this review aimed to fill this gap. Several search strategies were used, including searches in academic databases. Two reviewers completed screening, full-text review, data extraction, and quality determinations. Extracted qualitative data were synthesized for the 108 studies meeting inclusion criteria. The primary themes emerging from women's accounts of the effects of CSA on their current parenting included abuse of child, breastfeeding, child-rearing practices, coping related to parenting, mother-child relationship, perceptions of child, perceptions of motherhood, and protection of children from abuse. Given the current lack of interventions designed for these mothers, the results of this review may aid in the development of evidence-based interventions.

Can gestation be considered as trauma in adolescent girls: post-traumatic stress disorder in teen pregnancy. J OBSTET GYNAECOL 2019;40:936-940. [PMID: 31814498 DOI: 10.1080/01443615.2019.1673714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statementWhat is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents.What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group.What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative.

No straight lines - young women's perceptions of their mental health and wellbeing during and after pregnancy: a systematic review and meta-ethnography

Background

Young mothers face mental health challenges during and after pregnancy including increased rates of depression compared to older mothers. While the prevention of teenage pregnancy in countries such as the United States and the United Kingdom has been a focus for policy and research in recent decades, the need to understand young women’s own experiences has been highlighted. The aim of this meta-ethnography was to examine young women’s perceptions of their mental health and wellbeing during and after pregnancy to provide new understandings of those experiences.

Methods

A systematic review and meta-ethnographic synthesis of qualitative research was conducted. Seven databases were systematically searched and forward and backward searching conducted. Papers were included if they were from Organisation for Economic Co-operation and Development countries and explored mental health and wellbeing experiences of young mothers (age under 20 in pregnancy; under 25 at time of research) as a primary research question – or where evidence about mental health and wellbeing from participants was foregrounded. Nineteen papers were identified and the Critical Appraisal Skills Programme checklist for qualitative research used to appraise the evidence. Following the seven-step process of meta-ethnography, key constructs were examined within each study and then translated into one another.

Results

Seven translated themes were identified forming a new line of argument wherein mental health and wellbeing was analysed as relating to individual bodily experiences; tied into past and present relationships; underpinned by economic insecurity and entangled with feelings of societal surveillance. There were ‘no straight lines’ in young women’s experiences, which were more complex than dominant narratives around overcoming adversity suggest.

Conclusions

The synthesis concludes that health and social care professionals need to reflect on the operation of power and stigma in young women’s lives and its impact on wellbeing. It adds to understanding of young women’s mental health and wellbeing during and after pregnancy as located in physical and structural factors rather than individual capacities alone.

Targeting factors for change: contraceptive counselling and care of female adolescents

INTRODUCTION

Sexual and reproductive health care should empower and enable all individuals to have a sex life that is as safe and pleasurable as possible. Achievement of this goal for adolescents is often impeded by regional and sociocultural barriers.

OBJECTIVES

To review global barriers to provision of effective counselling and care of adolescents seeking advice on contraception and sexual and reproductive health and identify elements of best practice that can be adapted to meet their needs at regional level.

METHODS

Experts with clinical experience and a scholarly background in the provision of contraceptive services to adolescents participated in a stepwise process of literature review and discussion according to the agreed objectives.

RESULTS

The Global CARE (Contraception: Access, Resources, Education) group identified barriers to the access, availability and acceptance of contraception by adolescents, not only at the political and sociocultural level but also within health care practice. The group collected and summarized successful local strategies and tools suitable for adaptation in other regions. Elements of best practice for providing contraception regardless of setting or regional constraints, including required skills, knowledge, and attitudes, were also proposed.

CONCLUSION

Sharing of evidence-based best practice in delivering contraceptive services, improvements in health care provider education, and sharing of experience between countries will hopefully help to overcome the barriers to appropriate and effective counselling and care of adolescents.

Age at First Birth and Psychiatric Disorders in Low-Income Pregnant Women

BACKGROUND

Young maternal age at first birth has been associated with poor mental health. However, few studies directly compared the prevalence of psychiatric disorders among adolescent versus adult mothers at first birth using a comprehensive diagnostic tool. This study examined the association between age at first birth and 22 current and lifetime psychiatric disorders in a cohort of low-income pregnant women.

METHODS

The sample consisted of 744 low-income currently pregnant women who were Medicaid-eligible and enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Saint Louis City and 5 rural counties in Southeastern Missouri. Current (previous 12 months) and lifetime psychiatric disorders were assessed using the Diagnostic Interview Schedule IV (DIS-IV). Logistic regression analyses tested the association between women's age at first birth and psychiatric disorders, controlling for potential confounders, including relative poverty.

RESULTS

When adjusting for confounders, mothers giving birth in their teens had 2.5 times the odds of having a lifetime behavior disorder (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.35-5.24) and current posttraumatic stress disorder (PTSD) (OR 2.54, 95% CI 1.38-4.70) and almost twice the odds of having at least one anxiety disorder compared to older women at first birth (OR 1.78, 95% CI 1.10-2.85).

CONCLUSION

Low-income women who have their first birth in adolescence have higher odds of psychiatric disorders and should be the target of psychiatric screening during their pregnancy. Mothers beginning childbearing before age 19 should be screened during pregnancy for anxiety disorders, including PTSD, and behavior disorders.

Teen Mothers' Experience of Intimate Partner Violence: A Metasynthesis

Pregnant and parenting teens suffer higher rates of intimate partner violence (IPV) than older mothers. This qualitative metasynthesis explores teen mothers' experience with IPV during pregnancy and postpartum. Organized by the metaphor of a web, findings highlight how pervasive violence during childhood contributes to teen pregnancy and the risk of IPV as violence is normalized. The web constricts through the partner's control as violence emerges or worsens with pregnancy. Young mothers become increasingly isolated, and live with the physical and psychological consequences of IPV. Trauma-informed nursing practice is needed to support teen mothers in violent intimate relationships to spin a new web.

Reported physical and sexual abuse in childhood and adult HIV risk behaviour in three African countries: findings from Project Accept (HPTN-043)

Childhood sexual and physical abuse have been linked to adolescent and adult risky sexual behaviors, including early sexual debut, an increased number of sexual partners, unprotected sex, alcohol and drug use during sex and sexual violence. This paper explores these relationships among both men and women who report histories of childhood abuse from representative samples of communities in three countries in southern and eastern Africa (South Africa, Zimbabwe and Tanzania). Data were collected as part of a 3-year randomized community trial to rapidly increase knowledge of HIV status and to promote community responses through mobilisation, mobile testing, provision of same-day HIV test results and post-test support for HIV. The results indicate that reported childhood sexual and physical abuse is high in all three settings, also among men, and shows strong relationships with a range of sexual risk behaviors, including age at first sex (OR -0.6 (CI: -0.9, -0.4, p < 0.003)-among men, OR -0.7 (CI: -0.9, -0.5, p < 0.001)-among women), alcohol (OR 1.43 (CI: 1.22, 1.68, p < 0.001)-men, OR 1.83 (CI: 1.50, 2.24, p < 0.001)-women) and drug use (OR 1.65 (CI: 1.38, 1.97, p < 0.001)-men, OR 3.14 (CI: 1.95, 5.05, p < 0.001)-women) and two forms of partner violence-recent forced sex (OR 2.22 (CI: 1.66, 2.95, p < 0.001)-men, OR 2.76 (CI: 2.09, 3.64, p < 0.001)-women) and ever being hurt by a partner (OR 3.88 (CI: 2.84, 5.29, p < 0.001)-men, OR 3.06 (CI: 2.48, 3.76, p < 0.001)-women). Individuals abused in childhood comprise between 6 and 29 % of young adult men and women living in these African settings and constitute a population at high risk of HIV infection.

Early breastfeeding experiences of adolescent mothers: a qualitative prospective study

Background

Teen mothers face many challenges to successful breastfeeding and are less likely to breastfeed than any other population group in the U.S. Few studies have investigated this population; all prior studies are cross-sectional and collect breastfeeding data retrospectively. The purpose of our qualitative prospective study was to understand the factors that contribute to the breastfeeding decisions and practices of teen mothers.

Methods

This prospective study took place from January through December 2009 in Greensboro, North Carolina in the U.S. We followed the cohort from pregnancy until two weeks after they ceased all breastfeeding and milk expression. We conducted semi-structured interviews at baseline and follow-up, and tracked infant feeding weekly by phone. We analyzed the data to create individual life and breastfeeding journeys and then identified themes that cut across the individual journeys.

Results

Four of the five teenagers breastfed at the breast for nine days: in contrast, one teen breastfed exclusively for five months. Milk expression by pumping was associated with significantly longer provision of human milk. Breastfeeding practices and cessation were closely connected with their experiences as new mothers in the context of ongoing multiple roles, complex living situations, youth and dependency, and poor knowledge of the fundamentals of breastfeeding and infant development. Breastfeeding cessation was influenced by inadequate breastfeeding skill, physically unpleasant and painful early experiences they were unprepared to manage, and inadequate health care response to real problems.

Conclusions

Continued breastfeeding depends on a complex interplay of multiple factors, including having made an informed choice and having the skills, support and experiences needed to sustain the belief that breastfeeding is the best choice for them and their baby given their life situation. Teenagers in the US context need to have a positive early breastfeeding experience, be able to identify and claim a reliable support system supportive of breastfeeding, and gain through their experience, a belief in their own agency and competency as mothers.

Reflections of Native American teen mothers

OBJECTIVE

To understand the previously lived experience of early childbearing among adult Native American women.

DESIGN

A community-based participatory research approach.

SETTING

The first interview took place at a mutually agreed-upon time and place and averaged 120 minutes. Second interviews were conducted 1 to 3 months later.

PARTICIPANTS

A convenience sample of 30 self-identified Native American adult women was recruited, and a semistructured interview explored their early childbearing experiences.

METHOD

An interpretive phenomenological study was conducted with a Northwestern tribe.

RESULTS

All of the women in the study described stressful childhoods. Two primary themes were identified: Chaotic childhoods represented stressful events in youth that introduced or resulted in ongoing chaos in women's lives and diminished childhoods described early maturity as a result of assuming extensive responsibilities at a young age.

CONCLUSIONS

The findings suggest that the childhood experiences described by participants may be related to the risk for early childbearing. Prospective research should examine the relationship between young women's lives and early childbearing to design interventions to support them in postponing pregnancy and when they do become pregnant.

Experience of sexual abuse in childhood and abortion in adolescence and early adulthood

OBJECTIVE

The present study examined the associations between the experience of sexual abuse in childhood (CSA) and the number of abortions in adolescence and early adulthood.

METHOD

A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1,265 New Zealand children (630 females). Measures included assessments of experience of CSA using retrospective data gathered at ages 18 and 21, self-reported abortions from ages 15 to 25, measures of childhood socio-economic disadvantage, family stability, family functioning, experience of childhood physical abuse, and pregnancy in adolescence and early adulthood.

RESULTS

Severity of CSA experience was significantly (p<.01) associated with an increasing rate of abortions during ages 15-25. Adjustment of the association for potentially confounding factors from childhood reduced the magnitude of the association, but it remained marginally statistically significant (p<.10). However, controlling for the mediating effects of pregnancy risk in adolescence and early adulthood reduced the association between experience of CSA and abortion to statistical non-significance (p>.70).

CONCLUSIONS

The current study suggested that the association between experience of CSA and increased rates of abortion was mediated by the increased rates of pregnancy associated with CSA experiences. The results suggest a causal chain in which experience of CSA leads to increased rates of pregnancy, which in turn leads to increased rates of abortion.

Child abuse in young, HIV-positive women: linkages to risk

In this article we explore the lives of young women living with HIV who experienced physical and/or sexual abuse in childhood. Using a modified version of the Life Story Interview, 40 women recruited from HIV clinics in three different states participated in a qualitative interview. Interviews covered abuse experiences, cognitive and emotional consequences of abuse, coping strategies, and sexual behavior and relationships. Overall, these young women had complex abuse histories, often experiencing more than one type of abuse in the context of other difficult life events. Avoidance and substance use were frequently utilized as coping strategies for abuse-related distress. Young women reported sexual and relationship concerns, including avoidance of sex, sexual dysfunction, sex as a trigger for abuse memories, and difficulty establishing intimacy and trust. Relationships between abuse-related reactions and sexual risk behavior, as well as recommendations for interventions, are discussed.