Teenage pregnancy: the impact of maternal adolescent childbearing and older sister's teenage pregnancy on a younger sister

Teen pregnancy involvement among African, Caribbean and Black adolescent boys and girls: A scoping review

OBJECTIVES

This study aims to investigate the incidence, associated factors and interventions to address teen pregnancy involvement (TPI) among African, Caribbean and Black (ACB) adolescents in North America.

DESIGN

We conducted a scoping review of the literature, guided by the social-ecological model.

DATA SOURCES

Studies were retrieved from databases such as Ovid Medline, Ovid Embase, CINAHL, CAB Direct and Google Scholar and imported into COVIDENCE for screening.

ELIGIBILITY CRITERIA

The Joanna Briggs Institute scoping reviews protocol guided the establishment of eligibility criteria. Included studies focused on rates, associated factors and interventions related to TPI among ACB boys and girls aged 10-19 in North America. The publication time frame was restricted to 2010-2023, encompassing both peer-reviewed and non-peer-reviewed studies with diverse settings.

DATA EXTRACTION AND SYNTHESIS

Data were extracted from 32 articles using a form developed by the principal author, focusing on variables aligned with the research question.

RESULTS

The scoping review revealed a dearth of knowledge in Canadian and other North American literature on TPI in ACB adolescents. Despite an overall decline in teen pregnancy rates, disparities persist, with interventions such as postpartum prescription of long-acting birth control and teen mentorship programmes proving effective.

CONCLUSION

The findings highlight the need for increased awareness, research and recognition of male involvement in adolescent pregnancies. Addressing gaps in housing, employment, healthcare, sexual health education and health systems policies for marginalised populations is crucial to mitigating TPI among ACB adolescents.

IMPACT

The review underscores the urgent need for more knowledge from other North American countries, particularly those with growing ACB migrant populations.

Preventing Teen Pregnancy: A Qualitative Study of the Perspectives of Parenting and Expecting Latino Adolescents

STUDY OBJECTIVE

Latino youths in the United States experience disproportionately high rates of teen pregnancy. The aim of this study was to obtain expecting and parenting Latino adolescents' perspectives regarding factors contributing to teen pregnancy and pregnancy prevention.

METHODS

Expecting/parenting Latino adolescents were recruited from high schools with high proportions of Latino youths and teen pregnancy. Participants completed a questionnaire on sociodemographic and background characteristics. Focus groups were stratified by age and gender and audio recorded. Grounded theory was used to identify themes from the transcribed audio recordings.

RESULTS

Thirty-two expecting/parenting Latino adolescents (20 females, 12 males) 14-19 years old participated in four focus groups. Quantitative results revealed that two-thirds of participants at birth had adolescent mothers. Over three-quarters of participants reported that their pregnancies had occurred too soon. Qualitative themes for factors contributing to teen pregnancy included lack of contraceptive knowledge/access, belief of invincibility, influence within relationships, male decisions on contraceptive use, desire to belong among peers, lack of parental support for contraceptive use, lack of parental attention, rebellion, normalization of adolescent parenthood in Latino culture, and media. Themes for pregnancy prevention included time alone with physicians, parenting teens as mentors, reproductive health education, and community pregnancy-prevention programs.

CONCLUSION

Multiple factors contribute to teen pregnancy in Latino youth, including influences from Latino culture, family, peers, partners, and social determinants of health. Pregnancy prevention should incorporate interventions to address these aspects, including disseminating culturally sensitive education materials, providing parenting teens as peer mentors, encouraging time alone with health care providers, and addressing various social determinants of health.

Naïve, uninformed and sexually abused: circumstances surrounding adolescent pregnancies in Malawi

BACKGROUND

Pregnancy and childbearing in adolescence could negatively affect girls' health and socio-economic wellbeing across the life course. Previous studies on drivers of adolescent pregnancy in Africa have not fully considered the perspectives of parents/guardians vis-à-vis pregnant and parenting adolescents. Our study addresses this gap by examining pregnant and parenting adolescents' and parents/guardians' narratives about factors associated with early and unintended pregnancy.

METHODOLOGY

The descriptive study draws on qualitative data collected as part of a larger mixed-methods cross-sectional survey on the lived experiences of pregnant and parenting adolescents. Data were collected between March and May 2021 in Blantyre, Malawi, using semi-structured interview guides. We interviewed 18 pregnant and parenting adolescent girls, 10 parenting adolescent boys, and 16 parents/guardians of pregnant and parenting adolescents. Recorded interviews were transcribed verbatim into the English language by bilingual transcribers. We used the inductive-thematic analytical approach to summarize the data.

FINDINGS

The data revealed several interconnected and structural reasons for adolescents' vulnerability to early and unintended pregnancy. These include adolescents' limited knowledge and access to contraceptives, poverty, sexual violence, school dropout, COVID-19 school closures, and being young and naively engaging in unprotected sex. While some parents agreed that poverty and school dropout or COVID-19 related school closure could lead to early pregnancies, most considered stubbornness, failure to adhere to abstinence advice and peer influence as responsible for adolescent pregnancies.

CONCLUSION

Our findings contribute to the evidence on the continued vulnerability of girls to unintended pregnancy. It highlights how parents and adolescents hold different views on reasons for early and unintended pregnancy, and documents how divergent views between girls and their parents may contribute to the lack of progress in reducing adolescent childbearing. Based on these findings, preventing unintended pregnancies will require altering community attitudes about young people's use of contraceptives and engaging parents, education sector, civil society organizations and community and religious leaders to develop comprehensive sexuality education programs to empower in- and out-of school adolescents.

Early sexual debut is associated with drug use and decreased educational attainment among males and females in Kisumu County, Kenya

Differing global sociocultural contexts of sexual relationships influence age at first sexual intercourse with potentially long-lasting region-specific effects such as increased risk of contracting HIV and other sexually transmitted infections (STIs). In these cross-sectional analyses of data from the screening and enrollment visits for an HIV incidence study in Kisumu County, Kenya, we evaluated factors associated with having experienced an early sexual debut (ESD) among males and females aged 18-35 years. Clinical evaluation was performed and sexual behaviors were assessed via questionnaire. ESD was defined as self-reported age 15 years or younger at first sexual intercourse. Robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ESD. Of 1057 participants, 542 (51.3%) were female. Participants' median age at study screening was 25 years (interquartile range [IQR]: 22-29), and at sexual debut was 16 years (IQR: 14-17). Five hundred and four participants (47.7%) reported ESD. ESD was less common among females (PR 0.78, CI 0.67-0.90) and participants with more than primary education (PR 0.56, CI 0.47-0.66). ESD was more common in participants with a history of drug use (PR 1.28, CI 1.10-1.49). Drug use removed the protective effect of education (some secondary education or less, no drug use: PR 0.72, CI 0.61-0.85; some secondary education or less, drug use: PR 0.94, CI 0.74-1.18). ESD was common in our study and associated with lower educational attainment and increased likelihood of drug use. Interventions are needed early in life, well before 15 years of age, to encourage engagement in schooling and prevent drug use. Comprehensive sexual education and interventions to prevent drug use may be beneficial before the age of 15 years.

Teen pregnancy involvement among African, Caribbean and Black adolescent boys and girls: a scoping review protocol

INTRODUCTION

African, Caribbean and Black (ACB) adolescents are disproportionately affected by teen pregnancy in North America. Teen pregnancy poses risks to the quality of life of adolescent boys and girls, including physical, psychosocial and socioeconomic risks. Our review aims to explore this public health concern for ACB adolescents within North America. We aim to identify and analyse available evidence on the incidence and prevalence of, associated factors of and interventions to curtail teen pregnancy involvement (TPI) among ACB adolescent boys and girls in North America. This review will explore TPI, rather than teen pregnancy, to ensure a review of men' involvement in teen pregnancy outcomes.

METHODS AND ANALYSES

Health literature databases such as CINAHL, OVID (Medline and Embase) and CAB direct. Searches will be conducted for evidence published from 2001 to October 2021. Search results will be exported to Covidence for subsequent steps of the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines will be used to ensure reproducibility and transparency. We will include all study designs focused on ACB boys and girls between 10 and 19 years old, residing in North America. Studies with a mixed racial sample will be included if sample consists of greater than 50% ACB individuals.

ETHICS AND DISSEMINATION

TPI is a public health concern with socioeconomic and health consequences for ACB teens in North America. A scoping review such as this will provide direction for healthcare practice, policy changes, education and further research in reducing the incidence of TPI in North America. Study results will be disseminated via presentations at conferences, at target populations, communities and organisations and publications via peer-reviewed journals. As knowledge generated from this scoping review will stem from previously published evidence, an ethical approval is not needed.

Unwinding the tangle of adolescent pregnancy and socio-economic functioning: leveraging administrative data from Manitoba, Canada

BACKGROUND

Understanding the relationship between adolescent pregnancy and adult education and employment outcomes is complicated due to the endogeneity of fertility behaviors and socio-economic functioning. Studies exploring adolescent pregnancy have often relied on limited data to measure adolescent pregnancy (i.e. birth during adolescence or self-reports) and lack access to objective measures of school performance during childhood.

METHODS

We use rich administrative data from Manitoba, Canada, to assess women's functioning during childhood (including pre-pregnancy academic performance), fertility behaviors during adolescence (live birth, abortion, pregnancy loss, or no history of pregnancy), and adult outcomes of high school completion and receipt of income assistance. This rich set of covariates allows calculating propensity score weights to help adjust for characteristics possibly predictive of adolescent pregnancy. We also explore which risk factors are associated with the study outcomes.

RESULTS

We assessed a cohort of 65,732 women, of whom 93.5% had no teen pregnancy, 3.8% had a live birth, 2.6% had abortion, and < 1% had a pregnancy loss. Women with a history of adolescent pregnancy were less likely to complete high school regardless of the outcome of that pregnancy. The probability of dropping out of high school was 7.5% for women with no history of adolescent pregnancy; after adjusting for individual, household, and neighborhood characteristics, the probability of dropping out of high school was 14.2 percentage points (pp) higher (95% CI 12.0-16.5) for women with live birth, 7.6 pp. higher (95% CI 1.5-13.7) for women with a pregnancy loss, and 6.9 pp. higher (95% CI 5.2-8.6) for women who had abortion. They key risk factors for never completing high school are poor or average school performance in 9th grade. Women who had a live births during adolescence were much more likely to receive income assistance than any other group in the sample. Aside from poor school performance, growing up in poor households and in poor neighborhoods were also highly predictive of receiving income assistance during adulthood.

DISCUSSION

The administrative data used in this study enabled us to assess the relationship between adolescent pregnancy and adult outcomes after controlling for a rich set of individual-, household-, and neighborhood-level characteristics. Adolescent pregnancy was associated with higher risk of never completing high school regardless of the pregnancy outcome. Receipt of income assistance was significantly higher for women having a live birth, but only marginally higher for those who had a pregnancy that ended in loss or termination, underlining the harsh economic consequences of caring for a child as a young mother. Our data suggest that interventions targeting young women with poor or average school marks may be especially effective public policy priorities.

Exposure to family planning messages and teenage pregnancy: results from the 2017 Philippine National Demographic and Health Survey

BACKGROUND

Teenage pregnancy is known to have physical, emotional, and psychosocial effects. Because of these risks, family planning and contraception messages have been disseminated in various forms of media, but their association with teenage pregnancy has not been studied previously in the Philippines. This study aims to examine the association between exposure to various family planning and contraception messages disseminated in various media channels and pregnancy among Filipino women aged 15-19. The study also intended to examine interactions between the different media channels where these family planning and contraception messages are being disseminated on their effect on teenage pregnancy.

METHODS

We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to  study the association between exposure to family planning and contraception messages and teenage pregnancy.

RESULTS

Out of 5120 respondents, 44% of respondents have accessed information on contraception from the internet, 25% have heard information about contraception through the radio, 55% of respondents have heard about contraception via television, 15% have read about contraception in the newspapers and magazines, and only 6% have received information on contraception via short messaging service (SMS). There were 420 (8.56%) who have ever been pregnant. After adjusting for confounding variables, those who were exposed to family planning/contraceptive messages via the internet (aOR: 0.90; 95% CI: 0.59, 1.35) and newspapers/magazines (aOR: 0.78; 95% CI: 0.44, 1.41) have lower odds of teenage pregnancy, but no strong evidence of their effectiveness. On the other hand, exposure to family planning messages through the radio (aOR: 1.06; 95% CI: 0.71, 1.59), television (aOR: 1.09; 95% CI: 0.72, 1.65), and short messaging service (aOR: 1.29; 95% CI: 0.51, 3.22) marginally increase the risk of teenage pregnancy. We did not find any pairwise interactions between the different exposure variables.

CONCLUSIONS

Our results highlight the need to improve the content and key messages of contraceptive and family planning messages in the Philippines, especially those that are broadcasted online and in print media. There is also a need to increase the reach of these different family planning and contraception messages, especially by utilizing social media and other print and online media platforms commonly used by the youth.

Perceptions of secondary school management teams in managing pregnant learners in an urban context

BACKGROUND

Teenage pregnancy is a complex issue globally, which is also a challenge in South Africa. Pregnant learners are allowed by the law to attend school for the whole duration of pregnancy. Although not medically trained or equipped to handle any emergencies, the school management teams are tasked to manage these learners by the Measures of the Prevention and Management of Learner Pregnancy Policy.

AIM

This study aimed to determine the school management teams' perceptions of managing pregnant learners in urban secondary schools.

SETTING

This study was conducted in four secondary schools in Gauteng province, Soweto-Pimville District 10.

METHODS

This study employed a qualitative, descriptive design. Purposive sampling was carried out (n = 13), semi-structured WhatsApp video call interviews were conducted and Tesch's data analysis steps were utilised to analyse the data.

RESULTS

Five themes emerged: Theme 1: the role of school management teams in managing pregnant learners; Theme 2: challenges of unplanned deliveries at school; Theme 3: personal thoughts of educators on managing pregnant learners; Theme 4: skills training requirements for educators to manage pregnant learners; and Theme 5: coping mechanisms for school management teams.

CONCLUSION

Collaboration between the department of health, department of education and the department of social development is essential in the management of pregnant learners at school.

CONTRIBUTION

Similar studies have been conducted in various rural areas of South Africa. Limited literature was found for urban areas; therefore, the researcher is of the opinion that the findings of this study could contribute to the body of knowledge.

A Latent Class Analysis: Identifying Pregnancy Intention Classes Among U.S. Adolescents

PURPOSE

Few studies have captured the multidimensionality of pregnancy intentions for adolescents on a national level, particularly missing the perspectives of male adolescents. Therefore, this study aimed to identify and describe pregnancy intention profiles among U.S. adolescents.

METHODS

Latent class analysis was conducted using data from two cycles of the National Survey of Family Growth (2015-2017 and 2017-2019) among U.S. adolescents 15-19 years old (N = 3,812). Stratified by sex, six National Survey of Family Growth indicators around desires, feeling, timing, and social acceptability were included. Multinomial logistic regression was used to identify the correlates of class membership.

RESULTS

Three latent classes of pregnancy intention were identified for each sex, which were distinguished by immediate and future desires, feelings, timing, and social acceptability. For both females and males, Delayed Pro-pregnancy (53% vs. 82%) and Near Pro-pregnancy (28% vs. 8%) were identified. Ambivalent-pregnancy (14%) and Anti-pregnancy (10%) were specific to females and males, respectively. Near Pro-pregnancy females and Anti-pregnancy males were more likely to be sexually active, older, of Hispanic descent, report receiving public assistance, and have a teen mother than adolescents classified as Delayed Pro-pregnancy. Females with a pregnancy history were more likely to be classified as Ambivalent than Delayed Pro-pregnancy.

DISCUSSION

While most adolescents intend to delay or avoid childbearing, there are subsets of adolescents whose pregnancy intentions are in favor of early childbearing, which is often dismissed in adolescent sexual and reproductive health. Current efforts can use these distinct pregnancy intention classes to tailor sexual and reproductive health services specifically for diverse adolescent populations.

Record Linkage and Big Data-Enhancing Information and Improving Design

OBJECTIVE

To highlight the potential of multiple file record linkage. Linkage increases the value of existing information by supplying missing data or correcting errors in existing data, through generating important covariates, and by using family information to control for unmeasured variables and expand research opportunities.

STUDY DESIGN AND SETTING

Recent Manitoba papers highlight the use of linkage to produce better studies. Specific ways in which linkage helps deal with different substantive issues are described.

RESULTS

Wide data files-files containing considerable amounts of information on each individual-generated by linkage improve research by facilitating better design. Nonexperimental work in particular benefits from such linkages. Population registries are especially valuable in supplying family data to facilitate work across different substantive fields.

CONCLUSION

Several examples show how record linkage magnifies the value of information from individual projects. The results of observational studies become more defensible through the better designs facilitated by such linkage.

Hispanic Mother-Daughter Communication About the Risks of Sex, Drugs, and Alcohol: Influences and the Strategies Mothers Use

PURPOSE

U.S. Hispanic adolescents are at risk for negative health outcomes due to risk-taking behaviors involving sex, drugs, and alcohol. Mother-daughter communication can reduce these risk-taking behaviors and reinforce parents' expectations. The purpose of this study was to explore mothers' descriptions of their communication about risk-taking behaviors with their early adolescent Hispanic daughters.

DESIGN AND METHODS

This qualitative descriptive study involved focus groups with 21 Hispanic mothers of 7th grade (12-14 years old) girls. Conventional content analysis was conducted to identify the strategies they used during these conversations.

RESULTS

Strategies mothers used included warning, focusing on negative consequences, creating opportunities to express maternal expectations, and stressing the importance of positive influences. Communication was also influenced by daughters' physical development and social media.

CONCLUSIONS

The mothers were concerned about their daughters' exposure to risk-taking behaviors but were unsure about how to talk to their daughters about how to avoid them, particularly regarding topics related to sex.

PRACTICE IMPLICATIONS

Our study results have implications on how to facilitate parent-child conversations about risk-taking behaviors and to equip mothers and parents to teach their children how to avoid engaging in these behaviors.

Determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle: a case-control study

Background

Adolescent pregnancy carries a high risk of severe health issues for both the mother and the newborn. Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America. Most of the risk factors are met in indigenous communities, which is an underrepresented and poorly studied population. We aimed to assess the determinants of adolescent pregnancy in indigenous communities from the Peruvian central jungle.

Methods

Through a case–control study, female adolescents aged 13 to 19 years old from seven indigenous communities of the Peruvian central jungle were interviewed. Adolescents with (cases) and with no (controls) pregnancy history, such as current pregnancy, children and abortion, fulfilled our eligible criteria. Our instrument explored: sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. We performed a penalized maximum likelihood logistic regression analysis to obtain Odds Ratios (OR) and their 95% confidence intervals (95% CI).

Results

We enrolled 34 cases and 107 controls. Overall, 53.9% were 15 to 19 years old. We found a significant association of being 15–19 years old (OR = 6.88, 95% CI 2.38–19.86, p < 0.0001) and an elementary school level of instruction (OR = 5.59, 95% CI 1.95–16.06, p = 0.001) with the risk of adolescent pregnancy. A marginal statistical significance between having five to six siblings and adolescent pregnancy was also reported (OR = 2.70, 95% CI 0.85–8.61, p = 0.094). Furthermore, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy (OR = 0.17, 95% CI 0.06–0.47, p = 0.001).

Conclusion

Our results suggest that public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health topics with adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01247-z.

Worldwide, 21 million adolescents give birth every year, with high percentages in Latin America and rural areas. Indigenous communities are mainly located in rural areas and are exposed to multiple risk factors of adolescent pregnancy. We aimed to find the factors that have an influence on adolescent pregnancy in indigenous communities from the Peruvian central jungle. We conducted a case–control study identifying female indigenous adolescents from the Peruvian central jungle with or without pregnancy history. Our survey explored sociodemographic, adolescent and family characteristics, as well as perceptions of adolescent pregnancy. Being 15 to 19 years old, having an elementary educational level, and five to six siblings increased the risk of adolescent pregnancy. On the other hand, adolescents with sexual and reproductive health communication with parents had a lower risk of adolescent pregnancy. Furthermore, eight out of ten adolescents opposed to sexual intercourse at an early age. Public health and educational efforts should be age-specific focused within indigenous communities of the Peruvian central jungle, encouraging parents to talk about sexual and reproductive health with adolescents.

Adolescent Sexual Development: A Family Perspective

Adolescent sexual development is informed by individual, relational, generational, institutional, and cultural perspectives. Families matter: they are the social institution at the intersection of adolescent development and broader social systems, charged with the responsibility for rearing children and adolescents to adulthood. This narrative review maps insights from family theory and research onto adolescent sexual development research. Our purpose is to inform sexuality researchers from diverse fields about how family perspectives can enrich understanding of adolescent sexual development. We present the critical, intersectional theoretical framework guiding this review as consisting of three meta-themes for understanding families through an examination of family structure, process, and context. Then, we apply those meta-themes to current research on adolescent sexual development by selectively organizing our review around the contexts of family structural diversity and family relational complexity, demonstrating that both the structure and the process components are embedded within the intersectional and cultural contexts that shape and are shaped by families. Our review demonstrates that diverse, intersectional family structures and transitions may affect adolescent sexual development by influencing family processes, particularly around sexual communication. We conclude with implications of using family perspectives for future inquiry related to adolescent sexual development.

Intergenerational persistence of family formation trajectories among teenage-mothers and -fathers in Sweden

In this paper, we address the questions of whether early family trajectories of parents are reflected in childbearing teenagers, and how socio-economic and family background factors impact these intergenerational correlations. We use within-dyad sequence analysis to examine combined marital and childbearing trajectories, up to age 30, of two generations of a representative sample of childbearing teenagers born between 1975 and 1985 and their progenitors, drawn from the Swedish population register data. We find evidence for within-family persistence of early family trajectories, with better matches across family state sequences for dyads composed of childbearing teenagers and their parents, than for dyads composed of childbearing teenagers and parents of random birth cohort peers. Regression analysis shows that these intergenerational associations are stronger and occur among later-born siblings from non-traditional family backgrounds, and among families with lower socio-economic backgrounds. This study fills gaps in the knowledge of intergenerational family life course dynamics beyond the early parenthood event.

Teenage Pregnancy and Its Associated Factors in Eastern Ethiopia: A Community-Based Study

Background

Teenage pregnancy is a global issue raising concerns for all who are interested in the health and well-being of young women and their children. It carries major health and social issues with unique medical and psychosocial consequences for both adolescents and society in general. This study aimed at assessing the prevalence and factors associated with teenage pregnancy in eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted. Multi-stage simple random sampling procedure was used to select 2258 female teenagers. Interviewer-administered questionnaire was used for data collection. Data were entered into EpiData and analyzed using stata software. The Poisson regression model with robust variance estimation was used to examine the association of the independent variable with teenage pregnancy. An adjusted prevalence ratio (APR) with 95% confidence intervals (CI) was reported.

Results

The prevalence of teenage pregnancy was 30.2% (95% CI: 28.3, 32.1). Age 16–17 years old (APR=7.05; 95% CI: 4.15,11.96), 17–18 years old (APR=9.85; 95% CI: 5.72,16.98), not being in school (APR=2.83; 95% CI: 1.93,4.16), lack of formal education (APR=1.11; 95% CI: 1.03,1.19), being married (APR=3.59; 95% CI: 2.83,4.56), parental divorce (APR=1.24; 95% CI: 1.08,1.42), having elder sister who had a history of teenage pregnancy (APR=1.11; 95% CI: 1.02,1.21), and not knowing fertile period in menstrual cycle (APR=1.31; 95% CI: 1.16,1.47) were independently associated with teenage pregnancy.

Conclusion

One in three teenagers had been pregnant. Age, not being in school, lack of formal education, being married, parental divorce, having an elder sister who had a history of teenage pregnancy, and not knowing fertile period during the menstrual cycles were the factors associated with teenage pregnancy. In Ethiopia, further efforts are required in the prevention of teenage pregnancy, keeping girls in school and strengthening the policy of delaying child marriage, particularly in rural areas.

Live Experiences of Adolescent Mothers Attending Mbale Regional Referral Hospital: A Phenomenological Study

BACKGROUND

Adolescence is a period of transition from childhood to adulthood, and is a critical stage in ones' development. It is characterized by immense opportunities and risks. By 2016, 16% of the world's population was of adolescents, with 82% residing in developing countries. About 12 million births were in 15-19 year olds. Sub-Saharan Africa, particularly East Africa, has high adolescent pregnancy rates, as high as 35.8% in eastern Uganda. Maternal mortality ratio (MMR) attributable to 15-19 years olds is significant with 17.1% of Uganda's MMR 336/100.000 live births being in this age group. Whereas research is awash with contributing factors to such pregnancies, little is known about lived experiences during early motherhood. This study reports the lived experiences of adolescent mothers attending Mbale Hospital.

MATERIALS AND METHODS

A phenomenological study design was used in which adolescent mothers that were attending Young Child Clinic were identified from the register and simple random sampling was used to select participants. We called these mothers by way of phone numbers and asked them to come for focus group discussions that were limited to 9 mothers per group and lasting about 45 minutes-1 hour. Ethical approval was sought and informed written consent obtained from participants. At every focus group discussion, the data which had largely been taken in local languages was transcribed and translated verbatim into English.

RESULTS

The research revealed that adolescent mothers go through hard times especially with the changes of pregnancy and fear of unknown during intrapartum and immediate postpartum period and are largely treated negatively by family and other community members in addition to experiencing extreme hardships during parenting. However, these early mothers' stress is alleviated by the joy of seeing their own babies.

CONCLUSION

Adolescent motherhood presents a high risk group and efforts to support them during antenatal care with special adolescent ANC clinics and continuous counseling together with their household should be emphasized to optimize outcome not only during pregnancy but also thereafter. Involving these mothers in technical courses to equip them with skills that can foster self-employment and providing support to enable them pursue further education should be explored.

The association of maternal age with adverse neonatal outcomes in Lusaka, Zambia: a prospective cohort study

Background

Pregnancy among adolescents, whether intended or not, is a public health concern as it is generally considered high risk for both mothers and their newborns. In Zambia, where many women engage in early sexual behaviour or marry at a young age, 28.5% of girls aged 15–19 years were pregnant with their first child in the year 2013–2014. This study sought to explore associations between maternal age and neonatal outcomes among pregnant women in Lusaka, Zambia.

Methods

This was a secondary analysis of data nested within a larger population-based prospective cohort study which was implemented in three government health facilities-two first level hospitals and one clinic in Lusaka, Zambia. Women presenting to the study sites for antenatal care were enrolled into the study and followed up for collection of maternal and neonatal outcomes at 7, 28 and 42 days postpartum. The study’s primary outcomes were the incidence of maternal and newborn complications and factors associated with adverse neonatal outcomes. Statistical significance was evaluated at a significance level of P < 0.05.

Results

The study included 11,501 women, 15.6% of whom were adolescents aged 10–19 years. Generally, adolescence did not have statistically significant associations with poor maternal health outcomes. However, the risk of experiencing obstructed labour, premature rupture of membranes and postpartum hemorrhage was higher among adolescents than women aged 20–24 years while the risk of severe infection was lower and non-significant. Adolescents also had 1.36 times the odds of having a low birthweight baby (95% CI 1.12, 1.66) and were at risk of preterm birth (aOR = 1.40, 95% CI 1.06, 1.84). Their newborns were in need of bag and mask resuscitation at birth (aOR = 0.62, 95% CI 0.41, 0.93). Advanced maternal age was significantly associated with increased odds of hypertension/ pre-eclampsia (95% CI 1.54, 5.89) and preterm labour (aOR = 2.78, 95% CI 1.24, 6.21).

Conclusions

Adolescence is a risk factor for selected pregnancy outcomes in urban health facilities in Lusaka, Zambia. Health care workers should intensify the provision of targeted services to improve neonatal health outcomes.

Trial registration

Clinical trial number and URL: NCT03923023 (Retrospectively registered). Clinical trial registration date: April 22, 2019.

<p>A Multilevel Analysis of Factors Associated with Teenage Pregnancy in Ethiopia</p>

Background

A significant number of girls in Ethiopia begin childbearing at an early age. Teenage pregnancy is the main contributor to maternal and child morbidity and mortality, and the vicious cycle of ill-health and poverty. However limited evidence exists about individual- and community-level factors affecting teenage pregnancy in Ethiopia.

Methods

This study used data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 3381 (weighted) teenagers aged 15–19 years were included in the study. A two-stage stratified cluster was used. Data were analyzed using Stata version 14. Multilevel mixed effect logistic regression was used to identify factors affecting teenage pregnancy.

Results

Being 17 (AOR=9.26, 95% CI=2.67–32.04), 18 (AOR=9.53, 95% CI=2.97–30.04) and 19 years old (AOR=20.01, 95% CI=5.94–67.39), uneducated (AOR=3.83, 95% CI=1.05–14.00), primary educated (AOR=3.34, 95% CI=1.01–11.08), being married (AOR=70.12, 95% CI=27.55–178.4), and communities with a higher proportion of poor (AOR=3.86, 95% CI=1.80–8.26) were predictors of teenage pregnancy.

Conclusion

Age, educational status, and marital status from individual-level factors, and community wealth status from community-level factors were predictors of teenage pregnancy. The government should strive to improve female education, and fight against early marriage and sexual initiation.

Not all the same: Swedish teenage mothers' and fathers' selection into early family formation trajectories

Previous research has focused on teenage parenthood as a single outcome, and has overlooked the wider family formation trajectory in which it is situated. In this paper, using Swedish register data and sequence analysis tools, we explore the diversity in timing and ordering of childbearing and (re)partnering events among teenage parents. We identify trajectory clusters of traditional family patterns, modern family patterns, single parenthood and re-partnering patterns. We also examine the role of resources in the family of origin for the probability of following the different types of family formation trajectories among teenage parents. Where economic resources in the family of origin is related to the type of trajectory teenage fathers follow, family structure is of greater importance for teenage mothers. The family formation trajectories of teenage parents display substantial heterogeneity, which contradicts a view that a person who has a child early in life suddenly has their life's script written.

A housing mobility program's impacts on teen and young adult parenting

OBJECTIVE

To assess the impact of Moving to Opportunity for Fair Housing Demonstration Program (MTO) implemented in 1994 in five U.S. cities (Baltimore, Boston, Chicago, Los Angeles, and New York City) on teen births.

METHODS

We analyzed baseline and long-term evaluation data for youth (ages 13-20) and young adults (ages 21-30) (N = 7861) who were children or teens at baseline. We used regression analyses to estimate the impact of housing vouchers on having a teen birth.

RESULTS

Overall, MTO had no significant effect on teen births. However, among young adults whose parent had a child before age 20, the proportion with a teen birth themselves was 21% lower among those offered housing vouchers to low-poverty neighborhoods with no restrictions compared to those not offered housing vouchers (p < 0.05).

CONCLUSION

MTO appeared to decrease intergenerational teen births among young adults. Further exploration of housing relocation may help untangle risks and protective factors for reducing intergenerational teen births.

PUBLIC HEALTH IMPLICATIONS

Reducing intergenerational teen births is important, especially among those facing economic, environmental, and health risks. Comprehensive programs addressing multiple social determinants of health are vital to reducing teen births.

The Public Health Family Impact Checklist: A Tool to Help Practitioners Think Family

Families are an important cornerstone of individual and community health across the lifecourse. Not only do families play a role in the development of health, but the family's health is likewise influenced by individual health behaviors and outcomes. Therefore, to improve population health, public health programs must support families. Limited training in family science, as well as lack of instruments to help “think family,” often result in Public Health practitioners feeling ill-equipped to develop programming that supports, targets, and/or involves a diverse range of families. Tools to help public health practitioners think family are limited. The Family Impact Checklist is one tool that may help improve the degree to which policies support families. The purpose of this study was to adapt the Family Impact Checklist specifically for use in public health programming efforts. Through a two-round Delphi approach comprised of 17 public health professionals, the Public Health Family Impact Checklist was developed. The adapted Checklist includes 14 items across four think family principles: family engagement, family responsibility, family stability and family diversity. We propose that this tool will help practitioners develop high impact, family-friendly programs that ultimately lead to improved individual and community health.

Estimating the educational consequences of teenage childbearing: Identification, heterogeneous effects and the value of biological relationship information

Understanding the contribution of childbearing to social disadvantages of teenage mothers requires estimates that control for unobservables and generalize to teenage mothers. Sibling-differences and Instrumental Variables (IV) are common approaches to this end. Using the "Add Health" data, which oversampled siblings, and building on IV specifications from a widely-cited study, we compare various estimates of the consequences of teenage childbearing for schooling attainment. These IV-based estimates suggest moderate to large adverse impacts of teenage births (point estimates of -0.7 years of schooling or larger). However, the IV estimates are highly sensitive to choice of instrument and model specification. Estimates based on sibling and twin differences are consistently near zero-e.g., an estimated difference of -0.1 years between a teen mother and her biological full sister who did not have a teen birth-and are estimated with sufficient precision to exclude effects larger than -0.5 years. We review concerns about sibling methods and conclude that, despite their limitations, sibling estimates should be admitted along with other evidence on the consequences of teenage childbearing. Appreciation of the sensitivity of IV estimates and their other limitations would reinforce this conclusion.

The multigenerational effects of adolescent motherhood on school readiness: A population-based retrospective cohort study

Background

Children born to adolescent mothers generally perform more poorly on school readiness assessments than their peers born to adult mothers. It is unknown, however, whether this relationship extends to the grandchildren of these adolescent mothers. This paper examines the multi-generational outcomes associated with adolescent motherhood by testing whether the grandchildren of adolescent mothers also have lower school readiness scores than their peers; we further assessed if this relationship was moderated by whether the child’s mother was an adolescent mother.

Methods

We used population-based data to conduct the retrospective cohort study of children born in Manitoba, Canada, 2000–2009, whose mothers were born 1979–1997 (n = 11,326). Overall school readiness and readiness on five domains of development were analyzed using logistic regression models.

Results

Compared with children whose mothers and grandmothers were both ≥ 20 at the birth of their first child, those born to grandmothers who were < 20 and mothers who were ≥ 20 years old at the birth of their first child had 39% greater odds of being not ready for school (95% CI: 1.22–1.60). Children whose grandmothers were ≥ 20 and mothers were < 20 at the birth of their first child had 25% greater odds of being not ready for school (95% CI: 1.11–1.41), and children born to grandmothers and mothers who were both <20 at the birth of their first child had 35% greater odds of being not ready for school (95% CI: 1.18–1.54).

Conclusions

These findings suggest a multigenerational effect of adolescent motherhood on school readiness.

Determinants of teenage pregnancy in Degua Tembien District, Tigray, Northern Ethiopia: A community-based case-control study

BACKGROUND

Approximately 16 million teenagers aged 15-19 years and 2 million teenagers under the age of 15 years give birth annually, with 95% of these births occurring in developing countries. Ethiopia has one of the highest teenage fertility rates in Sub-Saharan Africa; however determinants of teenage pregnancy are not well studied. Therefore, this study aimed to identify determinants of teenage pregnancy among female teenagers in Degua Tembien district, Tigray, Northern Ethiopia, in 2015.

METHODS

A community-based case-control study was conducted in Degua' Tembien district from February 01, 2015 to March 15, 2015 with a randomly selected total sample size of 414 females (with a ratio of 1:2 case to control, 138 and 276 respectively). Data were entered in to Epi-Info and analyzed using SPSS software. Multivariable logistic regression was used to assess predictors of the outcome variable; variables with a p-value <0.25 in bivariable analysis were included in the model. Statistically significance was considered at a p-value ≤0.05 in both bivariable and multivariable logistic regression analyses.

RESULT

The mean ages (plus or minus standard deviation (±SD)) of cases and controls were 18.47 (0.72) and 17.09 (1.2) years, respectively. After adjustment for other variables, predictors of teenage pregnancy included: lower monthly income below ~$25 and ~$25-50 (adjusted odds ratio (AOR) = 23.96; 95% confidence interval (95%CI) 4.89-117.29 and AOR = 4.91; 95%CI 1.64-14.66, respectively); aged 18-19 years (AOR = 16.75; 95%CI 6.45-43.47); being married (AOR = 15.91; 95%CI 7.43-34.04); not communicating with parents on reproductive health issues (AOR = 6.52; 95%CI 3.12-13.64) and having a history of maternal teenage pregnancy (AOR = 4.14; 95%CI 1.84-9.33).

CONCLUSION

The factors associated with teenage pregnancy in our study were lower family monthly income, being married, being in the 18-19 year age group, not communicating with parents on reproductive health issues and having a maternal history of teenage pregnancy. Programs that encourage parent-teenage communication of reproductive health issues, starting from early adolescence, in order to build skills to prevent pregnancy in the late teenage years, are very important. In addition, multi-pronged activities across sectors that encourage delayed marriage and improve health service utilizations for girls are essential.

Intergenerational teen pregnancy: a population-based cohort study

OBJECTIVE

To estimate the intergenerational association in teenage pregnancy, and whether there is a coupling tendency between a mother and daughter in how their teen pregnancies end, such as a termination of pregnancy (TOP) versus a live birth.

DESIGN

Population-based cohort study.

SETTING

Ontario, Canada.

POPULATION

A total of 15 097 mothers and their 16 177 daughters.

METHODS

Generalised estimating equations generated adjusted odds ratios (aOR) of a daughter experiencing a teen pregnancy in relation to the number of teen pregnancies her mother had. Multinomial logistic regression estimated the odds that a teen pregnancy ended with TOP among both mother and daughter. All models were adjusted for maternal age and world region of origin, the daughter's socio-demographic characteristics and comorbidities, mother-daughter cohabitation, and neighbourhood-level teen pregnancy rate.

MAIN OUTCOME MEASURES

Teen pregnancy in the daughter, between ages 15 and 19 years, and also the nature of the daughter's teen pregnancy, categorised as (1) no teen pregnancy, (2) at least one teen pregnancy, all exclusively ending with a live birth, and (3) at least one teen pregnancy, with at least one teen pregnancy ending with a TOP.

RESULTS

The proportion of daughters having a teen pregnancy among those whose mother had zero, one, two, or at least three teen pregnancies was 16.3, 24.9, 33.5 and 36.3%, respectively. The aOR of a daughter having a teen pregnancy was 1.42 (95% CI 1.25-1.61) if her mother had one, 1.97 (95% CI 1.71-2.26) if she had two, and 2.17 (95% CI 1.84-2.56) if her mother had three or more teen pregnancies, relative to none. If a mother had at least one teen pregnancy ending with TOP, then her daughter had an aOR of 2.12 (95% CI 1.76-2.56) for having a teen pregnancy also ending with TOP; whereas, if a mother had at least one teen pregnancy, all ending with a live birth, then her daughter had an aOR of 1.73 (95% CI 1.46-2.05) for that same outcome.

CONCLUSION

There is a strong intergenerational occurrence of teenage pregnancy between a mother and daughter, including a coupling tendency in how the pregnancy ends.

TWEETABLE ABSTRACT

Strong intergenerational association for teenage pregnancy between mother and daughter.

Motherhood in early adolescence: a case-control study in Southern Brazil

This paper investigates factors associated with motherhood among adolescents from 14 to 16 years of age in Porto Alegre, Brazil. This is a case-control study with 431 adolescent mothers (cases) and 862 adolescents who had never given birth (controls). D. ata were obtained through home visits by an interviewer-applied questionnaire. Sociodemographic characteristics, quality of social and family relationships, lifestyle and history of abuse were studied as potential determinants to early adolescent motherhood. Conditional logistic regression was used for data analysis according to a two-stage hierarchical model. Results showed that lower economic class, schooling failure, tobacco consumption, alcoholic drunkenness at least once in life and having a mother who gave birth before 20 years of age were positively associated with early adolescent motherhood. Later menarche and having relatives or having friends in whom to trust remained as protective factors. Schooling failure, which obtained the highest risk, points to the important role of the school in this population's development and its potential to stimulate healthy life habits.

Adolescent Pregnancy Outcomes Among Sisters and Mothers: A Population-Based Retrospective Cohort Study Using Linkable Administrative Data

OBJECTIVES

Female family members affect both the likelihood of adolescent pregnancy and the outcome of that pregnancy. We examined the degree to which an older sister's adolescent reproductive outcomes affect her younger sister's reproductive behavior, and whether relationships in adolescent pregnancy among sisters born to adolescent mothers differ from those born to nonadolescent mothers.

METHODS

We followed a birth cohort in Manitoba, Ontario, Canada, to age 20 using linkable administrative databases housed at the Manitoba Centre for Health Policy. The cohort consisted of 12 391 girls born in Manitoba between April 1, 1984, and March 31, 1996, who had 1 older sister. We used logistic regression models to examine the relationships among familial adolescent pregnancy outcomes.

RESULTS

Compared with adolescent girls whose older sister did not have an adolescent pregnancy, adolescent girls whose older sister had an adolescent pregnancy were more likely to have a pregnancy (adjusted odds ratio [aOR] = 2.57), regardless of whether that pregnancy was completed (aOR = 2.56) or terminated (aOR = 2.59). Relationships in adolescent pregnancy among sisters were much stronger for those born to nonadolescent mothers (aOR = 3.16 [older sister completed adolescent pregnancy] and 3.18 [older sister terminated adolescent pregnancy]) than to adolescent mothers (aOR = 1.65 [older sister completed adolescent pregnancy] and 1.77 [older sister terminated adolescent pregnancy]). For younger sisters having an adolescent pregnancy, the odds of her completing the pregnancy were reduced if her older sister had terminated an adolescent pregnancy and her mother had not been an adolescent mother (aOR = 0.38).

CONCLUSIONS

Younger sisters of adolescents who had a pregnancy may benefit from targeted interventions to reduce their likelihood of adolescent pregnancies.

Protocol for establishing an infant feeding database linkable with population-based administrative data: a prospective cohort study in Manitoba, Canada

INTRODUCTION

Breast feeding is associated with many health benefits for mothers and infants. But despite extensive public health efforts to promote breast feeding, many mothers do not achieve their own breastfeeding goals; and, inequities in breastfeeding rates persist between high and low-income mother-infant dyads. Developing targeted programme to support breastfeeding dyads and reduce inequities between mothers of different socioeconomic status are a priority for public health practitioners and health policy decision-makers; however, many jurisdictions lack the timely and comprehensive population-level data on infant-feeding practices required to monitor trends in breastfeeding initiation and duration. This protocol describes the establishment of a population-based infant-feeding database in the Canadian province of Manitoba, providing opportunities to develop and evaluate breastfeeding support programme.

METHODS AND ANALYSIS

Routinely collected administrative health data on mothers' infant-feeding practices will be captured during regular vaccination visits using the Teleform fax tool, which converts handwritten information to an electronic format. The infant-feeding data will be linked to the Manitoba Population Research Data Repository, a comprehensive collection of population-based information spanning health, education and social services domains. The linkage will allow us to answer research questions about infant-feeding practices and to evaluate how effective current initiatives promoting breast feeding are.

ETHICS AND DISSEMINATION

Approvals have been granted by the Health Research Ethics Board at the University of Manitoba. Our integrative knowledge translation approach will involve disseminating findings through government and community briefings, presenting at academic conferences and publishing in scientific journals.