There are several problems associated with teenage pregnancy including social, economic, cultural, educational and political issues. Both pregnancy and adolescence are times of emotional upheaval and when the two are combined there is need for support and counselling. When an adolescent becomes a parent her education will, at best, be delayed but more usually it will be discontinued. Her employment opportunities are reduced, her income is likely to be low, long-lasting relationships are infrequent and there is often need for prolonged welfare support. Many adolescent mothers, whilst aware of their own needs, may be less sensitive to the needs of their child.
Teenage pregnancy is becoming a serious public health problem, particularly in less developed countries where obstetric facilities are limited. Teenage pregnancies are associated with increased risks of miscarriage, premature labour, blood pressure problems (pre-eclampsia), small-for-dates babies and perinatal mortality (death of the baby before birth or in the first week of after delivery) is increased.
Prevention of unplanned pregnancy in adolescents has become an international medical priority.
The United Kingdom has the highest rate of teen pregnancyin Western Europe.While there are plentiful figures in the literature on teen
pregnancy,many of the studies are somewhat dated. Furthermore, many originatein the USA and caution is
required when extrapolating this datato the UK
situation.
The UK government has issued a national target of halving the
rate of conception in under18-year-olds by 2010.
This is part of a broader government strategyfor
improving sexual health in the UK.
In recent years the rate of teenage conception has fallen
steadilyin the USA and Europe. In 2004 the
conception rate in Englandwas 41.5 per 1000 girls
aged 15–17 years, representingan overall decline of
11.1% since 1998. However, the UK stillhas the
highest rate of teen pregnancy in Western Europe,
while the USA possesses the highest rate in the world at 43.0per 1000.
It is important to recognise that teen pregnancy can be apositive life choice for some young women, particularly
thosefrom certain ethnic or social groups. In some
South Asian ethnicgroups in the UK, rates of teen
pregnancy within marriageare high. Ethnicity and
culture play a role and are an important
consideration for healthcare professionals.The higher rates of teen pregnancy tend to be concentratedin inner cities and are linked to poverty. Multiple
socioeconomicrisk factors have been identified.Teenagers from unskilled manual backgrounds (social class V)are 10 times more likely to become teenage mothers than
thosefrom professional backgrounds (social class I).
Teenagers fromsocially deprived areas are up to six
times more likely to becomepregnant than teenagers
from other areas and are much less likelyto opt for
a termination.
Young people scoring below average on measures of educationalachievement at ages 7 and 16 years have been found to be
atsignificantly increased risk of becoming teenage
parents, especiallythose whose performance declines
between these ages. Wellings2001-01
surveyed over 11000 males and females aged 16–44
years across the UK. They found that 29% of sexually activeyoung women who left school at 16 years of age without any
qualificationshad a child before the age of 18
years, compared with 14% ofthose who left at 16 with
qualifications and 1% of those wholeft at age 17
years or over.
Women who were themselves children ofteenage mothers
are more likely to have a teen pregnancycompared
with those born to older mothers and the offspring
are at risk for becoming teenaged mothers or fathers themselves.2003-01
Girls who have had a teen pregnancy are more likely to have
smoked than those who havenot conceived as
teenagers.1998-01
This is an important clinical problemas smoking
compounds the potential for adverse outcomes of adolescentpregnancy, particularly intrauterine growth restriction.
Thebirthweight-for-gestational-age curves of smoking
adolescentsshow a marked fall-off in weight from 36
weeks of gestation. Furthermore, at least 10% of
adolescent smokers have pregnanciesaffected by
severe early onset (before 32 weeks of gestation)
fetal growth restriction.2006-12
Smoking during pregnancy is also known to be associated withan increased risk of placental abruption, preterm
prematurerupture of membranes, preterm birth,
stillbirth and sudden infantdeath syndrome. Research
has shown that prenatal exposure totobacco smoke is
a risk factor for respiratory infections, asthma,
allergy, childhood cancer and adverse neurobehavioural
development.
Teenagers may have poor eating habits and neglect to take theirvitamin supplements. They are less likely than older women
tobe of ade Quate pre-pregnancy weight or to gain an
ade Quate amountof weight during pregnancy.
Low weight gain increases therisk of having a low
birthweight baby. This is frequently compoundedby
adverse social circumstances.
While there is no evidence, to date, of medical interventionsthat can specifically improve pregnancy outcome, we must
ensurethat teenage mothers receive supportive care
and are directedtowards the social support they
need. Smoking cessation shouldbe targeted and
attendance at an antenatal clinic encouraged.In
addition, effective postnatal counselling, particularly
regardingcontraception, can help prevent subsequent
pregnancies and STIs.
Termination of pregnancy and adoption
Teen pregnancy is often viewed as unplanned and unwanted.However, the reality is more complex. Although
approximately40% of teenagers in the UK terminate
their pregnancies, themajority choose to continue.
Of those with a history of teen pregnancy, over 25% will become pregnant againduring their
teenage years, including 18% of those who terminate
their first pregnancy. These figures suggest that many teenagersbecome pregnant by design rather than by accident.
Nevertheless,termination is very commonly performed
in these circumstances.Teenagers are more likely to
have later terminations, are morelikely to resort to
unskilled practitioners and dangerous methodsand,
when complications do arise, they are more likely to presentlate.2001-02
While termination and adoption are options that are availableand should be presented to the pregnant teenager, the
realityis that most girls choose to continue with
their pregnanciesand keep their infants. It is,
therefore, imperative that everyeffort is made to
encourage pregnant teenagers to access antenatalcare
and that the care they subsequently receive is tailoredto the unique needs of this age group. The healthcare
professionalmust be aware of the potential
complications and the opportunitiesfor intervention
that exist.
The postnatal period provides an opportunity for counsellingand education from the obstetrician, midwife, general
practitioner,health visitor and social worker.
Teenage mothers are more likelyto have unhealthy
habits that place the infant at greater riskof
inade Quate growth, infection and chemical dependence. Belowthe age of 20 years, the younger the mother, the greater
therisk of her infant dying during the first year of
life. Infantfeeding, growth and safety need to be
observed. Having her firstchild during adolescence
makes a woman more likely to have morechildren
overall. Women in this group are also less likely to
receive child support from the biological fathers: over 50%of children of adolescent mothers never live with their
biologicalfather.1991-01
They are less likely to complete their education and
establish the independence and financial security that enablethem to provide for themselves and their children without
outsideassistance. There are, therefore, some areas
that need specialattention, particularly discussion
regarding financial issues,returning to school and
contraceptive advice.
Preventing teen pregnancy
There are many different kinds of teen pregnancy preventionprogrammes. Studies in pregnancy prevention have attempted
toaddress the many facets of adolescent sexual
activity, contraceptiveuse and pregnancy.
Kirby
has identified five main categoriesof teen pregnancy
prevention programmes: education, improvingaccess to
contraception, education for parents and their families,multi-component prevention and youth development.
Increasing the availability of contraceptive clinic servicesfor young women is associated with reduced pregnancy
rates.The role of the general practitioner is
paramount: over 70%of consultations for
contraception in the UK occur in generalpractice. In
the UK, 91% of teenagers who become pregnant havehad
at least one visit to their general practitioner withinthe previous year – 71.3% of them specifically for
contraceptiveadvice.2000-02
Location of services is also very important. Accordingto adolescents, there are several factors that determine
whetherthey use the services or not. These include:
confidentiality,a non-judgmental approach,
accessibility and whether they aretreated by a male
or female clinician. Contraceptive servicesshould be
easily accessible, confidential, cheap or free and
safe. They also benefit from having close links with associatedservices such as STI clinics, smoking cessation
programmes,substance abuse clinics, social services,
maternity hospitalsand termination services.
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