Teen Pregnancy

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 pregnancy in Western Europe. While there are plentiful figures in the literature on teen pregnancy,many of the studies are somewhat dated. Furthermore, many originate in 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 steadily in the USA and Europe. In 2004 the conception rate in England was 41.5 per 1000 girls aged 15–17 years, representing an overall decline of 11.1% since 1998. However, the UK still has 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 ethnic groups 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 educational achievement at ages 7 and 16 years have been found to be at significantly increased risk of becoming teenage parents, especially those whose performance declines between these ages. Wellings 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 qualifications had a child before the age of 18 years, compared with 14% of those 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 pregnancy compared with those born to older mothers and the offspring are at risk for becoming teenaged mothers or fathers themselves Girls who have had a teen pregnancy are more likely to have smoked than those who have not conceived as teenagers.  This is an important clinical problem as smoking compounds the potential for adverse outcomes of adolescent pregnancy, particularly intrauterine growth restriction. The birthweight-for-gestational-age curves of smoking adolescents show a marked fall-off in weight from 36 weeks of gestation. Furthermore, at least 10% of adolescent smokers have pregnancies affected by severe early onset (before 32 weeks of gestation) fetal growth restriction. Smoking during pregnancy is also known to be associated withan increased risk of placental abruption, preterm premature rupture of membranes, preterm birth, stillbirth and sudden infant death syndrome. Research has shown that prenatal exposure totobaco smoke is a risk factor for respiratory infections, asthma, allergy, childhood cancer and adverse neuro behavioural development.

Teenagers may have poor eating habits and neglect to take their vitamin supplements. They are less likely than older women tobe of adequate pre-pregnancy weight or to gain an adequate amount of weight during pregnancy. Low weight gain increases the risk of having a low birthweight baby. This is frequently compounded by adverse social circumstances.

While there is no evidence, to date, of medical interventions that can specifically improve pregnancy outcome, we must ensure that teenage mothers receive supportive care and are directed towards the social support they need. Smoking cessation should be targeted and attendance at an antenatal clinic encouraged. In addition, effective postnatal counselling, particularly regarding contraception, 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, the majority choose to continue. Of those with a history of teen pregnancy, over 25% will become pregnant again during their teenage years, including 18% of those who terminate their first pregnancy. These figures suggest that many teenagers become 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 more likely to resort to unskilled practitioners and dangerous methods and, when complications do arise, they are more likely to present late.  While termination and adoption are options that are available and should be presented to the pregnant teenager, the reality is that most girls choose to continue with their pregnancies and keep their infants. It is, therefore, imperative that every effort is made to encourage pregnant teenagers to access antenatal care and that the care they subsequently receive is tailored to the unique needs of this age group. The healthcare professional must be aware of the potential complications and the opportunities for intervention that exist.

The postnatal period provides an opportunity for counselling and education from the obstetrician, midwife, general practitioner,health visitor and social worker. Teenage mothers are more likely to have unhealthy habits that place the infant at greater riskof inadequate growth, infection and chemical dependence. Below the age of 20 years, the younger the mother, the greater the risk of her infant dying during the first year of life. Infant feeding, growth and safety need to be observed. Having her firstchild during adolescence makes a woman more likely to have more children 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 biological father.  They are less likely to complete their education and establish the independence and financial security that enable them to provide for themselves and their children without outside assistance. There are, therefore, some areas that need special attention, particularly discussion regarding financial issues, returning to school and contraceptive advice.

Preventing teen pregnancy

There are many different kinds of teen pregnancy prevention programmes. Studies in pregnancy prevention have attempted toaddress the many facets of adolescent sexual activity, contraceptive use and pregnancy. Kirby has identified five main categoriesof teen pregnancy prevention programmes: education, improving access to contraception, education for parents and their families, multi-component prevention and youth development.

Increasing the availability of contraceptive clinic services for 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 within the previous year – 71.3% of them specifically for contraceptive advice. Location of services is also very important. According to adolescents, there are several factors that determine whether they use the services or not. These include: confidentiality, a non-judgmental approach, accessibility and whether they are treated by a male or female clinician. Contraceptive services should be easily accessible, confidential, cheap or free and safe. They also benefit from having close links with associated services such as STI clinics, smoking cessation programmes, substance abuse clinics, social services, maternity hospitals and termination services.