Care for adolescent pregnancy and childbirth

The Incidence of Adolescent Pregnancy at Clinic of Gynecology and Obstetrics of Clinical Center Kragujevac

Adolescent pregnancy belongs to a group of high-risk pregnancies with high maternal and fetal mortality and morbidity rate with high prevalence globally (11%). The aim of this observational study is to show the incidence of adolescent deliveries in relation to the total number of births in the twelve-year period from 2007 to 2019 at the Department of Gynecology and Obstetrics of Clinical Center in Kragujevac from medical protocols and patients’ medical records. By evaluating the data of our research, we noticed a continuing decrease in the percentage of adolescents that give births each year. The total number of births in our clinic in this twelve-year period was 26544, and the number of teenage deliveries was 390 (1.74%), which is in accordance with the results of a similar research which was conducted in our clinic in the period from 2002 to 2007 (16.1%). However, despite the increase in the number of caesarean sections, Apgar score of newborn babies was similar to the results of previous tests - 8.31 which proves that the increase in caesarean sections is not correlated with growth of Apgar score. The average pregnancy duration of adolescents is similar as in the previous five-year period (37.5 w.g.), while in the general population of pregnant women it is 39.2 w.g which represents a statistically significant difference. The main causes of poor outcomes of adolescent pregnancies are biological immaturity of mothers, poor health care, that comes from poor socio-demographic conditions, as well as emotional stress. It is necessary to change the attitude of society towards these young people, give them support in the environment they live and provide them with better health care and social treatment.

The Outcomes of Pregnancy and Childbirth in Adolescents in Slovenia

Introduction

The objective of the study was to determine the course and outcomes of pregnancy and childbirth in adolescents compared to women aged 20–24 years in Slovenia.

Methods

In the retrospective study, the course of pregnancy and labour and the perinatal outcome of newborns in primiparous adolescents aged ≤19 years (study group) have been compared to the control group of primiparous women aged 20–24 years. The study group was further divided into a study subgroup of adolescents aged ≤17 years. Data were retrieved from the National Perinatal Information System in Slovenia for the period 2008–2012. Altogether, 13,663 women and their newborns were included.

Results

Adolescent pregnancy was associated with increased rates of unknown estimated date of delivery, preterm labour, low birth weight newborns, small for gestational age newborns and low gestational weight gain. Spontaneous labour was more common in adolescents, while emergency and elective Caesarean sections were less common than in women aged 20–24 years. In addition, pregnancy in adolescents aged ≤17 years was associated with increased rate of maternal anaemia and labour without complications. Higher rates of smoking, lower rates of parenting school attendance, lower rates of pregnancy check-ups and screening tests in pregnancy such as nuchal translucency in adolescents were found.

Conclusions

The results of the study show that adolescent pregnancy is related to higher health risks for pregnant adolescents and their newborns. In addition, adolescents are subject to poorer prenatal care comparing to older women.

Sociodemographic, sexual, reproductive and relationship characteristics of adolescents having an abortion in Portugal: a homogeneous or a heterogeneous group?

OBJECTIVES

The aims of the study were to describe the sociodemographic, sexual, reproductive and relational characteristics of adolescents having an abortion in Portugal and to explore the differences between three adolescent age groups.

METHODS

We recruited a nationally representative sample of 224 adolescents (<16 years, n =  18; 16-17 years, n =  103; 18-19 years, n =  103) who had an abortion. Data were collected from 16 health care services that provide abortion.

RESULTS

The adolescents were predominantly single, were from non-nuclear families, had low-socioeconomic status and were students. Mean age at first sexual intercourse was 15 years and mean gynaecological age was 5 years. Most had had multiple sexual partners, and for most it was their first pregnancy. At conception, the majority were involved in a long-term romantic relationship, were using contraception but did not identify the contraceptive failure that led to the pregnancy. Significant age group differences were found. Compared with the younger age groups, the 18-19 year age group was more frequently married or living with a partner, had finished school, had attained a higher educational level (as had their partner), intended to go to university, and had a greater number of sexual partners. Compared with the other groups, those under 16 years of age reported earlier age at menarche and at first sexual intercourse, and had a lower gynaecological age.

CONCLUSIONS

Our study characterises the life contexts of Portuguese adolescents who had an abortion. It highlights the need to recognise the heterogeneity of this group according to age. The findings have important implications for the development of age-appropriate guidelines to prevent unplanned pregnancy.

Rural-Urban Inequity in Unmet Obstetric Needs and Functionality of Emergency Obstetric Care Services in a Zambian District

Background

Zambia has a high maternal mortality ratio, 398/100,000 live births. Few pregnant women access emergency obstetric care services to handle complications at childbirth. We aimed to assess the deficit in life-saving obstetric services in the rural and urban areas of Kapiri Mposhi district.

Method

A cross-sectional survey was conducted in 2011 as part of the ‘Response to Accountable priority setting for Trust in health systems’ (REACT) project. Data on all childbirths that occurred in emergency obstetric care facilities in 2010 were obtained retrospectively. Sources of information included registers from maternity ward admission, delivery and operation theatre, and case records. Data included age, parity, mode of delivery, obstetric complications, and outcome of mother and the newborn. An approach using estimated major obstetric interventions expected but not done in health facilities was used to assess deficit of life-saving interventions in urban and rural areas.

Results

A total of 2114 urban and 1226 rural childbirths occurring in emergency obstetric care facilities (excluding abortions) were analysed. Facility childbirth constituted 81% of expected births in urban and 16% in rural areas. Based on the reference estimate that 1.4% of childbearing women were expected to need major obstetric intervention, unmet obstetric need was 77 of 106 women, thus 73% (95% CI 71–75%) in rural areas whereas urban areas had no deficit. Major obstetric interventions for absolute maternal indications were higher in urban 2.1% (95% CI 1.60–2.71%) than in rural areas 0.4% (95% CI 0.27–0.55%), with an urban to rural rate ratio of 5.5 (95% CI 3.55–8.76).

Conclusions

Women in rural areas had deficient obstetric care. The likelihood of under-going a life-saving intervention was 5.5 times higher for women in urban than rural areas. Targeting rural women with life-saving services could substantially reduce this inequity and preventable deaths.

Comparison of medical issues in antenatal and perinatal periods in early youth, adolescent, and young adult mothers in Taiwan: a 10-year nationwide study

BACKGROUND

Limited information is available concerning investigating the separate effect of teenage childbirth on medical issues in the antenatal and perinatal periods. Therefore, this study aimed to assess medical problems in antenatal and perinatal periods among early youth, adolescent and young adult mothers in Taiwan.

METHODS

This retrospective population-based cohort study was conducted by using data from Taiwan's National Health Insurance Research Database. A total of 335,590 mothers aged less than 25 years who had singleton births were identified between 2002 and 2011. Univariate and multivariate logistic regression analyses were conducted to estimate unadjusted and adjusted odds ratios (OR) and 95% confidence intervals (CI) of each medical problem category in the antenatal and perinatal periods.

RESULTS

Compared with mothers aged 20-24 years, adolescents (16-19 years) and early youth mothers (≤ 15 years), particularly those aged 10-15, had a significantly higher risk of intrauterine growth retardation (IUGR, OR = 1.37, 95% CI: 1.00-1.89) and preterm delivery (OR = 2.98, 95% CI: 2.48-3.58) after adjusting for demographic characteristics and clinical factors. Additionally, adolescents mothers were at an increased risk of anemia (OR = 1.32, 95% CI: 1.24-1.40), oligohydramnios (OR = 1.21, 95% CI: 1.12-1.32), failed labor induction (OR = 1.33, 95% CI: 1.24-1.43), and fetal distress (OR = 1.20, 95% CI: 1.14-1.26) after adjustment.

CONCLUSIONS

Not all young mothers in our study experienced the same magnitude of increased medical problems in the antenatal and perinatal periods. However, a sufficiently higher probability of having IUGR and preterm delivery was observed among early youth and adolescent mothers.

Perinatal outcomes and risk factors in adolescent and advanced age pregnancies: comparison with normal reproductive age women

The objective of the study was to analyse and compare demographic characteristics and clinical outcomes of pregnancies in adolescent, advanced age and normal reproductive age women. All completed pregnancies in a 6-month period, registered by the family practitioners in Denizli province, were included into the study. A face-to-face questionnaire was used to gather information. Participants were asked for demographic information, pregnancy outcome and obstetric history, obstetric and neonatal problems. Overall 5,882 pregnancies in different age groups: 296 (5%) adolescent (< 20-years-old); 4,957 (84.3%) normal reproductive age (20-35-years-old) and 629 (10.7%) advanced age (> 35-years-old ) (group III), were included into the study. Adolescent women had a lower educational status (p < 0.01), and family played a major role in decision of marriage (p < 0.01). Birth weight of the baby was lower in adolescents (p < 0.01). While adolescents tended to deliver vaginally (OR = 1.9, p < 0.01), elderly women were more prone to operative delivery (OR = 1.2, p < 0.05). Risk of caesarean section rate was higher in elderly nulliparous women (OR = 2.2, p 0.01). The number of spontaneous and induced abortions were increased with age (p < 0.01). Antenatal problems were seen least frequently in normal reproductive age women. Both antenatal (OR = 1.7, p < 0.01) and neonatal problems (OR = 1.5, p < 0.05), were significantly higher in advanced age pregnancy. It was concluded that with sufficient antenatal care, adolescent pregnancy is not associated with an increase in adverse pregnancy outcome, except low birth weights. Advanced maternal age is more likely to be associated with increased obstetric, maternal and neonatal complications.

A global perspective on adolescent pregnancy

Adolescent pregnancy is an international dilemma affecting not just the adolescent and her infant, but entire societies. Of almost 300 million female adolescents worldwide, 16 million give birth yearly, accounting for 11% of all births worldwide. The Millennium Development Goal # 5 incorporates reducing adolescent births worldwide. The purpose of this paper is a comprehensive critique of findings on a global perspective on adolescent pregnancy and evaluation of strategies to reduce this international concern. In Latin America and the Caribbean, unmet need for family planning made little change in 20 years. In Dutch and Scandinavian countries, there are national sex education programmes and family planning clinics run by nurse midwives with direct authority to prescribe contraceptives. In Japan, strong conservative norms exist about premarital sex. In the UK, a lack of consistent targeted sex education, delay in access to contraception and contraceptive use failure are associated with high teen pregnancy rates. In the United States, 750,000 teen pregnancies occur yearly, costing $9 billion per year. Health disparities exist: Whites had 11, Blacks had 32 and Hispanics had 41 per 1000 births. Programmes to reduce teen pregnancy should incorporate family, contraception and abstinence education, and sustained commitment of media, businesses, religious and civic organizations.

Young women's experiences as consumers of maternity care in Queensland

BACKGROUND

Young motherhood is commonly associated with vulnerabilities, stereotyping of young women's behavior, and poor outcomes for them and their children. The objective was to understand how maternity care is experienced by this group in the transition to parenthood.

METHODS

Data from a large-scale 2010 survey of women's experience of maternity care were analyzed using qualitative methods with open text responses.

RESULTS

Overall, 7,193 women responded to the survey: 237 were aged 20 years or less. Most (83%) of these young women provided open text responses. The main themes were: "being a consumer," "the quality of care," "needing support," and "pride in parenthood" whereas subthemes included "being young" and "how staff made me feel," "testimonials for staff," "not being left," and "it is all worthwhile."

CONCLUSION

Many young women responding described a positive experience. For many first-time mothers this feeling marked a change in their identity. Nevertheless, staff perceptions and attitudes affected how they saw themselves and what they took away from their experience of maternity care. A key message for other women is offered, supporting and reinforcing their role as active and involved consumers who, in engaging with services, have to stand up for themselves and make their needs and wishes known.

Young women's recent experience of labour and birth care in Queensland

BACKGROUND

young parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on women's experience of intrapartum care.

METHODS

secondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15-20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken.

RESULTS

in the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment.

CONCLUSION

this study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups

OBJECTIVE

To determine the risk factors of adolescent pregnancies and to ascertain the effects of this condition on the maternal and infant outcomes.

METHODS

The study was carried out on 100 adolescent mothers less than 20 years of age and on a same number of adult mothers between 22 and 32 years of age and their infants. A socio-demographic attributes questionnaire form, a pregnancy follow-up and birth history form, and a mother and infant follow-up form were used.

RESULTS

The mean age of the adolescent mothers was 17.8 ± 0.7 years and that of the adult mothers was 26 ± 0.3 years. Income level of 83% of the families of adolescent mothers and 69% of the families of adult mothers was below the poverty line (p < 0.05). Dropout rate (i.e. rate of those not attending any school) was 36% in the adolescent group and 21% in the adult group. Rate of exclusively breastfeeding during the first 2 months was 40% in adolescents and 62% in adults (p < 0.01). Higher rates of adolescent mothers felt themselves inadequate infant care and with 7% of them experiencing problems in accessing a healthcare institution.

CONCLUSIONS

Properly following up adolescent pregnancies during prenatal and postnatal periods may be helpful for preventing the negative impacts on mother and infant health.

Timing of antenatal care for adolescent and adult pregnant women in south-eastern Tanzania

Background

Early and frequent antenatal care attendance during pregnancy is important to identify and mitigate risk factors in pregnancy and to encourage women to have a skilled attendant at childbirth. However, many pregnant women in sub-Saharan Africa start antenatal care attendance late, particularly adolescent pregnant women. Therefore they do not fully benefit from its preventive and curative services. This study assesses the timing of adult and adolescent pregnant women's first antenatal care visit and identifies factors influencing early and late attendance.

Methods

The study was conducted in the Ulanga and Kilombero rural Demographic Surveillance area in south-eastern Tanzania in 2008. Qualitative exploratory studies informed the design of a structured questionnaire. A total of 440 women who attended antenatal care participated in exit interviews. Socio-demographic, social, perception- and service related factors were analysed for associations with timing of antenatal care initiation using regression analysis.

Results

The majority of pregnant women initiated antenatal care attendance with an average of 5 gestational months. Belonging to the Sukuma ethnic group compared to other ethnic groups such as the Pogoro, Mhehe, Mgindo and others, perceived poor quality of care, late recognition of pregnancy and not being supported by the husband or partner were identified as factors associated with a later antenatal care enrolment (p < 0.05). Primiparity and previous experience of a miscarriage or stillbirth were associated with an earlier antenatal care attendance (p < 0.05). Adolescent pregnant women started antenatal care no later than adult pregnant women despite being more likely to be single.

Conclusions

Factors including poor quality of care, lack of awareness about the health benefit of antenatal care, late recognition of pregnancy, and social and economic factors may influence timing of antenatal care. Community-based interventions are needed that involve men, and need to be combined with interventions that target improving the quality, content and outreach of antenatal care services to enhance early antenatal care enrolment among pregnant women.

Factors affecting the utilisation of postpartum care among young mothers in Bangladesh

This article addresses the hypothesis that predisposing, enabling and need factors of households influence utilisation of postpartum care among the young mothers according to the timing and type of providers. To reach our goal Bangladesh Demographic and Health Survey of 2007 data (n = 2376) were used. Findings revealed that only one-third of the young mothers received postpartum care. Postpartum care by medically trained personnel and within the most critical period (within 48 h after delivery) was found to be very low (25.5 and 16.6%). Regarding postpartum morbidities, only one-fifth to one-half of the women reporting a complication consulted medically trained providers. Indeed, between one third and two thirds did not seek any postpartum care. The highest percentages contacting healthcare providers were for convulsions and the lowest was when the baby's hands or feet came first. The stronger influence of the mother's education and antenatal care on the utilisation of postpartum care is consistent with findings from other studies. Concern of the husband or family about pregnancy complications showed a significant and positive impact on the utilisation of postpartum care. Multivariate analysis showed that mother's age at delivery, residence, education, antenatal care, place of delivery, wealth, husband's occupation, husband's concern about pregnancy complications and mother's permission to go to a health centre alone were likely to affect utilisation of postpartum care services. The results indicate urgent needs in Bangladesh for an awareness-raising program highlighting the importance and availability of postpartum care; for strategies to improve the availability and accessibility of antenatal care services and skilled birth attendance, including focused financial support; for women's education to be given high priority; and to enable women to exercise their rights to control their freedom of movement, own health care and access to economic resources.

Outcome of adolescent pregnancies in southwestern Nigeria: a case-control study

BACKGROUND

The most important health problems among adolescents in the developing countries are increased incidence of preterm labour and delivery, hypertensive disease, anaemia, more severe forms of malaria, obstructed labour, poor maternal nutrition and poor breastfeeding, low birth weight and increased neonatal mortality and morbidity.

OBJECTIVES

To evaluate the risk factors of adolescent pregnancy, assess and explore the occurrence of specific complications and compare pregnancy complications among adolescent parturients to older controls in a tertiary health centre in order to design appropriate policies and interventions.

METHOD

A retrospective study was conducted in a population of adolescents (age <18 years) delivered at the University College Hospital, Ibadan, Nigeria from January 2007 to November 2008. The birth register for the study-period was reviewed and socio-demographic data and labour records were extracted for both cases and controls.

RESULTS

The proportion of adolescent pregnancy between January 2007 and November, 2008 is between 1.5% and 2.2%. Overall, considering all the complications considered in the study 44.44% of adolescent pregnancies had one form of complication or the other. The corresponding figure among the control was 22.22%. The p-value = 0.002 showing that adolescents had statistically more significant complication rates in pregnancy. Concerning the individual complications, the incidence of eclampsia and pre-eclampsia among adolescent was 20% which was only 3.33% among the controls. The p-value when this was compared was 0.001 showing statistical significance.

CONCLUSION

Psychological, nutritional and social work services should be an integral part of obstetrical care in adolescent pregnancy especially in low resource country like Nigeria.

Pregnancies and births among adolescents: a population-based prospective study in rural Vietnam

OBJECTIVE

To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam.

MATERIAL AND METHOD

Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15-19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors.

RESULT

A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18 years. The estimated adolescent birth rate during 1999-2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW.

CONCLUSION

Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.

Comparison of prenatal care coverage in early adolescents, late adolescents, and adult pregnant women in the Peruvian Amazon

OBJECTIVE

To compare prenatal care coverage between adolescent (early and late) and adult pregnant women in Iquitos, Peru.

METHODS

A random sample of 4467 birth records was collected. Multivariate analyses were performed to compare prenatal care coverage in all adolescent (10-14 years, 15-19 years) and adult (>or=20 years) age groups and then for primiparous women only.

RESULTS

The mean number of visits was 5.0 for adolescents aged 10-14 years, 6.1 for adolescents aged 15-19 years, and 6.2 for women aged 20 years or older. For primiparous women, the means were 5.1, 6.2, and 6.8, for the respective age groups. Both the proportion attending and the number of prenatal visits were significantly lower in primiparous adolescents aged 10-14 years than in primiparous women aged 20 years or older (aOR 0.25; 95% CI, 0.10-0.62 and aRR 0.83; 95% CI, 0.74-0.94, respectively).

CONCLUSION

All women attended prenatal care more frequently than the WHO's recommended 4 visits; however, early adolescents attended significantly less often than late adolescents or adult women. Further study of this inequality is warranted to adequately inform local health services.

Cesarean delivery rates in adolescent pregnancy

OBJECTIVES

To investigate the rates of cesarean deliveries in two different hospitals, which serve different populations in Turkey.

METHODS

The study was conducted at two centers, one of which is a university hospital in a rural area and the other a community hospital in capital city, for 5 years (1999-2003). The subjects were < 18 years old adolescent mothers. The adult controls ( 18 years) were further divided in two age groups: 18-35 years and > 35 years.

RESULTS

A total of 40,391 pregnant women were evaluated in both hospitals. Cesarean delivery rates in adolescent pregnancies were not higher than adults. Moreover, in community hospital, cesarean delivery rate in adolescents was significantly lower (17.12% vs. 28.84%).

CONCLUSIONS

We concluded that, the cesarean deliveries are not increased, and even decreased in adolescent pregnancies and biological immaturity is not a significant problem in adolescent pregnancy.

Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan Africa

INTRODUCTION

Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers women's ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complications during antenatal care for the most recent pregnancy, and examined the impact of advice receipt on the likelihood of institutional delivery.

METHODS

A cross-sectional, cross-country analysis was performed on data from the most recent Demographic and Health Surveys (DHS) of 19 countries of sub-Saharan Africa. Multilevel logistic regressions were used to predict the probability of receiving information and delivering in a health centre, by clinical risk factors (age, parity, previous pregnancy termination), social factors (area of residence, education), and the frequency of service utilization (number of visits).

RESULTS

The percentage of women recalling information about potential complications of pregnancy during antenatal care varied widely, ranging from 6% in Rwanda to 72% in Malawi, and in 15 of the 19 countries, less than 50% of women reported receiving information. Institutional delivery ranged from 29% (Ethiopia) to 92% (Congo Brazzaville). Teenagers (OR = 0.84), uneducated (OR = 0.65) and rural women (OR = 0.70) were less likely to have been advised, compared with women aged 20-34 years, women with secondary education and urban women, respectively. Likelihood of recalling information increased with the number of antenatal visits. Advice reception interacts with the number of antenatal visits to increase the likelihood of institutional delivery.

CONCLUSION

There is a high level of unmet need for information on pregnancy complications in sub-Saharan Africa, particularly among those who face significant barriers to accessing care if complications occur. Educational interventions are critical to safe motherhood initiatives; health providers must fully use the educational opportunity in antenatal care.

One foot wet and one foot dry: transition into motherhood among married adolescent women in rural Vietnam

This study explores married Vietnamese adolescents' perceptions and experiences related to transition into motherhood and their encounter with health care service. In-depth interviews were conducted with 22 women younger than 20 who were either pregnant or had newly delivered. It emerged from the narratives that young women experienced ambivalence in the transition to motherhood in that they felt too young but also happy to be able to please their husband and the extended family. Patterns were shown indicating that the participants experienced lacking power with regard to decisions in relation to pregnancy, delivery, and contraceptive usage. Feelings of being patronized and ignored in the encounter with health care providers were seen in the narratives. Findings might be used for reproductive health care providers, social workers, and educators in their contact with young mothers to empower them to make their own decisions with regard to marriage, childbearing, and contraception.

Determinants of malnutrition in Senegal: individual, household, community variables, and their interaction

The relationship between poverty and nutrition is a two-sided one: on the one hand, economic growth (which is generally associated with an eradication of poverty) leads to reduced malnutrition. On the other hand, nutrition is one of the key ingredients for human capital formation, which in turn represents one of the fundamental factors of growth. There are numerous studies that show the correlates of malnutrition using both household- and community-level variables. However, few of these studies allow for the potential endogeneity of community infrastructure or indicate their interplay with characteristics of the mother. The current study considers the socio-economic determinants of child malnutrition and investigates how programs compensate for the increased risks facing young mothers and their children or substitute for a low social status of the mother in the household. The empirical results show that children of mothers giving birth at a young age are disadvantaged in terms of their anthropometric status. Interaction effects of the presence of a non-governmental organization (NGO) or a health post in the village with characteristics of the mother stress the important role played by these institutions in helping disadvantaged mothers overcome their difficulties. These findings have implications for efficient program design and represent a further step towards gaining an improved understanding of the complex determinants of child (mal)nutrition.

Potential use of birthweight indicators in rural Tanzania for monitoring malaria control in pregnancy

OBJECTIVE

Birthweight outcomes in rural Tanzania were determined in relation to place of delivery (hospital, dispensary or home), parity and maternal age (adolescent or non-adolescent) in order to evaluate the usefulness of birthweight data for monitoring malaria control in pregnancy.

STUDY DESIGN

Retrospective descriptive study.

METHODS

Birthweight data for the years 1997-2001 were obtained from Kilosa district hospital (n=6269), nine dispensaries (n=3688) and for home deliveries (n=677).

RESULTS

The prevalence of low birthweight in singletons was highest in hospital births (primigravidae, 23.4%; multigravidae, 10.0%). Adolescent primigravidae with home deliveries had the lowest mean birthweight (2.611 kg; 95% confidence interval 2.546-2.676 kg). An excess risk of low birthweight in primigravidae compared with multigravidae was seen with increasing distance from the district hospital. The population attributable risk percent for low birthweight in primigravidae associated with malaria increased with distance from the hospital, from 30% for Kilosa town to 45.7% at distances >50 km. Young adolescent primigravidae were at highest risk of poor birthweight outcomes. Dispensary birthweight data were considered to provide the most representative sample for routine birthweight surveillance.

CONCLUSIONS

Birthweight indicators show that malaria control in pregnancy is poor in this population, deteriorates with distance of place of birth from the main hospital location, and is worst in adolescent primigravidae. Greater attention should be given to the use of birthweight indicators in rural areas of Tanzania for monitoring malaria control in pregnancy.

Optimizing breastfeeding promotion and support in adolescent mothers

The United States has the highest teen birth rate in the industrialized world, and adolescents continue to have the lowest rates of breastfeeding. Although individual pregnancy and parenting experiences in adolescents are modified by a variety of factors, common themes of adolescent psychology and behavior may help plan effective strategies for breastfeeding promotion and support. Breastfeeding promotion and support in adolescents need to be developmentally appropriate, patient centered, and linked to multidimensional support.

Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential

Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today's adolescents at heightened risks for poor health outcomes. Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programmes should offer accurate, comprehensive information while building skills for negotiating sexual behaviours. Girls and boys also need equal access to youth development programmes that connect them with supportive adults and with educational and economic opportunities. Although progress has been made since the 1994 International Conference on Population and Development, adolescents continue to be disproportionately burdened by threats to their sexual and reproductive health.

Vitamin–mineral supplement use by low-income Brazilian pregnant adolescents and non-adolescents and the predictors for non-use

OBJECTIVES

To determine (1) the intake of vitamin-mineral supplements by 855 low-income Brazilian pregnant adolescents and non-adolescents in three interviews (gestational ages < or =16, 20-26 and 30-36 weeks), (2) the relationship between vitamin-mineral supplementation and toxic exposure, and nutritional, psychological, socio-economic, demographic and obstetric characteristics of the women.

DESIGN

Longitudinal cohort study.

SETTING

Jundiaí city, São Paulo, Brazil.

SUBJECTS

A total of 855 pregnant adolescents and non-adolescents who attended antenatal care from September 1997 to August 2000.

METHODS

A general questionnaire was utilized three times in pregnancy (gestational ages < or =16, 20-26 and 30-36 weeks) to investigate the vitamin-mineral supplements ingested by the women, their smoking habit and alcohol intake, anthropometric measurements (pre-pregnancy and actual weight, height, mid-upper arm circumference) and psychological (anxiety, stress and distress), socio-economic (per capita income), demographic (education, age, marital status) and obstetric (gravidity) characteristics. The associations between vitamin-mineral supplementation and maternal characteristics were assessed in 12 multiple logistic regression models, stratifying the women by age and per capita income.

RESULTS

Iron and vitamin C were the most ingested supplements by adolescents and non-adolescents, in the three interviews. Logistic regression analysis revealed that the maternal predictors for non-use of vitamin-mineral supplementation were acute anxiety and alcohol intake for adolescents, and low education, single without partner, distress (anxiety, depression, etc.) and stress for non-adolescents.

CONCLUSIONS

These are important data to identify groups of low-income pregnant women in need of supplementation guidance and nutrition education. Stress/distress was a predictor for non-use of vitamin-mineral supplements for both adolescents and non-adolescents pregnant women.

Maternal mortality among adolescent women in Jos, north-central, Nigeria

The adolescent maternal mortality ratio is high in Jos, north-central Nigeria. The main causes of maternal deaths among the adolescents were unsafe abortion, eclampsia and sepsis. The Hausa/Fulani ethnic group constituted the largest ethnic group of adolescent maternal deaths in our study. The risk factors for adolescent maternal mortality found in our study were illiteracy, non-utilisation of antenatal services and Hausa/Fulani ethnic group.

Principais mudanças corporais percebidas por gestantes adolescentes assistidas em serviços públicos de saúde de Goiânia

OBJETIVO: O objetivo do estudo foi identificar as mudanças corporais percebidas por gestantes adolescentes e a opinião delas sobre tais mudanças. MÉTODOS: Os dados foram coletados por meio de entrevista, fundamentada em questionário, com 132 gestantes adolescentes, menores de 18 anos que faziam o pré-natal em três serviços públicos de saúde de Goiânia entre 1996 e 1997. Também foi aplicada uma escala de avaliação do apoio familiar e outra de atitude quanto ao ganho de peso. RESULTADOS: As gestantes adolescentes tinham em média 16 anos, 64% eram casadas ou viviam em união consensual e 78% não estudavam. Os dados da escala de apoio familiar indicaram apoio positivo em relação à gestante. As principais mudanças corporais identificadas foram o seio, o peso e a barriga. A mais apreciada foi o crescimento da barriga, possivelmente em função do papel da maternidade na sociedade; a menos apreciada foi o aumento do seio. Constatou-se uma divergência estatisticamente significante (p<0,05) entre a avaliação do peso pré-gestacional e a auto-avaliação deste, sendo que 92% manifestaram atitudes positivas em relação ao ganho de peso. CONCLUSÃO: Uma adequada orientação do serviço de saúde, durante o pré-natal, deve compreender a adolescente a partir da interação entre o universo vivenciado pela gestante e a percepção sobre as mudanças ocorridas em seu corpo.

Perfil sócio-demográfico e psicossocial de puérperas adolescentes do Município do Rio de Janeiro, Brasil - 1999-2001

Identificar o perfil sócio-demográfico de puérperas adolescentes, segundo a faixa etária e a situação conjugal. Foram entrevistadas 1.228 adolescentes no pós-parto imediato em maternidades públicas, conveniadas com o SUS e privadas do Município do Rio de Janeiro. A análise estatística consistiu em utilizar testes qui-quadrado (chi2) para testar hipóteses de homogeneidade de proporções. Ao comparar os dois grupos, observa-se que as adolescentes mais jovens e sem união consensual estão mais sujeitas a engravidar de outros adolescentes, muitos dos quais desempregados; a não desejar a gestação; a não receber apoio familiar ou do pai do bebê e a realizar mais tentativas de aborto. A aderência às consultas pré-natais foi influenciada pela presença de uma união consensual. As adolescentes com menos idade e sem união consensual demonstraram maior insatisfação com a gestação, e a união conjugal influenciou positivamente a maneira como a gestação foi percebida pela família e pela própria adolescente. Os resultados obtidos revelam que as adolescentes em idade mais precoce e sem união consensual apresentam piores condições sócio-demográficas e psicossociais.

Family and community support to adolescent mothers in Swaziland

BACKGROUND

Early pregnancy and unplanned childbirth have far-reaching physical, psychological and social consequences to the adolescent girl and her offspring and is therefore a public health problem for concern. At Mbabane Government Hospital 25% of the deliveries are by women aged 10-19 years. Little has been documented about family and community support for adolescent mothers in Swaziland.

AIM

The aim of this study was to generate more systematic data on support to adolescent mothers and their newborns during the early postpartum period by families, communities and health professionals.

METHODS

Thirty-one adolescent mothers were recruited from Mbabane Obstetric Unit after childbirth and were visited in their homes 7 days after delivery and interviewed about the family, community and health professional support experienced for themselves and their newborns. A semi-structured interview guide was used to obtain both quantitative and qualitative data.

FINDINGS

Support from families, community and health professionals were generally poor, and pregnancies among adolescents were unplanned. There was poor or no communication, and information from parents and the community on sexuality and reproductive health had been grossly lacking. Peers were the primary source of information about sexuality and reproduction. Communities did not offer services aimed at providing adolescents with information and skills regarding safe sexual behaviour.

CONCLUSIONS

Adolescents need contraceptive counselling and services in order to prevent pregnancies at a young age. Communication among parents and their daughters needs to be encouraged in order to monitor postpartum care and also to ensure continuity of maternity care.

Sexual abstinence and the Sexual Abstinence Behavior Scale

INTRODUCTION

Nurses may choose to promote sexual abstinence, particularly when they are working with young adolescents. However, it is difficult to know how to intervene because sexual abstinence has not been well defined in the literature. The purpose of this study was to evaluate the psychometrics of a four-item measure of sexual abstinence behavior (the SABS) that both registered nurses and advanced practice nurses may find useful in their practice.

METHOD

African American, middle school students (n = 113) completed a self-administered questionnaire during their health education class. The questionnaire contained the SABS along with items assessing demographics, sexual behavior, and psychosocial variables related to sexual behavior.

RESULTS

Psychometric analysis supported SABS reliability (alpha =.73) and validity. For example, SABS scores correlated with perceived negative consequences of teen sex (r = 0.38) and sexual abstinence self-efficacy (r = 0.48).

DISCUSSION

Although the SABS is still in a preliminary stage of development, it is useful for assessment purposes and for directing registered nurses and advanced practice nurses toward specific behaviors they may want to promote when teaching sexual abstinence to their young adolescent patients.

Nursing care for pregnant adolescents

Although the physical care of pregnant adolescents is similar to that required by adult women, adolescents have additional unique needs. Adolescents often need more support and extensive teaching during pregnancy and the postpartum. Moreover, adolescents often have fewer life experiences than do adult women, making them less able to cope with the life changes they are experiencing related to pregnancy and birth. Nonjudgmental and developmentally appropriate interactions are essential to the care of pregnant adolescents. This article explores nursing care for the physical, emotional, and educational needs of adolescents during the prenatal, intrapartum, and postpartum periods.

Effective prenatal care for adolescent girls

Provision of prenatal care for adolescents requires an understanding of routine prenatal care as well as developmental and psychosocial issues unique to this population. In this article, management of adolescent pregnancy, including the prenatal history, physical examination, diagnostic testing, and follow-up care are presented. Collaboration with other disciplines, which optimizes care, is also discussed.

Characteristics of inner-city pregnant smoking teenagers

OBJECTIVE

To describe baseline characteristics of inner-city pregnant adolescent smokers and examine these variables as potential predictors of long-term tobacco abstinence.

STUDY DESIGN

Descriptive study design of the characteristics of pregnant adolescent smokers, with conceptual underpinnings from the Problem-Behavior Theory.

SETTING

Recruitment and data collection were completed in inner-city outpatient clinics and public schools.

PARTICIPANTS

The study enrolled 142 pregnant smoking adolescents.

MAIN OUTCOME MEASURES

Self-reported smoking behavior (abstinence vs. smoking) assessed at 12 months from study enrollment was the criterion outcome variable. Variables from Problem-Behavior Theory, tobacco use, and demographics variables were selected as predictors of interest.

RESULTS

Twelve months following study enrollment, 123 (87%) participants were smoking, with 19 (13%) reporting abstinence. Pregnant adolescents received messages of encouragement from parents and peers to quit smoking but complicated their pregnancies and smoking cessation efforts by concurrently consuming alcohol during the pregnancy.

CONCLUSION

Findings from this study support previous research on adolescent smokers and extend our knowledge to the inner-city pregnant adolescent smoker. These pregnant teenagers present many needs and challenges for the nurses responsible for their care.