Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

Determinants of teenage pregnancy in Malawi: a community-based case-control study

BACKGROUND

Teenage pregnancies are a global concern. Malawi is one of the countries with the highest teenage pregnancy rates despite government efforts to reverse the situation and yet studies on determinants of teenage pregnancy are rare with some factors remaining unexplored. Therefore, this study aimed to identify factors associated with teenage pregnancies in Malawi.

METHODS

This was a community-based case-control study that used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. The study population comprised women aged 20-24 who participated in the survey. The study ran from September 2021 to October 2022 and used a sample size of 3,435 participants who were all women aged 20-24 in the dataset who met the inclusion criteria. Data were analysed using Stata 16 software. Logistic regression analyses were used to determine factors. Variables with a P value of < 0.1 in the univariable analysis were included in the multivariable analyses, where statistical significance was obtained at a P value < 0. 05.

RESULTS

Data on 3435 participants were analysed. In multivariable analyses: no teenage marriage (AOR 0.13); secondary education (AOR 0.26); higher education (AOR 0.39); richest category of wealth index (AOR 0.51), use of contraception (AOR 3.08), domestic violence by father or mother (AOR 0.37) were found to be significant factors.

CONCLUSION

This study identified determinants of teenage pregnancy. The government has to sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy. Further research is also recommended to resolve inconclusive results.

Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

BACKGROUND

Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women's and children's health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA.

METHODS

The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20-24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design.

RESULTS

The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15-24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA.

CONCLUSION

The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women.

Prevalence and correlates associated with early childbearing among teenage girls in Ethiopia: A multilevel analysis

BACKGROUND

Teenage childbearing remains a significant global health concern, and in nations with limited resources, it is the major cause of newborn and maternal deaths. Early teenage childbearing is still Ethiopia's public health issue. Therefore, the goal of this study was to identify the prevalence and correlates of influencing early childbearing among teenage girls across Ethiopia.

METHODS

We conducted a secondary analysis of cross-sectional data from the 2016 Ethiopian Demographic and Health Survey. A multistage stratified cluster sampling strategy based on the community was used to include the 3,498 participants in total. To determine the significantly correlated factors that influence adolescent pregnancy, a multilevel binary logistic regression analysis was used. The factors that have a significant association with early childbearing were identified using the Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI).

RESULTS

This study demonstrated that 10.3% of teens across the country had children at an early age. The odds of early childbearing among teenage girls increased with first marriages occurring before the age of 18, non-formal education, being from a lower- or middle-class family, not using contraceptives, following Muslim or other religious beliefs, and being aware of the fertile window. Teenagers who had exposure to the media, however, had a reduced chance of becoming pregnant early.

CONCLUSIONS

The study indicates that early teenage childbearing is still Ethiopia's most significant public health problem. Therefore, the Ethiopian government should ban early marriage while also taking steps to reduce the risk through formal education, improved access to reproductive health education, and contraception, particularly for adolescent girls from low-income families and, by educating religious institutions about pregnancy dangers.

Trends change in teen pregnancy among adolescent women in Ethiopia based on Ethiopian demographic and health surveys: Multivariate decomposition analysis

BACKGROUND

Teenage pregnancy may adversely affect their health, economic, and social life. Evidence shows that no studies in Ethiopia used decomposition analysis to identify factors for the trend change in teen pregnancy. Therefore, this study aimed to examine the trends and identify contributing factors to teen pregnancy in Ethiopia using multivariate decomposition analysis.

METHOD

We obtained the data on adolescent women from three Ethiopian Demographic and Health Surveys. A weighted sample of 3266 in 2005, 4009 in 2011, and 3381 teenagers in 2016 were involved in this study. Statistical analysis was performed using STATA 14. Multivariate decomposition analysis was used to identify contributing factors to the change in teen pregnancy. The coefficient value with a 95% confidence interval was used to identify significant factors associated with teen pregnancy.

RESULTS

The prevalence of teen pregnancy in Ethiopia decreased significantly from 15.9% [95% CI: 14.3, 17.7] in 2005 to 12.5% [95% CI: 10.8, 14.3] in 2016. Multivariate decomposition analysis showed that approximately 83% of the overall change in teen pregnancy over time was due to differences in women's composition. Age, marital status, education status, working status, contraceptive use, and sexual status before age 18 were statistically significant contributing factors to the decline in teen pregnancy over time.

CONCLUSION

The prevalence of teen pregnancy in Ethiopia decreased significantly over time. The overall decline in teenage pregnancy is due to differences in population composition. Public health interventions should focus on changing cultural norms or attitudes regarding early marriage and pregnancy within religious leaders and uneducated communities.

Perception, practices, and understanding related to teenage pregnancy among the adolescent girls in India: a scoping review

BACKGROUND

Teenage pregnancy is a concerning public health problem in India. Misperception and misunderstanding about pregnancy and its preventive methods lead to pregnancy when adolescents are involved in unsafe sexual intercourse. This scoping review aims to discuss the evidence on the perception, practices, and understanding related to teenage pregnancy among adolescent girls in the Indian context.

METHOD

The Arksey and O'Malley scoping review framework and Joanna Briggs Institute Reviewers' Manual were used for the scoping review. The Population, Concept, and Context strategy (PCC) ensured the review questions, eligibility criteria, and search strategy. The Systematic Review and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) was used. A literature search was done using electronic databases by specific keywords such as "teenage", "adolescences", "pregnancy", "perception", "knowledge", "awareness", etc. Relevant grey literature was identified through further searching. The review included studies that fulfil inclusion criteria having female adolescent groups aged from 10 to 19 years in the Indian context between the years 2000 and 2021.

RESULT

We found 40 eligible studies; more than half of these were from southern (35%) and northern (27.5%) regions, and studies from the rest of India were very sporadically distributed. Most studies (72.5%) were published in the last 10 years. The relevant extracted data from individual studies were synthesized and presented in the two major sections, perception, practices, and the second one, understanding and experiences among teenage girls. The understanding of pregnancy and teenage pregnancy-related preventive methods was detailed analysis in about 72% of papers whereas other aspects, such as perception (22.5%), practices (25%), and experiences (7.5%) were discussed in the remaining papers related to pregnancy among adolescent girls.

CONCLUSION

Evidence in the selected studies shows that understanding and practices are the major areas that were primarily explored, where perception, practices and experiences are the topics that are relatively less investigated. Literature synthesis derives misconception, lack of understanding, and practices without knowing the consequences are the key factors responsible for early pregnancies. Future interventions like increasing awareness, providing comprehensive reproductive knowledge, convenient health care aids, and proper counselling are adequate measures for minimalising the problem. The present analysis showed that studies are limited in their scope concerning various aspects of teenage pregnancy in India, so this scoping review gives essential perspectives on future research and implementation plans and policies in this field.

Epidemiology of Adverse Outcomes in Teenage Pregnancy-A Northeastern Romanian Tertiary Referral Center

Background: Despite being a very well-documented subject in the literature, there are still conflicting results regarding teenage pregnancies and their fetal outcomes. Methods: We conducted a retrospective, comparative cohort study that included 1082 mothers aged less than 18 years, compared to 41,998 mothers aged over 18 years, who delivered in our tertiary referral center between January 2015 and December 2021. To check for significant differences between the two groups, the chi-qquared or Fisher’s test for categorical variables were used. Results: We detected statistically significant higher rates of fetal malformation, premature birth, FGR and SGA fetal growth conditions, preeclampsia, condylomatosis and vaginal infection with E. coli in our cohort of teenagers. In this subpopulation of teenagers, the rate for premature birth at less than 32 weeks of gestation was 3.26-fold higher and 3.25-fold higher for condylomatosis, and these results referred to the cohort of adult patients (>18 years old) that gave birth in the same interval of time. Conclusions: Teenage pregnancies still remain a major health problem that burdens all countries worldwide regardless of their income. It needs solutions initially to prevent pregnancy in this young age segment and last but not least to improve both maternal and fetal outcomes.

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.

Determinants of early marriage among married women in nine high fertility sub-Saharan African countries: a multilevel analysis of recent demographic and health surveys

BACKGROUND

Early marriage is global issue that seriously harms women's personal development and rights. Regarding this, information about married women's early marriage is inadequate in the world, including sub-Saharan Africa; therefore, this study aimed to assess the early marriage of women in the top nine highly fertile SSA countries.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 121,077 married reproductive-age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of early marriage. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.

RESULTS

Overall prevalence of early marriage was 55.11% (95% CI: 54.8, 55.4) and ranged from 28.11% in Burundi to 80.77% in Niger. The factors significantly associated with early marriage were women's educational status; primary education (AOR = 0.39; 95% CI: 0.38, 0.41), secondary and higher (AOR = 0.1; 95% CI: 0.09, 0.11), employed (AOR = 0.73; 95% CI: 0.71, 0 .75), classified as rich wealth index level (AOR = 0.87; 95% CI: 0.85, 0.91), a number of family size ≥ 7 (AOR = 1.28; 95% CI: 1.23, 1.33), community-level poverty, (AOR = 1.28; 95% CI: 1.23, 1.33) and rural residency (AOR = 1.16;95% CI: 1.12, 1.21).

CONCLUSION

Marriage before the age of 18 is moderately high in high-fertility countries. Therefore, the respective countries government should give due attention to access to education, and encourage the participation of women in making marriage-related decisions, especially those residing in rural areas.

Trends and determinants of adolescent pregnancy: Results from Kenya demographic health surveys 2003-2014

Background

Adolescent pregnancy increases the risk of disability and death due to unsafe abortion, prolonged labour and delivery, and complications after birth. Availability of accurate data is important to guide decision-making related to adolescent sexual reproductive health (ASRH). This study analyses the trends in prevalence and factors associated with adolescent pregnancy in Kenya using data from three national Demographic Health Surveys (2003, 2008/2009, 2014).

Methods

Our analysis focused on a subsample of data collected from women aged 20 to 24 years. A trend analysis was performed to establish a change in the rate of adolescent pregnancy in 2003, 2008/2009, and 2014 survey data points. Binary Logistic regression and pooled regression analysis were used to explore factors associated with adolescent pregnancy.

Results

The percentage of women aged 20 to 24 years who reported their first pregnancy between ages 15 and 19 years was 42% in 2003 and 42.2% in 2009 but declined to 38.9% in 2014. Using regression analyses, we established that education status, marital status, religion and wealth quintile were associated with adolescent pregnancy. Trend analysis shows that there was an overall decreasing trend in adolescent pregnancy between 2003 and 2014.

Conclusion

Although Kenya has made strides in reducing the prevalence of adolescent pregnancy in the last decade, much more needs to be done to further reduce the burden, which remains high.

Definition

Adolescents: Although WHO defines the adolescence period as being 10–19 years, this paper focuses on the late adolescent period, 15–19 years, here in referred to as adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01986-6.

'Direct' and 'instant': the role of digital technology and social media in young Filipinos' intimate relationships

Young people today grow up in a social landscape in which digital technology and social media are ubiquitous in daily life and interpersonal relations, including intimate (romantic and sexual) relationships. This study sought to study Filipino young people's relationship motivations and contexts in the digital age. We found that digital technology and social media are transforming the way Filipino young people approach and behave in intimate relationships. Digital technology and social media are making it easier for young people to engage in social comparison with their peers and role models, expanding possibilities for social interaction, facilitating rapid relationship progression, and enabling digital togetherness and self-expression in a context where conservative religious and sociocultural norms and sexual double standards remain dominant. This social environment brings opportunities to engage in relationships in new ways but also exposure to risks that may lead to poor sexual and reproductive health outcomes. Our findings underscore the importance of comprehensive sexuality education in schools and at home, and highlight the need for critical dialogue about the social norms and stereotypes that perpetuate gender-based violence and inequality in online and offline spaces.

A structural equation modeling of reproductive health promoting behaviors among female adolescents in the Philippines

AIMS

Integrated reproductive health promoting behaviors, including safe sexual intercourse, preventing sexually transmitted diseases, sexual responsibility, and genital health management, are essential for adolescents in developing countries. The Philippines is currently facing several reproductive health threats. The aim of this study was to identify factors affecting reproductive health promoting behaviors based on a theoretical model using structural equation modeling.

METHODS

In this cross-sectional study and a structural equation modeling, a total of 227 female adolescents in the Philippines participated in a self-reported questionnaire survey.

RESULTS

The results indicated that reproductive health knowledge (β = .14, p = .033), attitudes regarding reproductive health behaviors (β = .31, p = .027), and reproductive health self-efficacy (β = .31, p = .002) influenced participants' reproductive health promoting behaviors. Social norms (β = .31, p = .021) influenced reproductive health self-efficacy and indirectly influenced reproductive health promoting behaviors. Attitude toward gender roles (β = .20, p = .020) was associated with reproductive health knowledge.

CONCLUSIONS

This study confirmed the direct effect of reproductive health knowledge, attitudes regarding reproductive behaviors, and reproductive health self-efficacy, as well as the indirect effect of social norms, on reproductive health promoting behaviors using structural equation modeling.

Early union, 'disgrasya', and prior adversity and disadvantage: pathways to adolescent pregnancy among Filipino youth

BACKGROUND

Few studies explore what it means to be an adolescent parent in the Philippines from the young parents' perspective. This study sought to improve understanding of how adolescent mothers and young fathers experienced pregnancy in Palawan, Philippines.

METHODS

We conducted narrative analysis of 27 semi-structured interviews with 15 Filipino young parents.

FINDINGS

Our findings point to three pathways to adolescent pregnancy differentiated by life circumstances and perceived self-efficacy: through early unions, through 'disgrasya' (accident) in romantic relationships, and when pregnancy is directly related to adversity and disadvantage. Some young people adopted agentic narratives and had intended pregnancies within early unions. Young people who had unintended pregnancies in romantic relationships recounted constrained choice narratives, taking responsibility for their decisions while emphasising external factors' influence on their decision-making. Other young mothers described the ways that prior adversity and disadvantage gave rise to unfavourable circumstances-including sexual violence-that led to unintended pregnancy but shared narratives showing how they had reclaimed agency in their lives.

CONCLUSION

Our findings highlight the need to (1) address underlying poverty and structural inequalities that limit Filipino young people's life choices and contribute to their pathways to adolescent pregnancy; (2) provide Filipino young people with access to essential sexual and reproductive health information, services, and supplies; and (3) change social norms to rectify gender-based power imbalances and sexual violence.

Prevalence and predictors of teenage pregnancy in Pakistan: a trend analysis from Pakistan Demographic and Health Survey datasets from 1990 to 2018

Background

Teenage pregnancies carry an increased risk of adverse obstetric and health outcomes for mothers and children.

Methods

This study assessed the prevalence and predictors of teenage pregnancies over time in Pakistan using the Pakistan Demographic and Health Survey (PDHS). Data on 400 076 ever-married pregnant women aged 15–49 y from four PDHS datasets were used. Teenage pregnancy was the outcome variable, whereas a woman's and her partner's education, occupation, wealth quintile, region, place of residence and access to knowledge on family planning were the explanatory variables. Pooled prevalence was estimated and regression analysis was undertaken to produce an adjusted prevalence ratio with 95% CIs.

Results

Although the prevalence of teenage pregnancy decreased from 54.4% in 1990–1991 to 43.7% in 2017–2018, the pooled prevalence was 42.5% (95% CI 37.9 to 49.6%). The prevalence of teenage pregnancy was significantly associated with place of residence, wealth quintile, education and occupation.

Conclusion

Despite a growing focus on women's education, access to sexual and reproductive health (SRH) services and contraception in the last decade in Pakistan, the prevalence of teenage pregnancy is still high. There is a pressing need to develop appropriate strategies for increasing access to education, SRH services and use of contraception in Pakistan.

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

INTRODUCTION

In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa.

METHODS

We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy.

RESULTS

Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy.

CONCLUSION

The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

Narratives on Sex and Contraception From Pregnant Adolescent Women in a Northern Province in Thailand: A Phenomenological Study

Gaps in understanding, a lack of awareness of contraceptive use and a lack of control, related to gender dynamics, may influence the demand for contraception among adolescents and their decision-making around pregnancy prevention. This study explored the experiences of pregnant adolescents at the time of pregnancy and prior to becoming pregnant, examining attitudes toward sex and contraception. An interpretive phenomenological study guided by Heideggerian philosophy, analysed data from 30 in-depth interviews conducted with purposively selected consenting pregnant adolescents aged 15–19. Interviews were audio-recorded and transcribed verbatim and were analysed using a modified interpretative phenomenological approach. Participants exposed 5 key findings or experiences associated with sex and contraception: ‘Premarital cohabitation and sex’, ‘Staying in the relationship’, ‘Unforeseen future’, ‘Parental conformity’, and ‘Male command’. These findings can have far-reaching implications for the holistic understanding of the needs of adolescents in Thailand. They can be used to inform the development of appropriate and responsive interventions to support female and male adolescents, their families, and society. This includes interventions around reproductive health rights and sex education from health care providers, educators providing counselling to facilitate adolescents’ decision-making in order to reduce unintended adolescent pregnancy.

<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.