Social and Biological Transgenerational Underpinnings of Adolescent Pregnancy

Identifying the causes and consequences of pregnancy in Iranian Kurdish women under the age of 18: A grounded theory study

Background

Since teenage pregnancy is one of the major challenges for healthcare systems worldwide and can pose risks to the health of young mothers and their infants, the present study was conducted to identify the Identifying the causes and consequences of pregnancy in Iranian Kurdish women under the age of 18.

Method

The present qualitative research was conducted using the grounded theory method among women with experience of pregnancy under the age of 18 and key informants who had experience and knowledge in this field. Data were collected through semi-structured face-to-face interviews with 26 women and 17 key informants who were selected through purposive, snowball, and theoretical sampling methods. Sampling continued until theoretical saturation. The data were collected and analyzed for 8 months, from November 2021 to June 2022. Data analysis was performed based on the approach of Strauss and Corbin in the MAXQDA-2018 software environment. The Guba and Lincoln criteria were observed to ensure the trustworthiness of the data and results.

Results

After the data analysis and coding process, the conceptual model of causes and consequences of pregnancy in adolescents emerged, including 1) predisposing conditions (sociocultural factors: Social learning, misconceptions about fertility and childbirth, preventing stigma), 2) causal conditions (individual factors: lack of knowledge on how to prevent pregnancy, improper use of contraceptives, inadequate knowledge about the risks of pregnancy in adolescence, fear of the side effects of using contraceptives, filling the vacuum of loneliness, family factors: husband's and his family's pressure, committing her husband to life, consolidating her position in family), 3) intervening conditions (structural factors: no barriers to pregnancy, difficult access to contraceptives), 4) strategies and interactions (positive reactions: trying to prepare herself for raising a child, taking better care of herself and her child, negative reactions: trying to kill herself and the kid, fear and concealment), and 5) consequences (destructive consequences: threats to the health of the child, threat to mother's health, inadequate access to health services, constructive consequences: increase of support, strengthen the sense of empowerment).

Conclusion

Pregnancy in adolescence is influenced by socio-cultural, family, personal, and structural factors that can lead to positive and negative consequences for women, which in most cases make the lives and health of them and their children difficult. The findings of the study can be used in the areas of health and social policy, program planning, and designing interventions and educational programs aimed at changing beliefs and cultural attitudes related to pregnancy under the age of 18 at the individual, family, and societal levels.

Who is to blame for the 'problem' of teenage pregnancy? Narratives of blame in two South African communities

BACKGROUND

The framing of teenage pregnancy in social discourse influences the way in which adolescent girls and young women (AGYW) are treated, the extent to which they are supported, and to which they are able to engage with services and enact pregnancy prevention behaviours.

METHODS

Through the analysis of data from a qualitative study conducted in the South African communities of Newcastle in KwaZulu-Natal and Moretele in the North-West province, we explored narratives of blame for teenage pregnancy. Data derived from seventy-one in-depth interviews conducted with forty AGYW aged between 15 and 24, twenty-four parents/caregivers of AGYW, five service providers, ten school educators, and two other community members. Interpretation of data drew upon blame, attribution and framing theories.

FINDINGS

The overall framing of teenage pregnancy was overwhelmingly negative, with participants labelling it immoral and 'wrong'. Findings were arranged into key thematic areas that emerged in the data relating to blame for teenage pregnancy: the individual centred 'wrong-girl' and developmental discourses, in which blame was apportioned to AGYW for being immature, reckless, irresponsible, disobedient and greedy; the 'wrong-family' discourse in which blame was attributed to parents of AGYW for poor parenting and failing to adequately care for the adolescents in their responsibility; the 'wrong-men' discourse in which blame was attributed to men for luring AGYW into transactional sex, and for perpetrating gender-based violence; and lastly the 'wrong-society' discourse which attributed blame to contextual/structural factors such as poverty, a high volume of unregulated drinking establishments, and a lack of youth-friendly services.

CONCLUSIONS

Policies, interventions and programmes focusing on adolescents' sexual and reproductive health need to carefully consider the framing and narratives of blame and responsibility. There is an urgent need to shift away from the individualised moralistic shaming of pregnant AGYW, towards a recognition of a complex interplay of multilevel factors that enable or constrain AGYW's agency. Policies and programmes should focus on both providing sufficient support to AGYW, while also addressing structural factors and harmful narratives and thus create the conditions necessary to enable AGYW to enact safe, informed, agentic and responsible decisions and behaviours about their own sexual and reproductive health.

Pubertal Development and Pregnancy Outcomes Among System-Involved Youth

System-involved youth are a vulnerable population at high-risk of experiencing numerous sexual reproductive health (SRH) outcomes. They are likely to have several risk factors for teen pregnancy and parenting including abuse and neglect histories, lack of a supportive consistent adult in their lives, and limited opportunities to experience normal romantic relationships. Issues of pubertal development are rarely addressed in this population. Data is from system-involved adolescents (n = 301) enrolled in a SRH intervention. The final analysis is restricted to those who were sexually active at baseline (n = 229). Most participants were African Americans between 13-21 years of age. More than 70% reported an early mean age of first sex. Approximately a quarter self-reported early pubertal development. Logistic regression was utilized to examine the odds of pregnancy in relation to self-reported pubertal timing. The findings support the need to develop programming for system-involved youth which address their unique needs.

Applying Life History Theory to Understand Earlier Onset of Puberty: An Adolescent Brain Cognitive Development Cohort Analysis

PURPOSE

Life history theory posits that multigenerational exposure to adversity and deprivation influences childhood growth and development, including pubertal maturation. We applied this ecological, evolutionary theory to examine the contributions of distal and proximal adversity on early puberty, a potentially important marker for population health.

METHODS

Baseline data from 5,645 girls in the adolescent brain cognitive development study were included. Early puberty was defined as midlate/post pubertal development by age 9-11 years. The contributions of multigenerational Black/Indigenous (Black, Indigenous and People of Color [BIPOC]) or Hispanic identities, intergenerational mental health, economic deprivation, personal trauma exposure and mental health, and proximal biological factors of premature birth and body mass index on early puberty were examined with hierarchical modeling.

RESULTS

1,225 girls (21.7%) had early puberty. BIPOC/Hispanic identity, familial adversity, economic deprivation, personal trauma, depression, and a higher body mass index contributed significantly toward early puberty. The effect of multigenerational adversity remained significant across models, but the likelihood of early puberty decreased sequentially for BIPOC and Hispanic youth as proximal adversities were added (e.g., OR decreased from 2.93 to 2.38 for BIPOC youth), supporting a synergistic effect of layered adversity on early puberty.

DISCUSSION

This analysis supports life history theory as a coherent framework to understand early puberty among girls. Findings suggest monitoring pubertal timing as a population health indictor, like birth weight, prematurity, or life expectancy. Addressing early puberty may require policy and social changes to mitigate the negative impact of multiple layers of adversity including racial/ethnic disadvantage, family, and individual mental health and trauma, as well as economic insecurity.

Maternal distress, DNA methylation, and fetal programing of stress physiology in Brazilian mother-infant pairs

Maternal prenatal psychosocial stress is associated with adverse hypothalamic-pituitary-adrenal axis (HPAA) function among infants. Although the biological mechanisms influencing this process remain unknown, altered DNA methylation is considered to be one potential mechanism. We investigated associations between maternal prenatal psychological distress, infant salivary DNA methylation, and stress physiology at 12 months. Mother's distress was measured via depression and anxiety in early and late pregnancy in a cohort of 80 pregnant adolescents. Maternal hair cortisol was collected during pregnancy. Saliva samples were collected from infants at 12 months to quantify DNA methylation of three stress-related genes (FKBP5, NR3C1, OXTR) (n = 62) and diurnal cortisol (n = 29). Multivariable linear regression was used to test for associations between prenatal psychological distress, and infant DNA methylation and cortisol. Hair cortisol concentrations in late pregnancy were negatively associated with two sites of FKBP5 (site 1: B = -22.33, p = .003; site 2: B = -15.60, p = .012). Infants of mothers with elevated anxiety symptoms in late pregnancy had lower levels of OXTR2 CpG2 methylation (B = -2.17, p = .03) and higher evening salivary cortisol (B = 0.41, p = .03). Furthermore, OXTR2 methylation was inversely associated with evening cortisol (B = -0.14, p-value ≤ .001). Our results are, to our knowledge, the first evidence that the methylation of the oxytocin receptor may contribute to the regulation of HPAA during infancy.