Exploring mental health problems and support needs among pregnant and parenting teenagers in rural areas Of Limpopo, South Africa

BACKGROUND

Globally, teenage pregnancy is among the most social problems, affecting 21 million adolescents aged 15-19. Due to the increased responsibility of prenatal and postnatal care for their infants without support, pregnant and parenting teenagers, tend to experience mental health problems. Factors contributing to these problems among pregnant and parenting teenagers in rural African settings have hardly received scholarly attention and, therefore, are less understood. The purpose of the study was to explore mental health and challenges among pregnant and parenting teenagers,.

METHOD(S)

The study adopted a qualitative descriptive, exploratory, and phenomenological design. Purposive sampling was used to select 22 pregnant and parenting teenagers 18 years or older. Data were collected in ten selected clinics within the Demographic Surveillance Systems (HDSS) of DIMAMO and analysed using qualitative content analysis.

RESULTS

The findings reveal that pregnant and parenting teenagers in rural areas experience various mental challenges such as depression. These challenges are caused by social problems such as stigmatisation, lack of support from families and friends, as well as parenting demands that contribute to poor progress at school or dropouts. Pregnant teens expressed concerns about the lack of spousal support resulting from abandoning their partners.

CONCLUSIONS

Stress and depression were self-reported as mental problems among participants with various psychosocial implications, such as school dropout and miscarriage. There are various contributing factors to the mental health problems identified among pregnant and parenting teenagers, including inadequate family and spousal support. Access to integrated reproductive, psychosocial, and mental health services could be essential for these pregnant and parenting teenagers, to improve their mental well-being and improve the support system.

Teenage pregnancy in Tambogrande, Peru: causes, consequences and cycles of violence and disadvantage

Teenage pregnancy carries adverse consequences for health and well-being. In this article, we investigate the perceived causes, consequences and cycles of violence and disadvantage associated with teenage pregnancy in Tambogrande, Peru using an applied anthropological approach. Data were drawn from a larger project investigating the relationship between water insecurity and gender-based violence in Indonesia and Peru. The analysis presented here is derived from 49 semi-structured interviews and 5 focus groups with local community members and stakeholders in Peru. Study participants highlighted two main factors contributing to teenage pregnancy in Tambogrande: machismo and religious deterrents to contraceptive use. Participants described how these factors overlapped, resulting in gendered power imbalances that increased the risk of violence, decreased educational opportunities, and reduced the economic independence of women. However, study participants stated that educational interventions targeting machismo could reduce teenage pregnancy and break the associated cycle of disadvantage. Future research will further investigate local social and gender norms to inform the design of a rights-based educational intervention, targeting upstream factors associated with teenage pregnancy in this area.

Unintended pregnancies in the lives of young people in Luwero, Uganda: a narrative analysis

Using a feminist narrative approach, this article explores how unintended pregnancy can rupture young lives, and how young people respond to and navigate these ruptures. We analyse qualitative data from a longitudinal cohort study in Luwero, Uganda, focusing on narratives of a girl and a boy about their recent experiences of unintended and unwanted pregnancy during COVID-19 school closures. We argue that laws, policies and norms relating to education, sexual and reproductive health, and the family in Uganda position young people in complex and contradictory ways, that create the conditions for unintended pregnancies, and restrict the choices open to them. The analysis traces how pregnancy ruptures their everyday lives, their identities, and relationships. Their narratives reveal gendered ways in which they enact identities to manage the ruptures. Families are sites of contestation, where gender and sexuality are regulated, but are also mobilised by young people to support their efforts to repair the ruptures. Our analysis underscores the importance of working with young people to understand their positionalities, resource environments and social networks as they make and navigate decisions about pregnancy, and of addressing the structural forces that underpin the rupturing effects of pregnancy on teenage lives.

Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis

BACKGROUND

Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea.

METHODS

Data for this cross-sectional study were obtained from the 2016-2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15-19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality.

RESULTS

Weighted ECI for teenage pregnancy was - 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy.

CONCLUSIONS

A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.

Effect of COVID-19 lock down on teenage pregnancies in Northern Uganda: an interrupted time series analysis

BACKGROUND

Pregnancy and childbirth complications are the leading cause of death among girls aged 15-19 years globally, with low- and middle-income countries (LMICs) accounting for 99% of global maternal deaths of women aged 15-49 years. Despite teenage pregnancies declining in many developing countries in recent years, the COVID-19 period intensified the problem and altered the trend for most countries. We determined the effect of the COVID-19 lockdown on the teenage pregnancy trend in Pakwach district, Uganda, to understand its magnitude in our study population.

METHODS

Using interrupted time series analysis (ITS), sometimes known as quasi-experimental time series analysis. We constructed a time series of the first ANC service utilization records for girls aged 10-19 years in Pakwach district, Uganda, and conducted an interrupted series analysis. We compared the two periods of March 2019 to March 2020 and March 2020 to March 2021. We used Stata 15 to conduct our analysis, performed OLS, and plotted the results.

RESULTS

The teenage pregnancy trend before the lockdown was decreasing by - 0.203 pregnancies per month, but in the first month after the institution of the lockdown (March 20, 2020), there was an increase in the teenage pregnancy rate of 13.9 pregnancies [95% CI: - 33.6 to 61.5], which corresponds to an increase in the monthly trend in teenage pregnancies (relative to the period before the COVID-19 lockdown trend) of 1.53 girls per month.

CONCLUSION

Teenage pregnancies increased during the lockdown. This slight increase depicted the impact of the pandemic on the teenage pregnancy trend associated with the COVID-19 outbreak. The government needs to focus on intervention to reduce this trend and avoid any further increases.

Risk of teenage pregnancy among adolescents with bipolar disorder: a cohort study of 35,398 adolescent girls

Teenage pregnancy is a major public health concern. However, few studies have investigated the relationship between pediatric bipolar disorder and early pregnancy, and whether bipolar disorder medications reduce the risk of early pregnancy remains unknown. In total, 3218 adolescent girls with bipolar disorder and 32,180 controls matched for age, family income, residence, and time of enrollment were enrolled in this study from 2001 to 2009. Early pregnancy, defined as pregnancy occurring in patients younger than 20 years old, was identified during the follow-up period from enrollment until the end of 2011. After adjustment for demographic data, psychiatric comorbidities, and bipolar disorder medications, adolescent girls with bipolar disorder had 20 times the risk of early pregnancy (hazard ratio [HR] = 20.63, 95% confidence interval [CI] [15.68, 27.16]) and about 25 times the risk of repeated early pregnancy (HR = 24.59, 95% CI [15.20, 39.78]) compared with those without bipolar disorder. Long-term use of both mood stabilizers (HR = 0.34, 95% CI [0.23, 0.52]) and atypical antipsychotics (HR = 0.32, 95% CI [0.20, 0.51]) was associated with a reduced risk of early pregnancy. Bipolar disorder was associated with an increased risk of early pregnancy in adolescent girls. Bipolar disorder medications reduced this risk. The results suggest that interventions targeting the vulnerable population of adolescent girls with bipolar disorder are warranted to prevent early pregnancies.

Attitudes to adolescent pregnancy among families in the Dominican Republic and El Salvador: insights from a longitudinal study

Over the past few decades growing attention has focused on the perceived challenge of adolescent pregnancy and the need for girls to make 'smart choices'. This has generated considerable debate particularly because of the failure of many programmes and interventions to consider the structural constraints faced by young women in accessing sexual and reproductive health and rights (SRHR). Yet limited attention has been given to the views and experiences of girls' parents and caregivers, many of whom were often adolescent parents themselves. We use data from the Real Choices, Real Lives longitudinal study conducted by Plan International to consider how the experiences of girls' families shape their attitudes to teenage pregnancy in the Dominican Republic and El Salvador. Many families believe girls need to practise abstinence and avoid men and boys but given the lack of provision for SRHR faced by young women this response is not unexpected.

Service delivery inaccessibility as a predictor of teenage pregnancy in South Africa

Background

With the onset of the South African democracy in 1994 it was hoped that many social inequalities would be addressed urgently. However, studies have shown that service delivery inaccessibility remains a challenge and investigating the social implications of such injustices remains important.

Objective

This study determined to establish the association between service delivery inaccessibility and adolescent pregnancy in South Africa.

Methods

Using data from 2019 and 2021 general household surveys, 7 737 teenage females were included. The study applied descriptive statistics, chi-squared testing as well as multilevel binary logistic regression.

Results

Random-intercept multilevel binary logistic regression revealed that the risk of adolescent pregnancy independently increased as the level of service inaccessibility increased at household level (no services: OR=1.73, 1 service: OR=1.40, 2 services: OR=1.28) and community level (medium: OR=1.22, high: OR=1.38) at a P-value of 0.05.

Conclusion

Findings highlight the need to guarantee universal service delivery urgently not only for development, but also to prevent adolescent pregnancy. Furthermore, the findings present evidence of structural factors driving adolescent pregnancy in South Africa, which renders continued cycles of poverty, injustice and early pregnancy amongst the majority of Blacks.

Drivers of child marriage in specific settings of Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia - findings from the Yes I Do! baseline study

BACKGROUND

Child marriage persists in many countries and has severe impacts on health, education, economic and social status of girls. Child marriage has many interlinked causes. This study aimed to explore the drivers of child marriage in specific contexts in Ethiopia, Indonesia, Kenya, Malawi, Mozambique and Zambia.

METHODS

The study combined a household survey among youth (15-24 years) with focus group discussions and interviews conducted with youth (15-24 years) and parents. A variety of community stakeholders were interviewed as well. Logistic regression was done to explore associations between individual and family-level characteristics of young women and the occurrence of child marriage. Transcripts were analysed using an inductive approach. Narratives on the main drivers of child marriage across study contexts were written and inspired by the theory of normative spectrum.

RESULTS

A lack of education was associated with the occurrence of child marriage in Ethiopia, Kenya and Zambia. In all countries, teenage pregnancy was associated with child marriage. In Ethiopia, Kenya and Mozambique, fathers' education seemed a protective factor for child marriage. Narratives of study participants showed that in Ethiopia, Indonesia and (to a lesser extent) Kenya, child marriage was perceived as an 'appropriate practice' to avoid premarital sex or pregnancy, whether it involved sex with or without consent. In all countries, child marriage was driven by difficult economic circumstances, which were often intertwined with disapproved social circumstances, in particular teenage pregnancy, in case of Kenya, Malawi, Mozambique and Zambia. These circumstances made child marriage an 'acceptable practice'. Some youth, particularly in Indonesia, made their own choices to marry early, making child marriage a 'possible practice'.

CONCLUSIONS

Multiple intersecting drivers, which were present in different degrees in each country setting, influenced the occurrence of child marriage. We found that child marriage is a manifestation of social norms, particularly related to girls' sexuality, which are intersecting with other factors at individual, social, material, and institutional level - most prominently poverty or economic constraints. Child marriage was, in some cases, a result of girls' agentic choices. Efforts to prevent child marriage need to take these realities of girls and their families into account.

Knowledge, and practices on sexual and reproductive health among youth trainees attached to youth training centers in Sri Lanka

BACKGROUND

Sexual and reproductive health is a major concern among adolescents and youth in Sri Lanka. The study was carried out to assess the knowledge, and practices of the youth trainees attached to youth training institutes in Sri Lanka.

METHODOLOGY

A descriptive, cross-sectional study was carried out among randomly selected 425 youth trainees attached to youth training centers in Sri Lanka using a pre-tested self-administered questionnaire. Statistical analysis was conducted using SPSS-21. Categorical variables were presented as numbers and percentages. A comparison of categorical variables was conducted using the Chi-Square test and Fisher's exact test as applicable. The bivariate logistic regression model was used to determine the independent association of the selected demographic factors with youth trainees' sexual and reproductive health knowledge.

RESULTS

Study group consisted of 51.8% (n = 220) males and 48.2% (n = 205) females with a mean age of 18.6 years (SD = 1.8). Youth trainees' knowledge of the physiology of the reproductive tract was not at a satisfactory level, where Only 49% (n = 211) knew that nocturnal emission is normal in young men. The trainee's knowledge of contraception was also at a poor level. Only 47.5% (n = 202) had ever heard of condoms, and 13.2% (n = 56) knew about the emergency contraceptive pill. Nearly 8% (n = 33) of the youth had engaged in sexual intercourse at least once in their lifetime. Male gender (AOR = 2.3, p < 0.001), and age above 20 years (AOR = 1.9, P = 0.005) were positively associated with SRH knowledge.

CONCLUSIONS AND RECOMMENDATIONS

Knowledge and practices on sexual and reproductive health among youth trainees were sub-standard. The study recommends strengthening sexual and reproductive health education at youth training centers.

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001-2018)

BACKGROUND

Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors.

METHODS

A total pooled weighted sample of 10,010 teenagers (in the age group 15-19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment.

RESULTS

Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02-1.42), married (aOR = 7.71, 95% CI: 6.31-9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34-1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy.

CONCLUSION

The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

Prevalence of teenage pregnancy and its associated factors in high fertility sub-Saharan Africa countries: a multilevel analysis

BACKGROUND

Teenage pregnancies are persistently high among adolescent women in high fertility countries in sub-Saharan Africa. It has been attributed to the high unmet need for family planning in this population. The aim of this study was to determine the prevalence and factors associated with teenage pregnancy in high fertility countries in sub-Saharan Africa.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys. A total weighted sample of 33,391 adolescent girls who had ever had sexual contact were included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors for teenage pregnancy. Finally, the Adjusted Odds Ratio (AOR) with a 95% confidence interval was used to declare as statistically significant.

RESULTS

The overall teenage pregnancy in sub-Saharan Africa high frtility countries was 24.88% (95% CI, 24.42, 25.35). Educational status; no formal education (AOR = 1.39, 95% CI, 1.23, 1.56) and primary education (AOR = 1.45, 95% CI, 1.30, 1.62), not working (AOR = 1.32, 95% CI, 1.21, 1.45), being married (AOR = 67.88, 95% CI, 61.33, 75.12), poor (AOR = 1.47, 95% CI, 1.32, 1.65) and middle wealth quantile (AOR = 1.21, 95% CI, 1.07, 1.35), knowledge about contracptives (AOR = 2.45, 95% CI, 2.19, 2.74), unmet need for family planning (AOR = 2.42, 95% CI, 2.14, 2.74), Angola (AOR = 9.59, 95% CI, 7.82, 11.77), Chad (AOR = 3.05, 95% CI, 2.49, 3.74), DR.Congo (AOR = 3.77, 95% CI, 3.06, 4.65), and Mali (AOR = 1.84, 95% CI, 1.47, 2.28) were factors significantly associated with teenage pregnancy.

CONCLUSIONS

This study found that teenage pregnancy remains a common public health problem in the study areas. Level of education, marital status, occupation, wealth index, unmet need for family planning, knowledge about contraceptives, and country were significantly associated with teenage pregnancy. Hence, for sustainable development goal 3 to be realized by 2030, there must be investment in policy implementation and evaluation, as well as engagement with stakeholders in adolescents' sexual and reproductive health.

Adapting to poverty and dealing with gender: a comparative perspective on teenage pregnancy in the Peruvian Amazon

Teenage pregnancy rates in the Peruvian Amazon are double the national average and among the highest in Latin America. Peruvian women living in rural, underserved and Amazon areas are more likely to become teenage mothers but the factors contributing to this socio-demographic trend are unclear. Thirty-one interviews and ethnographic observations of teenage and adult mothers living in the Peruvian Amazon were conducted to examine how social class and gender impacted their motherhood experiences. Despite preconceptions concerning the undesirability of teenage pregnancy, results show that teenage and adult mothers have similar experiences of motherhood. Both groups of women lack career and educational opportunities and are therefore economically dependent on men. This, combined with the cultural valorisation of motherhood, pushes them toward pregnancy and motherhood. In other words, pregnancy is a response to a lack of career and educational opportunities and not vice versa. The one difference found between teenage and adult mothers is that the former have less agency over reproductive decision making. In conclusion, motherhood among teenage and adult mothers in the Peruvian Amazon is an adaptive mechanism that gives women protection and fulfilment but is also the result of gender and class constraints that limit their life choices.

What to expect when girls are expecting: psychosocial support challenges and opportunities in the context and aftermath of teenage pregnancy in Kenya

BACKGROUND

An understanding of the psychosocial support challenges and opportunities in the context of teenage pregnancy is important for developing appropriate interventions for pregnant and parenting girls. This qualitative study was conducted in Homa Bay County, Kenya, to examine the experience of teenage pregnancy and the resultant psychosocial support needs from the perspectives of both pregnant/parenting girls and their own parents, who are typically expected to provide various forms of support.

METHODS

The study used a descriptive case study design, drawing on counseling case notes documented by psychologists who held counseling sessions with 20 pregnant or parenting girls and 6 of their parents as part of a psychosocial support intervention. The counseling case notes formed a qualitative data set, which was analyzed thematically.

RESULTS

Emerging master themes were related to pregnant and parenting girls' experience of sexual violence and adverse childbirth outcomes; psychological trauma confronted by girls and their parents alike; parental need for support in communicating with pregnant/parenting girls about sex and sexuality; and the availability of family support as a resource for teenage mothers.

CONCLUSION

Pregnant and parenting teenage girls require a range of psychosocial support responses that recognize the realities of sexual violence and other challenges in the lives of the girls themselves, as well as in the lives of their parents and caregivers. While parents and other caregivers can serve as an important resource for supporting affected girls, they often need assistance as well, in order to support pregnant/parenting girls effectively. These realities need to be taken into account to maximize the effectiveness of health and development programs for pregnant and parenting girls. Furthermore, emerging themes from actual counseling sessions with affected girls and parents can provide important insights into the potential psychosocial support needs of the broader population of pregnant and parenting girls.

Causes, enablers and perceived solutions to teenage pregnancy: a qualitative study in a South-Western State in Nigeria

Introduction

teenage pregnancy remains a major public health issue in Nigeria with many teenagers being fated to early motherhood resulting in a life filled with turmoil. The aim of this study was to explore the perspectives of teachers and students of high schools on the causes, enablers and solutions to teenage pregnancy.

Methods

this study employed an exploratory design using a qualitative approach. Participants were selected using purposive sampling technique and a total number of 33 participants interviewed. Data collection was done by means of audio-recorded semi-structured interviews and data were analysed using a thematic analysis approach. Descriptive statistics were used to generate participants' demographic profile.

Results

three themes emerged from the study. They include perception of teachers and students on the causes of teenage pregnancy, perceived enablers of teenage pregnancy and solutions to teenage pregnancy. Findings revealed that the majority of the participants had knowledge of teenage pregnancy but had limited knowledge of contraceptives, particularly the students. Almost all participants viewed teenage pregnancy as a more common occurrence in their community than in schools. Participants identified poverty, peer pressure and poor parental control as causes of teenage pregnancy. Participants further identified poverty, substance abuse and lack of education as enablers of teenage pregnancy while perceived solutions included poverty eradication, abstinence from sexual activities, girl child education and government involvement. Majority of the participants disagreed with giving condoms to teenagers in schools.

Conclusion

among other causes of teenage pregnancy identified in this study, poverty was a recurring theme. Therefore, there is, a need for the government of Nigeria to combat poverty at all levels, as a strategy to curb teenage pregnancy while not neglecting other causes.

Teenage pregnancy and its predictors in Africa: A systematic review and meta-analysis

OBJECTIVE

Although teenage pregnancy has declined in the last decade, it remains a major public health issue in Africa. Maternal mortality is common among teenagers due to their increased risk of obstetric and medical complications. In Africa, there is a lack of robust and comprehensive data on the prevalence and predictors of teenage pregnancy. As a result, this systematic review and meta-analysis were carried out to summarize evidence that will assist concerned entities in identifying existing gaps and proposing strategies to reduce teenage pregnancy in Africa.

METHODS

The review is registered by the international prospective register of systematic reviews (CRD42021275013). This search included all published and unpublished observational studies written in English between August 23, 2016, and August 23, 2021. The articles were searched using databases (PubMed, CINHAL [EBSCO], EMBASE, POPLINE, Google Scholar, DOAJ, Web of Sciences, MEDLINE, Cochrane Library, and SCOPUS). Data synthesis and statistical analysis were conducted using STATA version 14 software. Forest plots were used to present the pooled prevalence and odds ratio (OR) with a 95% confidence interval (CI) of meta-analysis using the random effect model.

RESULTS

A total of 43,758 teenagers (aged 13-19) were included in 23 studies. In Africa, the overall pooled prevalence of teenage pregnancy was 30% (95% CI: 17-43). Western Africa had the highest prevalence of teenage pregnancy 33% (95% CI: 10-55). Age (18-19) (OR = 2.99 [95% CI = 1.124-7.927]), wealth index (OR = 1.84 [95% CI = 1.384-2.433]), and marital status (OR = 6.02 [95% CI = 2.348-15.43]) were predictors of teenage pregnancy in Africa.

CONCLUSION

In Africa, nearly one-third of teenagers become pregnant. Teenage pregnancy was predicted by age (18-19), wealth index, and marital status. Strengthening interventions aimed at increasing teenagers' economic independence, reducing child marriage, and increasing contraceptive use among married teenagers can help to prevent teenage pregnancy.

Intergenerational Replication of Teenage Pregnancy and Educational Attainment in Mexico

Mexico ranks among the OECD countries with the highest prevalence of teenage pregnancies, exhibiting a fertility rate of 70.6 births for every 1000 adolescents. Mexican adolescents with a history of pregnancy are twice as likely to lag behind in their studies as those who have not been pregnant. Research on adolescent maternity and its explanatory mechanisms is required as a basis for implementing policies and programs that effectively curb teenage pregnancy-related behaviors, prevent educational gaps, and reduce the intergenerational transmission of poverty. Based on quasi-experimental methodology and a non-recursive structural equation model with instrumental variables, this paper analyzed the intergenerational transmission of teenage pregnancy from mothers to daughters, as well as the relationship between teenage pregnancy and educational attainment. Using data from the 2009 National Survey of Demographic Dynamics in Mexico, our estimated model indicated a unidirectional relationship from teenage pregnancy to educational attainment. An association was observed between teenage pregnancy and an increased probability of a moderate or severe educational gap (≥ 1 year) by 21% ± 5 and a severe educational gap (≥ 2 years) by 33% ± 8. Adolescents whose mothers reported teenage pregnancy at < 15 years of age were approximately 84% more likely to experience teenage pregnancy themselves than other adolescents. Relevant explanatory mechanisms included low socioeconomic status and a low level of education in the household. Mexico needs to formulate, implement, and expand comprehensive and early prevention strategies as well as teenage pregnancy care throughout its most vulnerable regions. Efforts should be made at the individual, family, and community levels; incorporate alliances with teenage networks; actively engage parents, teachers, and health care providers; and reinforce educational initiatives on sexual and reproductive health for adolescents. It would be convenient for the Government to implement public policies that emphasize the results obtained. There is no better instrument than to show the evidence of the gradual deterioration of human capital in Mexico associated with adolescent pregnancy.

Socioeconomic inequalities in teenage pregnancy in Nigeria: evidence from Demographic Health Survey

Background

Despite the high rate of teenage pregnancy in Nigeria and host of negative medical, social and economic consequences that are associated with the problem, relatively few studies have examined socioeconomic inequality in teenage pregnancy. Understanding the key factors associated with socioeconomic inequality in teenage pregnancy is essential in designing effective policies for teenage pregnancy reduction. This study focuses on measuring inequality and identifying factors explaining socioeconomic inequality in teenage pregnancy in Nigeria.

Methods

This is a cross sectional study using individual recode (data) file from the 2018 Nigeria Demographic Health Survey. The dataset comprises a representative sample of 8,423 women of reproductive age 15 – 19 years in Nigeria. The normalized Concentration index (C_n) was used to determine the magnitude of inequalities in teenage pregnancy. The C_n was decomposed to determine the contribution of explanatory factors to socioeconomic inequalities in teenage pregnancy in Nigeria.

Results

The negative value of the C_n (-0.354; 95% confidence interval [CI] = -0.400 to -0.308) suggests that pregnancy is more concentrated among the poor teenagers. The decomposition analysis identified marital status, wealth index of households, exposure to information and communication technology, and religion as the most important predictors contributing to observed concentration of teenage pregnancy in Nigeria.

Conclusion

There is a need for targeted intervention to reduce teenage pregnancy among low socioeconomic status women in Nigeria. The intervention should break the intergenerational cycle of low socioeconomic status that make teenagers’ susceptible to unintended pregnancy. Economic empowerment is recommended, as empowered girls are better prepared to handle reproductive health issues. Moreover, religious bodies, parents and schools should provide counselling, and guidance that will promote positive reproductive and sexual health behaviours to teenagers.

Teenage pregnancy is a global public health concern. It is an undesirable occurrence and seems to be one of the social problems facing several countries, including Nigeria. Previous studies suggest socioeconomic differences in teenage pregnancy in Nigeria. However, relatively few studies have examined the socioeconomic inequality in teenage pregnancy in the country. This study focuses on measuring and explaining predictors of socioeconomic inequality in teenage pregnancy in Nigeria using the Nigeria Demographic Health Survey conducted in 2018. Findings suggest that teenage pregnancy is more concentrated among poor teenagers, while the most important factor contributing to the teenage pregnancy in Nigeria were marital status, wealth index of households, exposure to information and communication technology, and religion. These findings emphasise the need for targeted intervention to reduce teenage pregnancy among low socioeconomic status women in Nigeria to break the intergenerational cycle that expose teenagers to unwanted pregnancy. Since, empowered girls are better prepared to handle reproductive health issues. In addition, religious bodies, parents and schools should give teenagers counselling, and guidance that will promote positive reproductive and sexual health behaviours.

The Prevalence and Outcome of Teenage Pregnancies in a Secondary Health Facility in Delta State, Nigeria: A Four-Year Retrospective Review

INTRODUCTION

This study determined the prevalence, obstetric characteristics and pregnancy outcomes in teenagers who delivered at a secondary health facility in a Southern State in Nigeria.

MATERIALS AND METHODS

A retrospective study was employed to review pregnancies that were managed in Central Hospital Warri, Delta State, Nigeria between 2014-2017. Patients' notes were retrieved and analyzed with respect to the socio-demographic characteristics, pregnancy, labor and delivery complications and fetal outcome. Chi-square test was used to test the association between the independent variables and the main outcomes of the study with statistical significance set at p<0.05.

RESULTS

Out of the 14,067 pregnancies reviewed, the prevalence of teenage pregnancy was 2.8%. The mean age of the teenagers was 17.5 (±1.4) years, 243 (61.5%) of them had completed secondary school. Majority 286 (72.4%) delivered via spontaneous vaginal delivery, while 73 (18.5%) and 36 (9.1%) delivered via caesarean section and instrumental delivery respectively. The commonest complications encountered among the pregnant teenagers were perineal laceration (23.3%), iron deficiency anemia (17%) and delivery of low birth weight infant (14.9%). The younger teenagers were twice at risk of iron deficiency anaemia {OR (95%CI); p = 2.60 (1.08-5.92); p=0.028}. A similar association was seen between the age of the teenagers and route of delivery {OR (95%CI); p = 3.11 (1.34-6.93); p=0.002}, delivery of low birth weight infant {OR (95%CI); p = 3.12 (1.28-7.15); p=0.003} and perineal laceration {OR (95%CI); p = 2.54 (1.13-5.55); p=0.010}.

CONCLUSION

Teenage pregnancy is associated with high risk of complications, especially among younger teenagers. Increasing public awareness as well as improving educational, socio- economic and reproductive health opportunities for adolescent girls is recommended.

Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors

Objective

Adolescent females in the United States continue to have unmet sexual and reproductive healthcare needs. Research shows that interventions incorporating peer support can augment perceived self-efficacy and reinforce healthy behaviors. Yet, few user-centered digital sexual health interventions incorporate peer support, and aim to change perceptions of peer norms and model social skills. The objective of this study was to design and demonstrate the receptivity of adolescent females to illustrated digital social media stories that promote healthy sexual behaviors and peer social support.

Methods

We conducted a three-phase study approved by our Institutional Review Board. In Phase 1, we presented sexually active adolescent female emergency department patients aged 14-19 with eight sexual health scenarios via a survey study. Participants wrote three text messages addressed to the protagonist of each scenario which motivated and encouraged her to consider the use of contraceptives. Messages were scored based on the construct of peer support (emotional, tangible, informational, and belonging). In Phase 2, we worked with a professional artist and screenwriter to design digital sexual health comics using the gathered messages. In Phase 3, we gathered feedback on the comics from adolescent female emergency department patients.

Results

Females (n  =  22) provided 352 messages. Using top rated messages, we designed five digital visualizations in a running story called Mari tells it like it is. Each story incorporated 5-12 peer-authored quotes. We inserted the final images into Instagram®. Additional females (n  =  39) found the images "relatable," "super-realistic," and "educational."

Conclusion

Collecting peer-authored texts from our local adolescent community led to the creation of well-received sexual health visualizations. This novel method of design incorporated adolescent voices to promote peer support and healthy behaviors.

Maternal and Neonatal Complications in Teen Pregnancies: A Comprehensive Study of 661,062 Patients

PURPOSE

To provide a comprehensive assessment of maternal and neonatal complications associated with teen pregnancies in the United States.

METHODS

Retrospective analysis of the Centers for Disease Control and Prevention natality live births database (2016-2019). Singleton births to women younger than 35 years from the following racial/ethnic groups were included: non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic. The risks of various complications were compared between teen patients (<20 years old) and nonteen patients (20-35 years old) using Pearson's chi-square test with the Bonferroni correction. Multivariate logistic regressions were used to adjust outcomes for potential confounders, including body mass index, race/ethnicity, payment method, prenatal care, parity, and the presence of chronic comorbidities.

RESULTS

Teen pregnancies comprised approximately 6% of the study population (661,062 of 11,038,489). Teen pregnancies were associated with increased odds of several maternal complications, such as hypertensive disorders of pregnancy, eclampsia, preterm birth, blood transfusion, and chlamydial and gonorrheal infections. Teen pregnancies were also associated with increased odds of several neonatal complications, including congenital birth defects, low 5-minute Apgar score, suspected neonatal sepsis, and assisted ventilation. Conversely, teen pregnancies were associated with decreased odds of gestational diabetes, unplanned hysterectomy, macrosomia, low birth weight, and neonatal intensive care unit admission.

DISCUSSION

Teen pregnancies in the United States are associated with increased risks of multiple adverse outcomes. This information should inform clinicians and policy makers about the unique risks of this highly vulnerable patient population and provide further knowledge for the important efforts to reduce teen birth rates in the United States.

Low birth weight infant among teenage pregnancy in Terengganu, Malaysia: A cross-sectional study

INTRODUCTION

The purpose of this research is to determine the factors associated with low-birth-weight (LBW) infants in teenage pregnancy.

METHODS

A cross-sectional study was conducted in Terengganu, Malaysia, from January 1, 2020, to May 31, 2020. Records of teenage pregnancies in 2018 were retrieved from the Maternal Health Record Book and Pregnant Woman and Postnatal Book Registry. Simple logistic and multiple logistic regression analysis was used to analyse the factors associated with LBW infants in teenage pregnancy.

RESULTS

All 357 cases that fulfilled the study criteria were included. LBW infants were the most common perinatal outcome among teenage pregnancies (19.3%), followed by preterm birth (9.0 %), and both low Apgar score and stillbirth (1.4% each). Factors associated with low-birth-weight infants in teenage pregnancy in Terengganu were a teenage husband (AOR 2.0; 95% CI: 1.01, 3.96; p=0.047) and a mother with a low level of education (AOR 3.07; 95% CI: 1.20, 7.85; p=0.019).

CONCLUSION

Teenage husband and low level of maternal education are significant factors that need to be addressed to improve teenage pregnancy outcomes. Interventions to improve these factors should continue to be encouraged.

Feasibility and acceptability of a whole-school social-marketing intervention to prevent unintended teenage pregnancies and promote sexual health: evidence for progression from a pilot to a phase III randomised trial in English secondary schools

Background

Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness.

Methods

Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13–14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12–13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome.

Results

All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants.

Conclusions

The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial.

Trial registration

ISRCTN65324176.

Outcomes of serious antisocial behavior from childhood to early adulthood in two Puerto Rican samples in two contexts

PURPOSE

The patterns or trajectories of serious antisocial behavior (ASB) in children are examined to determine the extent to which context, gender, and the severity and persistence of ASB from childhood/early adolescence to later adolescence/early adulthood is associated with negative outcomes.

METHODS

A four wave longitudinal study obtained data on two multi-stage probability household samples of Puerto Rican background children (5-13 years at baseline) living in the San Juan Metropolitan Area of Puerto Rico (PR) and the South Bronx (SBx) of New York. The outcomes studied were any psychiatric disorder including substance use disorders and teenage pregnancy.

RESULTS

Both males and females raised in the SBx had much higher risk of serious ASB (42.3%) as compared to those in PR (17.8%). Concurrent ASB4 + in the fourth wave was strongly related to SUD and MDD for both males and females at Wave 4.

CONCLUSIONS

Serious ASB is likely to persist at least to the next developmental period of a child and is likely to be associated with substance use disorders and major depression later in life.

Teenage childbearing and school dropout in a sample of 18,791 single mothers in Cameroon

Background

Adolescent childbearing increases the risk of adverse health and social consequences including school dropout (SDO). However, it remains unclear why some teenage mothers drop out of school and others do not, especially in sub-Saharan Africa settings. We aimed to investigate the background and behavioral characteristics of single mothers, associated with school dropout in a sample of 18,791 Cameroonian girls, who had their first child during adolescence.

Methods

We used data from a national registry of single mothers, collected during the years 2005–2008 and 2010–2011. Both bivariate analysis and logistic binary regression models were used to explore the relationship between adolescence motherhood and SDO controlling for a range of socio-economic, family, sexual and health seeking behavior characteristics.

Results

Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. The multivariable regression model showed that SDO was more common in those who were evicted from their parental home (aOR: 1.85; 95% CI: 1.69–2.04), those who declared having other single mothers in their family (aOR: 1.16; 95% CI 1.08–1.25) and in mothers who had their first child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout.

Conclusions

Strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies.

There is compelling, worldwide evidence that pregnancy and birth during teenage years are significant contributors to high school dropout rates, especially in developing countries. Research has also shown that education continuity of teenage mothers can lessen the long term negative social consequences of teenage pregnancies and childbearing. In this study, we investigated the factors associated with school dropout in a sample of Cameroonian teenage mothers.

The information collected included socio-economic, family, sexual characteristics, and health-seeking behavior.

Among the 18,791 single mothers, 41.6% had dropped out of school because of pregnancy. School dropout was more common in those who were evicted from their parental home, those who declared having other single mothers in their family and in mothers who had their 1st child before 15. Using modern contraceptive methods, having declared no sexual partner during the last year and having less than 2 children were associated with a reduced likelihood of school dropout.

In conclusion, strong social support is essential to ensure school continuity in this vulnerable population. Dropping out of school may put the teenage mother more at risk of unsafe health behaviour and new pregnancies.

Differences in perinatal outcomes in teenage mothers with their first and third pregnancies and predictors of adverse neonatal events: A cross-sectional study

Background

Repeated teenage pregnancy is a major burden on the healthcare system worldwide.

Objective

We aimed to compare teenagers with their first and third pregnancies and to evaluate the likelihood of neonatal complications.

Materials and Methods

This cross-sectional study was performed on female teenagers (aged ≤ 19 yr) with singleton pregnancies. The subjects (n = 298) were screened over 12 months. Ninety-six women were excluded, based on the exclusion criteria. The remaining subjects (n = 202) were divided into two groups: teenagers with first pregnancy (n = 96) and teenagers with third pregnancy (n = 47). The subjects were observed throughout pregnancy and delivery. The final sample size of the first and third pregnancy groups was 96 and 47, respectively.

Results

There was a significant risk of preeclampsia in the first pregnancy group (p = 0.01). Low birth weight, five-min Apgar score < 7, and neonatal intensive care unit admission were the most significant neonatal outcomes in the first pregnancy group. In the third pregnancy group, significant predictors of neonatal complications included very young age in the first pregnancy ( ≤ 15 yr), an inter-pregnancy interval < 2 yr, current anemia, and history of obstetric and/or neonatal complications in previous pregnancies.

Conclusion

Based on the results, teenagers with their first pregnancy had comparable obstetric outcomes (except for preeclampsia) as teenagers with their third pregnancy, whereas neonatal complications occurred more frequently in the first pregnancy group. Overall, we can predict high-risk neonates in the third pregnancy, based on the abovementioned parameters.

Dislike for schooling as risk factor for teenage pregnancy: Development of a hypothesis using data from a study conducted on understanding factors associated with teenage pregnancy

This paper is informed by the data extracted from a study conducted by the Multidisciplinary Research Centre (MRC) in 2014, titled, 'Understanding Factors Associated with Teenage Pregnancy in Namibia' that focused on 602 boys and 2875 girls aged between 14 to 22 years of age. The aim of the paper was to test the hypothesis of dislike of school as a catalyst to teenage pregnancy. The analysis of the paper is based on 1,393 school learners that were all female. In testing the hypothesis both univariate and multivariate regression analysis were used. No clear associations were found between dislike of school and attitudes and behaviours (outcome measures) which may predict the risk of subsequent teenage pregnancy except for alcohol use and parental employment. Parental employment as proxy for socio-economic status emerged as a significant predictor of unhappiness at school while higher levels of alcohol use predicted higher odds of dislike of school. Interventions to promote youth satisfaction with schooling should be based on longitudinal research to inform effective policy and practice.

The impact of teenage pregnancy on school dropout in Brazil: a Bayesian network approach

BACKGROUND

As reported by the World Health Organization, adolescent pregnancy is a major public health concern given its impact on the life of mothers and their family members. In this study we investigated possible cause-effect relations between teenage pregnancy and school dropout, and other attributes that gravitate around them, using the Bayesian network approach.

METHODS

We used a database prepared by the Adolescent House Project and invited experts in the areas of Health, Education and Social Assistance to answer a survey containing questions aimed at detecting possible causal relationships. To perform the statistical analysis and the numerical simulations we employed the language and formalism of Bayesian networks.

RESULTS

The analysis indicated a strong cause-effect relation between teenage pregnancy and school dropout, bolstered by economic vulnerability. We were able to identify the profile of the female teenager who drops out from school: white girls older than 15 years who got pregnant at least once, are not working to generate an income, and who belong to the group where the family income is less than or equal to US$780 per month. Also we detected the "maternal impact factor", i.e., the effect caused by whether or not the mothers of the teenagers have experienced teenage pregnancy.

CONCLUSION

There are many factors that lead teenagers to drop out of school; we confirmed not only the commonsense notion that pregnancy of the teenager is a major factor but found that a history of teenage pregnancy on the part of the mother is a major factor. Moreover, Bayesian networks emerged as an interesting mathematical framework to perform the statistical analysis.

Teenage pregnancy and the sociodemographic attributes as a major contributor: Findings from an urban referral center in Nepal

BACKGROUND

Teenage pregnancy is a challenging issue worldwide. Yet, despite the increased health risk and socioeconomic impact of teenage pregnancy, the numbers remain high in Nepal.

AIM

To determine the prevalence and sociodemographic factors associated with teenage pregnancy in Nepal.

METHODS

A hospital-based cross-sectional study was conducted in the Paropakar Maternity and Women’s Hospital from April to August 2017. A total of 1359 mothers were assessed and interviewed regarding their reproductive history and sociodemographic attributes. Ethical approval from the Nepal Health Research Council, permission from the concerned hospital, and consent from study subjects were obtained.

RESULTS

Of the 5526 deliveries, 679 (12.3%) were teenage pregnancy deliveries. The majority (85.1%) of mothers (out of 1359) were married at < 20 years of age, with a mean age of marriage of 17.57 years (± 1.994, range: 12-25 years). Marriage age was a significant determinant of teenage pregnancy (odds ratio [OR] 2.423 [2.262-2.596]; P < 0.001). Likewise, a love marriage (OR: 2.018 [1.585-2.570]; P < 0.001) and first teenage pregnancy (OR: 3.622 [3.265-4.017]; P < 0.001) were significant determinants for subsequent teen pregnancies. Knowledge of family planning methods (OR: 0.474; 0.288-0.779; P = 0.003) and use of any methods of family planning utilization (OR: 0.345; 0.248-0.479; P = 0.000) significantly lowered the chance of teenage pregnancy.

CONCLUSION

Teenage pregnancy occupies a substantial proportion of total deliveries in the Nepalese maternity hospital. In addition, early pregnancy was significantly associated with age and type of marriage, education level, knowledge, and practice of contraceptive methods.

[Unplanned pregnancy-now what? : Effectiveness and acceptance of medical teaching units for primary and secondary prevention in schools]

BACKGROUND

The German Medical Society for Health Promotion (ÄGGF) has developed a school-based teaching unit for students in grade 8 and higher that aims at primary and secondary prevention of unplanned pregnancies.

AIMS

The accompanying evaluation study analyzes the effects of the teaching unit on the students' knowledge and their experience with self-efficacy concerning unplanned pregnancies.

METHODS

A two-armed cluster-randomized controlled study was conducted using a ten-page anonymous questionnaire with a closed answer format before and after the intervention.

RESULTS

In the first survey, 1855 students participated; 1523 students participated in the second. Participants in the intervention group showed a greater increase in knowledge over time. Compared to the control group, they showed an increased intention to use the pill and condoms as well as a marked increase in self-efficacy in the case of an unplanned pregnancy. Furthermore, they significantly corrected their perception of the age at which same-aged boys start having sexual intercourse. All effects remained stable when covariates were controlled. The teaching units were highly accepted: more than 90% of the participants stated that they would recommend them to other students.

DISCUSSION

A school-based medical teaching unit about the prevention of unplanned teenage pregnancies was able to contribute to the improvement of students' knowledge and competency. The intervention itself was highly accepted within the target group.

Early marriage and teenage pregnancy: The unspoken consequences of COVID-19 pandemic in Nigeria

Early marriage and its sad consequences to the girl child and socio-economic development of the nation has been an age-long issue being advocated against in many parts of Nigeria. At the onset of COVID-19, the teeming efforts to curb this issue almost got jeopardized with harsh economic situations in many households due to the lockdown and the willingness to marry off their girls to reduce this burden. Closure of schools and cases of sexual gender based violence also impacted the prevalence of early marriage during the pandemic in Nigeria. We also argue in this commentary that the pandemic has so much impacted on programs aimed at ending early marriage in the nation. Therefore, if serious and concerted efforts are not taken by relevant stakeholders, more girls will be at risk of early marriage and teenage pregnancy with their related health consequences. They will also be left behind in fulfilling their potentials and their aspirations cut off with early marriage, thus sustainable development cannot be achieved.

A mixed reception: perceptions of pregnant adolescents' experiences with health care workers in Cape Town, South Africa

Background

Maternal mortality among adolescent mothers in South Africa is higher than many middle-income countries. This is largely attributable to conditions that can be prevented or managed by high quality antenatal care. The way in which pregnant adolescents are treated at antenatal clinics influences their timely utilization of antenatal services. This qualitative study reports on the experiences of pregnant adolescents with health care workers when accessing antenatal care.

Methods

Pregnant girls aged 13–19 (n = 19) who attended public health care facilities that provide Basic Antenatal Care (BANC) services in Cape Town, South Africa were recruited. Four face to face in-depth interviews and four mini focus group discussions were undertaken, facilitated by a topic guide. Thematic analyses were used to analyse the data.

Results

Experiences that reinforce antenatal attendance, such as respectful and supportive treatment, were outweighed by negative experiences, such as victimization; discrimination against being pregnant at a young age; experiencing disregard and exclusion; inadequate provision of information about pregnancy, health and childbirth; clinic attendance discouragement; and mental health turmoil.

Conclusions

There is evidence of a discordant relationship between the health care workers and the pregnant adolescents. Adolescents feel mistreated and discriminated against by the health care workers, which in turn discourages their attendance at antenatal clinics. Maternal health care workers need to receive support and regular training on the provision of youth friendly antenatal care and be regularly evaluated, to promote the provision of fair and high quality antenatal services for adolescent girls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01211-x.

Antenatal care is the routine health care of pregnant women in order to diagnose pregnancy complications and to provide information about lifestyle, pregnancy and delivery. Maternal deaths among teenage mothers in South Africa is high and is largely due to conditions that can be prevented or managed by high quality antenatal care. Timely and routine antenatal care is therefore crucial for pregnant teenagers. The way in which pregnant teenagers are treated by health care workers at antenatal clinics influences their clinic attendance. This study reports on the experiences of pregnant teenagers with health care workers, when accessing antenatal care in Cape Town, South Africa. Nineteen pregnant girls aged 13–19 years were interviewed. Some positive experiences such as respectful and supportive treatment were reported. However, more negative experiences were reported, including victimization; discrimination against being pregnant at a young age; feeling disregarded and excluded; a lack of information about pregnancy, health and childbirth; being discouraged from attending the clinics; and mental health distress. In conclusion, many teenagers felt mistreated and discriminated against by the health care workers, which discouraged their clinic attendance. Maternal health care workers in South Africa need to receive support and regular training to provide youth friendly antenatal care to teenage girls.

Hypertension in women: the role of adolescent childbearing

Background

Adolescent childbearing is associated with various health risks to the mother and child, and potentially with adverse socioeconomic outcomes. However, little is known about the role of adolescent childbearing in maternal health outcomes in adulthood. This study investigates the link between childbirth in adolescence and later-life risk of hypertension among women in India.

Methods

We obtained nationally representative data on demographic and health outcomes for 442,845 women aged 25 to 49 from the India National Family Health Survey (NFHS) 2015-16. We assessed the difference in hypertension prevalence between women who gave birth in adolescence (age 10 to 19) and those who did not, for the full sample and various sub-samples, using linear probability models with controls for individual characteristics, hypertension risk factors, and geographic fixed effects.

Results

Nearly 40% of the women in the sample gave birth in adolescence. The adjusted probability of being hypertensive in adulthood was 2.3 percentage points higher for this group compared to women who did not give childbirth in adolescence. This added probability was larger for women who gave birth earlier in adolescence (4.8 percentage points) and for women who gave birth more than once in adolescence (3.4 percentage points).

Conclusions

Adolescent childbearing was strongly associated with a higher probability of adult female hypertension in India. This finding illustrates the intertemporal relationship between health risk factors during the life cycle, informing the importance of addressing adverse early life events (e.g. child marriage and adolescent childbirth) for hypertension outcomes among women in India.

Trends in initiation of hormonal contraceptive methods among teenagers born between 1989 and 1997 in Norway and the United States

OBJECTIVE

To assess initiation of hormonal contraception among women aged 15-19 in the US and Norway by birth cohort.

STUDY DESIGN

We used population-based survey (US) and administrative (Norway) data to estimate the cumulative probability of age at first use of hormonal contraception for female residents born between 1989 and 1997 in 3-year birth cohorts. Differences between countries were assessed using confidence intervals, and differences between birth cohorts were assessed using survival analysis.

RESULTS

At age 15, first use of any hormonal method was higher among US respondents (16%-17% US vs 10%-13% Norway), whereas for ages 16 to 19 use was higher among Norwegian women (by age 19, 60%-64% US vs 76%-78% Norway). Similar patterns were observed for pill use; however, depot medroxyprogesterone acetate (DMPA), implant, and intrauterine device (IUD) use tended to be higher among US women. In both countries, cumulative first use of the pill, patch, ring, and DMPA declined across birth cohorts while first use of implants and IUDs increased.

CONCLUSION

Age at initiation and type of first hormonal method use differed between US and Norwegian teenagers. These differences may contribute to the lower teen birth rate in Norway.

Teenage pregnancy among unmarried teenagers in Malawi: Does sex of the household head matter?

The role of parents, especially the household head, is very crucial in the sexual values and behaviour of teenagers. This study used the Malawi Demographic and Health Survey (MDHS) data of 2015-16 to examine the impact of sex of the household head on pregnancy outcomes among unmarried teenagers in Malawi. Using STATA 14, the data was analysed using univariate, bivariate and multivariate level of analysis. The multivariate logistic regression analysis was employed to examine the association between sex of the household head and teenage pregnancy. Results showed that teenage pregnancy was higher among unmarried females living in female-headed households (OR 2.54; CI: 1.01-6.43) compared to females from male-headed households. The study also found that unmarried teenagers with secondary and higher education had lower risk of teenage pregnancy (OR 0.53; CI: 0.40-0.72) compared to those with no education and primary education. The study concludes that teenage pregnancy is higher in female-headed households, a finding which suggests that parenting styles differ between male and female heads of households. Policy interventions in regard to sex education should be specific to the sex of the household heads in which teenage girls reside, while unmet need for contraceptives among teenagers should also be addressed.

A comparative analysis of teenagers and older pregnant women concerning maternal and neonatal adverse outcomes in Raymond Mhlaba sub-District, South Africa

Teenage pregnancy has become a common global public health issue, associated with increased risk of obstetric complications and adverse neonatal outcomes. Teenagers are more prone to obstetric complications compared to older women. This study examined the maternal and neonatal adverse outcomes among teenagers, and compared them with older pregnant women. This study extracted maternal and neonatal adverse outcomes from 196 medical records of women delivered at Fort Beaufort Hospital from April 2017 to March 2018. Teenagers developed anaemia (13%) and pre-eclampsia (2.1%) during pregnancy as compared to older pregnant women. Most of the women delivered through normal vertex, although the teenagers had the highest percentage of caesarean section (27%) compared to the older women. Few proportions of women developed complications during delivery, however, obstructed labour (14.7%), prolonged labour (11.5%), foetal distress (14.8%) was more prevalent in teenagers. Most neonates were delivered at preterm birth and were alive across all age groups. However, few of the preterm births (23.2%) and very premature neonates (7.4%) occurred among the teenager mothers compared to older women. Few neonates had an Apgar score of less than 7 in 1 minute across all age groups. The risk of obstructed labour, prolonged labour, and foetal distress was predominant among teenagers compared to the older women. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. The findings of this study revealed that the teenagers start booking at the second trimester, which may impose the risk of complications if not observed at an early stage. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. Programmes to support early antenatal bookings for teenagers are important to address adverse maternal complications associated with late antenatal bookings.

Modeling spatial determinates of teenage pregnancy in Ethiopia; geographically weighted regression

Background

In developing countries, 20,000 under 18 children give birth every day. In Ethiopia, teenage pregnancy is high with Afar and Somalia regions having the largest share. Even though teenage pregnancy has bad maternal and child health consequences, to date there is limited evidence on its spatial distribution and driving factors. Therefore, this study is aimed to assess the spatial distribution and spatial determinates of teenage pregnancy in Ethiopia.

Methods

A secondary data analysis was conducted using 2016 EDHS data. A total weighted sample of 3381 teenagers was included. The spatial clustering of teenage pregnancy was priorly explored by using hotspot analysis and spatial scanning statistics to indicate geographical risk areas of teenage pregnancy. Besides spatial modeling was conducted by applying Ordinary least squares regression and geographically weighted regression to determine factors explaining the geographic variation of teenage pregnancy.

Result

Based on the findings of exploratory analysis the high-risk areas of teenage pregnancy were observed in the Somali, Afar, Oromia, and Hareri regions. Women with primary education, being in the household with a poorer wealth quintile using none of the contraceptive methods and using traditional contraceptive methods were significant spatial determinates of the spatial variation of teenage pregnancy in Ethiopia.

Conclusion

geographic areas where a high proportion of women didn’t use any type of contraceptive methods, use traditional contraceptive methods, and from households with poor wealth quintile had increased risk of teenage pregnancy. Whereas, those areas with a higher proportion of women with secondary education had a decreased risk of teenage pregnancy. The detailed maps of hotspots of teenage pregnancy and its predictors had supreme importance to policymakers for the design and implementation of adolescent targeted programs.

A comparison of the relationship between parental efficacy and social support systems of single teen mothers across different family forms in South African low socioeconomic communities

Background

Teenage parenting is recognised as one of the greatest health and social problems in South Africa. Research in South Africa has shown that by the age of 18 years, more than 30% of teens have given birth at least once. Teen mothers may feel disempowered because they are ‘othered’ and consequently, may develop forms of resistance which in most cases may inhibit their ability to parent. Social support is therefore, an imperative intervention for successful teen parenting but this is not clearly understood in South Africa. This study aimed to compare the relationship between parental efficacy and social support systems of single teen mothers across different family forms.

Methods

A quantitative methodology with a cross-sectional comparative correlation design was conducted with 160 single teen mothers who resided with a family in a low socio-economic community. The participants completed a self-report questionnaire that comprised of the Social Provisions Scale, and the Parenting Sense of Competence scale. Descriptive statistics and Pearson correlation were used to investigate the data.

Results

A significant positive relationship between social support and parental efficacy was found. When comparing different family forms, single teen mothers’ residing with one parent reported greater levels of parental efficacy and single teen mothers’ residing with two parents, re-counted high levels of social support under the subscales; guide, reliable and nurture. However, when computing for guardian-skip generation, results show that there is no significant relationship between parental efficacy and social support. As well as no correlation across subscales of social support.

Conclusion

The positive relationships between social support and parental efficacy are important for planning and applying parenting programmes amongst single teen mothers and facilitating awareness regarding the importance of social support and family forms when considering parenting practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01300-w.

A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study

PURPOSE

Female adolescents seeking emergency department (ED) care are at high risk of unintended pregnancy, primarily because of contraceptive nonuse; yet, few ED patients follow up for reproductive care when referred. The objective of this cohort study was to determine the feasibility, acceptability, adoption, fidelity, and potential efficacy of a personalized and interactive ED-based pregnancy prevention mobile health intervention (Emergency Room Interventions to improve the Care of Adolescents [Dr. Erica]).

METHODS

We conducted a prospective cohort study with sexually active female ED patients aged 14-19 years who were not using highly effective contraceptives. Dr. Erica consists of a 10-week, automated, two-way texting intervention based on an evidence-based sexual health curriculum, the Social Cognitive Theory, and motivational interviewing techniques. At 12 weeks, we conducted follow-up via online survey and phone call to measure feasibility, acceptability, adoption, fidelity, and preliminary efficacy data (contraception initiation).

RESULTS

We screened 209 female ED patients to enroll 42. The average age was 17.5 years (standard deviation ± 1.4); the majority were Hispanic (n = 37, 88%) and had a primary provider (n = 40, 95%). One participant opted out (1/42, 2%), and a total of 35 participants (83%) completed follow-up. Although interactivity diminished with time, 83% of participants (35/42) replied to one or more text. Ninety-four percent of participants (29/31) liked the messages, and 83% (25/30) would recommend the program. Hormonal contraceptives were initiated by 46% of participants (16/35).

CONCLUSIONS

Dr. Erica was feasible and acceptable among female adolescent ED patients and demonstrated high fidelity and adoption. The intervention also showed potential to increase highly effective contraceptive use among high-risk females.

Young women's and midwives' perspectives on improving nutritional support in pregnancy: The babies, eating, and LifestyLe in adolescence (BELLA) study

RATIONALE

Teenage pregnancy has a high risk of poor outcomes for both mother and baby. Teenage girls have the poorest diets of any population group in the UK, which compounds the risk of poor pregnancy outcomes. Pregnant teenagers trust advice from their midwives, but midwives feel they do not have time, confidence, or knowledge to discuss nutrition.

OBJECTIVE

This study examined how the relationship between pregnant teenagers and their midwives could be utilised to deliver support to improve diet quality.

METHOD

Qualitative interviews were conducted across three urban sites in the UK: Manchester, Doncaster, and Southampton with adolescent mothers and their midwives regarding diet and lifestyle, and what form of support would be helpful. In total, 106 young women and 20 midwives were interviewed. Most of the young mothers were 19 or younger (67%). Half had had their first child in the past year (52%) and 21% were pregnant during the study. Thematic analysis was used to identify ways to better support young mothers to eat well.

RESULTS

Young women found it difficult to prioritise healthy eating; they often felt isolated and not in control of their own lives and wanted support from their midwife. Midwives felt that it was their role to support young mothers with diet in pregnancy but were anxious about initiating conversations and felt they lacked clear guidance.

CONCLUSIONS

Pregnant teenagers and their midwives lack reliable resources and strategies for healthy eating support. An effective intervention to improve pregnant teenagers' diet quality must empower, inform, and motivate young mothers and their midwives, and enable connections between young mothers.

Maternal sexual empowerment and sexual and reproductive outcomes among female adolescents: Evidence from a cross-sectional study in Ecuador

Background

A vast literature has demonstrated that several mother-related variables are positively associated with their daughters’ sexual and reproductive outcomes. One underexplored variable is sexual empowerment––a subdimension of empowerment. In this study, we explore if maternal sexual empowerment is predictive of adolescent daughters’ outcomes like early sexual initiation, teenage pregnancy, and contraception use.

Methods

This study uses data from the 2018 National Health and Nutrition Survey of Ecuador (Ensanut), a cross-sectional survey in Ecuador that measures health and nutrition. We examine whether mothers’ sexual empowerment––measured as a woman’s autonomy in sexual relationships and her ability to turn down sex and demand contraception use from her partner––is predictive of sexual and reproductive outcomes among female adolescent children. Logistic regression was performed to test this association.

Results

Results showed that having a mother who lacked sexual empowerment increased the odds of early sexual initiation. Girls who had a mother who had a teenage birth were more likely to experience teenage pregnancy themselves.

Conclusions

Mothers may influence daughters’ attitudes towards sex through their own demonstration of sexual empowerment. This research demonstrates that a lack of maternal sexual empowerment can be a risk factor of early sexual initiation, teenage pregnancy, and lack of contraception use among female adolescents. More research is needed to confirm the robustness of these results and analyze other forms of sexual empowerment.

Limitations

Other variables not present in the data, like domestic violence, can be used to understand the sexual activity of young females and maternal sexual empowerment. Social desirability and recall bias are also common forms of bias in surveys regarding sexual activity among adolescents.

•

A lack of mothers’ sexual empowerment increased the odds of early sexual initiation of 16-year old women.

•

Having mothers who had had a teenage birth increased the odds of adolescents’ early sexual initiation and teenage pregnancy.

•

Mothers' sexual empowerment is not associated with their adolescent daughters’ use of contraception.

Co-production of two whole-school sexual health interventions for English secondary schools: positive choices and project respect

BACKGROUND

Whole-school interventions represent promising approaches to promoting adolescent sexual health, but they have not been rigorously trialled in the UK and it is unclear if such interventions are feasible for delivery in English secondary schools. The importance of involving intended beneficiaries, implementers and other key stakeholders in the co-production of such complex interventions prior to costly implementation and evaluation studies is widely recognised. However, practical accounts of such processes remain scarce. We report on co-production with specialist providers, students, school staff, and other practice and policy professionals of two new whole-school sexual heath interventions for implementation in English secondary schools.

METHODS

Formative qualitative inquiry involving 75 students aged 13-15 and 23 school staff. A group of young people trained to advise on public health research were consulted on three occasions. Twenty-three practitioners and policy-makers shared their views at a stakeholder event. Detailed written summaries of workshops and events were prepared and key themes identified to inform the design of each intervention.

RESULTS

Data confirmed acceptability of addressing unintended teenage pregnancy, sexual health and dating and relationships violence via multi-component whole-school interventions and of curriculum delivery by teachers (providing appropriate teacher selection). The need to enable flexibility for the timetabling of lessons and mode of parent communication; ensure content reflected the reality of young people's lives; and develop prescriptive teaching materials and robust school engagement strategies to reflect shrinking capacity for schools to implement public-health interventions were also highlighted and informed intervention refinements. Our research further points to some of the challenges and tensions involved in co-production where stakeholder capacity may be limited or their input may conflict with the logic of interventions or what is practicable within the constraints of a trial.

CONCLUSIONS

Multi-component, whole-school approaches to addressing sexual health that involve teacher delivered curriculum may be feasible for implementation in English secondary schools. They must be adaptable to individual school settings; involve careful teacher selection; limit additional burden on staff; and accurately reflect the realities of young people's lives. Co-production can reduce research waste and may be particularly useful for developing complex interventions, like whole-school sexual health interventions, that must be adaptable to varying institutional contexts and address needs that change rapidly. When co-producing, potential limitations in relation to the representativeness of participants, the 'depth' of engagement necessary as well as the burden on participants and how they will be recompensed must be carefully considered. Having well-defined, transparent procedures for incorporating stakeholder input from the outset are also essential. Formal feasibility testing of both co-produced interventions in English secondary schools via cluster RCT is warranted.

TRIAL REGISTRATION

Project Respect: ISRCTN12524938 . Positive Choices: ISRCTN65324176.

Recovering from an Epidemic of Teen Pregnancy: The Role of Rural Faith Leaders in Building Community Resilience

This study explores the role of faith leaders and congregations in preventing teen pregnancy and enhancing overall health. Seventeen faith-based leaders responded to an invitation to participate. Participants were recruited from two counties within Oklahoma, based on desired community characteristics. Findings were directly related to: (1) the vulnerability of rural communities to negative health outcomes; (2) resiliency of rural faith communities to address health issues; and (3) the adaptive capacity of rural faith leaders and their communities to decrease teen pregnancy and maximize community health. Culturally relevant public health programming is necessary to engage this at risk population; however, it requires engaging faith leaders in efforts to build congregation-based and community-based capacity.

"I was tricked": understanding reasons for unintended pregnancy among sexually active adolescent girls

Background

While the Kenya government is mobilizing high-level strategies to end adolescent pregnancy by 2030, a clear understanding of drivers of early unintended pregnancy in the country is a necessary precursor. In this study, we determine the prevalence, associated factors, and reasons for unintended pregnancy among sexually active adolescent girls (aged 15–19 in two Kenya counties with the highest rate of teenage pregnancy.

Methods

We used the “In Their Hands” (ITH) program's baseline evaluation data. The study adopted a mixed-methods design with 1110 sexually active adolescent girls in the quantitative component and 19 girls who were either pregnant or nursing a child in the qualitative. We used adjusted and unadjusted logistic regression to model factors associated with unintended pregnancy among respondents. We used a thematic analysis of qualitative data to examine girls’ reasons for having unintended pregnancy.

Results

Overall, 42% of respondents have had an unintended pregnancy; however, higher proportions were observed among girls who were 19 years (49.4%), double orphans (53.6%), never used contraceptive (49.9%), out-of-school (53.8%), and married (55.6%). After adjusting for relevant covariates, the odds of unintended pregnancy were higher among girls who resided in rural areas (AOR 1.64, 95% CI 1.22–2.20), had primary or no formal education (AOR 1.50 95% CI 1.11–2.02), and had never used contraceptive (AOR 1.69 95% CI 1.25–2.29) compared with their counterparts. Current school attendance was associated with a 66% reduction in the probability of having an unintended pregnancy. Participants of the qualitative study stated that the desire to maintain a relationship, poor contraceptive knowledge, misinformation about contraceptive side effects, and lack of trusted mentors were the main reasons for their unintended pregnancies.

Conclusion

A massive burden of unintended pregnancy exists among sexually active adolescent girls in the study setting. Adolescent boys and girls need better access to sexuality education and contraceptives in the study setting to reduce early unintended pregnancy.

'There is no more future for me? Like really, are you kidding?': agency and decision-making in early motherhood in an urban area in Johannesburg, South Africa

Background: The South African development goals for young women aged 15 to 24 are to reduce HIV incidence, teenage pregnancy and gender-based violence, and to increase school completion and economic security. Early, unintended pregnancy undermines these goals, creating discourses of early motherhood that position young women as powerless. There has been scant attention on the agency of young women in their structural context.Objective: This study explored how young women exercise agency after an unintended pregnancy and make decisions concerning their future, including sexual and reproductive health, school completion and/or income generation, and caregiving for their babies.Methods: I used narrative analysis to explore the lived experiences of young mothers, paying attention to decision-making during pregnancy and motherhood. Domains of analysis included health care, education, and caregiving. I conducted in-depth interviews with 30 young mothers: 30 were interviewed once, nine were interviewed twice, and six were interviewed three times. I interviewed four significant people in the lives of young mothers and six health care providers at a health centre.Results: Progressive policy facilitates increased access to services for young pregnant and parenting women. However, education and health care providers continue to discriminate against them, formally through denying them access to services and informally through discourses of shame which pervade their structural context. Kinship capital in urban and rural contexts and the Child Support Grant mitigate some struggles in early motherhood and help young mothers navigate decision-making.Conclusion: Young mothers exercise agency along a continuum to realise their aspirations. Social and structural support mediate their agency. Policy needs to expand the focus from prevention to include issues of care and support after an early, unintended pregnancy to ensure the health and wellbeing of young mothers and their children.

Geographic variation and risk factors for teenage pregnancy in Uganda

BACKGROUND

Teenage pregnancy is a global health issue with high rates in sub-Saharan Africa. In Uganda, teenage pregnancy is a public and community health issue.

OBJECTIVES

This study hypothesized that there would be regional variations in rates, risk factors and trends of teenage pregnancy in Uganda.

METHODS

Data were analyzed from the Uganda Demographic and Health Surveys (UDHS) in 2006 and 2011. The outcome of interest was current pregnancy for females 15 to 19 years of age at the time of the survey. Bivariate analysis was performed for each year to examine the rate and trends of pregnancy by various demographic characteristics. Logistic regression was conducted to assess the association between teenage pregnancy and sociodemographic variables.

RESULTS

Uganda's rate of teenage pregnancy increased from 7.3/1000 in 2006 to 8.1/1000 in 2011. The East Central region consistently had the highest rates than other regions. In 2006, teenage pregnancy was significantly associated with being married, living with a partner or separated, as compared to those who were single. Marital and wealth status were also significant predictors of teenage pregnancy based on the 2011 survey.

CONCLUSION

The rate of teenage pregnancy in Uganda is high and the trend demonstrated regional variation. Future interventions could focus on regions with high poverty and low education.

Trends in teenage motherhood in Ecuador: challenges and inequalities

OBJECTIVES

To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012.

METHODS

We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI.

RESULTS

The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador.

CONCLUSIONS

Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

Obstetric outcomes: A comparison of teenagers and adults in the Cape Coast metropolis, Ghana

Prevalence of teenage pregnancy is very high in the Central Region of Ghana. Although, pregnant teenagers are perceived to be high-risk mothers, very little has been documented about obstetric outcomes among these mothers in Ghana. This case-control observational study compared maternal and perinatal outcomes between teen and adult mothers in the Cape Coast metropolis. Data on maternal and perinatal outcome variables were collected with a data extraction form from maternal history record and delivery record books of 505 teens and 501 adults. Maternal and perinatal outcomes for the two groups were compared using chi-square or Fisher's exact test and odds ratios at 95% confidence interval. Prenatal services utilization was high among the participants. Prevalence of adverse maternal and perinatal outcomes were low, which is comparable between the two groups. Spontaneous vaginal delivery was higher in the teens with the adults having higher predisposition for caesarean section. The adult mothers were more likely to have preterm delivery and babies with low minute 1 APGAR score, the teens on the other hand had babies with significantly lower birth weight. The favourable and comparable pregnancy outcomes among the participants could be attributed to the high prenatal service utilization. Improved access to prenatal service utilization would produce better pregnancy outcomes.

Prevalence of teenage pregnancy and the associated contextual correlates in Rwanda

The rate of teenage pregnancy remains unacceptably high in most developing countries. In Rwanda, studies show a rapid increase over the past two decades despite the political achievements of women's empowerment, and efforts to curtail child sexual abuse. Unfortunately, the current knowledge of the household determinants of teenage pregnancies in Rwanda is limited, as recent studies have focused on providing numbers with little analysis of proximate causal factors or focused on the individual determinants. The study uses secondary data from the recent Rwanda Demographic and Health Survey (RDHS: 2014-2015) to analyse household factors associated with teenage pregnancies in Rwanda. In addition to descriptive analysis, we ran logistic regression models to determine the level of association between teenage pregnancy and household socioeconomic characteristics. Results indicate that marital status and age of household head, household size, number of bedrooms given the size of the household, and the educational level of the household-head are significantly associated with teenage pregnancy (p < 0.01). Teen girls from small households are more likely to get pregnant than those from large families, while financial, social and educational empowerment of parents, and harmonious household contexts contribute to lessening the cases of teenage pregnancy. It indicates that social and economic support to teen girls which include parental supervision, guidance, and financial care are essential aspects to consider in order to reduce teenage pregnancy rates. The study suggests that in addition to efforts directed to teens themselves, strategies for reducing teen pregnancies should focus on a range of household-level contexts that form two broad categories: empowering parents and maintaining parents' harmonious decisions on teen girls.

Understanding the decline in under-18 conception rates throughout England's local authorities between 1998 and 2017

We consider England's two-decade teenage conception decline in the context of societal changes: rising educational aspirations; growing second- and third-generation teenage ethnic minority populations; increased deprivation associated with economic recession and post-2008 Government austerity; and changing housing availability. Using England's Local Authority Districts (LAD) 1998-2017, we explore the role of area characteristics in explaining spatial differences in under-18 conception rates and how changing characteristics may explain temporal changes. Urban/rural distinctions in teenage conceptions are largely minimised after considering LAD characteristics. Area characteristics continue to partly explain teenage conception rates but are better at explaining area differences than variation over time.