School Papers

1. can have adverse health and social consequences

1. Introduction

1.1 Background

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One
of the major public health issues across the whole world these days is teenage
pregnancy which is defined as pregnancy in girls’ age ranging from 13 – 19
years old and very often the term adolescent pregnancy is also being used to
infer it. Furthermore it is categorized as early adolescents (10 -14 years) and
late adolescents (15 – 19 years) (1). According to
2017 UN world population prospect report, it is clearly depicted that from the
total world’s population of 7.6 billion, nearly half of them (42%) are under 25
years old and yet 16% of world’s population are comprised of youth age groups
(15 – 24 years). Apparently Africa, the second most populous continent next to
Asia, has the largest proportion of youth age groups (19%) followed by Latin America
& the Caribbean and Asia 17% and 16%, respectively (2). Globally it is
estimated that around 16 million babies (11% of all child births) are born to
adolescent girls. Ironically, 95% of these births occurred in countries with
low socioeconomic status (3). Furthermore
according to WHO, seven countries mainly constitute for half of all adolescent
births; namely, Bangladesh, Brazil,
the Democratic Republic of the Congo, Ethiopia, India, Nigeria and the United
States of America (1)(3) (4).

Levels
of adolescent childbearing which can have adverse health and social
consequences for both the young mothers and for the children they bear has
fallen in most countries. Nevertheless, high adolescent fertility remains a
concern in some parts of the world. Among regions, the adolescent birth rate
(births per 1,000 women aged 15-19) in 2010-2015 was highest in Africa, at 99
per 1,000 women, followed by Latin America and the Caribbean at 67 per 1,000.
The ratio of adolescent to total fertility was highest in Latin America and the
Caribbean, where the birth rate at ages 15-19 years contributed 16 percent of
total fertility. Births to adolescents as a
percentage of all births range from about 2% in China to 18% in Latin America
and the Caribbean. (2),(3),(4).

Determinants of teenage pregnancy in a study
employed in developing countries enumerated the following reasons as
attributing factors for teenage pregnancy; lack of knowledge on sexuality
education, ineffective utilization of modern contraceptives, cultural obedience
or permissiveness, poverty which lead to family disintegration, socioeconomic
dependence of females on males, peer influence and the like (5) . Due to the fact that adolescents are presumed
to be less mature both anatomically & physiologically than adult women. They
have the tendency to exhibit enormous adverse maternal and perinatal outcomes
when they get pregnant. Consequently teenage pregnancy have remained to be a
global public health problem, particularly in the third world countries (6). There are a lot of speculations for the
question why teenage pregnancy is associated with poor obstetric &
perinatal outcome. For instance, adolescents have lower socioeconomic status,
lower educational level, poor compliance to antenatal care, higher chance to
deliver low birth weight & premature babies (7). It is not surprising that teenage pregnancy is greatly
associated with adverse pregnancy outcomes like obstructed labour,
preeclampsia, anemia, operative deliveries, puerperal endometritis postpartum
hemorrhage, low birth weight, preterm delivery & perinatal death (8),(9),(10), (11). Nevertheless, the evidences have always been an
area of controversy; whether these adverse outcomes are owing to either
biological immaturity or socioeconomic deprivation & inadequate health care
service.

Pregnancy for the second time & more in
adolescents even carries higher risk of these adverse pregnancy & perinatal
outcomes. A study outlined the following predictors as significant indicators
of poor perinatal outcomes; age of first pregnancy less than 16 years old,
history of adverse pregnancy & perinatal outcomes in the previous pregnancy
and inter birth interval less than 18 months (12).

 

 

 

 

 

 

 

 

 

1.2.
Statement of the problem

 According to 2017 UN report 16% of total
world’s population are constituted by youth age groups, 15 – 24 years old (2).

Adolescent
pregnancies are becoming area of inquiries and emphasis as it is a public
health problem worldwide. According to WHO report, globally every year 16
million late adolescent girls and one million early adolescent girls get pregnant,
11% of total childbirth In which most of them (95%) reside in low and middle
income countries (3).

A
multi country assessment held in 29 countries of low and middle countries by
WHO ranked the following continents as the most prevalence areas for teenage
pregnancy; Latin America & the Caribbean, Africa and Asia with teenage
pregnancy rate of 35.5%, 35.1% and 11.5%, respectively (8). Moreover WHO
report also revealed that twenty three percent of overall morbidities owing to
pregnancy and childbirth are mainly attributed to adolescent pregnancies. Every
year it is estimated that around 3 million late adolescent girls undergo unsafe
abortion and on top of this complications that arise during pregnancy and
childbirth is the second commonest cause of death in late adolescent girls (3). There is also
an increased risk of NICU admission, preterm delivery, low birth weight,
stillbirths and neonatal death in babies born to adolescent mothers (13).

In
Ethiopia according to EDHS 2016, twenty two percent of total female populations
are late adolescents (15 to 19 years old). Of these 13% of them have begun
childbearing. Apparently teenage pregnancy is more predominant in rural residents
(15% Vs 5%) while Afar remained to be the most prevalent region for teenage
pregnancy (23%) followed by Ethiopian Somalia region (19%). Pertaining to the
educational level of adolescent mothers, teenage pregnancy predominantly
occurred in those with no education (28%) comparing to adolescent females
attained primary education (13%) and secondary education (4%) (14) .

 

Despite
the fact that there are studies which have concluded that teenage pregnancy is
associated with adverse maternal & perinatal outcomes, yet there are
other  researches which contradict to
these speculations (15). This is due to
the fact that some of the studies conclude their associations with descriptive
statistics and some are attributed to heterogeneity of population and some are
owing to their study designs, study area setting and difference in sample
sizes.

1.3.
Significance of the study

As
it is mentioned earlier Ethiopia is one of the seven countries which comprise
half of adolescent pregnancy rate in the world. According to EDHS 2016 it is
estimated that teenage birth rate in Ethiopia is 80/1000 (14).  Even though a
lot have been said about teenage pregnancy and its associated factors and some
deals about the outcomes across the globe, as far as the investigator knowledge
there are no published researches being employed pertaining to adverse
obstetric and perinatal outcomes of teenage pregnancy in Ethiopia.  Furthermore those studies which were done by
different researchers in different parts of the world, their finding about
obstetric and perinatal outcome of teenage pregnancy contradict one another.
Therefore this study is intended to explore this rampant situation and its
aftermaths which could in turn provide preliminary information for other
researchers in Ethiopia

Identification
of the adverse outcomes in the area also has greater input for the program
managers and policy makers for designing proper implementation and evaluation
of programs to reduce the occurrence of these adverse outcomes.

 For the midwifery professionals it will assist
to provide evidence based information about the adverse outcomes related to
maternal age and to promote the preventive and curative care of the mother and
the neonates to reduce the bad outcomes.

Furthermore
the findings of the study will create awareness in the community about the
problem and contribute towards formulating solutions at the grass root level.

 

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