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					Adolescent
Pregnancy
A Global Perspective




Martha Gibson
HS 6423
Spring 2007
    Worldwide
    about 14
    million
    adolescent
    girls give
    birth, while
    about 4.4
    million have
    abortions.
Source: People’s Daily (2007)
   Implications of
Adolescent Pregnancy
                                       Social exclusion
                                       Greater
                                        reproductive health
                                        risks
                                       Increased risk of
                                        poverty
                                       Increased risk of
                                        maternal and infant
                                        mortality

Source: Guttmacher Institute (2006)
Adolescent Pregnancy Contributes to the
           Cycle of Poverty


  According to Yampolskaya,
  Brown, and Vargo (2004),
  “...approximately 60% of
  adolescent mothers live in poverty
  at the time of the birth of their
  babies, and approximately 73% go
  on welfare within 5 years of giving
  birth.”
Associated Factors
    Poverty                     Rape
    Unemployment                Alcoholism
    Failing Nuclear Families    Substance Abuse
    Abuse                       Social Pressures
    Early Menarche              Low Self Esteem
    Gang Activity               School Drop outs
    Domestic violence           Poor educational
    Coercion                     opportunities
    Early Marriage              Poor access to health care
                                 Influence of the media




                                Source: Data gathered from various cited resources (WHO, CDC,
                                      Guttmacher Institute)
Higher Risk with Adolescent
Pregnancy, Birth and
Postpartum Complications
  Hypertension
  Eclampsia
  Anemia
  Difficult labor and childbirth as a result of
   cephalopelvic disproportion
  Increased maternal mortality
  Low Birth Weight
Source: IRIN-Africa (2007)
It is a Global Issue
Most men have sex
before age 20.
  % of men 20-24
  100

   80

   60

   40

   20

    0
             11           13              15           18             20
          Burkina Faso          Nigeria                 Uganda
          Zimbabwe              Brazil                  Dominican Republic
          Mexico                Peru                    Italy
          Japan                 United States


 Copyright: The Alan Guttmacher Institute       In Their Own Right- Worldwide
Approximate Pregnancy Rate
Per 1,000 girls < 20-years-old
     350
                                                                                 Global
                                                                                 Latin America
     300
                                                                                 United States
                                                                                 South Africa
     250
                                                                                 Botswana
                                                                                 Netherlands
     200                                                                         Russian Federation
                                                                                 Japan
     150                                                                         Australia
                                                                                 France
     100                                                                         Sweden
                                                                                 Canada
       50                                                                        Great Britain
                                                                                 Ghana
         0
  Information in table was generated from data gathered from cited resources (Guttmacher Institute, WHO, CDC)
                      Worldwide, women
                         bear a greater
                     burden of sexual and
                        reproductive ill-
                       health than men.
                       More than half a
                     million women die in
                         pregnancy and
                     childbirth in resource
                     constrained settings.


Source: WHO (2006)
Adolescent Pregnancy Leads
to Unsafe Abortions
 A study in Nigeria in the early 1990’s, that included
  about 144 women (half of which were under 20 years
  of age), reported many complications- including a 9%
  death rate. Only 25% had no complications.
 In some urban areas unmarried adolescents represent
  the majority of all abortion seekers.
 In developing countries, the risk of death following
  unsafe abortions is several hundred times higher than
  one performed professionally in safe conditions.
 Almost 14% of all unsafe abortions occur in
  adolescents under the age of 20.
 The rate is higher in Africa than any other region.
Source: WHO (2004)
Chile
 More than 30,000 adolescents between the
  ages of 15 and 19 give birth every year.

 From 1990 to 2003, the proportion of live births
  to teenage mothers rose from 13.8 percent of
  all births to 14.9 percent.

 In 2003, 17 of the 994 babies (1.7 percent)
  born to mothers under age 15 died.

 335 of the 33,838 babies (1.0 percent) born to
  mothers between the ages of 15 and 19 died.
Source: Health-Chile (2007)
Botswana

 In 1996, six out of 10 teenage girls had
  been pregnant at least once, but only two
  out of 10 in 2003.

 Among girls between the ages of 15 and
  19 who have had sex, 40% have been
  pregnant.


Source: Plus News Global (2007)
 South Africa
 The number of pregnant school girls jumped from
  1,169 in 2005 to 2,336 in 2006 in Gauteng.

 One in three girls has had a baby by the age of
  20.

 16 percent of pregnant women under the age of
  20 tested HIV positive.

 30 percent of girls in South Africa said "their first
  sexual experience was forced or under threat of
  force".

Source: IRIN Africa (2007)
Afghanistan

  57% of marriages are by girls under
   the age of 16 years old which has
   led to an increased maternal
   mortality rate.




 Source: Guttmacher Institute (2006)
Ghana
  More than half marry in their teens.

  12% aged 15-19 have had a child.

  25% report sexual coercion that leads to an
   unintended pregnancy.

  39% aged 12-24 state that the last abortion
   they were involved in took place at home.

 The Alan Guttmacher Institute (2004)
United States
 One million teenagers become pregnant
  annually.

 The United States has the highest rate of teen
  pregnancy, childbirth and abortion among
  developed countries

 63% give birth, and 22% have abortions.



Source: Adolescent Pregnancy and Childbirth in the U.S. (1999)
    According to the Centers for Disease
    Control (CDC), teenage pregnancy rates
    nationally dropped 27 percent overall during
    the years 1990-2000. Despite the decline,
    the teenage pregnancy rate in the United
    States is still the highest among
    industrialized nations. Even with the drop,
    35 percent of U.S. teenage girls become
    pregnant at least once before age 20.




Source: Centers for Disease Control (CDC) (2004)
The 2005 Youth Pregnancy
Risk Behavior Survey
  47% of high school students had
   sexual intercourse at least once.
  37% of sexually adolescent
   students had not used a
   condom.

 Source: Branson (2006).
 Adolescent Maternity
 Threatens Achievement of the Millennium
 Development Goals (MDGs) by 2015
 Since adolescent pregnancy leads to an
  increased infant and maternal mortality rate,
  achievement of the following goals will not be
  met if current trends continue:
       Reduce by three-quarters the maternal mortality rate
       Reduce by two-thirds the under-five mortality rate

 Since in many parts of the world, pregnant girls
  are not allowed to remain in school,
  achievement of this goal will also not be met:
       Eliminate gender disparity in all levels of education

Source: Millennium Project (2005)
Healthy People 2010
  In an attempt to decrease adolescent
   pregnancy, Healthy People 2010
   recommended the goal of ….increasing the
   “proportion of sexually active, unmarried
   adolescents aged 15 to 17 years who use
   contraception that both effectively prevents
   pregnancy and provides barrier protection
   against disease”


 Source: Healthy People 2010
  Recommendations
 Focus on women and girl’s reproductive
  health and education outcomes.

 Provide Emergent obstetric care.

 The provision of reproductive health care
  services to teens requires sensitivity to
  the special needs of this age-group
  including knowing about laws about
  confidentiality and services for birth
  control, pregnancy, abortion, and
  adoption.


Source: Stanhope and Lancaster (2006)
 Thorough assessments are vital, because factors
  such as a history of sexual victimization, family
  dysfunction, substance use, and failure to use birth
  control can influence whether a young girl becomes
  pregnant.

 The pregnant teen will need support during and
  after pregnancy from her family and friends and
  from the father of the baby.




Source: Stanhope and Lancaster (2006)
 Reforms
 In Chile, under the new regulations, public health services are
  authorized to prescribe, and to provide free of charge, traditional and
  emergency contraceptives to adolescents over 14, without the need
  for parental consent.

 In Botswana, increased child support rules and daycare and
  encouragement for teens to stay in school have led to decreased teen
  pregnancy rates.

 In Ghana, Media Campaigns to encourage condom use among
  sexually active youth are proving to be effective in reducing the
  number of adolescent pregnancies.



Source: Health-Chile and Plus News Global
   The “Young and Wise” campaign sponsored by Planned Parenthood in
    Ghana is another good campaign to decrease the number of adolescent
    pregnancies.

   The African Youth Alliance is moving towards progress in reducing
    adolescent pregnancy.

   The “Stop Aids Love Life” program in Ghana is also an effective tool in
    promoting self esteem leading to lower incidences of adolescent pregnancy.




Source: Plus News Global (2007)
Successful Pregnancy
Prevention Programs
  Include collaborative approaches by the
   teens, their families, teachers, health
   professionals, businesses, the faith
   community, lawmakers, and other
   community organizations.




 Source: Brandis, Sattley, and Mamo (2005)
 The Parent-Adolescent
 Relationship Education
 (PARE) Program
       The program provides a curriculum for prevention of
        STDs and pregnancy in middle school youth and
        focuses on strengthening family communication about
        sexual issues and behaviors to help prevent teen
        pregnancy.

       The National Campaign to Prevent Teen Pregnancy
        advocates PARE and includes information about
        reproduction, sex risks, and safe-sex behaviors
        including contraception and abstinence.

       PARE emphasizes the importance of parental
        involvement on the reduction of early pregnancies.
Source: Lederman, R.P., & Mian, T.S (2003).
Education is Key
                                   Education should be started before the age
                                    of 14, when young people become sexually
                                    active.
                                   Information should be provided for
                                    teenagers about avoiding unintended
                                    pregnancies, including detailed information
                                    about contraception and its side effects.
                                   There should be better management and
                                    training for nurses, so they can deal
                                    sympathetically with teenagers requiring
                                    contraception and provide the necessary
                                    information and education campaigns that
                                    take away the stigma of teenage sexuality,
                                    so that adolescents are not afraid to ask for
                                    contraception.
                                   All teenagers should not just be allowed to
                                    remain in school and to return to school
                                    after birth, but they should be strongly
                                    encouraged to do so.


Source: People's Daily (2007)
            Every minute, somewhere in the
            world a young mother dies from
            complications in pregnancy and
            childbirth. Four million babies die
            each year within their first 28 days
            of life, and another 3.3 million are
            stillborn. Millions of lives could be
            saved using the knowledge we have
            today, but the challenge is to
            transform this knowledge into
            action.


Source: World Health Organization (WHO) (2006)
                               References

Adolescent Pregnancy and Childbirth in the U.S. (1999) Retrieved March 10, 2007, from
http://www.prcdc.org/adolescent_pregnancy_and_childbearing_us.pdf.
Alan Guttmacher Institute (2004). Adolescents in Ghana: Sexual and reproductive health.
Retrieved March 10, 2007, from www.guttmacher.org
Alan Guttmacher Institute ( 2006). In their own right-Addressing the sexual and reproductive
health needs of men worldwide. Retrieved March 11, 2007, from www.guttmacher.org
Brandis, C. D., Sattley, D., & Mamo, L. (2005). Theory to action: Frameworks for
implementing community-wide adolescent pregnancy prevention strategies. Retrieved
October 27, 2006 from http://crhrp.ucsf.edu
Branson, B. (2006). Revised recommendations for HIV testing of adults, adolescents, and
pregnant women in health-care settings Retrieved March 5, 2007, from
www.cdc.gov/mmwR/preview/mmwrhtml/rr5514a1.htm
Centers for Disease Control and Prevention (CDC) (2004). National Center for Health
Statistics (NCHS) data on teenage pregnancy. Retrieved September 26, 2006 from
www.cdc.gov.
Guttmacher Institute (2006). Retrieved March 10, 2007, from http://www.guttmacher.org
Health-Chile (2007). Teen pregnancy bucks global downward trend. Retrieved March 14,
2007, from http://ipsnews.net/news.asp?idnews=36729
Healthy People 2010. Retrieved September 27, 2006 from www.healthypeople.gov
•   IRIN-Africa (2007). South Africa: Teenage pregnancy figures cause alarm. Retrieved March 14,
    2007, from http://www.irinnews.org/Report.aspx?Reportid=70538

   Lederman, R.P., & Mian, T.S. (2003). The parent-adolescent relationship education (PARE)
    program: A curriculum for prevention of STDs and pregnancy in middle

   Millennium Project (2005). Investing in development: A practical plan to achieve the millennium
    development goals.

   People’s Daily (2007). Health services grow to meet increase in teen pregnancy. Retrieved
    March 9, 2007, from http://english.people.com

   Plus News Global (2007). Botswana: Baby steps in bringing down teen pregnancy. Retrieved
    March 14, 2007, from http://www.irinnews.org/Repoert.aspx?Reportid=39151

   Stanhope, M. and Lancaster, J. (2006). Foundations of nursing in the community. Mosby. St
    Louis.

   WHO (2004). Unsafe abortion: Global and regional estimates of the incidence of unsafe
    abortion and associated mortality. Retrieved March 8, 2007, from www.who.int/reproductive
    health/publications/unsafe_abortion_estimates_04

   WHO (2006). Sexual and reproductive health of women living with HIV/AIDS. Retrieved March
    5, 2007, from http://www.who.int/hiv/en

   Yampolaskaya, S., Brown, E. C., & Vargo, A. C. (2004). Assessment of teen pregnancy
    prevention interventions among middle school youth. Child and Adolescent Social Work
    Journal, 21, 69-83.