Wednesday, 10 July 2013

Adolescent pregnancy

This year’s World Population Day theme is Adolescent Pregnancy.

There was a time when the news of teenage pregnancy was a shocking one in our country, however, the trend has changed. The new trend is too alarming but not surprising. 

The factors in India are poverty, lack of education, disintegration of joint families, peer pressure and media exposure. Such incidents are much higher in villages than in cities. 

In one Indian study from Banaras published in Indian Journal of Pediatrics 2007, teenage pregnancy was associated with significantly higher risk of pregnancy induced hypertension, pre-eclemptic toxemia, eclampsia, premature onset of labour, fetal deaths and premature delivery.  Increased neonatal morbidity and mortality were also seen in babies delivered to teenage girls. Younger teenager group (17 years) was most vulnerable to adverse obstetric and neonatal outcomes.

The Union Health Ministry has recorded the maximum number of child marriage and teenage pregnancies in the State of West Bengal. While poverty and gender bias, non education have been identified as the primary causes in rural areas, growing teenage sex and lack of sex education have been blamed for the higher increase in cities.

In West Bengal, 14% of the births are by teenage girls between 15-19 years of age. 41% of the girls are married before the age of 18.

A teenager has 90% chances of becoming pregnant if contraception is not used.
Causes of teenage pregnancy in India are:
i.              Child marriage
ii.            Getting into relationship at an early age.
iii.           High risk behaviors such as drinking, smoking and drugs.
iv.           Lack of supporting group of friends.
v.            Unhealthy environment at home
vi.           Stressful and depressed mental status
vii.          Living in community where child bearing is common
viii.        Exposure to sexual violations
ix.           Financial problems

Facts about teen pregnancy
·         Ten percent of all women aged 15 to 19, and 19 percent of those who have sexual intercourse, become pregnant.
·         One-quarter of adolescent mothers have a second child within two years of their first.
·         A pregnant adolescent may complain of missing her periods or of irregular periods.
·         Pregnant adolescent may present with vague complaints and may or may not have considered the possibility of pregnancy.
·         It is important to ask the teenager what she would do if her pregnancy test were positive before the test is performed.
·         When the results of a positive pregnancy test are disclosed to the adolescent, her thoughts and feelings about the test result should be elicited, and emotional support provided.
·         Factual information regarding the duration of pregnancy and estimated date of confinement (EDC) should be provided.
·         It is also important to determine how the adolescent wants to go about informing her parent(s) and the father of the baby.
·         Options regarding the pregnancy should be discussed in a nonjudgmental manner and the adolescent referred as soon as possible to a clinician or clinic where comprehensive pregnancy counseling is provided.
·         The healthcare provider should contact the adolescent about one week after the scheduled referral for follow-up information, to demonstrate concern for the adolescent, and to ensure appropriate care.

·         Adolescents appear to be at increased risk for adverse pregnancy outcomes, such as low-birth-weight babies and infant deaths. Adolescent pregnancy is associated with several adverse socioeconomic outcomes for the mother, father, and child. 

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