PREGNANCY IN ADOLESCENCE: A PUBLIC

HEALTH ISSUE

Researcher: Zaireen Belo

Research Teacher: Mrs. Fely M. Tubil
 Table Of Contents

Abstract ---------- 21
Introduction ---------- 21
Prevalence of Pregnancy in
Adolescence ---------- 2
Marriage and Pregnancy in early adolescence
(10-14 years old) ---------- 21
Marriage and pregnancy in late adolescence (15-
19 years old) ---------- 21
Factors associated with pregnancy in
Adolescence ---------- 21
Health, social, and economic impacts of
Pregnancy ----------- 21
Conclusions ---------- 21
References ---------- 21
Acknowledgements ---------- 21
 Abstract

Health education is an important tool for health promotion

and focuses on building individuals’ capacities through educational,
motivational, skill-building and consciousness-raising techniques.
Comprehensive and abstinence-only educational interventions are the two
approaches that employ structured knowledge without the need for high-
tech resources and are focused on the prevention of pregnancy in
adolescence.
Comprehensive interventions include both abstinence and
responsible sexual behavior as effective methods and aim to reduce risky
sexual behaviors, like unprotected sex, and consequently the risk of
pregnancy, HIV, and other sexually transmitted infections (STIs).
Abstinence-only interventions promote abstinence from sexual activity, being
considered the only certain way to avoid pregnancy and STIs.
Secondary, studies demonstrated that the evidence on the
effectiveness of comprehensive interventions is inconsistent, owning a lot of
heterogeneity in the results of the studies and the evidence about the
effectiveness of abstinence-only interventions is scarce, as well as the results
showed no significant benefits in the prevention of pregnancy.
 Introduction

The rise of the health concept, addressing issues such as quality of life
and social well-being, is related to a change of perspective encompassing what
are the necessary measures for maintaining and promoting the health of
a population. Moreover, in order to guarantee the right to health, the
complexity of individuals regarding social, cultural, religious, and political
issues must be considered. To achieve this goal, health technologies must be
adopted.
The health technologies are classified into hard, soft-hard, and soft.
Hard technologies include technological equipment, machines, norms and
organizational structures, while soft-hard technologies include well-
structured knowledge applied for a certain purpose, such as for the
prevention, diagnosis or treatment of health conditions.
Furthermore, soft technologies are based on care methods to
welcome individuals, considering their needs, and offering a relationship of
learning, thus promoting autonomy over their own health and wellness.
Soft technologies include educational interventions provided to a
determined population in which structured knowledge is used without the
need for high-tech resources and that aim to improve health conditions,
allowing the individuals accepting or rejecting new information and may or
may not lead to behavioral changes.

Educational interventions such as strategies focused on

preventing teenage pregnancy must establish bonds with adolescents,
facilitating their acceptance. These interventions include actions that result in
greater knowledge and autonomy of this population, expanding their
decision-making capacity regarding their behavioral choices.
These approaches can be classified into comprehensive or abstinence-
only interventions, depending on whether the focus is only on postponing the
onset of sexual activity and abstinence, or whether it includes education on
the use of contraceptive methods and the importance of safe sexual behavior.
This chapter addresses the concept of educational interventions
and promotes discussion about the comprehensive and abstinence-only
approaches focused on the prevention of pregnancy in adolescenc

Prevalence of Pregnancy in
 Adolescence

According to the WHO, adolescent pregnancy is characterized

as pregnancy occurring in girls aged between 10 and 19 years. Besides
the previously mentioned adolescence classification in three age ranges,
which takes into account physiological aspects, the WHO additionally
subdivides pregnancy in adolescents in two ranges: early adolescent
pregnancy, which includes girls from 10 to 14 years of age, and late adolescent
pregnancy, comprising pregnant girls aged between 15 to 19 years. This
subdivision is important, not only because of the different physiological and
psychological levels of maturity, or rather prematurity, but also because of
the different social contexts under which pregnancy occurs in early and late
adolescence , such as child marriage, often forced, lack of access to
contraceptives, and information about contraception.
When talking about teenage pregnancy, one cannot ignore the
correlated institution of child marriage. Child marriage is recognized as a
human rights violation, and by various international conventions, such as
"The Universal Declaration of Human Rights", "The Convention on the
Elimination of All forms of Discrimination against Women", and the
"Convention on the Rights of the Child". Additionally, the SDG, adopted by
the United Nations in 2015 as a universal call to action to achieve a better and
more sustainable future for all people in the world, in respect of goal 5, which
aims to "Achieve gender equality and empower all women and girls",
by eliminating harmful practices, such as child, early and forced marriage (as
well as female genital mutilation).
The SDG additionally considers adolescent pregnancy as a health
issue. Indicator 3.7.2 understands the need of ensuring healthy lives and
promoting well-being for all at all ages, by, amongst others, controlling
adolescent birth in girls under 18 years of age. The following two sections
describe epidemiological aspects of pregnancy in early and late
adolescence, respectively.
 Marriage and Pregnancy in early adolescence
(10-14 years old)

Although data on early adolescent childbirth is often scarce, due

to underreporting and concealment of information , child pregnancy is
highly associated with forced child and early marriages.
Regarding childbearing, despite the recent global diminishing rates
since the year 2000, rates and absolute numbers are still far from reaching
desirable levels. The African continent is the only region to contain countries
with rates of early teenage pregnancies between 4 and 8 births per 1,000
adolescents between 10 and 14 years of age, and despite the decline in
relative numbers, the total number of childbirths has grown following
population growth under the same age range. Some countries in Latin
America, Eastern Europe, and the Middle East reach rates of 3 births per 1,000
early adolescents, while the other regions of the world achieved the rate of
maximum 1 childbirth per 1,000 early adolescents. Albeit it is important
to note that similarly to early marriages, South Asian countries, despite
lower rates of childbirth in young adolescents (1 per 1,000), may present
higher absolute numbers.
In absolute numbers, the region with the highest childbirth rate in
2021 was sub-Saharan Africa, with a total of 332 000 births among adolescents
between the ages 10 and 14. South-East Asia presented the lowest
number with a corresponding 22 000.
 Marriage and pregnancy in late adolescence
(15-19 years old)

Regarding child marriage in late adolescence, poverty and

geographic patterns exert the same influence as in early adolescence, in a
higher magnitude. Except for Mauritania and Somalia, in which the
proportion of married girls under 15 to married girls between 15 and 18 is
around the ratio of 1:1, the majority of countries present ratios ranging
between around 1:2.4 to 1:5.
Relative to childbearing, the WHO estimates that in low- and
middle-income countries, 21 million teenage pregnancies (15 to 19 years)
occur each year and although declines have occurred in all regions, sub-
Saharan Africa, Middle East, South Asia and Latin America and the
Caribbean continue to have the highest rates globally between 20 and 180
births per 1000 women in 2021 [8,19]. Although the estimated global rate of
childbearing in adolescents has declined, absolute numbers remain high. Sub-
Saharan Africa accounted for approximately 6 million total births in
adolescents from 15 to 19 years of age in 2021, while Central Asia presented
the lower number of births occurring in the same age range, estimated at
68 000.
 Factors associated with pregnancy in
Adolescence

Teenage pregnancy is a significant worldwide health concern that

negatively affects childbirth outcomes and can result in intergenerational
poverty and poor health, with lasting consequences for both the mother and
child. There are several significant predictors of this phenomenon, including
age, educational status, marital status, and community wealth status.
The following sections aim to provide an overview of these factors
that have been associated with pregnancy in adolescence. Specifically, the
following factors were evaluated: age, marital status, healthcare system,
family structure, mental health, educational status, and socioeconomic status
(see Figure 1). By identifying and discussing these factors, this section seeks
to contribute to a better understanding of the complex and multifaceted
nature of teenage pregnancy. Furthermore, the insights provided may aid in
the development of effective interventions to address this public health issue.

Figure 1. Factors associated with Pregnancy in Adolescence

 Age
A study that analyzed teen pregnancy in Ethiopia has
demonstrated that age is a critical predictor for this event. The authors
discovered that teenagers aged 17 and above are at higher risk of
experiencing pregnancy compared to 15-year-olds. This finding is
consistent with another study performed in Ethiopia that showed that
with each additional year of age, the odds of pregnancy increased by 2.1%.
A study conducted in Nigeria also found a significant relationship
between increasing age and teenage pregnancy. This is likely because as
adolescents age, they have more exposure to sexual activity and may also
become more likely to get married, which can increase the chances of
pregnancy.
 Marital Status
Studies conducted in Bangladesh, Uganda and Nepal have found
a consistent relationship between married teens and pregnancy. Married
teenagers were found to have a higher risk of experiencing teenage
pregnancy than single teenagers.
One study carried out in Nigeria found a statistically
significant relationship between teenage marriage and pregnancy. The
authors suggest that this may be due to the traditional view of
marriage, which emphasizes childbearing. According to the authors, if
a couple is unable to conceive after marriage, the woman may be sent
back to her family and the man may marry someone else. Therefore,
teenage girls may experience significant pressure to prove their fertility
and strengthen their position in the family through childbirth .
Additionally, another factor that was suggested by a study in Iran,
which found a high prevalence of teenage marriage in Iranian society,
is that teenage girls are not empowered or adequately prepared for
marriage and birth control.
 Healthcare System
The limited access to health services can result in limited access to
health promotion and contraceptive methods, which in turn can increase
the incidence of teenage pregnancy. This is particularly true when
there is a lack of health education initiatives. Additionally, the inability
to obtain free contraceptives and the lack of privacy may also contribute to
the non-use of contraceptives and risk behavior, increasing the risk of
pregnancy.
The low quality of educational and counseling in the healthcare
system has also been identified as an important factor contributing to
teenage pregnancy. This is because it affects women's awareness of
contraceptive methods, which remains low due to the poor quality of
educational services.
 Family Structure
Studies suggest that family structure is linked to teenage
pregnancy. A study conducted in Finland analyzed sociodemographic
differences in the occurrence of teenage pregnancies and found that
girls whose family composition was other than living with both parents
had 2.3 times the pregnancy risk compared to those who had such a family
structure.
Similarly, a study conducted in Ethiopia found that
teenagers from divorced parents were nearly two times more likely to
be exposed to teenage pregnancy compared to adolescents from married
parents. Furthermore, a cross-sectional survey conducted exclusively with
boys in Sweden revealed that those who had been involved in a
pregnancy were more likely to come from households that had
experienced a family breakdown.
There are several studies from various places in the world that
highlight the importance of family structure in preventing teenage
pregnancy. For instance, research conducted in England found that
unstable family structures were associated with a significantly greater
risk of teen pregnancy. This finding is consistent with another study that
analyzed teenage pregnancy in both the United States and Canada.
 According to Bonnel et al., young women who live with their
mothers may have an advantage in discussing sexual subjects, which
could be a contributing factor to preventing teenage pregnancy. However,
Habitu’s study suggests this communication advantage is not as
prevalent among adolescents with divorced parents, which can lead to
increased early sexual debut and risky sexual behavior, ultimately
increasing the risk of teenage pregnancy.
 Mental Health
Mental health plays a significant role in understanding
teenage pregnancy. One study conducted in the United States with young
women aged 13 to 24 found that those with depressed mood or
psychological stress are more likely to discontinue oral contraceptives,
which may result in unintended pregnancy.
Another study that highlighted the link between mental
illness and teenage pregnancy was a cross-sectional study conducted
in Canada that analyzed the fertility rates of adolescent girls with major
mental illness (including psychotic, bipolar, or major depressive
disorder) compared to those without mental illness. The study found
that the pregnancy rate was almost three times higher among adolescents
with mental disorders. These studies underscore the significance of
considering mental illness when designing and executing pregnancy
prevention programs.
 Educational Status
The association between educational status and adolescent
pregnancy has been consistently identified in numerous studies. Lower
levels of education have been found to be associated with higher odds
of teenage pregnancy, as evidenced by studies conducted, for example,
in Nepal , Pakistan, and Bangladesh.
A multilevel analysis study also corroborated these findings,
revealing that primary and below-educated teenagers had higher odds
of experiencing teenage pregnancy than secondary and above-educated
teenagers. This result is also consistent with studies conducted in
Ethiopia, Nigeria, Philippines, and Japan.
 A study conducted in Finland found that, in addition to the
educational status of the adolescent, the father’s educational level was also
linked to early pregnancy in the family. The study revealed that girls
whose fathers had less than nine years of education were 2.2 times more
likely to become pregnant than those whose fathers had completed twelve
years or more of education.
It is believed that educated adolescents have better knowledge and
skills to prevent pregnancy, while those with limited education have
limited access to sexual and reproductive health information and
services, making them more vulnerable to pregnancy. Additionally,
higher levels of education are associated with delayed marriage and
greater confidence in rejecting early marriage and sexual abuse.
 Socioeconomic Status
Studies conducted in South Asia have consistently reported
that low economic status is associated with higher risk of adolescent
pregnancy. This trend has also been observed in other countries, such as
Bangladesh, Nepal, and Pakistan, where studies have shown that women
of lower economic background are more likely to experience teenage
pregnancy.
Kefale’s study has found that teenagers living in communities
with higher proportion of poverty face a greater risk of teenage
pregnancy due to several factors such as limited access to education,
sexual and reproductive health services, early marriage and school
dropout. Furthermore, research has shown that racial and ethnic
disparities are important social determinants of health and healthcare
access, which could also be associated with adolescent pregnancy.
According to Martin et al. , birth rates among different racial and ethnic
groups indicate that adolescent pregnancy rates are about twice as high in
Hispanic and non-Hispanic Black teens compared to non-Hispanic White
teens. Additionally, American Indian/Alaska Native teens have a rate
approximately 2.5 times higher than non-Hispanic White teens. These
findings highlight the significant role that racial and ethnic disparities
play in determining social determinants of health, including access to
healthcare.

Health, social, and economic impacts of

 Pregnancy

Unintended pregnancies among adolescents result in health, social,

and economic burdens to both individuals, families, and communities. This
includes unsafe abortions and several pregnancy complications,
culminating in preterm delivery, with serious consequences for child
development, or maternal and neonatal death. Globally, health-related
evidence shows that omplications resulting from pregnancy and childbirth
are the leading cause of death for girls aged 15 to 19 years.
Several adverse perinatal outcomes have been associated with
adolescent pregnancies, specifically, preeclampsia, preterm birth, low birth
weight babies, and an increase in stillbirths, intrapartum deaths, and
miscarriages. Wilson et al. reported a risk more than 4 times of
intrapartum stillbirth in the youngest teens and 50% higher in teens 15 to 19
years old compared with women aged 20 to 24. Furthermore, adolescent
mothers face increased risks of pregnancy-induced hypertension,
prolonged labor, puerperal endometritis, systemic infections, and anemia.
Annually, it is estimated that 3.9 of the 5.6 million abortions that
occur among adolescent girls aged 15 to 19 years are unsafe, thereby
contributing to maternal mortality, morbidity, and lifelong reproductive
health problems. Lambonmung et al. found that abortions were a dangerous
practice among teenage mothers, because most of them were conducted with
unsafe methods or were unsafely terminated, including techniques such as
insertion of objects into the vagina or the use of a combination of drugs and
herbal substances.
Perinatal mortality rate in adolescent pregnancy is at 11.2%, which is
1.9 times higher than in other pregnancies [56]. Regarding perinatal
complications, low birth weight (< 2500 g), preterm delivery, and lower
Apgar score are frequently observed. In the postpartum as well, it is asserted
that hemorrhage, anemia, depression, and urinary, sexual, and breastfeeding
problems occur at a higher rate in adolescent mothers.
 In a systematic review performed by Karaçam and colleagues,
they revealed the following criteria as more prevalent in adolescent
pregnancies: preterm labor, early membrane rupture, anemia, inadequate
prenatal care, low birthweight, intrauterine growth retardation and fetal
distress. Moreover, this study showed that pregnant adolescents and adults
exhibited similar outcomes in terms of preeclampsia/gestational
hypertension, eclampsia, breech presentation/abnormality and
cephalopelvic disproportion/dystocia. Additionally, it is known that the
younger the patient, the greater the risk, with rates of infant mortality, very
low birth weight and preterm delivery.
On the other hand, in a retrospective analysis of the Centers for
Disease Control and Prevention, Eliner et al. [59] found that 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.
Also, it was associated with increased odds of several neonatal complications,
including congenital birth defects, low 5-minute Apgar score, suspected
neonatal sepsis, and assisted ventilation. Nevertheless, in this study, teen
pregnancies were associated with decreased odds of gestational diabetes,
unplanned hysterectomy, macrosomia, low birth weight, and neonatal
intensive care unit admission.
In addition, pregnancy may lead to mental disorders in adolescent
girls, such as suicidal ideation, anxiety, depression, and stress.
Depression symptoms among young mothers are also more likely to persist
after the birth of their child. Attention with postpartum depression is
especially important in adolescent mothers since studies consistently show
that they are at a higher risk of developing the condition than adults with
incidence rates reported at 14 − 32% and 7.2 − 16%, respectively. Bottino
et al. predicted that maternal age was significantly associated with
postpartum depression independently of socioeconomic, reproductive
characteristics or conjugal status. Thus, for each additional year, a reduction of
4% in the chance of developing this condition could be anticipated.
 Furthermore, postpartum depression could affect both the mother and
her developing infant. In a study of 180 adolescent mothers, Huang and
colleagues found higher levels of maternal depression were also associated
with more negative impacts in the form of delayed child development.
Additionally, Lambonmung and colleagues also found that pregnant
teenagers face sadness and unhappy mood, moderate to severe
depression, feelings of fear, anger, and shyness. Findings of pregnancy-
related stress, suicidal thoughts, ideation and feelings of rejection, fear,
self-condemnation, guilt, and poorer coping ability and attitude toward
pregnancy were highlighted in this study.
It is also known that some adolescent mothers experience great
difficulty returning to school after birth. Adolescent pregnancy can be a
barrier to education in the population, keeping young women from achieving
professional roles and benefiting from economic resources. For Diaz and Fiel,
teen mothers are less likely to complete high school, attend college, or
earn a bachelor’s degree, and they tend to earn less and are more likely to
experience poverty, thereby impacting their future education and job
opportunities.
Teenagers who become pregnant are unable to contribute to
production, causing increased health expenditure and creating a significant
economic risk for society. In addition, the WHO indicates that adolescent
pregnancy occurring outside the context of marriage may have social
consequences such as stigma, rejection and/or violence by partners, parents,
or peers.
The social consequences pointed out for adolescent motherhood
include academic failure, alcohol and substance abuse, isolation by parents
and friends, stigma, poverty, unemployment, and intimate partner
violence. Evidence exists that children born to adolescent mothers are likely
to become adolescent mothers in the future. Consequently, this impact is
not restricted to adolescents and their families but extends to the social
sphere.
 Conclusions
This research introduced the topic of pregnancy in adolescence and its
associated factors. It showed how impactful this is for the health of the mother
and baby, its social consequences, and how costly it can be. Therefore,
intervention programs or public health initiatives should be adopted to
implement effective strategies to prevent unwanted adolescent pregnancy
worldwide.
 References

[1] World Health Organization (WHO). Adolescent health. Geneva: WHO;

2023. Available from: https://www.who.int/health-topics/adolescent-
health#tab=tab_1.
[2] Kar SK, Choudhury A, Singh AP. Understanding normal development
of adolescent sexuality: A bumpy ride. J Hum Reprod Sci. 2015; 8(2):70-4.
[3] Orben A, Tomova L, Blakemore SJ. The effects of social deprivation
on adolescent development and mental health. Lancet Child Adolesc Health.
2020; 4(8):634-40.
[4] Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón JL;
Miembros del Grupo de Salud Mental. Prevention of mental health disorders
in primary care: Pregnancy in adolescence. Aten Primaria. 2022; 54 (Suppl
1):102494.
[5] Hegde A, Chandran S, Pattnaik JI. Understanding Adolescent
Sexuality: A Developmental Perspective. J Psychosexual Health. 2022;
4(4):237-42.
[6] Arruda EPT, Brito LGO, Prandini TR, Lerri MR, Reis RMD, Barcelos TMR,
et al. Sexual Practices During Adolescence. Rev Bras Ginecol Obstet.
2020;42(11):731-38.
[7] Vasilenko SA. Sexual Behavior and Health from Adolescence to
Adulthood: Illustrative Examples of 25 Years of Research From Add Health. J
Adolesc Health. 2022;71(6S): S24-S31.
[8] World Health Organization (WHO). Adolescent pregnancy. Geneva:
WHO; 2022. Available from: https://www.who.int/news-room/fact-
sheets/detail/adolescent-pregnancy.
[9] Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J,
et al. Pregnancy and childbirth outcomes among adolescent mothers: a
World Health Organization multicountry study. BJOG. 2014; 121 (Suppl
1):40-8.

[10] Maly C, McClendon KA, Baumgartner JN, Nakyanjo N, Ddaaki WG,

Serwadda D, et al. Perceptions of Adolescent Pregnancy Among Teenage Girls
in Rakai, Uganda. Glob Qual Nurs Res. 2017; 4:2333393617720555.
[11] United Nations, Department of Economic and Social Affairs,
Population Division. Fertility among Young Adolescents at Ages 10-14
Years – A global assessment (ST/ESA/SER.A/453). 2020.
[12] Child marriage. UNICEF DATA. Available from:
https://data.unicef.org/topic/child-protection/child-marriage/.
[13] Universal Declaration of Human Rights | United Nations. Available
from: https://www.un.org/en/about-us/universal-declaration-of-human-
rights
[14] Convention on the Elimination of All Forms of Discrimination
Against Women (CEDAW) for Youth. UN Women – Headquarters.
Available from:
https://www.unwomen.org/en/digital-library/publications/2016/12/ceda
w-for-youth.
[15] Convention on the Rights of the Child. OHCHR. Available from:
https://www.ohchr.org/en/instruments-mechanisms/instruments/conventi
on-rights-child..
 Acknowledgements

I am overwhelmed in humbleness and gratefulness to acknowledge

my depth to all of thos who helped me to put these ideas, well above the level
of simplicity and into something concrete. I would like to express my social
thanks of gratitude to my teacher, Mrs. Fely M. Tubil, who also helped me a
lot on how to make an efficient research study and I came to know about so
many new things.
Any attempt at any level can’t be satisfactorily completed without the
support and guidance of my parents and friends. I would like to thank my
friends who helped me a lot in gathering different information collecting data
and guiding me from time to time in making this research, despite of their
busy schedules, they gave me different in making this study unique.

Zaireen Belo
Researcher