The Rise in Teenage Mothers Having Premature Births - Literature review Example

Literature review: The rise in Teenage mothers having premature births INTRODUCTION In one of the reports prepared by Save the Children foundation, it was found that, annually, 13 million children are born to women under age 20 worldwide out of which more than 90% are in developing countries.(Mayor, 2004) The leading cause of mortality among women between the ages of 15 and 19 are the complications of pregnancy and childbirth. The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age. (Treffers, 2003) Amongst the developed countries, the teenage birth rate in United States is the highest. (UNICEF, 2001), though the teenage pregnancy rate is decreasing significantly since the early 1990s. Research has shown that the worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. (Makinson, 1985) Actually the pregnant teens are do not seek prenatal care, and even if they do, they come very late usually in the third trimester. Thus most of the pregnant teens have nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of junk food. It has been seen that developed and developing countries have distinctly different rates of teenage pregnancy. In most of the developed regions, the root cause of teen pregnancies are the lifestyles and casual approach to sex and they are generally unmarried. Thus this is more of a social issue. But in the developing countries early marriages are the main cause of teen pregnancies. The parent are usually married, and their pregnancy is welcomed by family and society These countries are characterized by low age at marriage, poverty, low value and self-esteem of girls, low level of education and low level of contraceptive use, early childbearing, sexual abuse and assault.. But the incidence of malnutrition and poor health care still remains due to low educational levels. The table below shows the teenage birth rates across selected countries. Indicator: Births per 1000 women (15-19 ys) – 2002 UNFPA, State of World Population 2003 As we can see from the figures, this problem is prevalent all over the world. And this involves the birth of children who are the future citizens of the world. Thus the problem assumes significant proportions when seen from this perspective. And it is not only a medical issue , it is a social problem as well for the whole society. This is because the teenage pregnancies are strongly associated with a range of disadvantages for the mother, for her child, and for society in general. Specifically, giving birth as a teenager is believed to be bad for the young mother because the statistics suggest that she is more likely to drop out of school, to have no or low qualifications, to be unemployed or low-paid, to live in poor housing conditions, to suffer from depression, and to live on welfare. Similarly, the child of a teenage mother is more likely to live in poverty, to grow up without a father, to become a victim of neglect or abuse, to do less well at school, to become involved in crime, to abuse drugs and alcohol, and eventually to become a teenage parent and begin the cycle all over again. Therefore, teenage births are also seen as a burden for the society that must cope with this long list of negatives. That is why the issue attracts so much popular and political interest. BACKGROUND The adolescent or the teen age period covers the age of 10-19 years. This is a period of transition from childhood to adulthood. It is a well known fact that adolescence is a distinct and important biological and social stage of development. And pregnancy in a girl aged between 10-19 years is known as the adolescent or teenage pregnancy. This group is a high risk group requiring high priority services and focused approach. Early child bearing is a huge health risk for both mother and child. (United nations , 1989) It is estimated that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to suffer from health issues in childhood or be hospitalized than those born to older women. And the first and foremost amongst them is the premature birth and low birth weight. It has been studied that the phenomena of teenage childbearing is mostly concentrated among poor and low-income teenagers, and most of whom are unmarried. (Dangal, 2005) Many adverse outcomes have been associated with teenage pregnancy including: premature delivery ( Fraser et al., 1995, Scholl et al. 1994), low birth weight infants (Miller and Reed, 1996), increased neonatal mortality ( Olausson et al., 1999), anaemia (Knoje, 1992) and pregnancy induced hypertension (Scholl et al. 1994). Since, many studies do not adjust for the different variables such as socio-economic status and adverse lifestyle factors that are more prevalent in this group, the evidence is not conclusive. But in general, there is an agreement within the scholars that there is an increased risk of premature birth, especially amongst those in the very young (aged 13-16) age group ( Satin et al., 1994, Fraser et al., 1995). This may be due to biological immaturity at this age but other factors such as socio-economic and educational levels are also equally responsible for such a situation. AIMS AND OBJECTIVES The aim of this research is thus to attempt to find out the correlation between teenage mothers and premature births. Briefly, we are looking to find out, why the premature birth incidence is higher amongst teenage pregnancies. The idea is to establish credible link between the two and then attempt to make the situation better by providing better care and services to this group and create awareness amongst the teenagers regarding the consequences of teenage pregnancies. METHODOLOGY Since we are totally focusing on teenage group, we will not be considering studies which look at the reasons for premature births since they include other areas such as premature births in older women etc. These are beyond the scope of this review. We will take a close look at the reasons for the high incidence of premature births in teenagers along with other problems such as low birth weight, malnutrition etc., but we are not going into details of reasons of having intercourse at young age and the consequent pregnancies. In addition to health risks, teenage pregnancy hampers further education of female adolescents and consequently earning capacity and overall well being of the family(UN, 1995) – but this again is beyond the scope of this review. It has been seen that the teenage girls are more not only prone to pregnancy and child bearing but also to diseases and conditions specially the sexually transmitted diseases, substance abuse and accidents (Baral, 2004) We will not be including this in our study. Certain important ones that have been done specifically on our topic includes Fraser et al, Miller and Reed, Knoje etc. to name a few. FINDINGS Mohsin et al, (2003) identified the influences of neonatal and maternal factors on premature birth and low birth weight in New South Wales, Australia. As per the study, first-born infants, and infants born to mothers aged less than 20 years, or who were single, separated/divorced, aboriginal or who smoked during the pregnancy, were at increased risk of being premature or of low birth weight and gestational age was confirmed to be the single most important risk factor for low birth weight. They used Bivariate and multivariate analyses to explore the association of selected neonatal and maternal characteristics with premature birth and low birth weight. Another important study was conducted by Bhalerao et al. (1990) in India. Two hundred consecutive cases of mothers of ages up to 19 years, were used as a sample for the study at the N. W. Maternity Hospital, Mumbai, from July 1988 to October 1988. Medical, obstetric and socio- economic aspects of these pregnant girls were studied and results were analyzed. During the period under review i.e. from July 1988 to October 1988, there were 3150 total cases, of which 200 girls were aged 19 year or younger, giving an incidence of teenage pregnancy as 6.3%. Most of these teenage mothers to be belonged to poor or lower middle class families and were housewives. Fourteen girls (7%) were in the age group of 15-17 years and the rest (93%) were between 17 and 19 years. As expected, 173 girls (86.5%) were nulliparaous. Six girls were unmarried, giving an incidence of 3%.of unmarried teenage pregnancy. Only 24.7% got married when their age was between 17 and 19 years and only these were legal marriages since the legal age of marriage for girls in India is 18 years and above. As per the findings -- Six girls (43%) in the age group 15-17 years delivered prematurely as compared to only 26 girls (14%) in the age group of 17-19 years. This difference is quite significant. Also, only, 4 girls (29%) in the age group of 15-17 years had full term normal delivery as compared to 113 girls (61%) in the age group of 17-19 years signifying that the outcome of pregnancy becomes worst in girls below the age of 17 years. Ten babies (71%) of mothers in the age group of 15-17 years were Low Birth Weight as compared to 75 babies (44%) of mothers in the age group of 17-19 years signifying that the incidence of Low Birth Weight babies is inversely proportional to maternal age. The incidence of teenage pregnancy was found to be 6.3% while similar studies by Israel and Woutersze in 1963, estimated the incidence of teenage pregnancy as 9.8% and Ghose and Ghosh in 1976, estimated it to be as high as 14.9%. Thus it can be seen that pregnant teenagers are definitely at greater risk, requiring additional efforts and resources to serve and protect their total health. DISCUSSION AND CONCLUSION The UK has the highest rate of premature births in Europe. Approximately one in eight babies born in the UK every year are born prematurely or becomes ill soon afterwards. Out of these 70,000 babies, around 18,000 need intensive care. A premature baby is one that has been born less than 37 weeks into the pregnancy. This is about three weeks earlier than normal. A normal pregnancy will last between 37 to 42 weeks after the mother becomes pregnant. A moderately premature baby is born between 35 and 37 weeks, a very premature baby between 29 and 34 weeks and an extremely premature baby is born between 24 and 28 weeks. The high rate of premature babies in the UK may be linked to the high rate of teenage pregnancies in this country. The above mentioned studies have also proven the same thing. The rate of incidence of premature births is inversely proportional to the age of the mother. Lower the age of mother – high is the risk factor for baby to be born premature. Thus the literature is in general agreement with an increased risk of premature birth, especially amongst those in the very young (aged 13-16) age group. The relationship between teenage birth rates and overall birth rates varies considerably from country to country, suggesting that national differences in teenage birth rates are in large part caused by factors that affect teenagers in that particular country. Poverty is correlated significantly with adolescent pregnancy. In developing countries, early age at marriage is the main reason for early pregnancy. Moreover, having broken households and being raised by a single parent , having a mother who was an adolescent mother, or having a sister who has become pregnant are critical life events for becoming teen mother. Educational failure, poverty, unemployment and low self-esteem are the most common negative outcomes of early childbearing. These circumstances also contribute to the likelihood of teen pregnancy. In addition, adolescent pregnancy is associated with higher rates of morbidity and mortality for both the mother and infant. Teenage mothers are at greater risk of socioeconomic disadvantage throughout their lives than those who delay childbearing until their twenties. As per a report published by UNICEF (2001), the rising levels of education, more career choice for women, more effective contraception, and changing preferences, have increased the average age at first birth in all developed countries. But there is still a lot of work which needs to be done. RECOMMENDATIONS FOR MANAGEMENT OF TEEN PREGNANCIES The countries world wide need to devise a strategy to reduce teenage pregnancy rates. The goal should be to decrease the rate of teenage conceptions among the under 18s and to reduce the long term risk of social exclusion by getting more teenage parents into education, training or employment. Effort should be made to create more awareness among this age group regarding the long term effects and implications of their pregnancies. Effective birth control practices should be taught and availability of proper guidance and materials should be focused on. The contraceptives should be accessible and the advice should be delivered in an appropriate manner. Contrary to popular belief, many teenagers do seek advice. In a recent case controlled study, of 240 teenagers who conceived, 94% had consulted a health care professional in the year prior to conceiving. 71% had consulted specifically about contraception and 50% had been prescribed the oral contraceptive pill. Those who had conceived were far more likely to have consulted than those (controls) who had not. Smoking cessation should be targeted and attendance at antenatal clinic encouraged. In addition post natal contraception can help prevent second teenage pregnancy and sexually transmitted diseases. UNICEF report (2001) shows that the success in lowering teenage birth rates is a matter of both motivation and means. These means involve the degree of availability of contraception and the kind of sex education which enables young people to make informed and mutually-respectful choices which includes the choice to delay having sex or to insist on safe contraception. FURTHER RESEARCH Whilst there is no evidence to date of medical interventions that can specifically improve pregnancy outcome, we must ensure that teenage mothers receive supportive care and are directed towards the social support they need. A further research can be carried our to identify the gaps between the current delivery of maternity care offered to pregnant teenagers and the required services. Another area that can be looked into is the plan to encourage and popularize entry into prenatal care, and identify the need for teenage pregnancy specific maternity services. Moreover, professional should be specially trained to handle teenage pregnancies and the issues involving it. REFERENCES Baral KP , (2004) Trends of adolescent childbearing in Nepal- lesson and policy implication. J Nep Med Assoc. 43: 327-332 Bhalerao AR, Desai SV, Dastur NA, Daftary SN. (1990) Outcome of teenage pregnancy. J Postgrad Med ;36:136-9 Dangal, G. (2005), An Update on Teenage Pregnancy. The Internet Journal of Gynecology and Obstetrics. Volume 5 Number 1. Fraser AM, Brockert JE, Ward RH.(1995) Association of young maternal age with adverse reproductive outcomes NEJM ; 332: 1113 Ghose N, Ghosh B.(1976) Obstetric behaviour in Teenagers (A study of 1138 consecutive cases). J Obst Gynecol India ; 26:722-726 Israel SL, Woutersz TB.(1963) Teenage Obstetrics, A Co- operative Study. Amer J Obst and Gynaecol ; 85:659-668. Knoje JC, Palmer A, Watson A et al.(1992) Early teenage pregnancy in Hull. Br J Obstet Gynaecol ; 99: 969-973 Makinson, C. (1985). 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