A Multilevel Analysis of Trends and Predictors Associated with Teenage Pregnancy and Early Motherhood in Zambia (2001 - 2018)

IntroductionTeenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy and early motherhood as well as its individual and contextual determining factors. MethodsA total pooled weighted sample of 10,010 teenagers (in the age group 15 to 19) from four waves of the Zambia Demographic and Health Surveys (ZDHS) were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Parameter estimates were produced using Bayesian Markov chain Monte Carlo (MCMC) Methods in BRMS.ResultsResults show that the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four ZDHS waves. In multilevel analysis, the odds of being pregnant were higher for teenagers who were aged between 18 and 19 years (AOR = 2.57, 95% CI: 2.20-2.98), employed (AOR= 1.24, 95% CI: 1.06-1.46) married (AOR =8.33, 95% CI: 6.84-10.26) and those with knowledge of fertile period (AOR=1.69, 95% CI: 1.43-2.00). On the other hand, being in higher wealth quintile, 15-17 years of age, exposure to family planning messages and delayed sexual debut were associated with decreased odds of early teenage pregnancy. ConclusionThe study shows that early pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy and early motherhood include age, marital status, and employment, knowledge of fertility period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

Socioeconomic determinants of teenage pregnancy and early motherhood in the United Kingdom: A perspective

The United Kingdom has one of the highest teenage birth rates among countries in western Europe. Government initiatives such as the Teenage Pregnancy Strategy introduced by the labor government in 1999 to reduce the teenage pregnancy rate by half in ten years could be responsible for the steady decline in teenage conception and childbirth for the past two decades. However, to sustain this decrease it is crucial to consider the broader socioeconomic and environmental determinants of teenage pregnancy at the population level. A selected literature search was conducted in this respect to highlight the factors that could be neglected by recent interventions on teenage pregnancy and childbirth in the United Kingdom.

The Maternity Experience of New Zealand Samoan First-time Mothers

<p>Motherhood is a life-changing event. It is a significant milestone for a woman. This thesis explores the concept of motherhood from the perspectives of Samoan first-time mothers living in New Zealand. The thesis traces their experiences from conception, pregnancy and childbirth through to early motherhood. Their narratives are the focus of the research and are complemented by the viewpoints from some of their own mothers, and maternity health professionals. The overarching question, ‘What are the experiences of a group of first-time New Zealand-born Samoan mothers before and after birth?’ was framed from a strengths-based approach and draws on work which defines a strength-based approach to resilience as research that changed traditional deficit perspectives. Rather than focusing on how individuals or families have failed or struggled, emphasis is directed to how they can succeed or how they can manage (Walsh, 2006). Interviews were conducted in Wellington and Auckland with 11 first-time Samoan mothers prior to childbirth and follow-up interviews with nine of these women within 12 months of the birth of their child. Five Samoan grandmothers, i.e. mothers of these first-time mothers, five midwives and five Plunket nurses were also interviewed. Four sites of analysis were examined – the embodied experience of conception and pregnancy; the process of labour and childbirth; the new norm of early motherhood, and interpersonal relationships and encounters. Analysis was conducted through the overarching lens of the Samoan concept of the vā (Wendt, 1999), the theoretical frameworks of ‘negotiated spaces’ (Mila-Schaaf and Hudson, 2009) and sophisticated mediation (Churchward, 2011). It was found that the first-time New Zealand-born Samoan mothers engaged in a complex and, at times, contradictory process of seeking support during their transition to motherhood. They demonstrated resilience and their skill as sophisticated mediators. The women depended on relationships, some biological and some not, that were reliable and sustainable and the interaction and care that the relationship offered. Intergenerational relationships were important to these first-time New Zealand-born Samoan mothers, particularly ones they had with their own mother, or someone close to them, as it was pivotal in the way in which they constructed their maternity experience.</p>

The Maternity Experience of New Zealand Samoan First-time Mothers

<p>Motherhood is a life-changing event. It is a significant milestone for a woman. This thesis explores the concept of motherhood from the perspectives of Samoan first-time mothers living in New Zealand. The thesis traces their experiences from conception, pregnancy and childbirth through to early motherhood. Their narratives are the focus of the research and are complemented by the viewpoints from some of their own mothers, and maternity health professionals. The overarching question, ‘What are the experiences of a group of first-time New Zealand-born Samoan mothers before and after birth?’ was framed from a strengths-based approach and draws on work which defines a strength-based approach to resilience as research that changed traditional deficit perspectives. Rather than focusing on how individuals or families have failed or struggled, emphasis is directed to how they can succeed or how they can manage (Walsh, 2006). Interviews were conducted in Wellington and Auckland with 11 first-time Samoan mothers prior to childbirth and follow-up interviews with nine of these women within 12 months of the birth of their child. Five Samoan grandmothers, i.e. mothers of these first-time mothers, five midwives and five Plunket nurses were also interviewed. Four sites of analysis were examined – the embodied experience of conception and pregnancy; the process of labour and childbirth; the new norm of early motherhood, and interpersonal relationships and encounters. Analysis was conducted through the overarching lens of the Samoan concept of the vā (Wendt, 1999), the theoretical frameworks of ‘negotiated spaces’ (Mila-Schaaf and Hudson, 2009) and sophisticated mediation (Churchward, 2011). It was found that the first-time New Zealand-born Samoan mothers engaged in a complex and, at times, contradictory process of seeking support during their transition to motherhood. They demonstrated resilience and their skill as sophisticated mediators. The women depended on relationships, some biological and some not, that were reliable and sustainable and the interaction and care that the relationship offered. Intergenerational relationships were important to these first-time New Zealand-born Samoan mothers, particularly ones they had with their own mother, or someone close to them, as it was pivotal in the way in which they constructed their maternity experience.</p>

Stress and coping among unmarried pregnant university students in South Africa

Background The improvement of maternal and child health (MCH) outcomes is an important part of the sustainable development goals (SDGs). MCH remains an important issue globally as the SDGs have not yet been achieved in most countries. Young women in universities are likely to experience unintended pregnancy due to risky sexual behaviors in tertiary institutions which is characterized by lack of condom and/or contraceptive use and coercion. Pregnant young women in an academic environment are susceptible to stressors associated with unintended pregnancy and academic demands of universities. However, very little is known about the stress and coping among young people in tertiary institutions who get pregnant during the course of their studies and choose to keep the pregnancy. Methods Participants were purposively selected among pregnant students and those in the puerperal period at the time of the study. Semi-structured qualitative interviews were undertaken to explore the experiences of pregnancy and early motherhood, with particular focus on the various stressors experienced and possible coping strategies employed by students. The data were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Results The findings show that pregnancy and early motherhood was an experience that came with a lot of stress emanating from fear of parents’ reactions, academic pressure, financial constraints, relationship problems with male partners and experiences of social stigma. Participants used emotion-focused and problem-focused coping strategies to deal with the stressors confronting them during and after their pregnancy. Conclusion The experiences of pregnant students are multifaceted and generally characterised by financial crisis, academic challenges, shame, strenuous relationships and transitioning into a new identity. A multipronged approach to healthcare for pregnant students that focus on comprehensive antenatal services, health education, health promotion, psychosocial interventions including academic counselling will have positive outcomes for young mothers and their children.

Rituals and Embodied Cultural Practices at the Beginning of Life: African Perspectives

Cultural beliefs and practices find expression through rituals. Rites of initiation or passage are some of the most common rituals among the indigenous African societies. Pregnancy and Childbirth are not only biological events, but also socially and culturally constructed with associated symbols that represent the social identities and cultural values of Africans. Birth is a rite of passage, and children are perceived as special gifts from the Supreme Being. As such, pregnancy and childbirth are special events cherished and celebrated through varied rituals. Drawing on empirical literature and relevant commentaries, this paper aims to discuss selected rituals and embodied practices surrounding the start of life (pregnancy, birth, and early motherhood). The paper will specifically focus on the following aspects: pregnancy rituals; birth songs and dancing; the omugwo (care after birth); the cord and placenta rituals; and the naming ceremony. Some of the pregnancy rituals are purificatory in nature and therefore beneficial for maternal and infant health. The celebrations surrounding the birth of a child are community events, marked with singing and dancing. Following childbirth, the new mothers are not expected to participate in house chores to allow them time to recuperate. In all, discourses concerning the beginning of life, i.e., pregnancy and the periods surrounding it, are filled with rituals which are embodiments or expressions of cultural values, customs, and beliefs.

Sophisticated Mediators: New Zealand-Born Samoan First-Time Mothers and Strategies for Their Health and Wellbeing

<p>This thesis explores the experiences of four New Zealand-born Samoan first time mothers during pregnancy, childbirth and early motherhood living in Wellington. The impetus for this research arose from findings that showed a considerable variation in the prevalence of postnatal depression between Samoan women (7.6%), Tongan women (30.9%) and others (20% for all New Zealand mothers). Qualitative, face-to-face individual interviews were conducted within a qualitative feminist framework. The two interviews with each woman were conducted during the last trimester of their pregnancy (28+weeks gestation); and 12 months post-birth. The thesis drew upon the four-element model – Epistemology, Theoretical Perspective, Methodology and Methods to provide a framework to conceptualise and clarify the foundation for this research project. Thus the thesis is best described as a feminist phenomenological social constructionist approach. The findings revealed the women of this study were „Sophisticated Mediators‟ who, although faced with many challenges throughout their pregnancy, childbirth and early motherhood experiences, mediated successfully between, and within, existing cultural and belief systems i.e. Samoan traditional values and New Zealand cultural system; to acquire or maintain resilience toward depressive symptoms during early motherhood. Support structures such as family, in particular mothers, proved to be a vital source of support for the women. Recommendations arising from the research are targeted at support providers and family members and this is discussed in detail. Antenatal care was important although antenatal classes not so; conversely, the women were high adopters of technology in the form of the internet to access information. It is vital for support providers to recognise the high regard the women had for the internet as a source of valuable and easily accessible information, and utilise those avenues more to provide information that will complement or improve the existing support structures. During the antenatal period, women should be encouraged to develop or strengthen relationships with a significant female who will be with them throughout the childbirth and early motherhood process.</p>

Sophisticated Mediators: New Zealand-Born Samoan First-Time Mothers and Strategies for Their Health and Wellbeing

<p>This thesis explores the experiences of four New Zealand-born Samoan first time mothers during pregnancy, childbirth and early motherhood living in Wellington. The impetus for this research arose from findings that showed a considerable variation in the prevalence of postnatal depression between Samoan women (7.6%), Tongan women (30.9%) and others (20% for all New Zealand mothers). Qualitative, face-to-face individual interviews were conducted within a qualitative feminist framework. The two interviews with each woman were conducted during the last trimester of their pregnancy (28+weeks gestation); and 12 months post-birth. The thesis drew upon the four-element model – Epistemology, Theoretical Perspective, Methodology and Methods to provide a framework to conceptualise and clarify the foundation for this research project. Thus the thesis is best described as a feminist phenomenological social constructionist approach. The findings revealed the women of this study were „Sophisticated Mediators‟ who, although faced with many challenges throughout their pregnancy, childbirth and early motherhood experiences, mediated successfully between, and within, existing cultural and belief systems i.e. Samoan traditional values and New Zealand cultural system; to acquire or maintain resilience toward depressive symptoms during early motherhood. Support structures such as family, in particular mothers, proved to be a vital source of support for the women. Recommendations arising from the research are targeted at support providers and family members and this is discussed in detail. Antenatal care was important although antenatal classes not so; conversely, the women were high adopters of technology in the form of the internet to access information. It is vital for support providers to recognise the high regard the women had for the internet as a source of valuable and easily accessible information, and utilise those avenues more to provide information that will complement or improve the existing support structures. During the antenatal period, women should be encouraged to develop or strengthen relationships with a significant female who will be with them throughout the childbirth and early motherhood process.</p>

Trends and factors related to adolescent pregnancies: an incidence trend and conditional inference trees analysis of northern Nicaragua demographic surveillance data

Background We aimed to identify the 2001–2013 incidence trend, and characteristics associated with adolescent pregnancies reported by 20–24-year-old women. Methods A retrospective analysis of the Cuatro Santos Northern Nicaragua Health and Demographic Surveillance 2004–2014 data on women aged 15–19 and 20–24. To calculate adolescent birth and pregnancy rates, we used the first live birth at ages 10–14 and 15–19 years reported by women aged 15–19 and 20–24 years, respectively, along with estimates of annual incidence rates reported by women aged 20–24 years. We conducted conditional inference tree analyses using 52 variables to identify characteristics associated with adolescent pregnancies. Results The number of first live births reported by women aged 20–24 years was 361 during the study period. Adolescent pregnancies and live births decreased from 2004 to 2009 and thereafter increased up to 2014. The adolescent pregnancy incidence (persons-years) trend dropped from 2001 (75.1 per 1000) to 2007 (27.2 per 1000), followed by a steep upward trend from 2007 to 2008 (19.1 per 1000) that increased in 2013 (26.5 per 1000). Associated factors with adolescent pregnancy were living in low-education households, where most adults in the household were working, and high proportion of adolescent pregnancies in the local community. Wealth was not linked to teenage pregnancies. Conclusions Interventions to prevent adolescent pregnancy are imperative and must bear into account the context that influences the culture of early motherhood and lead to socioeconomic and health gains in resource-poor settings.