Silence as Self-care: Pregnant Adolescents and Adolescent Mothers Concealing Paternity in Mahama Refugee Camp, Rwanda

In Rwanda, sexual activity with and among adolescents under the age of 18 is a criminal offence. This is justified to reduce abuse and adolescent pregnancies. Despite this, the Burundian Mahama refugee camp in Rwanda is registering an escalating pregnancy rate among girls 13 to 15 years old. Drawing on ethnographic research conducted from December 2017 to April 2018, this paper shows how pregnant adolescents and adolescent mothers navigate punitive legal structures to protect their baby’s father by concealing his identity. In a challenging socioeconomic context with limited opportunities, silence provides pregnant adolescents and adolescent mothers with a strategy to protect their boyfriends from jail and to access humanitarian assistance available to single mothers. I suggest that silence can be a self-care strategy to negotiate and navigate temporalities as they seek to manage the circumstances in which they find themselves, whilst hoping for a better future for themselves and their children.

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.

Social Determinants of Health and Adverse Outcomes in Adolescent Pregnancies

The association between adolescent childbearing and adverse maternal and birth outcomes has been well documented. Adverse adolescent pregnancy outcomes are associated with substantial risk of long-term morbidities for the young mother and their newborns. Multiple levels of social disadvantage have been related to adverse pregnancy outcomes among adolescent mothers. Patterns of cumulative social adversity define the most marginalized group of adolescents at the highest risk of experiencing adverse maternal and birth outcomes. Using a social determinants of health (SDOH) framework, we present an overview of the current scientific evidence on the influence of these conditions on adolescent pregnancy outcomes. Multiple SDOH such as residence in remote areas, low educational attainment, low socioeconomic status, and lack of family and community support have been linked with increased risk of adverse pregnancy outcomes among adolescents. Based on the PROGRESS-Plus equity framework, this review highlights some SDOH aspects that perinatal health researchers, clinicians, and policy makers should consider in the context of adolescent pregnancies. There is a need to acknowledge the intersectional nature of multiple SDOH when formulating clinical and societal interventions to address the needs of the most marginalized adolescent in this critical period of life.

Female reproductive abnormalities in mouse adolescent pregnancy

There are around 300 million adolescent pregnancies worldwide, accounting for 11% of all births worldwide. Accumulating evidence demonstrates that many adverse perinatal outcomes are associated with adolescent pregnancies. However, how and why these abnormalities occur remain to be defined. In this study, pregnancy at different stages were compared between 25-30 day old and mature female mice. We found the litter size of adolescent pregnancy is significantly decreased from F1 to F3 generations compared to mature pregnancy. On days 8 and 12 of pregnancy, multiple abnormalities in decidual and placental development appear in F3 adolescent pregnancy. On days 5 and 8, uterine endoplasmic reticulum stress is dysregulated in F3 adolescent pregnancy. Embryo implantation and decidualization are also compromised in adolescent pregnancy. Many genes are abnormally expressed in adolescent estrous uteri. The abnormal endocrine environment and abnormal implantation from uterine immaturity may result in multiple pregnancy failures in adolescent pregnancy. This study should shed light on human adolescent pregnancy.

Younger Age in Adolescent Pregnancies Is Associated with Higher Risk of Adverse Outcomes

Adolescent pregnancy remains a health issue worldwide also in developed countries, since it has been associated with adverse maternal and neonatal outcomes. Some data suggest that very young adolescents have higher risk, likely due to immaturity. Therefore, we aimed to assess the influence of maternal age on complications during gestation and labor in pregnant women between 13 and 19 years of age. In particular, we evaluated the possible association between maternal age and obstetric, fetal and labor complications. This is a retrospective, observational and exploratory study conducted at Hospital Universitario La Paz (HULP, Madrid, Spain). The clinical history of 279 women who delivered between 2013 and 2018 was analyzed. Maternal age and the presence of maternal, fetal and labor complications, as well as risk of postpartum depression and breastfeeding intention, were recorded. General regression models were used to analyze the contribution of maternal age on each complication. The percentage of adolescent pregnancies at HULP between 2013 and 2018 was 0.9%. The risk of all the maternal complications analyzed decreased significantly with every year of age of the mother (hyperemesis, lower back pain, anemia, gestational diabetes mellitus, and threat of premature labor and premature rupture of membranes). Every year of maternal age decreased 0.8-fold [0.8; 0.9] the prevalence of fetal complications and also reduced the risk of C-section, postpartum hemorrhage and obstetrical hysterectomy. Furthermore, higher maternal age increased 1.1-fold [1.0; 1.2] the breastfeeding intention. In conclusion, young adolescents are at higher risk of complications during pregnancy and labor.

Complications of Pregnancy in Adolescents

Teenage pregnancy is a complex issue that can have negative socioeconomic and health outcomes. About 11% of births worldwide are by adolescents aged between 15 and 19 years and middle- and low-income countries account for more than 90% of these births. Despite the downward trend in international adolescent pregnancy rates, 10 million unplanned adolescent pregnancies occur annually. Adolescents are also at increase risks of poor obstetric outcomes including preterm delivery, low birth weight, eclampsia, postpartum hemorrhage, anemia, and infant, as well as maternal morbidity. Important additional considerations include increased risk of depression, poor social support, and the need for a multidisciplinary approach to their obstetric care. We look to highlight both the unique socioeconomic and medical factors to consider when caring for these patients and demonstrate that these factors are intertwined.

Adolescent Contraceptives

Adolescents contraceptive need to be the top most priority in the national policy to prevent the adolescent pregnancies and it’s adverse consequences. All the countries of the world should have their own national strategy liaison with global consensus regarding the Adolescent contraceptives. Global challenge is to tackle the adolescents Pregnancy. Contraceptives use is the answer. So adolescents should be the centrals to everything we want to achieve, and to the overall success of the 2030 SDG Agenda. Without Contraceptive “SDG achievement” is not possible. About 21 million 15-19 year old girls in developing countries become pregnant every year. Half of these pregnancies (49%) are unintended. If we are successful to implement contraceptives among the youngsters, adolescent’s pregnancy complications can be eliminated. But again this needs strong political motivation and hard work of health care providers. Health care team should design and deliver a Confidential, personalized, adolescent’s friendly service taking into account adolescent's psychosocial & sexual needs. Almost all methods of contraceptives are suitable for adolescents except few. After taking a comprehensive medical history & assessing risk factors counselling should be done for risks & benefits. Good & sensible communication with women, their husband or partner is important. It remains a critical aspect in empowering adolescents to make informed choices and only then adolescents will use contraceptives wholeheartedly.