Teenage pregnancy by definition is a pregnancy that occurs to a girl of age less than 19 years. Menarche has different mean age for different ethnic groups (Zuckerman, 2001) and apart from ethnicity there are a number of other factors like constitution, obesity etc. have an influence on the occurrence of menarche. After a girl achieves her menarche she becomes a potential mother but at an early age this motherhood carries risks to her health and her child’s health. This is the reason teenage pregnancy has become a point of debate for a number of societies but the amount of awareness is still not appreciable. Worldwide, rates of teenage pregnancy range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea. (Treffers, 2003, UNICEF. (2001) ).Among OECD developed countries, the United States and United Kingdom have the highest level of teenage pregnancy, while Japan and South Korea have the lowest.( national master, 2008) In countries such as India the majority of teenage births occur within marriage.( Mehta, 1998, UNICEF, 2001) in developed countries this is mostly outside a marriage and is regarded to be an illegal pregnancy but in US and UK a huge number of these pregnancies though occurring at teenage are taken to term and children are delivered. Age at the first child birth is very important prognostically for a woman’s gynecological history as well as other general health issues but this aspect has not been addressed the way it is needed. Most of the developing countries where early marriages are very common are the ones have a higher maternal and infant mortality and morbidity rates due to prenatal, antenatal and postnatal complication. With pregnancy there are a number of risks associated and they all have an impact on the outcome of the pregnancy and most of those disorders like pregnancy induced hypertension, gestational diabetes, and low birth weight babies occur if the mother’s age is less than 15 years. In UK young girls mostly have poor intake of nutritional food and they are more for putting their self on diet and for that reason their bodies are not prepared for conceiving. If we see for a woman to turn into a healthy mother she needs time to get prepared for becoming a mother and if she becomes a mother all of sudden without prepreparation she will obviously not be ready to handle the responsibilities. Pregnancy needs a close follow ups for antenatal care but if the mother is immature to the extent that she does not understand the importance f this aspect then how can a pregnancy be helped with antenatal care provision? That is so important for a pregnancy to go healthy till its term. Child bearing duration of a female has a significant impact on a family’s structure, economic status, health of that family, and even its particular social class and if taken at a larger scale it has a profound impact on a country’s economy. If a woman starts producing children at the age of 15 she is getting 25 plus potential years to be fertile which can potentially be leading to a good number of increases in a nation’s population. Pregnancy at an early age is very unhealthy in terms of its hazardous impact on the mother’s and child’s health, its impact on country’s economy and the social issues associated to this phenomenon.
Pregnancy is regarded to be a medical condition and it has to be given the due attention of a potential killer if not taken care of properly. Pregnancy is a much altered state of physiology of a woman. Pregnancy itself carried a significant risk to a mother’s health whether at occurs at any age or later. However; there are additional medical concerns for younger mothers, particularly those under 15 and those living in developing countries. (Mayor, 2004) A pregnant mother undergoes through a transition for 40 plus weeks and then gets able to give birth to a child. During all these nine months of continues transition the first three months are very important for a few medical conditions like pregnancy induced hypertension and gestational diabetes and these have a higher incidence of occurrence during first pregnancy and in younger mothers. For example if a girl who is 18 years old comes to clinic at gestation of 12 weeks she needs to be assessed for these conditions through physical exam and laboratory investigations. For mother less than 15 years teenage pregnancies carry significant risk to their health directly but for the ones between 15 and 19 years though still a teenage pregnancy but age in itself is not a risk factor, but additional risks may be associated with socioeconomic factors.( Makinson, 1985) and taking this aspect in consideration we need to take a through history of her economic status as multiple studies have shown a drastic impact of economic status on the outcome of a pregnancy and specially a teenage pregnancy. Others less than fifteen years are at higher risk than mother of 15-19 years which still falls in the category of teenage pregnancy the nature of complications changes though the risk still remains high. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19 in such areas. (Mayor, 2004) Apart from getting these medical disorders psychologically for a young girl to get prepared for the responsibilities of a mother is psychological trauma and due to pregnancy induced depression they are mostly not able to maintain a good pattern of their diet and that starts affecting their health as well as child’s health. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. (The National Campaign to Prevent Teen Pregnancy, 2002, Scholl, 1996 Makinson, 1985). The occurrence of developmental disabilities and behavioral issues is increased in children born to teenage mothers. (Maynard, 1996, Kalmuss, 1994) this is a very important phenomenon that can help in building a child’s healthy psychology. There was another research study which showed that those who had more social support were less likely to show anger toward their children or to rely upon punishment. (Crockenberg, S. (1987) So that makes it so clear that teen age pregnancy whether happening within marriage or without marriage have a very less social support because the age of the mother herself is not sufficient enough to have an understanding of the society and have the people around her support her. If the mother is not educated as is going to be the case with most of these teenage mothers, she can not make her children understand the importance of it and along with a number of other behavioral issues they loose to learn and have an income generating life through their academic performance. Daughters born to adolescent parents are more likely to become teen mothers themselves. (Furstenberg, 1990) (The National Campaign to Prevent Teen Pregnancy, 2002) reasons to that can be cultural pressures or just following the way the child has been brought up which includes a number of things seen in their mother. A son born to a young woman in her teens is three times more likely to serve time in prison. (Hofferth, 2002)And this is mostly because of lack of behavioral education, lack of education and awareness and absence of an understanding of social values. Less than one third of teenage mothers receive any form of child support, vastly increasing the likelihood of turning to the government for assistance. (Halloran, O. P. 1998).The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women. (The National Campaign to Prevent Teen Pregnancy, 2002) In 1988, a study found that 60 of teenage mothers were impoverished at the time of giving birth.(Dryburgh, H. 2002) Supportive research also found that nearly 50 of all adolescent mothers sought social assistance within the first five years of their child’s life. (The National Campaign to Prevent Teen Pregnancy, (2002).These are the factors which show that a teenage mother suffers so much that even if she is educated and understanding a lot of things she does not have the time to transfer it to her children. A research study having 100 teenaged mothers as subjects in the United Kingdom found that only 11 received a salary, while the remaining 89 were unemployed. (Social Exclusion Unit, 1999). For most of the cultures woman has to be an earning member of the family or it becomes a financial burden to rise up their children up to the mark with quality care and education that can help the children become healthy individual of a society. Most British teenage mothers live in poverty, with nearly half in the bottom fifth of the income distribution. (Sean, 2002)Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers. (Kalmuss, 1994) One-fourth of adolescent mothers will have a second child within 24 months of the first. Factors that determine which mothers are more likely to have a closely-spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married. (American Academy of Pediatrics, 2001)
Teenage pregnancy which is happening to a huge percentage of mothers is a serious medical and social problem of almost every society. Developed countries that have an understanding that letting the children get married at an earlier age is not healthy from financial status, health, social aspects and a nation’s progress so the incidence of early marriages is almost nil but the teenage pregnancy still is an issue there and rather more of an issues there because it is happening outside a marriage which means a lot of single parent children are given birth to. Having a child to a single mother is rather more harmful in terms of the mother’s progress towards her carrier, raising up the child, and going through all the financial and social problems. Poor academic performance in the children of teenage mothers has also been noted, with many of them being more likely than average to fail to graduate from secondary school, be held back a grade level, or score lower on standardized tests. (The National Campaign to Prevent Teen Pregnancy,2002) Teen mothers are more likely to drop out of high school. (The National Campaign to Prevent Teen Pregnancy, 2002) A country’s progress is measures through a number of things like education, health, awareness, fertility figures an a lot more but education carries utmost importance and as we saw already that mother who conceive at an early age looses the opportunity to study up to a good professional degree and similarly their children don’t get to study up to an appreciable level either so they basically lag behind. This way a county is loosing its potential citizens to adding to a county’s economy and along with that they need a lot help from the government to grow and this way they are consuming a country’s economy without providing anything in return. All these factors of dependency in these families if continue for a significant time is ultimately going to bring a county’s economy down. Teen pregnancy costs the United States over $7 billion annually.( National Facts, 2008) Having teenage pregnancy is a vicious cycle once a woman gets into it all the subsequent girls end up becoming teenage mothers and this cycle of consumption with no production in return continue and eat up a county’s resources. Teenage pregnancy is health burden as well, it is adding to the medical expenditures of a county significantly whether the pregnancy has to be carried out or aborted. Abortions at a younger age carry major health and psychological issues to the mother and she looses to be the same active and beneficial member of the society as she might be before ending up getting pregnant at such an age. Studies have shown that Poverty is associated with increased rates of teenage pregnancy. (Besharov. et al. 1997) Economically poor countries such as Niger and Bangladesh have far more teenage mothers compared with economically rich countries such as Switzerland and Japan. (World Population, 2003) Poverty can be leading to teenage pregnancy and then teenage pregnancy can be a perpetuating factor in bringing poverty to a country. In the UK, around half of all pregnancies to fewer than 18s are concentrated among the 30 most deprived population, with only 14 occurring among the 30 least deprived(Spring 2007) In Italy, the teenage birth rate in the well-off central regions is only 3.3 per 1,000, while in the poorer Mezzogiorno it is 10.0 per 1000. (UNICEF, 2001). Acountry can only progress and stand in competition with other co-nations if it is financially strong but if a country is having only male gender working and most of the females start having children at such an early age that their fertility period gets prolonged and they keep increasing financial burden on the society then the ultimate result will be poor health and a lot of depression on the earning members of the family. If we again consider the example of that young girl 18 years old with 12 weeks of gestation, her husband need to be counseled about these impacts of a teenage pregnancy and should be asked for following contraception strictly after the birth of this child.
Getting married or getting involved in a relationship are all the issues where society has a major role to play. If we are talking about a developed nation where it is socially acceptable to have relationships or pre marital sexual activity then abortion, the financial burden of the child and the mother, falling financial status of the teenage mother and carrying out with further relationships becomes a major social issue. As we know from different research studies carried out with this major concern that what is going o ultimately happen if thigh incidence of teenage pregnancy continues? It was found that girls delivered have the most probable outcome to become teenage mothers their self as well with less education and poor brought up with them. The sons given birth by teenagers mostly end up have behavioral issues and they end up being criminals or have major conduct problems which can never let them be healthy earning individuals of a society. Research has shown that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs(Maynard, 1996) . These things though minor per say but they play major role in making an individual a nice human beings for constructing a healthy society which in long term can potentially lead to a happy nation. Financial economy and man power are two very important components for country to use to get to a progressed and prosperous status. Teen mothers are more likely to drop out of high school. (The National Campaign to Prevent Teen Pregnancy, 2002) Less than one third of teenage mothers receive any form of child support, vastly increasing the likelihood of turning to the government for assistance. (Halloran, O. P. 1998) the correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women. (The National Campaign to Prevent Teen Pregnancy, 2002) These are basically the factors which show how happy and how successful a country is. If a nations’ government has to bear all these responsibilities it will be left with very less energy for a lot of other important activities. If we take an example of one single girl that is 15 years old and she gets married as per her culture she starts having children and by the time she is 20 years old she is a mother of 4 children and the first one is going o be school age by then. If we analyze the life of this girl she is getting no time for herself and her health, children being more and frequent are going to suffer too, they will have no health and life to stand in a competition for the opportunities the way others can. Apart from this entire how is this family going to get supported in a developing country. The parents are going o exploit all they have and the children will be left with nothing as their inherited property. The parents are going to keep exploiting resources from the government as well and their health issues will be adding to the country’s health issues as well though they will not be the kind of issues out of control but will be due to bad nutrition, bad hygiene, lake of awareness and bad health care practices. These are all direct and indirect looses of country. Some cultures support this system of early marriages and teenage pregnancies but even they have started questioning these issues now because the consequences of these pregnancies are so obvious that they can not be ignores.
Teenage pregnancies is the area was not that targeted just about a decade back and even pregnancies at an appropriate age were never paid due attention and due to that mothers were dying in a significant number, children with disabilities were taking birth due to intrauterine and delivery complications but now things are changing and now people have started talking about teenage pregnancy as an issue and they have started acknowledging the problems associated to it. People want to help and want to helped their self as well, they have started targeting this issue from every possible and apparently more suitable angles like for cultures where teenage pregnancies occur due to early marriages have started delaying their marriages but if still it happens as a result of cultural pressure they are focused enough to prevent teenage pregnancy. For cultures where teenage pregnancy happens out of marriage have started focusing more on the birth control side of it and they have started talking more about the different contraception methods for unmarried girls and have also started questioning the failure rates of different contraceptive options. Looking at the adverse effect of an early pregnancy at the mother’s and child physical health and the psychological issues related to it becomes mandatory to have a good control on this major issues in order to have a progressed and prosperous nation. In some cultures the social problem associated to a pregnancy out of marriage is not that much of an issue so in those cultures it is hard to control this problem from happening so, there the main focus should not be on controlling sexual activity amongst youngsters but rather giving them a good deal of awareness of the problems associated with teenage pregnancies a good education about contraception will be more useful. Control of pregnancy has always been a factor controlled by males though this should always be aright of the woman whether she has the willingness to have her body be used for bringing up a child or not but still in order to have a good control on the occurrence of teenage pregnancies the male partner should be involved actively. The social and economical aspect of early pregnancy should be explained very clear to the potential father and they should be made aware of the health burden they will be creating on their self and on larger scale on a country’s health issues by asking for a child at an earlier age. Pregnancy has always been a major risk issue for most the developing countries and they do not regard pregnancy to be a health issues to start with. I will share an example from my clinical practice of a young girl that was 15 years old and she got pregnant out of marriage so, the only way to deal with pregnancy in this culture was to get it aborted. She went ahead and got it aborted by an inexperienced nurse. She stayed in pain for a long time after her abortion but she never explored it on anyone in order to maintain confidentiality until she went into serious crises and got presented to us with a frozen pelvis. She had a major explorative laparotomy which showed organs sticking together so badly that there was no way to decrease the adhesions she had. She was closed back without any major intervention and on the second post op day she did not make it and she expired. Similarly another mother that I saw was 28 years old with 13 children was pregnant again and she was so anemic that she was not even able to talk. Her husband was so anemic weak and lethargic that he was not even interested in life. This couple did not want to have any more children, in fact they were never interested in having so many children but since the time they got married they had been having children without even knowing how to control it. This couple was physical not well, psychologically so disturb and socially, financially and personally were not able to bear their responsibilities but still did not know how to control their situation. These couples get stuck in this vicious cycle of going o down and further down and at times it become very difficult for them to get out of it. If we consider the example of this 18years old primy at her 12 week of gestation she is still at a healthy time of getting counseled. Her husband and she can be made aware of all the possible and probable adverse effects of this early age pregnancy and they should be made aware at least for their future to conserve a gape in their children in order to get out of this cycle. They need to have carrier counseling and they need to be aware of the responsibilities of a father and mother. Midwifery has a major role to play especially for UK where it is more in practice. Getting to a gynecologist is going t0 be expensive for couple in developing countries with compromised financial status so midwives can help them through their experienced life. Some people find it cumbersome to go to a fertility clinic for teenage women so these midwives can help them by going to their homes and can even help them get out accessing these facilities available. Teenage counseling clinics are not found in most of the cultures but countries that are more developed like United Kingdom, United States, Canada etc have well established teenage pregnancy counseling clinics which is a nice facility and should be availed.
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