Adolescent Pregnancy Rates Research Articles

Prevalence, Trends in and Determinants of Teenage Pregnancies in Rwanda: Analysis of Rwanda Demographic and Health Survey (2010 to 2020)

Background: According to the World Health Organization, roughly 16 million teen mothers aged 15 to 19 give birth annually resulting a 44,000 births per day worldwide. Moreover, the vicious cycle of poverty in sub-Saharan Africa is exacerbated by adolescent pregnancy, this also increases maternal, perinatal, and infant mortality hindering SDG goal 5 and target 3 of ending the child marriage of 2030 to be achieved. This study aimed to identify the prevalence, trends, and determinants of teenage pregnancies in Rwanda between 2010 and 2020. Methods: This study used Rwanda's demographic and health survey data from 2010, 2015, and 2020, and a cross-sectional study design. All data were cleaned and appended to get the final data set for analysis, all analyses were performed using R software package 4.3.1. Moreover, statistical significance was determined at a 5% p-value and 95% Confidence Interval (CI) while not crossing one. Results: The total number of teenagers between 2010 and 2020 was 9,050 and among them, the prevalence of teenage pregnancy was 6.11% (n = 553/9050). By trend, teenage pregnancy in 2010 was 6.22%, in 2015, 7.30%, and in 2015 5.41% in prevalence. After adjusting the variables in a multivariate logistic regression model, the following were found to be potential predictors of teenage pregnancy in Rwanda: Region by Eastern province (AOR: 1.55:95% CI: 1.078,2.24), lack of education and primary school teens (AOR: 2.9:95% CI: 1.22,6.89) and AOR: 1.67:95% CI: 1.25,2.24)respectively, Poorest households AOR: 2.02:95% CI: 1.27,3.12), those with knowledge of contraceptive methods (AOR: 8.70:95% CI: 3.34,23.01), sexually active unmarried women (AOR: 3.50:95% CI: 1.58,7.78), teens who did not access social media (AOR: 2.03:95% CI: 1.41,2.91), and it was protective against family size. Conclusion: These results imply that a combination of social, sociodemographic, and knowledge-related factors, as well as awareness of contraceptive techniques, may impact teenage pregnancy in Rwanda. The provision of contraception education and awareness should be the primary goal of efforts to minimize adolescent pregnancies in Rwanda, particularly in areas where the prevalence is higher. In addition, encouraging family planning and tackling economic inequalities can be effective tactics to lower adolescent pregnancy rates.

Relationship of Adolescent Women's Knowledge about Reproductive Health to Adolescent Pregnancy in Kelurahan Baru Ladang Bambu

Adolescence comes from the Latin "adolesscere" which means 12-24 years. According to the Indonesian Ministry of Health, adolescents are aged between 10-19 years and have not been married. According to BKKBN is 10-19 years. Teenage pregnancies can face the disgrace of getting pregnant without marriage, feeling guilty about an abortion, or increasing anxiety as the pregnancy gets older. This study aims to determine the relationship between knowledge of Adolescent Women about Reproductive Health and Adolescent Pregnancy. The research methodology in this study is descriptive analytic research with a cross sectional approach. The sample in this study was using accidental sampling as many as 30 people. Based on the results of research on 30 adolescents in the Baru Ladang Baru Village who lacked knowledge as many as 16 people, 53.3% and teenagers who had experienced pregnancy/abortion as many as 6.6%. It can be concluded in this study that there is a relationship between adolescent knowledge about reproductive health and adolescent pregnancy, which means that the lower the knowledge of adolescents, the higher the adolescent pregnancy rate.

Factors associated with adolescent pregnancy in Maharashtra, India: a mixed-methods study

Reducing the adolescent birth rate is paramount in achieving the health-related Sustainable Development Goals, given that pregnancy and childbirth are the leading cause of mortality among young women aged 15–19. This study aimed to explore predictors of adolescent pregnancy among girls aged 13–18 years in Maharashtra, India, during the COVID-19 pandemic. Using a mixed-methods approach, primary data were gathered from two regions in Maharashtra between February and April 2022. Quantitative data from face-to-face interviews with 3049 adolescent girls assessed various household, social, and behavioural factors, as well as the socioeconomic and health impacts of COVID-19. Qualitative data from seven in-depth interviews were analysed thematically. The findings reveal that girls from low socioeconomic backgrounds face a higher likelihood of adolescent pregnancy. Multivariable analysis identified several factors associated with increased risk, including older age, being married, having more sexual partners, and experiencing COVID-19-related economic vulnerability. On the other hand, rural residence, secondary and higher secondary education of the participants, and higher maternal education were associated with a decreased likelihood of adolescent pregnancy. In the sub-sample of 565 partnered girls, partner's emotional abuse also correlated with higher rates of adolescent pregnancy. Thematic analysis of qualitative data identified four potential pathways leading to adolescent pregnancy: economic hardships and early marriage; personal safety, social norms, and early marriage; social expectations; and lack of knowledge on contraceptives. The findings underscore the significance of social position and behavioural factors and the impact of external shocks like the COVID-19 pandemic in predicting adolescent pregnancy in Maharashtra, India. Plain Language Summary: Adolescent pregnancy is an important health issue for young girls. In South Asia, one out of every five adolescent girls becomes a mother before turning 18, and in India, around 9% of girls aged 15–19 get pregnant yearly. This study focused on understanding the factors associated with adolescent pregnancy in Maharashtra, India, especially after the COVID-19 pandemic. We collected information from both urban and rural areas in Maharashtra. A total of 3049 adolescent girls participated in a survey, and seven girls participated in detailed interviews. Our analysis showed that factors like older age, being married, having multiple sexual partners, and experiencing economic difficulties due to COVID-19 increased the chances of adolescent pregnancy. On the other hand, living in rural areas, higher education for both the girls and their mothers reduced the likelihood of adolescent pregnancy. Qualitative analysis revealed that economic challenges, concerns about safety and societal norms, early marriage, societal expectations, and lack of knowledge about contraceptives could contribute to adolescent pregnancy in Maharashtra.

Perinatal and Neonatal Outcomes of Refugee Infants in a Tertiary Hospital in Turkey.

Background Worldwide, the immigration problem has been increasing due to conflicts. In recent years, Turkey accepted more than 3.8 million refugees from many countries, principally Syria. Aims In this study, we aimed to evaluate the prenatal features and neonatal outcomes of refugees and Turkish controls hospitalized in a tertiary neonatal intensive care unit in Turkey. Materials and methods This retrospective case-control study included comparative data related to populations based on whether they were refugees or not. Their perinatal and neonatal "outcomes" were compared. Results Among the 254 analyzed neonates, 127 were born to refugee mothers, and 127 controls were born to non-refugee Turkish mothers. The refugee rate in our hospitalized neonates was nine, a young mother's age (p=0.010) with a higher rate of adolescent pregnancies at OR 2.78 (95% CI 0.96-8.05) (p=0.032), and consanguineous marriage at OR 0.57 (95% CI 0.32-1.02) (p=0.031) in comparison to non-refugees. The incidence of ABO incompatibility-related hemolytic jaundice (p=0.013) was higher in the refugees. The rate of formula feeding in the first month of life was significantly higher at OR 0.49 (95% CI 0.25-0.92) (p=0.027) in neonates born to refugee mothers. Despite lower perinatal care rates in refugees at OR 7.23 (95%CI 4.12-12.69) (<0.001), preterm morbidities did not differ between refugees and non-refugee preterm infants ≤32 gestational age (p>0.05). Conclusion The importance of breast milk must be strongly encouraged to initiate and promote exclusive breastfeeding for the infants of refugees. Race is still an important risk factor for ABO incompatibility-related hemolytic jaundice. Providing high-quality healthcare is sufficient to prevent worse outcomes in refugee neonates.

Obstetric practice differences between Syrian refugees and non-Syrian nonrefugee gravidae: A retrospective cross-sectional study.

To assess differences in obstetric practices between Syrian war refugees (SRs) and non-Syrian nonrefugees (NSRs) in a tertiary care provider in Germany. This was a retrospective study of SRs (n = 356) and NSRs (n = 5836) giving birth between January 2015 and December 2018. Data on medical history, birth mode, complications, and neonatal parameters was extracted. Group differences were evaluated using Mann-Whitney and χ2 test. Logistic regression models were fitted to investigate the association of refugee status with mode of birth in conditions associated with increased risk of cesarean section (CS). SRs had higher rates of adolescent pregnancies (1.7% versus 0.6%, P = 0.020) but fewer maternal diseases compared with NSRs (1.7% versus 3.9%, P = 0.035). The rate of CS was higher in the NSR group (43.9% versus 36%, P = 0.003), as well as the rates of premature rupture of membranes (P = 0.006) and steroid administration for lung maturation (P = 0.012). Cases of umbilical artery pH ≤7.0 were more common in SRs (0.4% versus 1.1%, P = 0.027). Women with previous CS had similar odds of CS in the current pregnancy irrespective of study group (odds ratio, 0.94 [95% confidence interval, 0.50-1.75]). SR women had lower rates of CS but higher rates of adolescent pregnancies and neonatal pH ≤7.0 at birth compared with NSR women.

Strategies to enhance sexual health education for prevention of teenage pregnancy in Vhembe District, Limpopo Province: different stakeholder’s perspectives, a co-operative Inquiry qualitative protocol paper

BackgroundSouth Africa is reporting higher rates of adolescent pregnancy as compared to other countries. There are different types of interventions that are in place to address teenage pregnancy. However, these interventions were developed using top-down strategy without the inclusion of different stakeholders and adolescents which makes it hard to implement those interventions particularly in countries like South Africa. Hence, this study aimed to develop strategies to enhance sexual health education for prevention of teenage pregnancy in Vhembe District, Limpopo Province of South Africa.MethodsThe research design of this study will be Co-operative Inquiry.The study will take place in Vhembe District in Limpopo province of South Africa through collaborating with a Non-governmental Organisation (NGO). The study population will be the teenagers and all the different stakeholders caring for teenagers in their areas of specialization. Purposive sampling will be used to sample the targeted participants of the study. The data collection method will be done in phases and focus group discussions will be used to collect data. Content analysis will be used to analyse data.DiscussionThis study will add to the body of knowledge regarding the strategies that maybe used to enhance sexual health education for prevention of teenage pregnancy.

Co-creating sexual and reproductive health interventions with adolescents: the experience from Rajasthan

Despite a clear policy recognition of the need for special programmatic attention for adolescents to ensure access to sexual and reproductive health information and services, almost all existing programs in India face critical challenges in effectively delivering sexual and reproductive health information and services, which leads to early marriages and teenage pregnancies. Teenage pregnancies directly threaten women's sexual and reproductive health and well-being. States like Rajasthan with high adolescent pregnancy rates demand better solutions. IPE Global implemented project Udaan to reduce teenage pregnancies in the state, adopting a 360 degree approach. Improving Sexual and Reproductive Health was one of the critical components of the project, and a human-centred design method was adopted to co-create an effective sexual and reproductive health intervention relevant to the community. The human-centred design approach incorporated multiple steps, including formative research, iterations, prototyping and piloting. Five potential interventions emerged after a series of iterative explorations. The in-school SRH intervention has emerged as an excellent model of reaching adolescents effectively in culturally sensitive rural geographies in the evaluation of the pilot, which successfully covered over 10,800 adolescent boys and girls across 66 government high schools in the Bari block of Dholpur. An independent evaluation suggested a significant increase in the awareness of contraceptive methods in the intervention area from 24 per cent to 50 per cent. Contraceptive self-efficacy, a measure of girls' agency, increased by 18 per cent in the intervention area. Further, qualitative findings showed a significant improvement in SRH awareness and service utilization.

Trends and factors associated with adolescent pregnancies in Tanzania from 2004-2016: Evidence from Tanzania Demographic and Health Surveys.

Adolescent pregnancy increases the risk of maternal and child morbidity and mortality. We aimed to determine trends and factors associated with adolescent pregnancy in Tanzania from 2004 to 2016 using the Tanzania Demographic and Health surveys (TDHS). We carried out an analytical cross-sectional study using the TDHS data for the years 2004 to 2005, 2010 and 2015 to 2016 among adolescent girls aged 15 to 19 years. Data analysis was performed using STATA version 15. Data analysis considered the complex survey design inherent in the demographic and health survey (DHS) data. The Poisson regression model was used to estimate Prevalence Ratios (PR) and 95% confidence intervals for factors associated with adolescent pregnancy. We analysed data for a total of 10,972 adolescents for the three TDHS rounds. The proportion of adolescent pregnancy significantly decreased from 26% to 22.8% from the year 2004/05 to 2010 and then increased again to 26.7% in 2015/16. Adolescents who were aged 18 to 19 years (APR 1.52; 95% CI, 1.38 to 1.68) married or cohabiting with their partners (APR 2.15; 95% CI, 1.93 to 2.40; P<.001), widowed/divorced/separated (APR 2.32; 95% CI, 2.03 to 2.66; P<.001), and among those who started sexual activity before 15 years of age (APR 1.20; 95% CI, 1.11 to 1.31; P<.001) were more likely to become pregnant during adolescence. In contrast, adolescents with secondary school education level and above were the least likely to become pregnant (APR 0.62; 95% CI, 0.51 to 0.75; P<.001) compared to those with no formal education. One in four adolescent girls aged 15 to 19 in Tanzania have already started childbearing and despite fluctuation, high rate of adolescent pregnancy persists. Preventive interventions should focus on adolescents with low education level, married/cohabiting with their partners, and who have started sex before 15 years of age. We advocate for the increase of school attendance until high school level to reduce the risk of early pregnancy in adolescents. Furthermore, qualitative studies are crucial to explore reasons for the rising trend of adolescent pregnancy in most zones of Tanzania, particularly between 2010 and 2015/16.

Barriers to adequate nutrition in pregnant adolescent Colombian females.

Pregnant adolescent females face nutritional challenges. The nutritional demands of a growing fetus, when added to the requirements for growing adolescent bodies, are risk factors for undernutrition. An adolescent expectant mother's nutritional status therefore affects both the mother's and the child's future growth, development, and potential development of diseases later in life. In Colombia, the rate of female adolescent pregnancies is higher than neighboring countries and the global average. The most recent data suggest that approximately 21 % of all pregnant adolescent females in Colombia are underweight, 27 % suffer from anemia, 20 % suffer from vitamin D deficiency, and 19 % suffer from vitamin B12 deficiency. Contributing factors to these nutritional deficiencies during pregnancy may be the region in which the female lives, the female's ethnicity, and the female's socioeconomic and educational status. In rural parts of Colombia, limitations regarding access to prenatal care and food choices that include animal source proteins may also contribute to nutritional deficiencies. To help remedy this, recommendations include encouraging nutrient dense food sources with higher protein content, eating one additional meal per day, and taking a prenatal vitamin throughout the pregnancy. Making healthy eating choices can be difficult for adolescent females with limited resources and education; therefore, it is recommended that discussions about nutrition begin at the first prenatal visit for optimum benefits. These factors should be considered for the development of future health policies and interventions in Colombia and other low-income and middle-income countries where pregnant adolescent females may be experiencing similar nutritional deficiencies.

Comparison of Perinatal Outcomes Between Syrian Refugees and Turkish Women in the Middle Anatolia Region of Turkey.

To compare the results of perinatal outcomes between Syrian refugees and Turkish women between 2016 and 2020. The birth results of 17,997 participants (Syrian refugees: 3579 and Turkish women: 14,418) who delivered in the Labor Department of our hospital between January 2016 and December 2020 were retrospectively analyzed. Maternal age was younger (24.73 ± 6.08 vs. 27.4 ± 5.91 years, p < 0.001) and adolescent pregnancy rate was higher (19.4% vs. 5.6%, p < 0.001) in Syrian refuges than in Turkish women. Bishop scores on admission (4.6 ± 1.6 vs. 4.4 ± 1.1, p < 0.001), birth weight (3088.19 ± 575.32g vs. 3109.76 ± 540.89g, p = 0.044), low birth weight (11.3% vs. 9.7%, p = 0.004), and the rate of primary cesarean deliveries (10.1% vs. 15.8%, p < 0.001) were also statistically different. Additionally, the rates of anemia (65.9% vs. 29.2%, p < 0.001), preeclampsia (1.4% vs. 2.7%, p < 0.001), stillbirth (1.3% vs. 0.6%, p < 0.001), preterm premature rupture of membranes (2.7% vs. 1.9%, p = 0.002), and obstetric complications were different between the groups. This study showed that inadequate antenatal care, communication and language barrier problems in Syrian refugees caused some adverse perinatal outcomes. All birth data of Syrian refugees must be disclosed by the Ministry of Health to confirm the accuracy of our data.

Mirroring Perinatal Outcomes in a Romanian Adolescent Cohort of Pregnant Women from 2015 to 2021.

Although the rates of adolescent pregnancies appear to have dropped according to the World Health Organization (WHO), the decrease in the age of the first menarche and better nutrition seems to contribute to the otherwise high rate of adolescent pregnancy worldwide, despite the efforts of different organizations to improve upon this trend. We conducted a population-based retrospective cohort study from January 2015 to December 2021 using our hospitals' database. We totaled 2.954 adolescent and 6.802 adult pregnancies. First, we compared younger adolescents' outcomes with those of older adolescents, as well as with adolescents aged between 18 and 19 years old; secondly, we compared adolescent pregnancies with adult ones. We detected higher percentages of cephalo-pelvic disproportion (43.2%), cervical dystocia (20.7%), and twin pregnancy (2.7%) in underage adolescents compared with 32%, 14.1%, and 1% in older underage adolescents, respectively, and 15.3%, 3.1%, and 0.6% in older ones. As teens became older, the likelihood of malpresentations and previous C-sections rose, whereas the likelihood of vaginal lacerations declined. When comparing adolescents with adult women, we found more cases that required episiotomy (48.1% compared with 34.6%), instrumental delivery (2.1% compared with 1%), and cervical laceration (10.7% compared with 8.4%) in the adolescent group, but the rates of malpresentation (11.4% compared with 13.5%), previous C-section (13.9% compared with 17.7%), and placenta and vasa praevia (4.5.6% compared with 14%) were higher in the adult women group. Adolescent pregnancy is prone to being associated with higher risks and complications and continues to represent a challenge for our medical system.

Factors Influencing high adolescent pregnancy rate in Riobamba, Ecuador

The country of Ecuador has the highest rate of adolescent pregnancy in Latin America and the Caribbean. Risk factors associated with this pregnancy rate need to be explored to effectively implement educational youth programs.1 Early sexual initiation, poor reproductive health knowledge, and disruption of family structure are hypothesized to be major risk factors of adolescent (&lt;20 years) motherhood (AMH) in Riobamba, Ecuador.2 We conducted a case-control study with case being women &lt;20 years of age during first pregnancy and control being women ≥20 years of age during first pregnancy. Controls were not matched. The study took place in June/July of 2021 in five public governmental primary health clinics within Riobamba, Ecuador with the primary goal of determining risk factors associated with AMH. Age responses were used to designate group status. Risk factors were analyzed using Welch’s two-sample t-tests and Fisher’s Exact tests. 198 participants were analyzed: 99 who had AMH and 99 who had non-AMH. Adolescent mothers were significantly younger during first sexual encounter than adult mothers. Adolescent mothers were also more likely to lack reproductive health knowledge and have a disruption in family structure. While our study was able to broadly explore the risk factors for AMH, the underlying causes of these risk factors, such as societal pressures, need to be examined further. Early education about sexual health and use of contraception should be an initial goal of Riobamba’s programs to reduce AMH.

Adolescent Contraception Management: A Review of Medical Options

Disparity in access to family planning and contraceptive services remains disproportional within underserved communities. The United States ranks highest among developed countries for rates of adolescent unplanned pregnancies. This coupled with legal implications including confidentiality further contribute to a lack of access to medically appropriate, safe, and reversible contraceptive options. The nurse practitioner is a key partner in the implementation of the evidence-based recommendations by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics. This article reviews medical options for the management of adolescent contraception.

"I Don't Support It for My Children": Perceptions of Parents and Guardians regarding the Use of Modern Contraceptives by Adolescents in Arua City, Uganda.

Despite the high rates of adolescent pregnancies, the utilization of modern contraceptives is still low among adolescents in Uganda which highlights a missed opportunity for the prevention of unwanted pregnancies among adolescents. We explored the perception of parents and guardians regarding the use of modern contraceptives by adolescents and the roles parents and guardians play in the use of modern contraceptives by the adolescents. A descriptive qualitative study was conducted in one of the suburbs of Arua city in the West Nile subregion in Uganda. Fifteen (15) in-depth interviews were conducted with parents and or guardians to explore their perceptions and roles regarding the use of modern contraceptives by adolescents. Thematic analysis was used in qualitative data analysis. Parents did not support adolescents' use of modern contraceptives. Lack of parental support was related to perceptions that modern contraceptives promote sexual promiscuity, fear that it causes infertility and that it is incompatible with cultural, religious, and moral norms. Parents and guardians opted to emphasize the importance of abstinence, conformity with cultural and religious norms, and the need to focus on completing school instead of encouraging the use of modern contraceptives. Few parents and guardians supported the use of modern contraceptives, specifically condoms, to prevent unwanted pregnancy by the adolescents and parents/guardians, sexually transmitted infections, and early school dropouts. Parents and guardians expressed feelings of inadequacy related to discussions on contraception use with their adolescent children and therefore avoided talking about it. Our study reveals a lack of parental support regarding the use of modern contraceptives among adolescents. Public health interventions which promote intergenerational, socioculturally, and religiously appropriate communication should be instituted in the communities in order to promote sustainable adoption of modern contraceptive use among adolescents.

Caregivers of youth in foster care in Texas and their role in contraception decision-making for adolescents in care

ObjectivesThis study describes the perspectives of caregivers of youth in foster care in Texas about the caregiver’s role in adolescent contraception decision-making for adolescents in their care, particularly for long-acting reversible contraception. The study also explores how providers and foster care agencies can better support pregnancy prevention for youth in care. Study designResearchers recruited 18 caregivers of youth in care from an academic center in Texas to complete in-person, one-on-one, semistructured interviews from August to December 2019. Two independent coders identified the main concepts with thematic analysis; discrepancies were resolved by consensus. ResultsMost caregivers identified as female (88%), Black (59%), and ranged in age from 30 to 69 years old. Half (47%) reported previously caring for an adolescent who was pregnant or parenting. Themes from the interviews included the importance of building relationships before contraception conversations, the balance between adolescent autonomy and strict caregiver oversight in contraceptive decision-making, variation in beliefs about contraception for youth in care, and extreme reactions to long-acting reversible contraception in both directions. Providers and foster care agencies played an important role managing confidential expectations and providing resources or trainings about contraception. ConclusionsIn a region of the country with high rates of adolescent pregnancy, strategies that empower adolescent autonomy allow delicate caregiver oversight, provide comprehensive information about all contraceptive options, and respond to extreme long-acting reversible contraception reactions and trainings that focus on the context of contraception that should inform communication-based interventions to address teen pregnancy prevention among youth in care. ImplicationsFew studies address the experiences of caregivers of adolescents in foster care. This study highlights a range of caregiver attitudes about contraception for adolescents in care. Provider training regarding contraception should include strategies to manage caregiver beliefs and extreme reactions to contraception use among youth in care.

A case for vaccinating adolescent girls for protection against COVID-19 during pregnancy and childbirth in resource-limited settings

The coronavirus disease 2019 (COVID-19) pandemic has had severe implications worldwide, including increased adverse maternal and neonatal health outcomes. Vaccination is one way of protecting against these adverse health outcomes. However, in some low-resource settings, vaccine inequity has led to poor uptake of COVID-19 vaccination. There are very high rates of adolescent pregnancy in low-resource settings, which are likely to become even higher as we begin to see the full effects of COVID-19 lockdown measures, including school closures. Although the benefits of COVID-19 vaccination in adolescents are debated, we propose that adolescent girls should be prioritised in COVID vaccination roll out in low-resource settings. This is to provide protection from severe COVID-19 disease in pregnancy, preventing adverse maternal and neonatal health outcomes.

Correlates of maternal, newborn and child health services uptake, including male partner involvement: Baseline survey results from Bangladesh

ABSTRACT South Asia bears a substantial proportion of the global maternal mortality burden, with adolescents disproportionately affected. Bangladesh has one of the highest adolescent pregnancy rates in the world, with low utilisation of maternal newborn and child health (MNCH) services. This hampers the country’s efforts to achieve optimal health outcomes as envisioned by the Sustainable Development Goals. Male partner involvement is a recognised approach to optimise access to services and decision-making. In South Asia data on male involvement in MNCH service uptake is limited. Plan International’s Strengthening Health Outcomes for Women and Children was implemented across four districts in Bangladesh between 2016 and 2020 and aimed to address these issues. Study results (N = 1,724) found higher maternal education levels were associated with use of MNCH services. After controlling for maternal education, service uptake was associated with male partner support level and perceived joint decision-making. The positive association between male support level and MNCH scale was robust to stratification by maternal education level, and by age group (i.e. adolescent vs. adult mothers). These findings suggest that one path for achieving optimal MNCH outcomes might be through structural-level interventions centred on women, combined with components targeting male partners or male heads of households.

A refugee mother's perspective: Healthcare satisfaction and access to health services as an immigrant in Turkiye.

The civil war that broke out in Syria in 2011 caused 3.7 million Syrians to migrate to Turkiye. Being particularly vulnerable women refugees may experience problems with access to healthcare services. This study aimed to determine the health problems of refugees in Ankara, their access to and use of these services. Healthcare-related levels of refugee mothers were assessed using a questionnaire and the study was conducted with the participation of 310 refugee mothers who presented to the Refugee Health Center, between 15 September 2017 and 15 December 2018. Among the participants, 28.4% were minors who were between the ages of 15 and 18 years. The mean age of the mothers was 31.18±13.84 years, while the mean age of the fathers was 32.37±10.76 years. During their residence in Ankara, the participants preferred Refugee Health Centers (94%) and State Hospitals (83%) for healthcare. Of the participants, 42.1% stated that one or more family members had health problems, which necessitated regular hospital visits. In this study, 95.2% of participants stated that they were satisfied with the healthcare services they were receiving. Although state hospitals were frequently used, refugees were also able to find solutions to their health problems through Refugee Health Centers. Nevertheless, while using other healthcare institutions, the biggest issue for the refugees was the language barrier. The high rates of adolescent pregnancy, disabilities, and chronic diseases were found to be among the main health problems of refugees. Women refugees seemed disadvantaged in education, language, income and employment.

Perinatal outcomes of young adolescent pregnancies in an urban inner city

Although substantial efforts have been made to reduce the rates of adolescent pregnancy, the United States continues to have higher rates than other industrialized countries. Research and reporting usually focus on adolescents aged 15 to 19 years. Although less common, there are pregnant young adolescents that are ≤15 years of age, with developmental and social differences from older, high school-aged adolescents. Because adolescent pregnancies are of particular concern because of long-term socioeconomic consequences to parent and child, we sought to determine whether young adolescents (≤15 years old) had worse perinatal outcomes than older adolescents (16-19 years old) and older parents (≥20 to 34 years old) among those living in an urban inner city. This was a study of pregnant individuals who delivered a singleton pregnancy without evidence of chronic hypertension or pregestational diabetes mellitus at a safety net hospital from January 2010 to May 2021. Parents were grouped by age at the time of delivery into young adolescents (≤15 years old) and older adolescents (16-19 years old). For a comparison group, nulliparous older parents aged 20 to 34 years with singleton pregnancies were analyzed for perinatal outcomes and compared with the adolescent cohorts. When analyzing baseline parental characteristics, a preponderance of obesity was noted in the young adolescent cohort. An analysis of parental characteristics and perinatal outcomes among young adolescents with obesity vs young adolescents without obesity ≤15 years old was performed. Statistical analysis included χ2 and Student t test with P values of <.05 considered significant. Logistic regression analysis was performed to control for potentially confounding demographic variables. Overall, 10,894 adolescent women delivered, with 868 young adolescents and 10,026 older adolescents. Pairwise comparisons showed young adolescents had a different race distribution than older adolescents (P=.006) and older parents (P<.001). Young adolescents were more likely to be Hispanic or non-Hispanic Black (P<.001) and accessed prenatal care at a later gestational age (19.7±8.9 weeks) compared with older adolescents (16.7±8.6 weeks) and the comparison older cohort of parents (15.7±8.7 weeks) (P<.001) and less frequently in pregnancy (P<.001) compared with older parents. Young adolescents were more likely to have preterm birth at <37 weeks of gestation (P<.001) and eclampsia (0.5% vs 0.1%) (P=.01) than older adolescents. Therefore, low birthweights of ≤2500 g (P=.02) and neonatal intensive care unit admission (P=.048) were also increased in adolescents. When adjusted for race, ethnicity, and body mass index, preeclampsia with severe features (P<.001) and preterm birth at <37 weeks of gestation (P=.048) remained significant. Young adolescents with obesity were more likely to have preeclampsia with severe features (odds ratio, 1.81; 95% confidence interval, 1.22-2.68) and be delivered via cesarean delivery (odds ratio, 2.71; 95% confidence interval, 1.85-3.99) than adolescents without obesity. In an urban inner city, young adolescent parents were more likely to be women of color, have later presentations to prenatal care, and have increased rates of preterm birth. Young adolescents had high rates of obesity, which was associated with increased rates of hypertensive disorders of pregnancy and cesarean delivery, than adolescents without obesity.

Operational Research on Transformative Education about Health and Sexual and Reproductive Rights During Adolescents’ Initiation Rituals

Introduction: Teachings during adolescent initiation rituals in Mozambique are one of the causes of adolescent pregnancy, high maternal and neonatal mortality rates, school dropout and premature marriage. Research in Nampula, “Alert Community for a Prepared Hospital”, identified rituals leaders and counsellors as relevant agents to achieve sexual and reproductive health education for adolescents. Lúrio University’s partnership with the University of Saskatchewan in Canada obtained funding for this operational research. Meetings were held with local partners and with the actors involved in the rites. The organisers of the ceremonies are the resource persons for a transformative education intervention on adolescent sexual and reproductive health and rights. Objective: Assess education provided in adolescent’ initiation rituals about sexual and reproductive health and rights. Methods: Descriptive qualitative study, using interviews, carried out in Lúrio University Campus in October 2022. The recommendations of the Declaration of Helsinki were respected, and the study had the approval of the Bioethics Committees for Health at Lúrio University and the University of Saskatchewan. Results: 17 organisers were interviewed, 15 men and 2 women, with an average age of 54 years, mostly with primary schooling and peasants, living in various neighbourhoods of Nampula. The interviewees show significant differences, but also some homogeneity in the teaching given, although limitations are found on sexual and reproductive health, with the subject of contraceptives being scarcely broached. The teaching on interpersonal respect is mentioned, however, this orientation shows gender inequity. Conclusion: Rituals organisers are a traditional class of broad social impact but reveal little knowledge about sexual and reproductive health and rights. Informing this group and educating the rituals counsellors will be necessary to achieve adolescents’ behaviour changes.