The teenage pregnancy
Adolescence is a period of identity seeking-a period of exploration and risk taking-their normal developmental actions and perceptions can put them at more risk than any other life stages(Dryfoos,1991;Kokotailo&Adger,1991).One such issue they create is the issue-Teenage pregnancy..
Bearing a child during adolescence adds up the stress and triggers changes in various aspects-physical, emotional, personal, and social. Among the well documented includes school dropouts, developmental and health problems, depression, poverty, etc (Dryfoos, 1991).It poses a lot of negative consequences to the mother as well as her child. Youthful sexuality continues to raise interest esp. in Britain. Though it`s not new (Wallace, 1987) and teenage pregnancy has now been recognized as one among the major governmental issue of the 21st century.
During the past four decades teenage pregnancy has become the rising concern both personally as well as politically.In addition to having the worst records on teen pregnancy in western Europe, Britain is the only EU County where rate hasn't declined since past two decade (Stewart,1999).The UK government, concerned about its aftereffects is repeatedly emphasizing on means to reduce teen pregnancy rate.
In 1992, "The Health of Nation" promised to halve the rate by 2000, but failed. Then another policy set its target to reduce the rate to half by 2010.In a way to achieve this, many policies were set based on researches esp. on stressing the importance of sex education in schools.
Though so, The Office of National Statistics (2008) shows a rise in 2.7%during the last year (42 per 1000 when compared to 40.9 in 2006) which shows a rise despite governmental efforts to reduce it. These figures say that Britain will soon cement its position as the country with highest teen pregnancy levels in Europe.This increasing Teen pregnancy rate has made the policy makers to explore new ways to tackle the issue on the basis of strong evidence based research.
The following paper critically reviews the available literature on teenage pregnancy and areas of further research.
WHY TEEN PREGNANCY RATES TO BE REDUCED
In UK, teen pregnancy is considered an important social problem as well as a health issue and has been the focus of governmental intervention for the past two decades. Teenage pregnancy rates needs to be reduced because of its negative consequences it bears on the teenage mother as well as her child.
Teenagers are not only at risk of conception but also at risk of many sexually transmitted infections (STI's). In a single act of unprotected sex, there is 1%chance for Genital herpes and 50%chance for gonorrhea (SEU, 1999).Risk of CA Cervix in teen mothers is doubled esp. if sexual activity commences before 16yrs (SEU, 1994), and also posses the risk of miscarriage or pre term delivery (Hay et al, 1994).Second teenage birth is associated with thrice risk for preterm or still birth (Smith, 2001).Moreover, teenagers on fearing parental responses and medical procedures conceal the fact of being pregnant and are at risk of more severe consequences.
Psychological concern is that most of the pregnant teen's esp. below 16yrs are psychologically immature and emotionally unstable and hence the additional stress that pregnancy impose brings up negative results.
Social concern is that 90%of teenagers become pregnant out of wed locks and more common among those who are homeless, facing violence etc (SEU, 1999) and thus deprives their life further due to the lack of socio-economic resources.
EFFECTS ON TEENAGER MOTHER
Although pregnancy is a good experience for few, it may have serious consequences and includes;
Short term mental problems like depression (Botting, 1998) 2. Education and employability; Teenage mothers are less likely to complete their high school education -lack of skills-low employment opportunities-low income-poverty (SEU, 1999).3. Lack of support; since 9 of 10 are out of wedlock pregnancies this can deprive the socioeconomic resources-poverty and homelessness.4. Family conflicts since teen pregnancy is high among those exposed to violence.
It's found that literature on teenage pregnancy mostly focuses on the negative consequences of being a teen parent though there are teen parents who said that they enjoy being so and the child has brought more joy to the family (Dilworth, 2004).
One of the consequences they pointed out is that on non-completion of high school education (Hoffman, 1993) however its validity is questionable! Education and its completion is purely a personal preference and moreover it's a short-term effect. If she has a will to complete her studies, she can (Ribar, 1994).Another effect is poor skills and hence low employability. Skills are attained through training and have no relation with pregnancy (Maynard, 1997).
Thus the outlook towards isn't positive. Moreover assistance has to be given to teenagers in all areas-academic, vocational, employability, life skills etc to achieve their socioeconomic independence.
However, a result of teen pregnancy on education and employability appears to be limited and are less clear.
Resources needs to be directed in tackling psychosocial factors influencing teen mothers like low self esteem, low expectations, unrealistic goals, limited support etc (Ettinger, 2001).
Despite high teen pregnancy rate in UK, interests on its consequences remain low.
EFFECTS ON CHILDREN BORN TO TEEN MOTHERS
Studies have proved that children born to teen mothers are at greater risk for many negative consequences like;
- Low birth weight (Botting et al, 1998).
- Infant mortality rate is 60%chance more among teen mother's children when compared to older adult (Berthoud, 2001).
- Only 20%teen mothers breastfeed their child-compromising normal growth and development (Botting, 1998).
- Single parent family-low income-poverty-poor housing-poor nutrition (Wolfe.B, 1997)
- Children of teen mothers are more likely to be teen mothers themselves (Kierman, 1995)
- Risk for developmental problems (Whiteman, 1997).7. Children more likely to grow in single parent families (Haveman et al, 1997).
It's said that living situation of the infant and the teen mother is the single most predictor of their well being (Flanagan P et al 1995).
WHY TEENAGE PREGNANCIES ARE HIGH
Social, economical, environmental as well as individual factors determines for the increase in teenage pregnancy rate and thus makes it difficult to disentangle the exact cause for teen pregnancies(Fullerton,1997).
Teen pregnancies seem to be high esp. in those who were disadvantaged during their childhood and those with poor educational and job expectations.
There are evidences showing vulnerability of certain groups for becoming teen parents like;
- Homelessness (JRF, 1995)
- School underperformance (Kiernan, 1998)
- Children of teen mothers (Botting, 1998)
- Ethnic minority group (Botting et al, 1998)
- Criminals (Botting et al, 1998)
- Abuse to drugs, alcohol. Smoking etc (J.C Boyce, 1999)
- Single parenthood (Jacobson, 2005)
To certain teens, it's a means to escape from violent homes (SEU, 1999)
On reviewing the literature, the rate of teen pregnancy is correlated to the risk of early sexual activity, unprotected sex and individual desire to become pregnant (National Longitudinal Survey, 2001).It's seen that 12%of boys and 13%girls involve in sex earlier.And poverty is seen as a cause as well as a consequence of teenage pregnancy (Dilworth, 2005).
REDUCING THE RATE OF TEENAGE PREGNANCY
With the growing concern over the issue of teen pregnancy, the UK government laid down many policies and interventions so as to reduce its rising rate which includes;
- School-based sex education esp. regarding contraception, delaying sexual activity in early teens and avoiding unprotected sex in older teens.
- Community based education services (for youth, families, etc)
- Youth development programs focusing on personal skill development.
- Family interventions
In spite of many interventions lay so as to reduce the teen pregnancy rate, recent statistics revealing increase of 2.7% since last year. While implementing interventions focus must be given on the use of contraception. Instead of stressing delaying sex in younger teens and avoiding unprotected sex in older teens, it would be ideal if both is synthesized together and applied for younger as well as he older teens. Make sure that the message reaching the teenagers is clear, unambiguous and age-appropriate. The interventions must more be focusing on high-risk-groups. Make sure there is dissemination of information and education is carried-out in clinics and is provided by trained staffs. Since teenager is more likely to get influenced by peers, interventions must also focus on peer-groups. Another concern is whether sex education is reached out to teenagers at. the right time
In order to make sure that the interventions are effective in these characteristics, continuous, periodic, evaluations has to be done, which seems to be lacking here esp. in UK context where interventions are rarely evaluated.
Another recent interest lies on the role of parents in reducing the risk for teen pregnancy by openly talking with the teens regarding sex and its issues-though many controversies still exist on whether this increases sexual activity or vice-versa.
Role of media also needs to be considered as recent studies showed watching pornographic videos seems to have an effect in sexual activity-still controversial!
Studies were also conducted on the effect of sexual abstinence, but still there's no strong evidence to support it (Dicenso etal, 2002).
There are evidences showing that contraceptive services are more cost-effective than teen pregnancies but the cost effectiveness of other interventions are not clearly identified.
IMPROVING TEENAGE PARENT OUTCOMES
Since researchers has studied the negative consequences of teen-pregnancy on the mother as well as the child, steps have been undertaken focusing on these consequences so as to improve the socioeconomic conditions and aiding healthy and safe delivery of the baby. This includes;
- Good antenatal care
- Home-visiting providing parental and psychological support
- Improving socioeconomic resources so as to improve their health
- Provide training in skills in support for continuing education and employability.
Home-visiting in the UK context is unclear and further research needs to be done explaining its effectiveness and how other interventions could combine in improving parental outcome.
STUDIES ON TEENAGE PREGNANCY;
Homelessness, violence-exposure and school participation among urban adolescent mothers.
METHODOLOGY: Quantitative method (self-administered Questionnaire); Purposive sampling; 120samples.
FINDING: Teenagers has experienced homelessness, majority due to home-violence, is associated with decreased schooling.
CRITIQUE: Generalisability of findings is a question because of non-probability sampling; moreover relationship between the variables changes over time and since schooling is associated with personal attitudes to schooling.
Care giving by low-income adolescent mothers and language abilities of their 30mnth old children.
BY: Tom Luster, Marcia Vandenbel
METHODOLOGY: Longitudinal study; Randomized-controlled-trails; Interview method; weekly home-visits;
FINDING: Care giving practice of low-income teen mothers predictive of individual difference in language abilities.
CRITIQUE: Study addresses an important issue in teen parenthood but its generalisability is questionable esp. to advantaged teen mothers, due to small sample size.
Who benefits most from a broadly targeted prevention program? Differential efficacy across population in teen outreach program.
METHODOLOGY: Questionnaire; N=1,673; Comparison=1,604;
FINDINGS: Teen outreach program has different levels of effectiveness when serving different population.
CRITIQUE: This study revealed in evaluating the program effectiveness showing a 54%risk in minority group against 1/5th risk among those participated. However, its question is on cost effectiveness.
Low -income adolescent mothers' knowledge about child development.
METHODOLOGY: Check-list (HELP/BSID1993);60 SAMPLES
FINDING: More knowledgeable about ordering of development but less about timing and more on cognitive, language and motor development than play and social development.
CRITIQUE: Small sample size; difficulty in exploring parenting experiences etc
Teen pregnancy, motherhood and unprotected sex
BY: Deborah, Janna L, 2003
FINDINGS: 13%associated with unprotected sex accounted by TRA Constructs.
CRITIQUE: Though an important study showing the immediate need for appropriate interventions, the validity of questionnaire used and the responses is questionable.
Maternal employment and teen childbearing
BY: Leonard.M (2006)
FINDING: Increase in mothers work hours shows reduced probability for teen daughter to become pregnant
CRITIQUE: Though this indicates that better socioeconomic conditions favors reduction of teen pregnancy rate, maternal employability is exogenous to teen's childbearing decision.
How many off springs born to teen fathers are produced by repeat serious delinquents
FINDING: More serious delinquents involves in sex at earlier ages
Determinants of attachment and mastery motivation in infants born to adolescent mothers
METHODOLOGY: Home-visits, longitudinal study-questionnaire. In lab, attachment &motivation is assessed
FINDING: Infant persistence was significantly assoc. with social network and financial aid.
CRITIQUE: The effectiveness of home-visits is questionable.
A comparison of adolescent and adult single mothers
FINDING: Adolescent mother underestimated developmental rate and perceived some infant behavior lesser.
CRITIQUE: Further research required to assess how maturity affects knowledge to behavior.
Does father absence place daughter and risk for early sexual activity and teenage pregnancy.
By: Ellis Bruse J
METHODOLOGY: Longitudinal study
FINDING: POSITIVELY ASSOCIATED
CRITQUE: Though it's a major finding the effect of other attributes needs to be taken into consideration.
There are many issues regarding the methodology used to research on the issue of teenage pregnancy. Some of the identified drawbacks include;
- Most of the methodologies used were of poor quality -where there seems to be a difference in finding when done in two different methodologies.
- Much of the available studies were U.S based and UK contexts were minimal
- There were fewer studies to evaluate the effectiveness of interventions esp. among the high-risk groups
- Most of the studies were done on traditional quantitative models, researching using advanced methodologies like qualitative, action researches, expert opinion etc are minimal
- There were minimal/no studies from were inferences could be drawn regarding the mode of teen pregnancy-planned/wanted;unplanned/wanted;unplanned/unwanted.
Hence, further researches needs to be done addressing these issues.
GAPS IN LITERATURE
While reviewing the available literature on teen pregnancy many gaps have been identified were further research is needed;
- Studies must focus on high-risk groups and frequent evaluations have to be conducted in order to assess its effectiveness.
- Studies has to be done to improve the parental outcomes
- Studies needs to be done on UK context since majority are U.S based.
- While considering teenage pregnancy, equal importance needs to be given to teenage boys/fathers, as to teen girls, who are missed at times.
- The relation between teen pregnancy, poverty, parenthood and its negative consequences are still not clear.
- Media influence on sexual behavior needs to be further studied.
- Parental role in decreasing sexual activity and avoiding unprotected sex in teens has become the present area of interest since it has an effect on healthy adolescent development, in selection of peers, media -TV co-viewing, etc
- Programmes on youth development seem to be promising but its effectiveness in UK context needs to be studied.
- Research on cost-effectiveness of interventions also needs special consideration.
- 10. Influence of parental role in this issue is unclear were some supports for an association (Darling&Hicks, 1982) while others find no association (Jaccard &Dittus, 1991).
Class-room education on sex must be initiated well before the initiation of sexual activity, combined with other interventions,, in decreasing early sexual activity and use of contraception.2. Prevention programs must include both psycho-education and skill training and one who carries out must also be well-trained.3. All interventions must be on strong theoretical basis and needs to be frequently evaluated at periodic intervals.
IMPLICATIONS FOR POLICY AND PRACTISE
- Policies needs to consider the provision of sex education in class rooms, community-clinics, along with youth development programs including psycho-education and skill training esp focusing the vulnerable group, regarding training in academic, vocational and life skills. These policies needs to put into practice through group discussions, role-plays etc.
- Training must focus on issues like how to avoid a sexually risky situation, buying, carrying, and use of condoms and other contraception if involves in sex etc.
- We need to undertake a new policy for parental consultation, easy access to contraception, and creating a climate where sexual activity needs to be decreased rather than an increase.
Thus while reviewing the available literature on teenage pregnancy it was revealed that though many interventions has been laid in order to decrease its rate the recent statistics showing an increase indicates that there remains still many major gaps in literature and future research needs to be focusing at these gaps in evidence. This is particularly true in UK where implemented interventions are rarely evaluated. Hence, further research and development is to be done to facilitate safe sexual practice.Moreover the bridge between research, policy and practice needs to be strengthened further.
A STUDY TO ASSESS THE EFFECTIVENESS OF PARENTAL INFLUENCE IN KNOWLEDGE, ATITUDE AND BEHAVIOUR AMONG TEENAGERS REGARDING SEX AND PERCIEVED CONSEQUENCES OF TEENAGE PREGNANCY.
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