The perils of adolescent pregnancy

16 World Health • 50th Year, No. 2, March-Aprill997 The perils of adolescent pregnancy K.G. Mapanga This young couple- aged 18 and 20- already have three children. Parenthood calls for care- giving responsibilities that are very demanding. Photo WHO/ H. Anenden. The reproductive health of adolescents requires urgent global attention. Midwives and community health nurses ore particularly well placed to deal with this alarming situation, especially if their skills ore enhanced for this purpose. 0 ne of the most common fea-tures of adolescence - the period of development be- tween the ages of 10 and 19 years - is engagement in sexual activity. In some cases this may start even in the earlier part of this age range. The proportion of adolescents in the population is increasing in develop- ing countries, and so is the extent of their involvement in sexual activity. In some cases a young person 's sexual activity may not be recog- nized by the family until a preg- nancy occurs. The reproductive health of ado- lescents concerns sex-related health problems that affect their physical, social and psychological well-being. Health problems related to preg- nancy in this particular age group are a major cause of concern. In a majority of cases, adoles- cents' pregnancies are unintended. In addition only a very small per- centage of such pregnancies are the result of contraceptive fai lure. Not only are adolescents ' first and sub- sequent pregnancies on the increase in several parts of the world but so too is early parenthood, leading to a situation where children are shou l- dering the responsibility for raising children. One corollary of the fact that many adolescent pregnancies are unintended is that most do not lead to marriage. This is resulting in the proliferation of very young one- parent families. In most cases it is the female who is left with the sole responsibility of raising a family with virtually no support from her male partner. Furthermore, she is highly likely to have another preg- nancy within a year or two. In this regard it is very important for young people of both sexes to be helped to develop responsible and equitable relationships. Most adolescents are either at school or training for a career. This is essential both for the economic development of society and for a more secure adulthood for the indi- vidual. Because of this, parenthood - and especially single parenthood- usually comes as a devastating blow to a young person's dreams for the future. Studies show that the adoles- cent who has previously been preg- nant has a much greater chance of becoming pregnant again than she did of becoming pregnant the first time. The likelihood of repeated pregnancy is further increased if the first pregnancy is carried to term. A recent study of unmarried first-time adolescent mothers indicated that 93% of them were sexually active and that most of them did not use contraceptives regularly. Single adolescent mothers who have re- peated pregnancies are likely to find that parenthood is a very heavy burden. Parenthood calls for care-giving responsibi lities that are very de- manding, even by adult standards. It calls for physical and emotional strength, knowledge, skills and a lot of resources. Adolescents' pregnan- cies most often bring in their train psychosocial problems for the young mothers. Adolescent mothers often have to give up their schooling, which means that they have poor educational attainment. This is frequently coupled with low eco- World Health • 50th Year, No. 2, March-Aprill997 nomic status, lack of employment and dependence on social services. Studies have shown that a majority of unmarried first-time mothers rely financially on public assistance. Adolescent mothers are not only less able to take care of their own needs but, in consequence, are also less able to care for the needs of others. This can lead to adverse health ef- fects both for themselves and for their children. 17 Pregnancy in adolescence is associated with premature birth, low birth weight, perinatal mortality, increased infant mortality and mal- treatment of children. The health- related disadvantages of adolescents who become parents heavily out- weigh any advantages there may be. Unmarried mothers may feel stigma- tized by becoming pregnant at such a young age. Later, the poorly edu- cated and unemployed single mother is likely to feel a sense of guilt and loss. An unwonted pregnancy is a devastating event when it obliges a girl to drop out of school. Photo WHO/UNICEF Frontline workers Midwives and community health nurses , as frontline health workers at health centres or engaged in commu- nity outreach activities , face the complex task of trying to avert or mitigate the health problems of adolescent mothers and their infants. Their activities range from the pre- vention of adolescent pregnancies to antenatal care, delivery, postnatal care and advice on parenting in general. Prevention focuses on the need to plan and delay parenthood. This clearly calls for sex education and the advocacy either of abstinence or of the use of contraceptives - although in many cultures sex and contraception are controversial issues with regard to unmarried adolescents. Access to contracep- tives may be difficult for young people. They may not know where contraceptives can be obtained, and they may feel reluctant to ask for them in view of the fact that older members of the community might disapprove. Midwives can encourage health- promoting behaviour as they provide antenatal care, but the adoption of such behaviour is often hindered by the adolescent's lack of knowledge and by the social stigmatization of adolescent pregnancy. The result can be delay in recognizing and seeking treatment for complications, and the consequences can be fatal for mother and child. The relationship between Helping young people understand sexuality better in India. Using contraceptives will ensure that adolescents delay having children until they hove reached adulthood. Photo WHO/H. Anenden. the unmarried pregnant adolescent and her parents is often strained. After the baby is born, postnatal care may be made more difficult not only by the young mother's lack of care- giving skills but also by the absence of emotional and financial support. Adolescent sexual activity lead- ing to unintended pregnancies also predisposes youngsters to sexually transmitted diseases, although these can be prevented. Adolescents not only run the risk of being infected themselves but they may pass on sexually transmitted diseases to others, including their own children. A particular cause of concern is HIV/AIDS, since all too few young people know enough about the risk or the need for safe sex to avoid contracting the disease. HIV I AIDS is increasing among adolescents and the result in the near future may be an alarming proliferation of orphans who may themselves be infected. The reproductive health of ado- lescents requires urgent global attention. Midwives and community health nurses are particularly well placed to deal with this alarming situation and to endeavour to pro- mote delayed parenthood. There can be no doubt that nurses in general constitute the backbone of the health delivery system in most countries. Enhancing their skills is a highly desirable and effective means of tackling this particular problem. • Or K.G Mopongo is Lecturer/Chairman in the Deportment of Nursing Science, Faculty of Medicine, University of Zimbabwe, P. 0. Box A 178, Avondole, Horore, Zimbabwe.