Teen pregnancies, how safe are they?

By Carol Aloysius

Teen pregnancies although now on the decline, are still a subject of concern not only to medical officials because of their adverse health impact on the young mothers, but on society as a whole, due to the stigma attached to such pregnancies if the pregnancy occurs in an unmarried mother. The Sunday Observer spoke to Consultant Community Physician, Dr Mrs Manjula Danasuriya, to find out more about the health impacts of teenage pregnancies.

Excerpts…

Question: Teenaged pregnancies are still prevalent in this country to be a subject of concern. Why? Is it life style changes? Or poor parenting?

Answer: There are many contributory factors for this, such as a low level of education of the teen mother as well as her parents. Studies have shown that the higher the level of education in a girl and her parents, the lower will be the risk of a teenage pregnancy. Another risk factor is the unstable and unsuitable living conditions and environment of the teen mother. Lack of a proper family unit which maintains high rules and regulations with regard to discipline and behaviour can lead to too much freedom which can be abused.

Q. What about young girls whose mothers have gone abroad to work in Middle East countries leaving them in the care of fathers, siblings, uncles, grandparents or neighbours?

A. These girls are very vulnerable to sexual abuse which can result in unwanted pregnancies.

Q. Any other contributory factors?

A. Lack of freedom within the family for the adolescent to discuss problems regarding own love affairs, within the family to discuss issues related to sexuality.

Poor support from teachers and peers in this matter can aggravate the situation, poor knowledge on fertility, reproduction and contraception. Familial tendency for teenage marriages is another contributory factor.

Q. In Sri Lanka, where do these pregnancies occur most . In villages? Towns, cities? Estate sector?

A. Estate Sector

Age groups at risk

Q. What are the age groups most at risk of adverse health impacts?

A. Those between 15-18 years.

Q. In your studies how many mothers fall into the pre-teen age group? I read that there were mothers of nine and 10 years who did not even know they had given birth and treated their children like their own siblings or playmates. Your comments?

A. We have only a very few of such young mothers.

Q. Since teen mothers are themselves children, and their bodies are still under developed, do they have different health complications from their more mature counterparts?

A. Teenage pregnant mothers have 2-5 times higher risk of having maternal deaths compared to mothers aged above 20 years. They are more likely to experience pregnancy induced hypertension and anemia.

Q. What about the psychological impact and mental stress they suffer from?

A. Research shows that brain maturation continues up to mid twenties. Thus teenagers have still developing brain. Therefore they tend to have impulsive behaviour, and they are adventure seekers. Teenage mothers are also the same although they are mothers. They are more likely to develop ante natal and post natal psychological problems, and depression.

Teenage mothers are more likely to attempt and commit suicide at the slightest provocation due to their immature brain (specially the decision making prefrontal cortex area) and due to their impulsive behaviour.

Q. When a teenager gives birth, she needs parental support? Does she receive such support? Or in most cases do the parents reject the girl and her baby?

A. In Sri Lanka, research shows most teenage mothers do receive parental support in caring and raring their children.

Nutritional needs

Q. Does a teen mother require special nutritional supplements and food? What are they?

A. Most of the adolescents suffer from thinness /Low BMI, anaemia. A pregnant teen mother thus needs a balanced diet especially during pregnancy and the lactating period.

In addition she needs micronutrient supplementation including iron, folic acid, vitamin C and Calcium.

Q. Does the Health Ministry have some interventions in this respect like a nutritional program for pregnant teenagers?

A. At present the Ministry of Health provides Threeposha - food supplementation to all pregnant and lactating mothers including teenagers.

Q. If the girl is able to get most of her food from her own home garden, how should the food be prepared to give her the maximum benefits?

A. If she can uses home grown vegetables and fruits it is better to eat those as raw salads / raw green leaves salads as much as possible to keep the vitamins and minerals intact. Small fish / sprats /eggs will help to provide the required protein, iron and calcium.

Any food without preservatives / crops without artificial fertiliser - will be safe for all mothers. Balanced diet with locally available home grown food is the best food for all mothers and their unborn child.

Impact on foetus

Q. What is the negative health impacts on a foetus of a teenaged or pre-teen mother? Eg. does it affect the baby’s development physically and lead to stunting, malnutrition, etc. Can it also affect the child’s mental capacity and lead to a low IQ?

A. They are more likely to have negative fetal outcomes like intra uterine deaths, intra uterine growth failures, pre term deliveries and babies born with low birth weight.

Babies born with low birth weight are more likely to get Non communicable disease later in life.

As a teenage mother has not developed physically and mentally she finds it difficult to provide a safe, secure, attuned and sensitive attachment for her baby.

This will have an adverse effect on the psychosocial development of the newborn which has shown in research on parenting and child development. Teenage mothers will have attachment problems which will lead to breast feeding problems as well.

Long term studies have shown that babies with poor attachment are more likely to experience delinquent behaviours and experience gender based violence during adolescents and adult age.

Q. Abortion is still illegal in Sri Lanka. Yet backstreet abortions continue to spiral with an estimated two lakhs of illegal abortions being done by quacks every year. Your comments?

A. Abortion is illegal except there is a risk to mother’s life. When you consider a teenage pregnancy it is itself medically a risk to the teenager’s life.

The decision needs to be reconsidered specially in relation to teenage mothers aged less than 16 years (Statutory Rape) and specially if the girl becomes pregnant following a rape.

Myths

Q. What are some of the most common myths about teenage pregnancy?

A. According to the teenage pregnancy study (2010) some of the most common myths among teenage mothers are as follows:

It is healthy for the mothers to have babies as early as possible: It is not good to postpone pregnancies using artificial methods: Using family planning will reduce sexual pleasure. But these are only myths and not based on evidence.

Q. What is the Family Health Bureau doing to help these mothers? Do you provide counsellors for them? Are there enough to meet the demand? Do you have special Nutrition Centres only for teen mothers? If so where are they?

A. The Family Health Bureau is a technical agency where we provide latest evidence based strategies/ interventions to improve health of all our mothers and children.

The health services (preventive and curative) are delivered through provincial health ministries.

We provide guidelines on providing care for teenage mothers for the field health staff including Public Health midwives and Medical officers of Health.

We do training (basic plus in service) to keep the knowledge and skills of our public health staff updated. We give support to upgrade the infrastructure facilities for maternal and newborn care, procure micronutrients for all mothers, facilitate uninterrupted maternal child health services in emergency and disaster situations. We also regularly monitor and evaluate the maternal and child health services delivered throughout the country using our MIS and district reviewing mechanism.

In addition FHB is the responsible focal point for maternal mortality and morbidity surveillance in Sri Lanka.

Q. If a teen unmarried mother seeks help and advice, where should she go?

A. In the state sector there are Probation Officers at most district offices. Additionally there are several NGOs and grass root level leaders and midwives who also provide services for them.

Q. Your message?

A: World studies have shown that sexual and reproductive health education coupled with life skill education, especially in decision making empowers the teenager. Self awareness and assertiveness will also help teenagers to say No to unwanted sex.

Interventions to keep children in school as long as possible and providing contraceptives for sexually active adolescent groups are also effective interventions in delaying sexual activity and preventing pregnancy among teenagers.

Q. Are most teenaged mothers happy with their decision to become mothers early? Or do they have regrets?

A. Our studies show that teenage mothers regret their decisions to have children early and regret that they could not complete their school period like their peers.

Q. So what do modern teenagers in present society really need to prevent them from becoming mothers too early?

A. We need to strengthen teen–parent relationships, and promote closer bonding, so that every parent becomes the best friend of their adolescent child. We need to ensure the adults around teens (parents, teachers, others) behave as role models for them.

Life skill education through all possible medium including family environment, and school curriculum, media, is also of utmost importance to protect adolescents from adopting risk behaviour. It is the responsibility of all adults around them to protect them and empower them with necessary knowledge and skills to stay healthy and happily.

Household routines can reduce BMI in children

An intervention to improve household routines known to be associated with obesity increased sleep duration and reduced TV viewing among low-income, minority children, and the approach may be an effective tool to reduce body mass index (BMI) in that population, according to a study published by JAMA Pediatrics .

Racial and ethnic minority children and those who live in low-income households are disproportionately overweight and it is urgent to develop an intervention for them, Jess Haines, of the University of Guelph, Canada, and colleagues, write in the study background.

“The purpose of this study was to assess the extent to which a home-based intervention, compared with a mailed control condition focused on healthful development, resulted in improvements in household routines that may be preventive of childhood overweight and obesity among racial/ethnic minority and low-income families with children aged two to five years,” the authors note.

The study assigned 121 families with children at random into intervention (n=62) or control groups (n=59). A total of 111 children-parent pairings completed the six-month follow-up assessments. The intervention, which used home-based counselling and phone calls, was designed to change behaviour related to excess weight gain, but child weight was not discussed in the intervention. Compared with the control group, which received educational materials, intervention participants experienced increased sleep duration (0.75 hours/day), greater decreases in TV viewing on weekend days (-1.06 hours/day) and decreased BMI (-0.40), according to the study results. “In summary, after six months, we found that the Healthy Habits, Happy Homes intervention improved sleep duration and TV viewing behaviour, as well as decreased BMI among racially/ethnically diverse children from low-income households. Future studies with a longer follow-up are needed to determine maintenance of these behaviour changes,” the authors conclude.

- MNT

Drug patch treatment sees new breakthrough

An assistant professor with the Virginia Tech - Wake Forest School of Biomedical Engineering has developed a flexible micro-needle patch that allows drugs to be delivered directly and fully through the skin. The new patch can quicken drug delivery time while cutting waste, and can likely minimise side-effects in some cases, notable in vaccinations and cancer therapy.

News of the delivery technology was published in a recent issue of Advanced Materials .

Micro-needle patch technology used on the skin has existed for several years, each patch containing an array of hundreds of micron-sized needles that pierce the skin and dissolve, delivering embedded therapeutics.

However, because of their rigid chemical makeup, the patches proved difficult in fully piercing into the skin, creating a waste of drug material and a slowed delivery time. Additionally, the patches also have been difficult to produce in bulk; typical fabrication procedures have required centrifugation.

The research team headed by Lissett Bickford, including Chapel Hill graduate student Katherine A. Moga, were able to develop a new flexible micro-needle patch that forms to the skin directly” think a regular household bandage - and then fully pierces the skin and dissolves. Bickford said the softer, more malleable and water-soluble material also allows for more precise control over the shape, size, and composition of the patch, with little to no waste.

The nanoparticle, micro-molding patch is based on Particle Replication In Non-wetting Templates (PRINT for short) technology, developed by University of North Carolina researcher and professor Joseph DeSimone. Unlike other methods for making these patches, the new technology allows for quicker and greater wide-scale production, reducing related costs.

- Medicalxpress