Teenage pregnancy: Nipping it in the bud
The pregnant teen mother and the child born are likely to suffer health, social, emotional and economic problems. It is high time teenagers are educated on their sexual behaviour, feels Dr. Duru Shah, one of India's top gynaecologists and infertility experts.
16 June 2005
Child marriages are still prevalent today in India the results of which are girls becoming mothers in their teens. In addition to that, the recent spate of incidents of rape on minors and the rising levels of promiscuity among teenagers are also a cause of great concern as they lead to teenage pregnancies.
Also known as adolescent pregnancy, teenage pregnancy is one that occurs from puberty to the age of 19. Puberty is the stage of adolescence when a girl can sexually reproduce, however a young woman can become pregnant even before her first menstrual cycle. This is because ovulation, the release of an egg from the ovary, may occur before the first period. In the absence of adequate contraception the egg can become fertilized. And this is quite common in teenagers, as most of them do not use any birth control measures like condoms when they have sexual intercourse. Our own study conducted on 400 college students of Mumbai showed that most of the sexually active girls start worrying about contraceptives only after 6 months of sexual activity.
For a woman including a teenager to conceive it is not necessary that actual penetration takes place. This is because sperm can travel upwards from its presence in the area of the external genital area and result in pregnancy. It is therefore very important for teenagers to have proper knowledge and understanding of their body and its functions before they become sexually active. Responsible sexual behaviour prevents pregnancy.
Whether the pregnancy is due to marriage or sex between unmarried teenagers there are nevertheless some issues concerning the higher rates of nutritional and obstetric problems associated with adolescent pregnancy. Also, the ignorance and immaturity can result in higher morbidity and mortality among mothers and babies.
Symptoms of pregnancy
The symptoms of a teenage pregnancy are not different from a normal pregnancy. They include:
* Missed period
* Breast enlargement and breast tenderness
* Irregular vaginal spotting or bleeding
* Stomach cramping
* Increased drowsiness and moodiness
In spite of experiencing these symptoms many teenagers do not tell anyone and as such often go unnoticed by friends and family. Unfortunately, the teenager with irregular periods may not even realize that she is pregnant until well into the fifth month of pregnancy – when she starts feeling the baby’s movements.
Teen pregnancy: Diagnosis
Any teenage girl who experiences irregular or absent periods or any of the symptoms is advised to undergo a pregnancy test. This should be done by the doctor even if she does not admit to have had sexual intercourse. An early diagnosis of pregnancy helps the teenager to adjust emotionally and physically. Also, early prenatal care is essential.
Usually, pregnancy is associated with weight gain but if nausea and vomiting are significant there could be weight loss. Further, pelvic examination by a gynaecologist may reveal bluish or purple coloration of vaginal walls, bluish or purple coloration and softening of the cervix, and softening and enlargement of the uterus. Finally, an ultrasound may be done to confirm the presence and current status of the pregnancy.
Teen pregnancy: Cause factors
The ultimate "cause" of teenage pregnancy is unprotected intercourse. A sexually active teenager who does not use contraception has a 90% chance of becoming pregnant within one year. Potential behaviour patterns for a teenage girl becoming pregnant include:
* early dating behaviour
* high-risk behaviours (smoking, alcohol and substance abuse)
* lack of a support group or few friends
* Unhealthy environment at home
* stress and depression
* delinquency / criminal behaviour
* living in a community where early childbearing is common and viewed as the norm rather than as a cause for concern
* exposure to domestic or sexual violence
* and most important, financial constraints
Health and social effects of teen pregnancy in India
Single motherhood is associated with the causes mentioned earlier and it can be overwhelming when an infant is born prematurely. The financial, emotional, and medical needs of the infant may be too difficult for a teenage mother and/or her extended family to deal with. It is further complicated with society’s attitude towards teenage unwed mothers. They experience isolation, guilt accompanied by stress and depression, low self esteem resulting in lack of interest in studies, limited job prospects and lack of a support group or few friends to name just a few.
Health wise teenage mothers have a much higher risk for anaemia, pregnancy-induced hypertension, lower genital tract infections (which may lead to premature labour and delivery), caesarean section because of pre-maturity, large baby within a small pelvis, foetal distress and sudden infant death syndrome. The major complications in young mothers are thought to be high blood pressure, iron deficiency, anaemia, disproportion and birth of low weight babies.
Similarly, infants born to such teenage mothers are at higher risk of complications of pre-maturity, low weight, accidental trauma and poisoning, minor acute infections, lack of immunization or vaccinations and developmental delays.
In the non-pregnant state, there is quite a high possibility of getting sexually transmitted diseases (STDs), chronic pelvic pain, cervical cancer, human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS).
Prevention and care
Pregnancy at a very young age especially an unwanted one leads to severe emotional and mental trauma for the girl. Hence, the first and foremost lines of defence are programs that are effective in delaying attempts at sexual intercourse. Parents, schools and healthcare professionals can have open, honest, and educational talks with teenagers and preteens. They can also provide advice to teenagers about how to prevent unwanted teenage pregnancies.
In this context it is apt to mention the “Growing Up” program. Initiated through the Federation of Obstetric & Gynecological Societies of India (FOGSI) in partnership with Johnson & Johnson the program educates schoolgirls on menstruation, its myths and hygiene, the anatomy and functioning of the reproductive system, the value of good nutrition and exercise, problems of drug, alcohol and tobacco abuse, and sexual abuse. Over 12 lakh girls in more than 50 cities all over the country have been addressed in the last 5 years.
Since unprotected sex is the main cause of teenage pregnancies, contraceptive counselling is highly important in order to prevent them, especially repeat ones. Clinics, private medical offices, or NGOs can play a major role in providing counselling. Birth control pills, the most popular form of contraception for teenagers, should be taken regularly or as advised else teenagers risk pregnancy. On the other hand, barrier methods such as condoms, diaphragms, and foam have high failure rates among teenagers. This is due to sporadic and improper use. To avoid pregnancy in the event of unprotected sexual intercourse, teenagers should be made aware of emergency contraception. Though all these help teenage girls avoid getting pregnant even after having sex, the best way however is to educate them on the importance of abstinence and /or having safe sex.
On the lines of “Growing Up” program, FOGSI initiated a program for women in the age group of 20-25 years in 2004. The Postgraduate College program titled “Let’s Talk” started in association with Organon educates women about the various forms of contraception. Unfortunately most of our young girls have never given much importance to contraception and only think about it after they have had an unwanted pregnancy.
It is high time that women take it upon themselves to make their choice of contraception – because it is they who suffer from the consequences of an unwanted pregnancy.
Think it over
Teenage mothers have a higher prenatal risk during child bearing. Not only for this reason but also for reasons of fertility limitations teenage pregnancy should be discouraged as more years are available for more pregnancies. In young women subsequent pregnancies should be discouraged as rapid repeat pregnancy in young mothers increases prenatal risks. For the benefit of their family and themselves, teenage girls should display responsible sexual behaviour and abstain from sex as far as possible.
(Dr. Duru Shah is one of India’s top gynaecologists & infertility experts who runs Gynaecworld – The Women’s Clinic)