TEENAGE PREGNANCY A CONTEMPORARY PROBLEM OF ADOLESCENCE

OPSOMMING Weens verskeie faktore in die hedendaagse samelewing word tienerswangerskappe 'n gemeenskapsgesondheidsprobleem. Swangerskap by die tiener het indirekte ekonomiese gevolge weens die lae vlak van skoolopvoeding en die hoër pariëteit wat gewoonlik daarmee gepaard gaan. Verder hou swangerskap by tieners ’n hoër risiko vir die moeder en kind in as by ouer vroue. Besondere probleme wat deesdae dikweis met tienerswangerskappe saamhang is seksueel-oordraagbare siektes en dwelmverslawing. Die alternatiewe van aborsie en die gee van die kind vir aanneming bring ook albei eiesoortige probleme mee. Gesondheidspersoneel het ’n rol in die voorkoming van tienerswangerskappe deur gesondheidsvoorligting en die verskaffing van kontrasepsie, asook in die voorsiening van ondersteunende dienste voor en na swangerskap.

T eenage pregnancy, particularly pregnancy in school-aged girls below the age o f 17 years, is a m ajor com m unity h ealth p roblem .T he in cidence of such pregnancies is in creasing to w hat som e believe are epidem ic pro p o rtio n s.
Girls who becom e preg nant while still at school, and who continue with their pregnancies, m ay rem ain disadvantaged for th e rest of their lives.C hildbirth in th e teenager in variably puts an en d to h er educa tion and causes a disruption in her r e l a t i o n s h i p s w i t h f a m i ly a n d friends.Infants b o rn to teenagers have an increased risk o f both m or bidity and m ortality as m ost are low birth weight infants.
Teenage m oth ers have consider able difficulty in providing ad e quate care for th eir infants -there are defects in m othering which range from in ap p ro p riate basic care to neglect and child abuse.This is perhaps u n d erstan d ab le in the light of the im m aturity of the m other herself.In fant and child care is a dem anding task for anyone and is likely to be overw helm ing for the teenage m other.
A sociologist stated The girl who has a child at the age o f 16 years sud denly has 90 % o f her life's script In last year's competition, the author of this article shared second prize.
written fo r her.She will probably drop out o f school even i f som eone else in her fa m ily helps her to take care o f the baby, she will not be able to fin d a steady jo b that pays enough to provide fo r herself and her child.She m ay be im pelled to m arry som e one she m ight no t have otherwise chosen.H er life choices are fe w and m ost o f them are bad.H ad she been able to delay the first child, her pros pects m ight have been different.(C am pbell. A. 1968 30: 236-237).

CHARACTERISTICS OF ADOLESCENCE
It would be appropriate to look at som e of the psychological and b e h a v i o u r a l q u a l i t i e s w h ic h a r e characteristic of adolescence.A thorough appreciation o f the needs and concerns of these young people m ust of necessity determ ine o u r ap proach to the problem o f teenage pregnancy.
A dolescence is a tim e of tu rb u lence, of rapid and tum ultuous physical and psychological change.
In this transitional period betw een childhood and the form ation of a stable adult identity, the young person experim ents with a variety of behaviours, oscillating betw een different moral codes and standards testing their own limits and those imposed upon them by society.Sometimes their behaviour takes dram atic and self-destructive forms.
They challenge the standards, views and behaviour of paren ts and the Older generation.D evaluation of the parents and older generation serves to establish the adolescents' individual identity and supports his/her rudim entary independence.The adolescent typically looks to the peer group for support o r a set of rules to guide behaviour -the peers become arbiters of app ro p ri ate behaviour.C ertain behaviours and experiences which would be considered abnorm al at any o th er time of life, are expected and norm al during adolescence.D ram atic m ood swings and in tense preoccupation with self and o n e's fantasies are characteristic.The adolescent is a mass of seem ing contradictions.They w ant to m ake their own decisions, yet fear grow ing up and losing the em otional and m aterial support provided by the older generation (B row n, W .A . 1980: 49).
A dolescents are strongly orien tated to the present, which m akes planning for the future difficult.
T eenagers everyw here need re productive health care.The kind of care will depend upon w here they live and how old they are.For young adolescents the only course of action which is unlikely to affect their health is chastity, and in many countries this is the social ideal for unm arried adolescents.Y et in many societies adolescents are under pressure to be sexually active, the young bride in India/A frica is urged to prove her fertility, whilst the teenager in the W est is bom barded with messages from the media saying th at those who do not have sexual relationships are miss ing out.
P re m a r ita l se x u a l a c tiv ity is common in the developed countries and is increasing in parts of the d e veloping world:

OUTCOME FOR TEENAGE MOTHERS AND THEIR OFFSPRING Economic impact
The economic im pact of teenage pregnancy is not direct.R ather, it seems to trigger a chain of events that continue to underm ine eco nomic well-being.One critical factor is the reduction in educational at tainm ent followed by higher subse quent child bearing, low er incom e and m arital instability.
A lthough the num ber of years of sc h o o lin g c o m p le te d d o e s n o t appear to affect the am ount of work experience a wom an accum ulates, it does affect the occupational status and earning of w orkers.W om en with less schooling obtain jobs of lower socio-econom ic status, m ake lower hourly wages, and earn less annually.T herefore, an early preg nancy can be said to indirectly reduce occupational status and earnings through its effects on schooling (See figure 1).
In figure 1 there are two arrows between education and the age of the first pregnancy.This represents the belief that not only does the age at which a wom an bears her first child affect the num ber of years of schooling she will com plete, but that her schooling affects the age at which she bears h er first child.Thus there are two distinct patterns: -a first birth to a teenager preci pitates dropping out of school -dropping out of school for reasons o ther than pregnancy is nevertheless followed by preg nancy.In general, teenage m others are considered to follow the first pat tern, whilst older m others tend to term inate their schooling p rio r to becoming pregnant (Scott.K .G . et al. 1981: 48).

Risks of pregnancy
W hen considering the risks of preg nancy it is im portant to distinguish between younger and older adoles cents.F or w om en aged 18 or 19 years their youth barely adds to the hazards of pregnancy.W here age seems to m ake the most difference is for girls who becom e pregnant when they are 15 years or younger.The risk for these girls to die in pregnancy is 60 % higher than for pregnant w om en in general.The two main obstetric risks of early pregnancy are toxaem ia (Pregnancy Induced H ypertension), which can endanger the life of the m o th er and the foetus, and cephalopelvic dis proportion.The young teenager is physically im m ature with an inade quate pelvis leading to a prolonged labour and often preventing a norm al vaginal delivery.

Figure 1 Effects of age at first pregnancy
A dolescent m o th ers have an in creased fertility and foetal w astage, that is, they have on average m ore live born children yet a g re ater p ro portion of foetal loss th an the older woman.

Risk to the baby
The risk to the baby is that of a low birth weight, due eith er to p re m a tu rity o r the delivery at term o f u n d er nourished babies.These babies are m ore likely to die at birth or in in fancy and physical and m ental d e velopm ent m ay be im paired.

Sexually transmitted disease
Sexually tran sm itted disease is an o th er health risk.It has been sug gested th at th ere is an increased in cidence of venereal disease in the young adolescent.Tw o factors are related to this.F irst, increased ado lescent sexual activity, and second, decreased use o f condom s which provide a m echanical b arrier to the transm ission of venereal disease (W ebb, G .A . et al. 1972: 511).
If the preg n an t teen ag er presents late for p ren atal care or is adm itted to the health services only w hen in labour, then prev en tio n and cure of these diseases becom es m ore diffi cult and thus transm ission of con genital venereal disease to the infant m ore likely.
G ood obstetrical services will reduce m ost risks to both m other and baby.H ow ever, in cases w here the baby is unw an ted and possibly illegitim ate, o r the m other very young o r p o o r, th e m other is less likely to tak e advantage early enough in th e pregnancy o f w hat ever care is available to her.

Drug abuse
T he teenage p o p ulation has been suggested to be at higher risk for drug abuse.D rug abusers should be identified as soon as possible, as the intake of pharm acological agents on a chronic basis increases the p rem a turity rate, congenital abnorm alities and the rate of com plications during pregnancy.
If drug dep en d en cy is found in an adolescent, the situation requires very careful m anagem ent.Therapy for the drug d ep en d en t pregnant teenager depends on w hether she requests w ithdraw al during preg nancy or rem ains an addictive o b stetric patient.W ith adequate p re natal care there is a chance of re ducing the risks associated with pregnancy in this special group of patients.U nfortunately, the gen eral outcom e of these pregnancies is not encouraging and, in addition, t h e c o m p l i a n c e r a t e i s (lo w (H ollingsw orth, D .R . et al. 1978: 12).

Abortion
F or som e young wom en there is the option of abortion, although this is a controversial, and in many coun tries illegal, procedure.Estim ates suggest that betw een 30 and 55 m illion induced abortions take place annually throughout the world and a substantial proportion of these involve teenagers (M cKay, J. 1984: 8-9).
The hazards of illegal abortion, usually done by unskilled practi tioners, are well known.H ow ever, even in countries w here abortion is legal it is the pregnant adolescent w ho is least likely to seek an ab o r tion early in pregnancy when ab o r tion presents the smallest risk to her health.This may be because adoles cents do not realise th at they are pregnant, and if they do know , they find them selves vainly hoping the pregnancy will go away o r they are inhibited from taking early action for some other reason.

Adoption
T he great m ajority of w om en who place their children for adoption are teenagers.H ow ever, the availabil ity of abortion had led to a drastic reduction in the num ber of wom en w ho bear children and place them for adoption.Clinical im pressions of women who have placed their children for adoption suggest that these wom en do no t suffer gross psychiatric disability, bu t they do experience prolonged unresolved guilt, sadness, and yearning for the abandoned child (B row n, W .A . 1980: 60).
The wom an who chooses the al ternative of adoption will be beset with conflict and misgivings.It is best that the presence of such con flicts be acknow ledged by both the CURATIONIS health professional and the preg nant woman.W hether or not the wom an who is placing h er child for adoption should have contact with the infant during the days im m edi ately following delivery is a point of considerable controversy.In the ab sence of definitive inform ation about the consequences of contact with the infant, we can do no better than to leave the decision up to the m other.Many people have an intu itive sense about what is best for them and how best to cope.

EARLY INTERVENTION
The prevention of teenage preg nancy involves ethical, legal and educational as well as health care issues.H ealth professionals by virtue of their know ledge, their authority and their access to de veloping young people and their families are being called upon to rem edy this increasingly complex and worrisom e problem .They are called upon to counsel and provide care for sexually active adolescents and to serve as consultants to schools and other com m unity o r ganisations involved in family plan ning.
W hether they are sexually active or not, attention to the sexual ques tions and concerns of all adoles cents is w arranted.Explicit infor m ation about sexuality, reproduc tion, contraception and access to birth control devices is required.
Discussion about sexuality, infor m ation about birth control and p ro vision of birth control devices are unlikely to stim ulate the young person to engage in sexual inter course.These approaches m ay, however, protect the sexually active girl from unw anted pregnancy.The adolescent should be introduced to Family Planning before, and not after, pregnancy.
It is worthwhile em phasising the critical im portance of not forgetting the adolescent and her baby after delivery.Intensive and frequent support relating to infant care and the m other's em otional, educa tional and vocational needs is essen tial if increased child bearing and m arital instability are to be p re vented.Those m ost in need of such services are the single m others who do not return to their families.
Continued on p. 40 first prize in the category for registered nursus in the 1985 Johnson and Johnson-Curationis Writing Competition.The topic was '"Nursing the Youth'" and entries had to be either a case study or a review on one or more o f the contem porary health education needs o f the youth.