Definition of Teenage Pregnancy and its Prevalence

Teenage pregnancy, most commonly known as adolescent pregnancy refers to pregnancy among females, aged less than 20 years. Pregnancy occurs in females after a sexual intercourse, following which she begins ovulation. This can occur before menarche, or the onset of her menstrual cycle. According to statistical data, approximately 21 million girls aged 15-19 years become pregnant each year in developing countries of the world (Ventura et al. 2012). Moreover, around 2 million girls living in developing nations also report similar results. In addition, 16 million girls of the same age group are found to give birth to children in their adolescent years. The age of mothers is generally determined by easy verification of the date of end of pregnancy. The date of conception does not help in determining the age (Sedgh et al. 2015). Furthermore, most statistical data do not include records of pregnancies that have started when a woman is 19 years old, and ends before her 20^th birthday.

According to reports by the United Nations Population Fund (UNFPA), pregnancies that occur among girls aged less than 18 years are found to have irreparable consequences (Kost and Henshaw 2013). Such pregnancies most commonly violate the rights of teenage girls. They also create life-threatening consequences with regards to the reproductive and sexual health of the women. This in turn affects the community by posing high development cost in terms of perpetuating the poverty cycle. Major health consequences involve the fact that such females are physiologically not yet ready for bearing a child. Subsequent childbirth leads to malnutrition and health complications. This can be attributed to the fact that majority of teenage pregnant females belong to lower-income households (Kearney and Levine 2012). There exists high risk of maternal death among girls aged below 15 years, living in low and middle income countries, upon comparison with women aged in twenties. Teenage pregnancy has also been found to exert significant negative impacts on the education and income potential. This occurs due to the fact that most girls are forced to stop their education and drop out of their schools, after becoming pregnant, which in turn creates potential threats for their economic prospects, and future career opportunities. Research studies state that for a handful proportion of adolescents, the pregnancies are wanted and planned. In developing countries, most often girls are forcefully married off due to social pressures and are made to have children.

Reports suggest that around 15 million girls are married off in their early teenage years and around 90% of childbirths occur among married females aged 15-19 years (Finer and Philbin 2013). However, for most adolescent females, the pregnancies are unplanned and unwanted. A large proportion of such teenage females do not have access to modern contraception equipments. This results in unintended pregnancies. Furthermore, according to the WHO reports, a 10% reduction in rates of child marriage can significantly contribute to a huge decrease in the maternal mortality rates of a country. The WHO also recognizes the need of creating provisions that will develop an awareness and a sound understanding of teenage pregnancy (Leppälahti et al. 2013). Efforts are being established by several government and non-governmental agencies and healthcare organizations, to develop support services for teenage pregnancies, with the aim of improving the health and wellbeing of the target population. This report will contain a research proposal that aims to identify the underlying factors that are responsible for the huge incidence of teenage pregnancy.

Irreparable Consequences of Teenage Pregnancy

Teenage pregnancy is a major public health concern, rather than a clinical problem. The major reason that categorises teenage pregnancy as an essential public health issue is the integrated action that exists across a range of sectors for providing necessary help to young women to avoid unwanted pregnancies. Healthcare efforts are required to provide assistance to teenage women for dealing with the negative consequences of unwanted/wanted pregnancies. Therefore, the healthcare sector plays an undeniable role in the same. There exist huge complexities in providing appropriate sexual healthcare services for the adolescents. In addition, organizing maternity care services for pregnant teenagers, deciding to continue with their pregnancies or creating termination services for teenagers who do not, is difficult. The major medical complications associated with teenage pregnancies include toxaemia, anaemia, placenta previa, hypertension, cephalopelvic disproportion, and premature birth of the babies (Ayuba and Gani 2012). Prenatal and maternal health is a major concern among teenage parents. There is a high incidence of low birth weight and premature births among teenage mothers globally. Research studies further indicate that pregnant teens are at a reduced likelihood of receiving adequate prenatal care.

According to reports by the Guttmacher Institute, more than 1/3^rd of pregnant adolescents are fond to receive inadequate amount of prenatal care and the children become more susceptible to suffering from a range of childhood health related issues and are more frequently hospitalized than other children are (Amoran 2012). Teenage mothers receiving inadequate maternity care services are more prone to suffering from a range of nutritional deficiencies due to presence of poor eating habits, snacking, food faddism, and junk food consumption. Teenage pregnancy related complications result in an estimated death of 70,000 teenage girls on an annual basis. Furthermore, research evidences have also established a strong correlation between HIV incidence and teenage pregnancies. Moreover, underdeveloped pelvis in pregnant teenagers often contributes to problems in childbirth. In addition to medical complications, teenage mothers also suffer from huge emotional crisis in case of unwanted pregnancies. This crisis results in rash behaviour such as, self-attempts to abort the child or suicidal ideations (Hoggart 2012). Teenage mothers also face an uncertainty about their future. Education also gets put on hold in such cases. Further negative implications are related to development of depressive symptoms, exhaustion, and financial troubles. In addition, early motherhood has also been correlated with poor psychosocial development of the children. Most common symptoms are associated with higher risks of language, intellectual and socio-emotional delays among the children. Children born to teenage mothers are also at an increased risk of behavioural issues and developmental disabilities. Thus, teenage pregnancy presents several issues and challenges to the mother as well as the child.

Health Complications Associated with Adolescent Pregnancy

Teenage pregnancy creates tremendous impact on the social, educational, and economic lives of teenagers. Early parenting often reduces the likelihood of a young woman completing high school. It also makes it difficult for teenage pregnant mothers to pursue higher education, which is crucial for the current global economy. According to reports from the National Campaign to Prevent Teen and Unplanned Pregnancy, a small proportion (38%) of teen girls, bearing a child before 18 years of age are able to secure get a high school diploma. Parenthood is cited as the major reason that prevents such females from pursuing their education (Arceo-Gómez and Campos-Vázquez 2014). This negative impact of teenage pregnancy directly affects the family finances and earning potential. Furthermore, research evidences also indicate the fact that children born to teenage mothers display a likelihood of lower school achievements, and are more susceptible of becoming teenage parents themselves. Teenage pregnancy is also found to exert huge costs to the state and taxpayers.

According to research reports, the average cost of providing economic and medical support during and after such pregnancy is approximately $16,000 per birth (Copping, Campbell and Muncer 2013). Moreover, most teenage mothers are found to be unmarried and fail to receive any kind of monetary help from the father of the child, for the upbringing of the latter. Thus, it creates huge financial burden on the females. Moreover, teenage pregnancies are often linked with dating violences and abusive relationship. Knowledge of such pregnancy often intensifies such violence. In addition, a large proportion of such pregnancies are also a direct result of sexual abuse such as, unwanted sexual experiences and rape (Viner et al. 2012). Such non-voluntary intercourse experiences are not considered consensual under the law. Thus, there is a need to identify all such factors that significantly contribute to this problem, in order to improve the physical and emotional wellbeing of teenage females.  

Identifying the contributing factors of teenage pregnancy will help in raising an awareness of the teenagers about their probability of personally getting affected with this public health issue. It will also facilitate a sound understanding of the negative consequences of teenage maternity. It will assist in creating effective campaigns and prevention programs that will address the effective use of contraceptives and the existing interpersonal, psychological and logislitc barriers that create abstinence to contraception use. Another significance is associated with the fact that factual information of teenage pregnancy causes and risk factors will also make females more aware of their social rights and will allow them to advocate for themselves (Sagili et al. 2012). It will also help teenage mothers get a sound understanding of the financial, emotional and reproductive ill consequences of having a child at a young age.

Effects of Adolescent Pregnancy on Education and Economic Prosperity

Furthermore, identification of the factors and their prevention will pave the way for formulation of education programs that will illustrate the importance of attitudes, communication and values, in addition to biological reproductive aspects. Another significance is related enforcement of policies and initiatives that will focus on increasing use of contraceptives and develop education programs that are correlated with teenage pregnancy (James et al. 2012). Thus, a thorough identification of the causative factors will also help in framing a list of best practices, focused on preventing teenage pregnancy.

Theoretical literature review refers to an exhaustive evaluation of relevant and selected information that is found in a range of research articles that are related to the topic of interest. This literature review will help in providing a base for the study and will also facilitate in determining the research problem related to the high frequency of pregnancies among teenage mothers. Certain words, such as, teenager, contraceptives, family planning services, and sex education were defined for the review. Teenagers refer to individuals present in the middle of childhood and adulthood, who are aware of the surroundings and the ongoing physical changes in their body (Gyan 2013). According to research studies, teenagers are defined as young people who fall in the age group of 13-19. Research studies define family planning as comprehensive, educational, social or medical activities that enable people, including minors to freely determine the spacing and number of their children and facilitate easy selection of the means by which they can achieve it. On the other hand, sex education refers to educational programs on the context of sexual relationships and sexual activities (Blackman 2013). Such education programs encompass teaching lessons on the anatomy of the human body (both male and female) that helps individuals learn and recognize essential concepts of puberty, contraception, personal relationships, sexually transmitted infections, childbirth, pregnancy, and parenting.

According to research studies, the major causes of teenage pregnancy include isolation and rejection by parents. Incomplete education or poor literacy was another issue identified by evidences in this regard. Evidences suggest that the major effects of teenage pregnancy include poor health status of the mother and the child, in addition to financial handicaps. Researches also stated that traditional gender roles, early marriage, peer pressure and absence of adequate sex education are some of the major factors that contribute to pregnancy among adolescents. Furthermore, research results also revealed an early age in which teenagers engaged in sexual intercourse, which often contributed to subsequent pregnancies. Poor socioeconomic backgrounds and non-use of adequate contraceptives during an intercourse significantly contribute to teenage pregnancies. These results in teenage mothers opt for worse decisions, such as, suicidal tendencies and abortions. Studies that investigate the contributing factors provided evidence that support transparency, sexual violence, and lack of recreational facilities as the major risk factors in developing countries (Mothiba and Maputle 2012). Inadequate access to prevention and government health facilities, health grants, reproductive services and substance abuse by the adolescents also significantly result in early pregnancies. Marital status has also been recognized as a strong predictor of teenage pregnancies. An increase in age of females has often been correlated with an increase in the odds of getting pregnant.

Financial and Social Costs of Teenage Pregnancy

 Thus, it is essential to ensure that female teenagers are allowed to remain enrolled in their school or educational institutions for mitigating the direct negative outcomes of early child bearing. Several researchers have been conducted to evaluate the effects of the responsible factors and perception of educators on effects of the aforementioned public health issue. Results from such study also revealed that insufficiency of family planning experts, poverty, absent parents, drug abuse, and lack of awareness on use of contraceptives create major impacts in the incident rates of pregnancy among adolescents (Akella and Jordan 2014). Furthermore, association has also been established between teenage pregnancies and their detrimental effects on school performance, attendance, relationship and emotional behaviour. Further results emphasise on the fact that teenage pregnancies and early motherhood are not a new concept and have been existing since historical times. However, the rights of women and teenage girls have recently gained enough recognition. In addition, the positive implications of continuing with basic education of girls for helping them achieve their financial independence. Research articles have also identified pregnancy as a social plague that has serious medical consequences. A study of the economic and social influences that play an impact of teenage pregnancies recognized it as a complex global issue. Statistical data suggest that countries of the African continent report higher rates of teenage pregnancies, when compared to other countries (Christofides et al. 2014). Data from the World Bank Organisation reports conducted during 2008-2010 successfully identified several economic and social variables that result in these high rates.

Female literacy rates, urban population rate, contraceptive prevalence, health expenditure, gender inequality and rates of unemployed females were some of the major variables. Several studies were able to identify role of culture in teenage pregnancies. Rates of teenage pregnancies have been determined to be higher among females living in societies that consider it customary for girls to get married at a young age (Black, Fleming and Rome 2012). Such societies often encourage women to bear children soon. In several parts of the world, such as, sub-Saharan African countries early pregnancies are often considered blessings that prove the fertility of a young woman. Early marriage and subsequent pregnancies are most prevalent in rural communities, than in cities. Most teenagers are not given sufficient information on birth control techniques and ways to deal with peer pressure that makes them have forced sex. Most often teenagers have also been recognized as not having cognition of central facts that pertain to sexuality (Minnis et al. 2013). Research studies have also established the role of economic incentives in influencing the decision to have children at an early age.

The Importance of Identifying Causative Factors for Prevention

Societies where children are required to earn money from an early age, also find early pregnancy and more number of children, economically attractive.  Most teenage pregnancies that occur in low or middle-income countries have been determined to be unplanned. Most Western countries focus on instituting sex education programs, the primary objective of which is aimed at reducing rates of unplanned pregnancies and consequent sexually transmitted diseases. Countries that have a comparatively less number of teenagers, who are capable of giving birth, accept such sexual relationships among them and devise plans that provide balanced and comprehensive information about sexuality (Liran et al. 2013). Such teenage pregnancies are also found to exert influences on younger siblings. According to evidences, younger sisters of teenage mothers have a reduced likelihood of emphasizing on the importance of employment and education. They were more likely to accept parenting, human sexual behaviour, and early marriages. These siblings have been determined to display tolerance towards non-marital pregnancies and early births. The probability of younger sisters to get pregnant themselves are quite higher, as evident from research articles. Adolescent sexuality has also been determined to play an important role in development of teenage pregnancies (Ganchimeg et al. 2014).

Males living in Western developed countries have been reported to have sexual intercourse for the first time much sooner, on comparing them with those belonging to culturally conservative or undeveloped countries, such as, most of Asia and Sub-Saharan Africa. Similar findings have been reported by other studies that indicated the role of peer pressure in encouraging teenagers to experience sexual intercourse. This increased sexual activity among adolescents often contributes to an elevation in teenage pregnancies and STDs. Alcohol and inhibition-reducing drugs have found to exert effects in the form of encouraging unintended sexual activities. Such drugs are found to directly trigger engagement in risky behaviors. Findings correlate substance abuse among teenagers with their tendency to engage in intended or unintended sexual activities. The drugs that demonstrate strongest evidence for teenage pregnancy are cannabis, alcohol, amphetamines and other ecstasy-inducing drugs (Ahorlu, Pfeiffer and Obrist 2015). Furthermore, results also correlate onset of early puberty among females with an increased desire to engage in sexual activities at their young age, which in turn increases their risk of getting pregnant. Lack of adequate knowledge and access to the conventional birth control methods often exist because teenagers are frightened or embarrassed to seek information on these matters. Teenage contraception has also been established as a major challenge for clinicians. Efforts were taken by the government of the United Kingdom to reduce rates of under-18 pregnancy to half, by the year 2010. Further reports hint at the formulation of Teenage Pregnancy Strategy (TPS) for the same (Karabulut et al. 2013).  

Teenage women have been identified to be under heavy influence of second-hand stories and negative concepts on contraception methods, from the media and their acquaintances. Results have also explored the difficulties that exist in overcoming the stereotypes and prejudices regarding early pregnancy (Weston et al. 2012). Presence of over concern about side effects, for example acne and weight gain are also found to affect choice of early pregnancy. Three major reasons that result in failure to use contraceptive include lack of intention for having sex, trouble in obtaining appropriate birth control tools, and misconception related incapability of bearing a child. Findings have also established evidences that 60% teenage mothers experienced unwanted sexual experiences that resulted in pregnancy (Koleva and Stuart 2014). Links between childhood sexual abuse and teenage pregnancy have also been established by multiple studies conducted in industrialized countries. Research studies have also identified the fact that most countries do not recongise intercourse between an adult and a minor as consensual, due to the fact that minors are often believed to lack maturity and are not competent to make informed decisions regarding engagement in consensual sex. Thus, such sexual experiences that may or may not result in teenage pregnancies are regarded as statutory rape (Al-Sahab et al. 2012).

Research articles also illustrated the fact that adolescent girls are often subjected to abusive relationship at the time of their conception. Studies conducted in the UK and the USA found more than 70% of teenage mothers of being abused by their partners. Several research studies have identified higher rates of teenage pregnancies among economically backward countries such as, Nigeria and Bangladesh (Thobejane 2015). Consistency has been shown other results that identified the most deprived population of the UK to account for more than half of all teenage pregnancies. Thus, following the results of the studies that have been undertaken by former researchers, the common arguments that underlie the cause of teenage pregnancies were identified.

The overall objective of the research proposal is to assess the factors that contribute to teenage pregnancies among women. Specific objectives were related to determining whether poverty contributed to high prevalence of teenage pregnancies. The proposal also intended to ascertain the role of lack of awareness, peer pressure, education level, and less access to family planning services in this context. The specific research question is given below:

What are the underlying factors that contribute to teenage pregnancies?

The importance of the study lies in the fact that it will increase the emphasis on providing adequate sex education at home and in schools to both parents and teachers for assisting them to pass relevant knowledge to the teenagers, thereby facilitating healthier lives and helping them to become empowered. The research will also help in determining level of attitude and knowledge of teenagers towards the family planning services and efforts undertaken by their parents and healthcare providers for reducing teenage pregnancy. Findings from the study will also help in enlightening community members on positive impacts of family planning services and the factors that contribute to adolescence pregnancy, thereby paving the way for development of interventions that will reduce the problem. Relevant information will be shared with policy makers, donors and other stakeholders involved in prevention campaigns.

The theoretical framework is based on social learning theory and evolutionary theory. The former states that behaviours are reciprocal determination of interactions that continue between individuals and the environment in which the behaviour is being performed. Such behaviours are directly influenced by characteristics of an environment or a person and can be used for changing both. Hence, behaviour should not be viewed in isolation. It is rather an outcome of dynamic interaction between environmental and personal variables. The social learning theory when applied in teenage pregnancy prevention programs will be focused on modeling teenagers to imitate behaviours from others true observational learning. Sociologists have investigated several ways that influence sexuality and have a certain the fact that every society is responsible for governing sexuality of all members at a macro level (Thomas and Simpson 2014). Sexuality of a particular society is affected by rules of certain basic Institutions such as families and religion. Moreover, culture plays an essential role in determining appropriateness or in appropriateness of particular sexual behaviour (Petersen 2012).

On the other hand the evolutionary psychology theory takes a different approach and illustrate importance of psychological mechanism that are modified by natural selection. According to the view health by socio-biologists, human sexual behaviour is a product of evolutionary natural selection and is therefore considered to be genetically controlled (Barnett et al. 2012). Such behaviour is thought to be outcome of an interaction between environmental influences and other mechanism.

The research design will be based on a cross-sectional study and will principally be descriptive in nature. Research Design refers to arrangement of appropriate condition that facilitate collection, analysis and evaluation of data in sequential order, for reaching the intended purpose. The cross sectional research design will be based on observational study that will analyse data from the target population, at a specific point of time. The primary objective of the research will be to provide important data on the entire population of teenagers under study. Descriptive nature of the study will help in describing the relative risk and absolute risk from prevalence of teenage pregnancy.

One major advantage is associated with the fact that the research design is cost efficient and can be conducted at little or no expense. Moreover, the survey group of teenagers will be closely observed to determine effects of particular activities and environmental factors on prevalence of teenage pregnancy. This will help in supporting hypothesis that correlates the aforementioned factors with adolescence pregnancy. The cross-sectional study will therefore be representative of the entire population and will include a sufficiently large sample size for estimating prevalence of teenage pregnancies among them (Lewis 2015). It will be relatively easy to conduct the study. No long periods of follow-up will be required for the same, and the data on all-important variables will be collected only one.

The research will be conducted in the faith based and government hospitals present in the district. The primary reason for conducting the research at those locations are based on higher rates of teenage pregnancies in the area and lack of similar studies that have been conducted earlier.  The target population will recruit 200 teenage girls, aged between years 14 to 19, either pregnant or not pregnant, who have been receiving appropriate reproductive health care services from the district best Healthcare organizations.

The basic rationale for selecting these girls is the fact that they are considered at an increased susceptibility of unintended pregnancies when compared to older counterparts. Eligibility criteria will be considered for maintaining for virginity of the participants. Inclusion criteria will include teenage girls belonging to the aforementioned age group, who lived in the area selected for the research study. Participants must show their willingness to participate in it, attended clinic sessions, and give their informed consent. The study will be conducted using an individualistic approach as in order to get uniform meaning of the contributing factors and comparing them to the responses, it is imperative to know the way by which an individual gets affected.

Primary data collection will involve distribution of self-administered question as to the participants via the reproductive health service centres present in the district. Data will be obtained for the purpose of providing specific answers to the research question and objective. This qualitative data will involve direct efforts on part of the researchers in conducting the observational study. All the questionnaires are most often design for a statistical analysis of the answers or responses. In this case it will be entirely used for a qualitative purpose. The basic reason for using questionnaires over other kinds of surveys or interviews are that questionnaires do not require much effort when compared to telephone or verbal surveys (Weigold, Weigold and Russell 2013). Moreover, presence of standardized answers facilitates compilation of the responses. The questionnaire will also be sharply limited by the fact that the participants must be able to read and respond to them.

It will include questions on different variables such as facts, behaviour, attitudes, and preferences. Open-ended questions will allow all the respondents to formulate their own answers. The answers will be coded in the form of a response scale, later on. All questionnaires will be prepared in English language and the respondents will be asked to fill in the details, without interference from any other person, including the researchers. They will be designed in a way that captures relevant information for the research question. It will be pre-tested for ensuring whether they are answerable, acceptable, and well understood.

Qualitative data analysis techniques will be used for the same. Data analysis refers to the process of applying logical or statistical techniques for illustrating describing, condensing, recapping, and evaluating relevant data. Initially the responses given by all participants will be recorded and summarised. This will be followed by looking for relevant themes. It will involve identification of meaningful phenomenon, or responses and applying appropriate label for correlating them to thematic ideas. This coding or labelling process will enable quick retrieval and collection of all information that can be examined and compiled together. All descriptions and themes will involve interpretation of the responses. This interpretation will help in explaining reasons behind the response.

Computer Based programs will be used for organising the data with the use of word processors. Computer-assisted qualitative data analysis packages will also be utilized for the data analysis procedures (Rademaker, Grace and Curda 2012). Final compilation of all data and their interpretation will be disseminated in an appropriate manner.

The major limitation is associated with the fact that the cross-sectional study design which focuses on measuring prevalence, rather than incidence of a particular phenomenon (teenage pregnancy in this case). The study might also be susceptible to bias due to this classification or no response rates. Lack of response can be attributed to existing stereotypes and myths associated with early pregnancy. Another limitation is that the participants involved only teenage girls belonging to a particular age group, but fails to include boys, healthcare professionals, and parents. Therefore, further studies should be conducted across other districts by including variables that create significant influence on the other target groups as well.

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