Factors that influence late booking among teenagers attending the Victoria Jubilee hospital

Adolescent pregnancy has been recognized as an international phenomena. A significant negative aspect of adolescent pregnancy is the risk of adverse health consequences for both mother and baby if left untreated. Health of mothers and children has been a priority for Caribbean health services for over fifty years and is included in the goals and targets for the Caribbean Corporation of Health. The antenatal coverage is more than 95 percent in Jamaica. In spite of high overall attendance in the Caribbean, however late booking to antenatal clinic is a common phenomenon especially amongst adolescents. This study aims to find out some of the factors associated with this phenomenon. The investigation sought to identify the knowledge, attitudes, practices and beliefs of pregnant teenagers towards booking at the antenatal clinic. The sample comprised 100 pregnant teenagers between 11-19 years, attending the antenatal clinic at the Victoria Jubilee Hospital. Fifty were late attenders and fifty early attenders. A case study method was employed to collect data. These were coded and analysed using the SPSS Statistical Package. The research findings revealed that both early and late attenders shared common characteristics. They were mainly single, in unstable relationships and for the most part unemployed,were not educated beyond secondary school, had unplanned pregnancies but had reasonable knowledge of contraceptive methods. The findings also suggested that educational and employment opportunites might alleviate some of the problems attenders experienced. Despite early diagnosis of pregnancy, the respondents were not motivated to register early in health facilities. Failure to register early was attributed to reluctance to disclose pregnancy. Implementation of the following were recommended: (1)Programmes aimed at motivating teenagers to access health facilities early in their pregnancy (2)Provision for high employability for those unable to return to school (3)Expansion of the services presently provided by the Women's Centre to serve a large percentage of the pregnant teenage population. These programmes should provide valuable insight into health seeking behaviours of teenage pregnant women and thereby result in effective interventions that address their needs (AU)

Contraceptive use among Jamaican teenage mothers

Objective: To compare the prevalence of contraceptive use among teenage mothers who were participating, and teenage mothers who were not participating, in a program in Jamaica that had been established to deal with the country's serious problem of repeat pregnancies among adolescents. Methods: A historical cohort design was used to assess the impact that the Women's Centre of Jamaica Foundation (WCJF) Programme for Adolescent Mothers had on contraceptive use among the target population of adolescents 16 years and under who had experienced a first live birth in 1994. Results: Contraceptive use at first intercourse was found to be higher among WCJF program participants (44 percent) than among nonparticipants (37 percent), but this difference was not significant (P=0.35). Contraceptive use after first live birth was also higher among WCJF program participants (94 percent) than among nonparticipants (86 percent), and this difference was significant (P=0.04). Contraceptive prevalence at last intercourse (in 1998) did not differ between participants and nonparticipants (both 69 percent). Conclusions. Contraceptive use among this population in Jamaica was highest when the respondents' perception of vulnerability to pregnancy was most acute, that is, after the first live birth. All adolescents, both males and females, need to be educated about the importance of sustained and effective use of contraception in order to reduce the risk of unintended pregnancy and sexually transmitted diseases (AU)

The impact of the women's centre of Jamaica foundation programme for adolescent mothers on repeat pregnancies

A random sample (n=260) of primiparous Jamaican adolescent mothers (12-16 years old) who gave birth in 1994 in the parishes of Kingston and St Andrew, St Catherine and Manchester was selected from vital records and interviewed in 1998 for this historical cohort study. Among programme participants, the incidence of repeat pregnancy was 37 percent compared with 60 percent among non-participants. Programme participation reduced the risk of one or more repeat pregnancies by 45 percent with 95 percent confidence interval (0.22, 0.91). Programme participants were also 1.5 times (1.005, 2.347) more likely to complete high school than non-participants; however, this effect did not achieve statistical significance. The results confirmed that the WCJF Programme exerts a considerable effect on the incidence of repeat pregnancy among participants. The benefits of programme participation were greatest among residents of the Kingston Metropolitan Area from single parent, female headed households with average incomes below J$10,000, who wanted to continue their education after the first live birth.(Au)

Decreasing prevalence of adolescent births in Antigua and Barbuda, 1969 to 1998 - Poster abstract

OBJECTIVE: To determine trends in teenage pregnancy in Antigua from 1969 to 1998. DESIGN AND METHODS: Maternity Ward records were reviewed at Holberton Hospital, site of 90 percent of deliveries in Antigua. Maternal age for all births were included. Births to mother <18 years, and 18-19 years were analysed separately. Yearly birth totals for each 5-year period were compared using Chi Square analysis. RESULTS: The number of births averaged 1081 per year. From 1969 to 1983, the yearly number of deliveries to women 12-17 yrs was constant, 161 to 166. From 1983-1988, the number dropped to 116 (p < 0.01), from 1989-1993 to 90 (p = NS) then from 1994-1998 to 76 per year (p < 0.02). The percent decrease for women 12 to 17 years was 54 percent from, 1969-1973 to 1994-1998. For women 18-19 yrs, from 1969-1983 the number was 163 to 169 per year. From 1983-1988, the number fell to 140 per year (p<0.05), from 1989-1993 to 106 per year (p<0.01) and from 1993-1998 stayed at one hundred and eleven per year. The percent decreased for women 18-19 yr was 33 percent from 1969-1973 to 1994-1998. For all teenage deliveries, the percent decrease was 43 percent from 1969-1973 to 1994-1998. Per capita GDP rose from US$4228 to US$6054 from 1982 to 1998 (a 43 percent increase). CONCLUSION: Antigua and Barbuda has seen a dramatic drop of 43 percent in teenage deliveries from 1969 to 1998.(AU)

Factors that influence the occurrence of teenage pregnancy - abstract

OBJECTIVES: To examine the way by which the family and other socio-environmental factors may influence the occurrence of pregnancies among teenagers. DESIGN AND METHODS: A case control methodology was used. The sample size was 90 with a 1:1 ratio of cases to control. Pregnant teenagers (14-19 years) who attended the antenatal clinic at the University Hospital of the West Indies and the Department of Social and Preventive Medicine, University of the West Indies (UWI) during February and March of 1995 were selected as cases. All female teenagers who had never been pregnant, and who lived on five randomly selected streets in the nearby community, were selected as controls. RESULTS: The adolescents who became pregnant were 2.7 times more likely to have a mother who was herself a teenaged mother. They were also likely to have had no discussion with their parent or guardian about human sexuality. CONCLUSIONS: There is the need to break the intergenerational cycle of teenage pregnancy. Parenting education, including effective communication skills, is vital.(AU)

The impact of the Women's Centre of Jamaica Foundation programme for adolescent mothers on repeat pregnancies

OBJECTIVES: To assess the effect of the Women's Centre of Jamaica Foundation Programme for adolescent mothers (WCJF) on the incidence of repeat pregnancies occurring between 1995 and 1998, and on the educational attainment of programme participants. DESIGN AND METHODS: A random sample (n=260) of primiparous Jamaican adolescent mothers, 12-16 years, who gave birth in 1994 in the parishes of Kingston and St Andrew, St Catherine and Manchester was selected from vital records and interviewed in 1998 for this historical cohort study. RESULTS: Only 23.5 percent of all repeat pregnancies in the entire study population were among programme participants compared with 76.5 percent among non-participant. Programme participation reduced the risk of one or more repeat pregnancies by 45 percent (0.22-0.9). Programme participants were also 1.5 times (1.00-2.3) more likely to complete high school than non-participants. CONCLUSION: The results confirmed that WCJF Programme exerts a beneficial effect on the incidence of repeat pregnancy among participants. The benefits of programme participation were greatest among residents of the Kingston Metropolitan Area from single parent, female-headed households with average monthly incomes below J$10,000, who wanted to continue their education after the first live birth.(AU)

Evaluation of a sexuality education program for young adolescents in Jamaica

Despite their increasing numbers, few of the sexuallity education and pregnancy preventative programs in developing countries have been evaluated. This study, conducted in 1995-1997, assesses the impact of a school-based sexuality education program, the Grade 7 Project, on 945 Jamaican seventh graders (aged 11-14) and their initiation of sexual activity and the use of contraception at first intercourse, as well as the knowledge and attitudes that influence their behaviors. Using a quasi-experimental design, the study measured the effects of the Grade 7 Project when the nine-month intervention was completed (short term) and one year after that (long term). Multivariate logistic regression analysis indicated that the project had no effect on initiation of sexual activity, but it had a positive short-term impact on use of contraception at first intercourse (P=.08); adolescents in the intervention group were more than twice as likely to use contraception. The project also had a positive short-term influence on several aspects of the adolescents' knowledge of and attitudes about sexuality and pregnancy. The modest impact of the Grade 7 project is encouraging, as school-based sexuality education programs of limited duration rarely have a long-term impact. Moreover, competing socioeconomic and cultural forces in Jamaica encourage early sexuality and parenthood among adolescents. The use of more participatory teaching methods and smaller class sizes might strengthen the Grade 7 Project and enhance its impact (AU)

Among young Jamaicans, sex and childbearing often begin during adolescence

Reveals that among young Jamaicans, sex and childbearing often begin during adolescence. Comparison between the average age at the first intercourse of sexually experienced young women and that of men; Decision to have sex and use contraceptives; Reason cited for not using them

Sexual Attitudes and Behaviour among young adolescents in Jamaica

Describes the attitudes and behaviour among low-income adolescents in Jamaica. Contributing factors to early sexual activity and pregnancy; Social pressure and encouragement among boys to be sexually active; Branding of young girls who become pregnant as having loose morals; Motivations for engaging in sex among girls and boys.(AU)

A comparative study of pregnancy outcome in teenage girls and mature women - abstract

In this retrospective study of birth outcome, 214 pregnant girls between the ages of 13 and 19 years and a matched control group of 297 older pregnant women (22-23 years) were selected from the records of 2394 live, singleton births between 200 and 305 days gestation, who attended antenatal clinics at the University Hospital of the West Indies, January - December 1990. Birth weight, crown heel length, head circumference, head circumference:length ratio, ponderal index, placental weight were measured. Weight and BMI at booking in the teenagers were less that those in the controls. Their haemoglobin levels in each trimester and their minimum haemoglbin levels were lower than those in their controls, but there was no significant difference in the third trimester or the delivery systole blood pressure. Babies of teenagers had lower birth weights and smaller head circumferences, but there was no significant difference between their crown heel length, ponderal index, head circumference:length ratio, and placental weight. These data support the hypothesis that teenage girls are not physically mature as demonstrated by their booking weight and BMIs and that as a consequence, their offspring are compromised as is evident by their lower birth weights and head circumference. (AU)

Outcome of teenage pregnancy in St. Vincent: neonatal outcome and adequacy of milk from teenage mothers

In a longitudional study, pregnancy, neonatal outcome and lactation performance of adolescent and adult primigravidae were examined and compared in 33 randomly selected women (14-25 years) in St. Vincent. The whole group of women were subdivided into three sub-groups: Group I (n=10, age 14-16 years), Group II (n=12, age 17-18 years), and Group III (n=11, age 19-25 years). Detailed data on obstetrical and neonatal (neurological) outcome were collected. After birth, information was obtained on early infant growth, maternal dietary intake and breast milk composition. Milk samples (transitional and mature milk) and maternal dietary information and neonatal anthropometric measurements were collected twice during the first month after birth through home visits. Between the 3 groups no significant differences in obstetric conditions, birthweight and early infant growth were found. The Neurological Optimality Score (NOS) was comparable for all groups, but a trend of more infants diagnosed as neurologically "suspect" infants in the younger age group shows the urgent need for more research in this field. Regarding the analysis of breastmilk samples, apart from lactose content, no major differences in the composition of macro-nutrients were found. Concerning the fatty acid composition of the milk fat, no major differences between the groups occurred, although a small number of individual fatty acids were different between the groups. Early infant growth patterns were similar in all groups. It is concluded that previously reported perinatal problems of healthy teenage primigravidae (14-16 years) were not substantiated fully in this series but neonatal outcome of infants of these mothers suggests that careful developmental follow-up of these children is indicated (AU)

Perinatal data on teenage pregnancies in Curacao

Over the past years many studies have been performed on perinatal data regarding teenage pregnancies. To update perinatal data on teenage pregnancies in Curacao, and to compare these with the data from earlier studies, a retrospective study was done using a new perinatal registration system. The study population comprised women who gave birth under the care of a midwife or who had been referred by a midwife to an obstetrician. Within this population perinatal data were compared between women aged <20 years at the first antenatal visit (teenage group) and those aged 20 years of age (controls). Statistical significance of differences in percentages were determined using Chi square tests. For the differences in mean values t-tests were performed. A p-value < 0.05 was considered significant. The duration of pregnancy was significantly more often in doubt in teenagers and they had significantly more spontaneous deliveries, in concurrence with the findings of most other studies. Teenagers did not develop more maternal pathology, but they are at risk for developing eclampsia, once pre-eclampsia occurs. In our study we found a significantly lower mean birthweight for the teenage group, a significantly higher incidence of preterm deliveries and significantly more neonatal pathology. Perinatal mortality was lower in teenage pregnancies, though not significantly so. Although the mean birthweight among the teenagers (3128 g) was lower than that of the controls, it was still very acceptable. The higher incidence of neonatal pathology is related to the higher incidence of preterm deliveries (AU)x

Factors affecting outcome of pregnancy in adolescents at the Victoria Jubilee Hospital in Kingston for the period December 1, 1995 to February 29, 1996

This study involved all the adolescents 10-19 years of age who were delivered at the Victoria Jubilee Hospital between December 1, 1995 and February 29, 1996. There was a total of 570 adolescents in the study. Teenage pregnancy is not a new phenomenon of modern times. In some countries it occurs within the framework of considerable kin and community approval. Fertility among adolescents varies from country to country. In Jamaica the fertility rate for adolescents 15-19 for 1993 was 108 per 100,000. Ninety percent of pregnancy in women under 20 years of age occur outside the formal marriage or common-law unions. The hazards of childbirth in adolescents are greater for both mother and infants than for women in their childbearing prime, age 20-29 years. There are higher incidence of prematurity and low birth weight to these babies. The purpose of the study was to deduce that preventive measures if any, may be required to improve reproductive outcome among adolescents. The method used was collection of data from adolescents' records and interviewing some of them. Of the total, 94.6 percent had normal delivery and 5.4 percent had caesarean section or other methods of delivery. There were 17.5 percent low birth weight and 20.7 percent prematurity. There was a significant association between multiparity and age of mothers. The results were generally in keeping with previous findings. The prediction of those adolescent mothers an babies at risk of poor outcomes due to pregnancy induced hypertension and other complications are particularly important in developing countries such as Jamaica. Hence, the importance of early and appropriate antenatal care and intervention are crucial. Unintended pregnancies and childbearing among adolescents are a source of increasing concern because of their impacts on the young mothers, the children and society at large. (AU)

Adolescent health and the adolescent's need for specialised health services and health promotion activities in Kingston

The adolescent period marks the important transition from childhood to adulthood. It is not an easy time for the youngster as he/she undergoes changes that are physical, emotional and social in nature. It is considered by the experts as one of the healthiest time in ones life. This age group however, is involved in much risk taking which is likely to lead to health problems. Whereas services are provided for children and adults, the adolescents do not seem to be any medical group's primary concern. Knowledge of the health problems and needs must be obtained in order to plan specific health programmes and health promotion activities. A sample of 176 adolescents from three high/secondary schools in Kingston was selected and data gathered from them. The findings revealed that 62.8 percent of the boys were aware of their health status while only 49 percent of the girls were aware. The major health problem as perceived by the adolescets are pregnancy and its complications, emotional problems, drug use and violence. The adolescents stated that the responsibility of their health care was their own with only a few stating that parents share the responsibility. The adolescents utilized the private and public facilities but preferred to go to the private doctors because of the privacy that is offered. There was general satisfaction with health care received and they did not identify alternative health care facilities. The adolescents' knowledge of health promotion was very limited with 42.8 percent stating that they did not know what it was. Those who responded thought that it was synonymous with health education or health improvement. The need for more information, education and counselling was seen to be crucial.(AU)

Factors that influence the occurrence of teenage pregnancies

After a constant decline in fertility rates among 15-19 year old Jamaican females from 1975 to 1989, there was in 1993 a sharp increase in births to this group of women. These increases come at a time when sexuality education programmes are taught in schools and contraceptives have been made more readily available to teenagers. Teenagers continue to be a group at risk for medical complications of pregnancy, not because of their age per se, but because of specific factors that are more common to them. A case control study was conducted attempting to examine ways in which the family and other factors may influence the occurrence of pregnancies among teenagers. Among the pregnant and the non-pregnant teens there were equal levels of knowledge and use of contraceptives. It was demonstrated that the pregnant teens were more likely to have mothers who were themselves teenaged mothers (OR=2.7, p=.02) to live away from their parents (OR=3.4, 9=.01) and to have had no discussions with their parents about sexuality (OR=3.0,p=.03). These findings indicate that the early socialization of young people, one of the functions of the family, is an important factor that impacts on the norms and behaviour patterns adopted by our young people. (AU)