TEENAGE PREGNANCY AS A GLOBAL CONCERN

Adolescence is a critical period of life with rapid brain development. One’s social environment and the opportunities provided during one’s teenage years crucially affect one’s capabilities to develop essential life skills, such as independence, completion of education and employment. Becoming pregnant as a teenager diminishes the possibilities of adopting these skills.^28,30 Globally, the majority of teenage pregnancies occurs in the least developed areas with poor opportunities for education and employment.¹ In these societies, teenage pregnancy is often intertwined with additional concerns, such as sexual violence and child marriage.³¹ Although child marriage is against human rights, it is still practised broadly, mostly in Sub-Saharan Africa and South Asia. The highest incidence of child marriage is seen in the Central African Republic, where approximately 68% of women are married before age 18.³² Child brides often become pregnant as teenagers and 90% of teenage births in developing countries occur among married girls.³³ Teenage pregnancies have serious consequences for both the teenagers and their children especially in low-income countries.³¹ Complications from pregnancy and childbirth is the leading cause of death among girls aged 15 – 19 years old globally.³⁴ Teenage mothers have also been shown to be at higher risk for eclampsia regardless of whether living in a developing or a developed region.^11,35–37 However, the incidence has been shown to be higher in low- and middle-income countries.³⁸ Further, babies of teenage mothers are more likely to be delivered preterm and have low birth weight than those of older mothers.^35,39,40

In addition to health consequences, pregnancy and childbirth during teenage years increase the risk for several social and economic hardships in life. For example, both married and unmarried pregnant teenagers especially in low- or middle-income countries experience isolation or violence by their family, partners and peers, contributing to physical and psychological consequences.^41,42 Furthermore, early childbearing is associated with school drop-out and a lower educational level, which compromises a girl’s possibilities for future education and employment.13,14,43–45

Alternatively, in many developing countries marriage and childbearing as a teenager might be the best option for young girls due to poor education and employment possibilities.⁴⁶

Attitudes towards teenage sexuality as well as cultural norms strongly affect accessibility to sexuality education and effective contraceptives. This is an enormous challenge when organising sexuality education especially in low- and middle-income

countries but also in developed areas. Additionally, teenagers may avoid seeking contraceptive services due to fear of judgement and social stigma. Thus, many teenagers across the world do not know how to use contraceptives or where to obtain them. Many also have misconceptions about contraception.⁴⁷ Other barriers to contraceptive use among teenagers globally include financial constraints and lack of youth-friendly services.20–22,47,48

WHO, the United Nations (UN), the United Nations International Children’s Emergency Fund (UNICEF) and the United Nations Population Fund (UNFPA) have launched programmes to enhance teenagers’ sexual rights and reduce teenage pregnancies in developing countries. For example, the Global Programme to End Child Marriage launched in 2016 by UNICEF and UNFPA, helps adolescent girls to avoid marriage and childbearing in the 12 countries with highest rates of child marriage.⁴⁹ WHO published guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries in 2011. These guidelines cover six areas and recommendations for action as shown in Table 1.⁴⁷

Table 1 WHO guidelines for preventing early pregnancy and poor reproductive

outcomes among adolescents in developing countries and recommendations for action.⁴⁷

DOMAIN ACTION RECOMMENDATIONS

Preventing early marriage Effective legal prohibition Keep girls in school

Engage community leaders to change norms

Preventing early pregnancy Engage community leaders to put forth efforts in preventing early pregnancy in culturally acceptable ways

Sexuality education at school Provision of contraceptives

Increasing contraceptive use Enable legal and community support for contraceptive provision

Adolescent-friendly contraceptive services Reduce financial barriers to contraception Education on sexuality and contraceptive use Reducing coerced sex Enforce laws to punish perpetrators of coerced sex

Promote community norms not to tolerate coerced sex Engage men to reconsider gender norms

Empower girls to resist unwanted sex by building their self-esteem, life skills and social networks

Reducing unsafe abortion Provide access to safe abortion where legal

Enable access to post-abortion care and contraceptive services

Improve family and community support for access Education on the dangers of unsafe abortion Increasing the use of skilled

antenatal, childbirth and postpartum care

Enable access to skilled antenatal, childbirth and postpartum care

Education on birth and emergency preparedness Education on the risks of abandoning skilled care

Although the majority of teenage pregnancies and related concerns occurs in developing countries, many teenagers in income areas also face barriers to high-quality sexuality education and effective contraceptives. Further, sexuality education and access to contraception varies between countries and even within a country. For example, in many Catholic countries, contraception is not accepted, whereas in some countries, contraceptives are provided free of charge. Thus, cultural norms and aspects strongly affect girls’ sexual rights, and this should be recognised when analysing teenage pregnancy and contraception in different areas.

The data of the present research have been obtained from Finland, which has high-quality and comprehensive health services. Thus, the main focus of this thesis lies in teenage pregnancies and contraceptive services in developed countries.