ABSTRACT
Globally, COVID-19 has had a negative impact on health systems and health outcomes, with evidence of differential gender impacts emerging. The COVID-19 timeline of events spanning from closures and restrictions to phased reopenings is well-documented in Kenya. This unique COVID-19 situation offered us the opportunity to study a natural experiment on pregnancy trends and outcomes in a cohort of Kenyan adolescent girls and young women (AGYW), enrolled in the KENya Single-dose HPV-vaccine Efficacy (KEN SHE) Study. The KEN SHE Study enrolled sexually active AGYW aged 15–20 years from central and western Kenya. Pregnancy testing was performed at enrollment and every 3 months. We determined pregnancy incidence trends pre- and post-COVID-19 lockdown, pregnancy outcomes (delivery, spontaneous, or induced abortion), and postabortion and postpartum contraceptive uptake. Kaplan–Meier survival estimates of incidence rates were used to estimate the cumulative probability of pregnancy during the study period. Cox regression was used to investigate factors associated with pregnancy incidence. Of the 2,223 AGYW included in the analysis, median age was 18.6 IQR (17.6–20.3), >90% had at least secondary school education, 95% were single at the time of enrollment, and 82% had a steady/primary sexual partner. Pregnancy incidence peaked at 2.27 (95% CI [1.84, 2.81])/100 women-years of observation at the end of the first quarter of 2020, a period coinciding with the government-imposed lockdown. AGYW had 60% increased risk of being pregnant during the lockdown when compared to prelockdown period (HR = 1.60, 95% CI [1.25, 2.05]). Among the 514 pregnancies reported, 127 (25%) ended in abortion, of which 66 (52%) were induced abortions. Our findings demonstrate the adverse sexual and reproductive health (SRH) consequences of the COVID-19 pandemic and the lockdown measures among AGYW. As services continue to be disrupted by the pandemic, there is an urgent need to strengthen and prioritize AGYW-centered SRH services, including contraception and safe abortion.
ABSTRACT
Background: Adolescent pregnancy is a worldwide public health issue, and the intrauterine device (IUD) has been shown to be a safe and highly effective method of long-acting reversible contraception (LARC) in this group. Patient concerns regarding IUDs are common, which should be addressed during routine office visits. Recently, both Pediatric and Gynecologic societies have recommended the IUD as a first line contraceptive for adolescents given their safety and efficacy. We are hoping to understand current IUD practices amongst providers, elucidate barriers to IUD insertion, and explore whether there have been any changes in IUD insertion patterns since the advent of the COVID-19 pandemic, which has increased telehealth and reduced operating room (OR) availability. Method(s): Survey was disseminated to NASPAG (North American Society for Pediatric and Adolescent Gynecologists) members via the listserv on two separate occasions. Consent was obtained upon completion of the survey. Results from the survey are anonymous. Results were tabulated with descriptive statistics. Ethics approval was obtained (REB22-0269). Result(s): There were 55 respondents, with the majority being Pediatric and Adolescent Gynecologists (71%) from North America (93%). As per providers, adolescents most frequently seek out the IUD for contraception (45%) and menstrual management (42%). Providers felt that the most common barrier to the IUD was misconceptions/myths (67%), as well as pain with insertion (64%). Most practitioners had no change in their IUD prescribing patterns since the start of the pandemic (62%), while some performed more office insertions (11%) and some reduced their IUD practice because of less operative time (15%) and less in-person appointments. Although many physicians perform office insertions, many found that a Procedural Sedation Center facilitated wait times (38%) or felt that such a center would be helpful (33%). Cases being done in the OR were often patients with disabilities/developmental delay (95%) or anxiety (75%). Conclusion(s): Our survey demonstrated that there are still some misconceptions surrounding the IUD. Education on contraception, specifically LARCs, is pivotal in decreasing adolescent pregnancy rates, reducing barriers to IUD use, and improving the attitude of adolescents toward the IUD. Pain with insertion is another limiting factor and a Procedural Sedation Center may be helpful in managing pain expectations and increasing acceptance of the IUD. Although there was no significant change in IUD practices during COVID, a decrease in operating room availability and increase in telehealth may impede IUD prescribing, especially in patients with developmental delay or disabilities who may require insertion in the OR.Copyright © 2023
ABSTRACT
BACKGROUND: Given the high burden of adverse sexual and reproductive health outcomes (SRH) and low levels of school attendance among adolescent girls in Kenya, this study sought to elucidate the association between school attendance and SRH outcomes among adolescent girls in Homa Bay and Narok counties. METHODS: This study uses baseline quantitative data from the mixed-methods evaluation of the In Their Hands (ITH) program which occurred between September to October 2018 in Homa Bay and Narok counties. In total, 1840 adolescent girls aged 15-19 years participated in the baseline survey, of which 1810 were included in the present analysis. Multivariable logistic regression models were used to assess the association between school attendance (in- versus out-of-school) and ever having sex, condom use during last sex, and ever pregnant, controlling for age, orphan status, income generation, religion, county, relationship status, and correct SRH knowledge. RESULTS: Across the 1810 participants included in our study, 61.3% were in-school and 38.7% were out-of-school. Compared to adolescent girls who were in-school, those out-of-school were more likely (AOR 5.74 95% CI 3.94, 8.46) to report ever having sex, less likely (AOR: 0.21, 95% CI 0.16, 0.31) to have used a condom during their last sexual intercourse, and more likely (AOR: 6.98, 95% CI 5.04, 9.74) to have ever been pregnant. CONCLUSIONS: School attendance plays an integral role in adolescent girls' SRH outcomes, and it is imperative that policy actors coordinate with the government and community to develop and implement initiatives that support adolescent girls' school attendance and education.
Adolescent girls in Kenya experience poor sexual and reproductive health outcomes (SRH) and have low levels of educational attainment. In this study, we aimed to examine if school attendance was associated with sexual and reproductive health outcomes among adolescent girls aged 15 to 19 years in Homa Bay and Narok counties in Kenya. The study used data from the evaluation of the In Their Hands (ITH) program which occurred between September to October 2018. A total of 1840 adolescent girls years participated in the baseline survey, of which 1810 were included in this study. We found that compared to adolescent girls in-school, those who were out-of-school were significantly more likely to report ever having sex, less likely to have used a condom during their last intercourse, and more likely to have ever been pregnant. This study found that attending school plays an important protective role in the SRH of adolescent girls. Therefore, it is important to develop and implement initiatives to support adolescent girls' school attendance, and ultimately their education attainment.
Subject(s)
Reproductive Health , Sexual Behavior , Pregnancy , Female , Humans , Adolescent , Cross-Sectional Studies , Reproductive Health/education , Kenya , SchoolsABSTRACT
Background Coronavirus disease 2019 (COVID-19) infection during pregnancy has been associated with high rates of preeclampsia, stillbirth, and preterm birth. Adolescent pregnancy has also been associated with various adverse maternal and neonatal outcomes, including preeclampsia, stillbirth, preterm birth, congenital anomalies, and low birth weight. Therefore, this study aimed to determine whether COVID-19 infection associated with adolescent pregnancy represents an additional risk factor. Methods We performed a study that included 17 adolescent COVID-19- positive patients, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital, Bucharest, between 01.04.2020 and 15.04.2022, and a control group of 17 patients who were COVID-19-negative and delivered in the same period in the same unit. In the control group, additional risk factors that could affect neonatal outcomes were excluded. The COVID-19 infection was confirmed using a polymerase chain reaction (PCR) test. The analysis of neonatal outcomes included preterm birth, low birth weight, stillbirth, congenital anomalies, and Apgar score calculated at one minute. Results The data from this study showed that COVID-19 infection does not influence the newborn's weight or Apgar score in adolescent patients. Also, in our study, COVID-19 infection was not statistically significant according to preterm delivery in adolescents. Conclusion Adolescent pregnancy represents an important health problem associated with a high risk of maternal and neonatal complications. However, COVID-19 infection does not influence neonatal outcomes in this population.
ABSTRACT
Articles on teenage pregnancies have been proliferating in both the popular press and the medical media. We analysed data available in the public sector database, the District Health Information System, from 2017 to 2021. During this time, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which is very high by developed-country standards) and the birth rate per 1 000 girls in this age category increased from 1.1 to 1.5. These increases occurred year on year in most provinces. In adolescent girls aged 15 - 19, the number of births increased by 17.9% (from a baseline of 114 329) and the birth rate per 1 000 girls in this age category increased from 49.6 to 55.6. These increases also occurred year on year in a continuous upward trend as well as in all provinces, but at different rates. Generally, rates were higher in the more rural provinces such as Limpopo, Mpumalanga and Eastern Cape than in more urban provinces such as Gauteng and Western Cape. The increases during the past 2 years were particularly large and may be due to disruption of health and school services with decreased access to these as a result of COVID-19. These metrics pose serious questions to society in general and especially to the health, education and social sectors, as they reflect socioeconomic circumstances (e.g. sexual and gender-based violence, economic security of families, school attendance) as well as inadequate health education, life skills and access to health services.
ABSTRACT
The study of adolescent fertility and its trends continues to be a priority for the social sciences. The political will to decrease this indicator is notable on international agendas, and for Cuba it is a priority. The article analyzes adolescent fertility, its evolutionary trend in the years up to 2020, and the behavior of its determinants. An approach to adolescent pregnancy in the context of COVID-19 in Cuba is presented. Demographic analysis is used as a method. Descriptive statistics (absolute and relative frequency), and comparison between years for an approximation of the possible impact of COVID-19 on adolescent fertility. The result is the disarticulation of Cuban fertility expressed in its low global fertility rate (TFR) and the specific adolescent fertility rate above what is expected and desired. Resistance to the notable decline in adolescent fertility continues, mainly in the eastern part of the country. Discontinuation rates exceed the fertility rate in this age group, accounting for the high rate of adolescent pregnancy. Contraception and marriage as proximate determinants still express gaps in the exercise of sexual and reproductive rights. The weight of adolescent fertility increased from 16.7% in 2019 to 17% in 2020, which means that adolescent girls contributed more to total fertility in 2020, the year of the pandemic, than in 2019. Among its conclusions, it stands out that in the context of COVID-19, adolescent fertility and its determinants have been impacted by all the conditions that this generates and are mediated by the social and economic scenario of the country, realizing that for an in-depth analysis in this regard, other data.
ABSTRACT
In the context of the viral spread of COVID-19 in 2020, Romanian authorities declared national confinement for two months. Our country faces a public health issue regarding adolescent pregnancy. This study assessed the predisposition of teenage mothers to postpartum depression and the influence of the viral pandemic on their emotional status. This study enrolled patients 10 to 19 years old who delivered in our department between March-December 2020. Teenagers were attributed to the "lockdown group" (n = 30) and the "open group" (n = 171). All study participants agreed to take an interview based on a three-part questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS). In the "lockdown group", 16.67% of patients felt stressed over the last year compared to 11.11% of individuals in the "open group", but there was no statistically significant difference between groups regarding overall EPDS scores (z value 0.51, Mann-Whitney U test). Predictable variables for postpartum depression were the use of cigarettes (OR = 1.08, 95% CI: 1.00-1.16), intended pregnancies (OR = 0.25, 95% CI: 0.09-0.68, p = 0.007) and absence of stressors in the last year (OR = 0.07, 95% CI: 0.02-0.30, p = 0.0002). More adolescents were stressed during confinement compared to those who delivered in the following time period; this aspect did not interfere with depression screening scores. A planned pregnancy, even during adolescence, can serve as a protective factor for postpartum depression.
ABSTRACT
An estimated 12 million girls aged 15-19 years, and 777,000 girls younger than 15 give birth globally each year. Contexts of war and displacement increase the likelihood of early marriage and childbearing. Given the developmentally sensitive periods of early childhood and adolescence, adolescent motherhood in conflict-affected contexts may put a family at risk intergenerationally. We propose that the specifics of normative neuroendocrine development during adolescence, including increased sensitivity to stress, pose additional risks to adolescent girls and their young children in the face of war and displacement, with potential lifelong consequences for health and development. This paper proposes a developmental, dual-generational framework for research and policies to better understand and address the needs of adolescent mothers and their small children. We draw from the literature on developmental stress physiology, adolescent parenthood in contexts of war and displacement internationally, and developmental cultural neurobiology. We also identify culturally meaningful sources of resilience and provide a review of the existing literature on interventions supporting adolescent mothers and their offspring. We aim to honor Edward Zigler's groundbreaking life and career by integrating basic developmental science with applied intervention and policy.