Prevalence and correlates of teenage pregnancy among in-school teenagers during the COVID-19 pandemic in Hoima district western Uganda-A cross sectional community-based study.

BACKGROUND: The COVID-19 pandemic related restrictions and lockdown measures had compromised the routine delivery and access of sexual and reproductive health and rights services to the population including the teenage girls. However, the teenage pregnancy rates during COVID-19 pandemic period were poorly documented. This study aimed at determining the prevalence and the factors associated with teenage pregnancy among in-school teenage girls during the COVID-19 pandemic period in Hoima District Uganda. METHODS: This was a descriptive cross-sectional study that employed quantitative research methods. A total of 314 in-school teenage girls aged 13-19 years were selected using a multi-stage sampling techniques. Interviewer-administered questionnaires were used to collect the data from the participant's homes during the period December 2021-January 2022. Data analysis was done using univariate, bi-variate, and multivariate. RESULTS: The prevalence of teenage pregnancy among the in-school teenage girls in Hoima district Uganda was 30.6% [96/314]. Higher teenage pregnancy rates were prevalent among the unmarried teenage girls [aOR: 9.6; 95%CI: 4.64-19.87; p = 0.000], teenage girls studying from boarding schools [aOR 2.83, 95%CI 1.36-5.86, p = 0.005], contraceptive non-users [aOR: 2.54; 95%CI: 1.12-5.4; p = 0.015] and teenage girls involved in sex trade [aOR 3.16, 95%CI 1.5-6.7, p = 0.003]. The factors associated with the reduced likelihood for teenage pregnancy included being an adult teenage girl aged 18-19 years [aOR: 0.15; 95%CI: 0.07-0.32; p = 0.000] and not receiving sex education during the period [aOR 0.36, 95%CI 0.13-0.62, p = 0.024]. CONCLUSION: The results indicated that 3 out of 10 in-school teenage girls from Hoima district Uganda got pregnant during the COVID-19 pandemic period of 2021. Teenage pregnancy was prevalent among teenage girls who don't use modern contraceptive methods and those involved in sex trade. Teenage pregnancy was however, less prevalent among adult teenage girls aged 18-19 years. The findings point to the need for health stakeholders to innovate creative policies, contingency plans and programmes aimed at delaying age for sexual activities, increasing contraceptive use and minimizing pregnancy risk from sex trade among in-school teenage girls during COVID-19 pandemics.

Adolescent pregnancy in the time of COVID-19: what are the implications for sexual and reproductive health and rights globally?

The COVID-19 pandemic has aggravated pre-existing challenges associated with adolescents' sexual and reproductive health and rights (SRHR). Evolving evidence suggest that it could adversely impact the progress made towards improving sexual and reproductive health outcomes among young people. The pandemic has stalled achievements in reducing adolescent pregnancy and child marriage by reinforcing contextual and structural determinants of these reproductive health outcomes, especially among girls. The pandemic has increased disruptions to schooling, decreased access to sexual and reproductive health services and compounded pre-existing socio-economic vulnerabilities. The consequences of neglecting adolescent sexual and reproductive health services over the past 2 years, to focus on COVID-19, continue to emerge. This commentary argues for targeted and responsive approaches to adolescent SRHR that tackle preventable consequences resulting from inequities faced by adolescents globally, particularly girls.

Births in the United States, 2021.

This report presents selected highlights from 2021 final birth data on key demographic, healthcare use, and infant health indicators. The number of births, general fertility rates (GFRs) (births per 1,000 females aged 15-44), age-specific birth rates (births per 1,000 females in specified age group), vaginal birth after cesarean (VBAC) delivery rates, and preterm (less than 37 weeks of gestation) birth rates are presented. Results for 2019, 2020, and 2021 are shown for all births to provide context for changes in birth patterns noted during 2020, the first year of the COVID-19 pandemic (1,2). VBAC and preterm birth rates are shown for the three largest race and Hispanic-origin groups: non-Hispanic White, non-Hispanic Black, and Hispanic.

Feasibility and Acceptability of Virtual Implementation of a Sexual Reproductive Health Teen Pregnancy Prevention Program for Native Youth.

American Indian/Alaska Native (Native) youth face high rates of substance use, teen pregnancy and sexually transmitted infections. In response to the COVID-19 pandemic, Respecting the Circle of Life (RCL), a sexual reproductive health and teen pregnancy prevention program for Native youth and their trusted adult, was adapted and delivered in a virtual format with Native youth in a rural, reservation-based Native community. This manuscript describes the adaptation process, feasibility, and acceptability of virtual program implementation. The manuscript describes the process of rapidly shifting the RCL program into a virtual format. In addition, a mixed-methods process evaluation of implementation forms, program feedback forms, in-depth interviews with participants, and staff debriefing sessions was completed. Results show virtual implementation of RCL is both feasible and acceptable for Native youth and their trusted adults. A key benefit of virtual implementation is the flexibility in scheduling and ability to have smaller groups of youth, which offers greater privacy for youth participants compared to in-person implementation with larger groups. However, internet connectivity did present a challenge for virtual implementation. Ultimately, sexual and reproductive health programs seeking to reach Native youth and families should consider virtual implementation methods, both during and outside of pandemic situations.

Barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy in Ghana: an exploratory qualitative study.

OBJECTIVES: This study explored the perceived barriers and facilitators regarding the implementation of policies and programmes aimed at reducing adolescent pregnancy among health and education professionals ('professionals'), grassroots workers and adolescent girls in Ghana. DESIGN AND SETTING: We employed an exploratory qualitative study design involving interviews with professionals, grassroots workers and adolescent girls in the Central Region of Ghana. PARTICIPANTS: This study involved 15 professionals employed in government or non-governmental organisations, 15 grassroots workers and 51 pregnant/parenting and non-pregnant adolescent girls. DATA ANALYSIS: Thematic analysis was conducted deductively using the ecological framework for understanding effective implementation. RESULTS: Eighteen themes mapped to the five domains of the ecological framework emerged. Perceived barriers included gender inequality, family poverty, stigma, community support for early childbearing and cohabitation, inadequate data systems, lack of collaboration between stakeholders and lack of political will. Effective implementation of community by-laws, youth involvement, use of available data, and collaboration and effective coordination between stakeholders were the perceived facilitators. CONCLUSION: Political leaders and community members should be actively engaged in the implementation of adolescent sexual and reproductive health policies and programmes. Gender empowerment programmes such as education and training of adolescent girls should be implemented and strengthened at both the community and national levels. Community members should be sensitised on the negative effects of norms that support child marriage, gender-based violence and early childbearing.

Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya.

INTRODUCTION: Secondary school closures aimed at limiting the number of infections and deaths due to COVID-19 may have amplified the negative sexual and reproductive health (SRH) and schooling outcomes of vulnerable adolescent girls. This study aimed to measure pandemic-related effects on adolescent pregnancy and school dropout among school-going girls in Kenya. METHODS: We report longitudinal findings of 910 girls in their last 2 years of secondary school. The study took place in 12 secondary day schools in rural western Kenya between 2018 and 2021. Using a causal-comparative design, we compared SRH and schooling outcomes among 403 girls who graduated after completion of their final school examinations in November 2019 pre-pandemic with 507 girls who experienced disrupted schooling due to COVID-19 and sat examinations in March 2021. Unadjusted and adjusted generalised linear mixed models were used to investigate the effect of COVID-19-related school closures and restrictions on all outcomes of interest and on incident pregnancy. RESULTS: At study initiation, the mean age of participants was 17.2 (IQR: 16.4-17.9) for girls in the pre-COVID-19 cohort and 17.5 (IQR: 16.5-18.4) for girls in the COVID-19 cohort. Girls experiencing COVID-19 containment measures had twice the risk of falling pregnant prior to completing secondary school after adjustment for age, household wealth and orphanhood status (adjusted risk ratio (aRR)=2.11; 95% CI:1.13 to 3.95, p=0.019); three times the risk of school dropout (aRR=3.03; 95% CI: 1.55 to 5.95, p=0.001) and 3.4 times the risk of school transfer prior to examinations (aRR=3.39; 95% CI: 1.70 to 6.77, p=0.001) relative to pre-COVID-19 learners. Girls in the COVID-19 cohort were more likely to be sexually active (aRR=1.28; 95% CI: 1.09 to 1.51, p=0.002) and less likely to report their first sex as desired (aRR=0.49; 95% CI: 0.37 to 0.65, p<0.001). These girls reported increased hours of non-school-related work (3.32 hours per day vs 2.63 hours per day in the pre-COVID-19 cohort, aRR=1.92; 95% CI: 1.92 to 2.99, p=0.004). In the COVID-19 cohort, 80.5% reported worsening household economic status and COVID-19-related stress was common. CONCLUSION: The COVID-19 pandemic deleteriously affected the SRH of girls and amplified school transfer and dropout. Appropriate programmes and interventions that help buffer the effects of population-level emergencies on school-going adolescents are warranted. TRIAL REGISTRATION NUMBER: NCT03051789.

Mapping adolescent sexual and reproductive health research in sub-Saharan Africa: protocol for a scoping review.

INTRODUCTION: Previous studies have attempted to review the vast body of evidence on adolescent sexual and reproductive health (ASRH), but none has focused on a complete mapping and synthesis of the body of inquiry and evidence on ASRH in sub-Saharan Africa (SSA). Such a comprehensive scoping is needed, however, to offer direction to policy, programming and future research. We aim to undertake a scoping review of studies on ASRH in SSA to capture the landscape of extant research and findings and identify gaps for future research. METHODS AND ANALYSIS: This protocol is designed using the framework for scoping reviews developed by the Joanna Briggs Institute. We will include English and French language peer-reviewed publications and grey literature on ASRH (aged 10-19) in SSA published between January 2010 and June 2019. A three-step search strategy involving an initial search of three databases to refine the keywords, a full search of all databases and screening of references of previous review studies for relevant articles missing from our full search will be employed. We will search AJOL, JSTOR, HINARI, Scopus, Science Direct, Google Scholar and the websites for the WHO, UNICEF, UNFPA, UNESCO and Guttmacher Institute. Two reviewers will screen the titles, abstracts and full texts of publications for eligibility and inclusion-using Covidence (an online software). We will then extract relevant information from studies that meet the inclusion criteria using a tailored extraction frame and template. Extracted data will be analysed using descriptive statistics and thematic analysis. Results will be presented using tables and charts and summaries of key themes arising from available research findings. ETHICS AND DISSEMINATION: Ethical approval is not required for a scoping review as it synthesises publicly available publications. Dissemination will be through publication in a peer-review journal and presentation at relevant conferences and convening of policymakers and civil society organisations working on ASRH in SSA.

A bioecocultural approach to supporting adolescent mothers and their young children in conflict-affected contexts.

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.

Adolescent girls, a forgotten population in resource-limited settings in the COVID-19 pandemic: implications for sexual and reproductive health outcomes.

Adolescent sexual and reproductive health is an essential aspect that may be forgotten in the COVID-19 pandemic. Valuable insights gained from previous humanitarian crises indicate undesirable short and long-term adolescent maternal consequences in low resource settings. Young girls are at a higher risk of dropping out of school and being forced into early child marriages and high-risk jobs that predispose them to sexual exploitation and sexual and gender-based violence. Economic recessions, supply chain disruptions and reallocation of resources may limit access and utilisation of services and commodities. The COVID-19 pandemic thus indirectly exposes adolescent girls to multiplied risks of unintended pregnancies, sexually transmitted infections including HIV and Human Papilloma Virus. Sexual and gender-based violence, including female genital mutilation cases may increase as intervention programmes to avert these are disrupted, and the resultant psychosocial and socioeconomic consequences may be devastating. Thus, a pro-active approach is required to come up with frameworks to ensure the minimum initial service package for reproductive health. A multi-sectoral collaborative intersection of relevant stakeholders in adolescent sexual and reproductive health is therefore urgently desired.

School closures and teenage pregnancy.

Pandemic-related school closures are impacting the sexual and reproductive health and rights of adolescent girls. Lynn Eaton reports.

Challenges for Midwives' Healthcare Practice in the Next Decade: COVID-19 - Global Climate Changes - Aging and Pregnancy - Gestational Alcohol Abuse.

Midwives are multifaceted healthcare professionals whose competence spectrum includes a large variety of knowledge and skills going from antenatal care to education and research. The aim of this review is to suggest the future challenges midwives are going to face in the upcoming decade of this Century. COVID-19 and other infections will reasonably impact healthcare workers all over the world. Midwives are frontline healthcare professionals who are constantly at risk of contagion as their job implies close contact with women, physical support and hand touch. Also, menstruation waste plays a large role in the pollution of waters, severely impacting hygiene in the developing countries and fueling climate change. Appropriate disposal of used menstrual material is still insufficient in many countries of the world especially because of lack of sanitary education on girls. As educators, midwives will be more involved into preventing inappropriate disposal of menstrual hygiene devices by educating girls around the world about the green alternatives to the commercial ones. Despite the evidences about the fertility decrement that occurs with aging, women keep postponing reproduction and increasing their chance being childless or suffering complications related to the advanced maternal age. Teen pregnancies are as well an important issue for midwives who will be called to face more age-related issues and use a tailored case to case approach, enhancing their family planning skills. Another crucial role of midwifery regards the information about the risk of drinking alcohol during gestation. Alcohol assumption during pregnancy is responsible for serious damage to the fetus causing a wide range of pathological conditions related to Fetal Alcoholic Spectrum Disorder, leading cause of mental retardation in children of western countries. On the whole, midwives have demonstrated their willingness to expand their practice through continuing professional development, and through specialist and advanced roles especially in preventive and educational positions.