Social Determinants and Teen Pregnancies

Pregnancy is the second leading cause of death among adolescent girls between ages 15-19 and around 3 million teenagers undergo unsafe abortions. Adolescent pregnancies remain an international and national concern. Worldwide, teen births account for sixteen out of 300 million births.” One million births occur in girls under the age of 15”. Among developed nations US teens have higher pregnancy rates and ten times more to experience unwanted pregnancies. Discrepancy in adolescent pregnancies was more prominent among racial and ethnic groups (Hispanics and blacks had double the rate than whites {Pew Research Center 2017}).

There has been decline in the teen birth rate from 1991 -2015 in US which was due to increase used of contraceptives during sexual activity.

The social determinants of health have shown a significant association with teen pregnancies not only in US, but also around the world. Income, housing, health insurance, healthy food and safe communities and education are some of the social determinants that have direct impact on teen births. While examining various ways of income, socioeconomic status, income inequality and low education levels all of these had strong and positive association with teen pregnancies.

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For example, adolescents living in rural areas with poverty and lack of economic opportunities have higher rates of teen pregnancies. The income inequality between rich and poor have impact on the difference in the healthcare access among the economic groups. Teenagers in lower economic group are more likely to be involved in sexual risk behaviors, unprotected sexual activity leading to increase in abortions and ultimately social isolation.

“According to Kearney and Levine welfare benefits and reforms, restrictive abortion policies and abstinence education had little or minimal effect on teen pregnancy rate in US”.

However, they also found correlation between adolescent births and income. Expanded education has two different effects on income inequality levels: negative effect being with growth in educated and skilled workers there’s also an increase in income inequality. And the positive effect being as there is increase in educated workers, their demand becomes less, wages also decrease which lowers income inequality between educated and less educated workers. In rural areas, age related pregnancy risks are due to low literacy levels, limited access to healthcare access and malnutrition. However, in some parts of world there are some ethnic minority groups where premarital sex is considered a norm and marriage being necessity before childbirth. Also teens face barriers to accessing contraception due to restrictive policies and laws. Due to low literacy rate in rural areas also the adolescents in urban area having of lack of sexual reproductive health knowledge and increase in the sexual violence such as rapes or sexual abuse of any form is also a leading cause of teens pregnancy. These pregnancies end up with higher risk of low birth weight, preterm delivery and other severe neonatal conditions.

These pregnancies have a negative impact both socially and economically. This condition causes teen to face stigma or rejection from society, schools, peers and even family. It has been predicted that girls getting pregnant before the age of 18 years are tend to experience violence within marriage or relationship. An estimated 5%-33% of teen girls aged between 15-24 years dropped out of school.” Dr. Thomas Friedan, director of centers for disease control and prevention has, discussed the economic benefits of public health preventive efforts that have both long and short term impact on individual behavioral interventions can have given their limited reach”. There have been preventive measures studied in various research like “CDC in 2010 in partnership with the Office of Adolescent Health funded state and community based organizations developed and implemented the Teen Pregnancy Community-Wideinitiative”. This effort approached teen pregnancy by identifying factors that influence teen pregnancy and other adverse sexual outcomes among vulnerable youth.

Improving adolescent health worldwide needs improving adolescents’ life with family, peers, in schools, addressing risks and other protective factors in the social environment at population level and factors that are protective across health outcomes. The most effective intervention are structural changes to improve access to education and more employment opportunity for adolescent and providing affordable access to contraceptives along with the mother and child health clinics for the adolescent mothers. Even WHO published guidelines in 2011 on preventing early pregnancies and reducing Adverse reproductive outcomes. Some of the objectives were being reducing marriage age before 18 years. This estimate suggested a 10% reduction in child marriage would decrease maternal mortality rate 10 70%, increasing the use of contraception by adolescents, reducing coerced sex among teens, reducing unsafe abortions and increasing use of skilled healthcare services.