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Background: We evaluated (a) opinion of Syrian and Turkish healthcare workers (HCWs), and perceptions and attitudes of Syrian refugee mothers, pregnant women, fathers and grandmothers on age-appropriate breastfeeding, (b) the effect of cultural characteristics, migration and pandemics on Syrian's infant nutrition, and (c) the suggestions of HCWs and Syrian family members to improve breastfeeding practices in the Syrian refugee society in a qualitative study. Methods: The qualitative study consisting of structured focus group discussions (FGDs) was held in four provinces in Turkey where Syrian refugees live intensely in September and October 2020. Seven different types of online FGDs were held with Turkish HCWs working in maternity hospitals, Syrian HCWs working in Refugee Health Centers (RHCs), Syrian pregnant women, mothers, fathers, and grandmothers. In total, we carried out 46 FGDs with 335 individuals. Thematic analysis of the transcripts in a deductive-inductive fashion was carried out with MAXQDA 11. Results: Most Syrian HCWs did not get any training on breastfeeding counseling. The short duration of breastfeeding in Syrian refugees was seen to be related to the cultural characteristics, and migration. Some cultural characteristics can be summarized as "believing that breastfeeding harms mother's health", "adolescent marriages", "wanting to have as many children as possible", "giving anise to infants and not breastfeeding at night", "prelacteal feeding", "believing that milk is not enough", "over controlling mother–child interaction by grandmothers, which limits the interaction", "short pregnancy intervals", and "not using modern family planning techniques". We found out that migration increased the tendency for adolescent pregnancies, deepened the poverty, and decreased family social support. We did not observe any change in breastfeeding practices during pandemics. Conclusions: Breastfeeding counseling programs should be designed in consideration of cultural characteristics of Syrian HCWs and family members. Continuing health education programs for family members with socially appropriate interventions to prevent adolescent marriages are important. [ABSTRACT FROM AUTHOR]

The issue of teenage pregnancies has become a public health problem and is the order of the day in national and international politics. With a theoretical background of two different images of the adolescent pregnancy, and the concepts of autonomy and responsibility, a research was done about the attribution of responsibility for teenage pregnancies in a population of 22 students from a school in Barranquilla, Colombia. The interviews allowed inferring that the majority of young people transfer responsibility to parents and teachers, an issue that calls into question the type of education received by those youngsters. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancies are persistently high among refugees. The pregnancies have been attributed to low contraceptive use in this population. The aim of this study was to determine the prevalence and factors associated with modern contraceptive use among female refugee adolescents in northern Uganda. Methods: This was a cross sectional study using both descriptive and analytical techniques. The study was carried out in Palabek refugee settlement in Northern Uganda from May to July 2019. A total of 839 refugee adolescents who were sexually active or in-union were consecutively enrolled. Interviewer administered questionnaires were used for data collection. Results: Modern contraceptive prevalence was 8.7% (95% CI: 7.0 to 10.8). The injectable was the most commonly used modern contraceptive method [42.5% (95% CI: 31.5 to 54.3)], and most of the participants had used the contraceptives for 6 months or less (59.7%). Reasons for not using modern contraceptives included fear of side effects (39.3%), partner prohibition (16.4%), and the desire to become pregnant (7.0%). Participants who were married (OR = 0.11, 95% CI: 0.04 to 0.35, p < 0.001), cohabiting (OR = 0.43, 95% CI: 0.20 to 0.93, p = 0.032) or having an older partner (OR = 0.93, 95% CI: 0.86 to 0.99, p = 0.046) were less likely to use modern contraceptives. Conclusion: Modern contraceptive use among female refugee adolescents was very low, and few reported a desire to become pregnant, leaving them vulnerable to unplanned pregnancies. Least likely to use modern contraceptives were participants who were married/cohabiting and those having older partners implying a gender power imbalance in fertility decision making. There is an urgent need for innovations to address the gender and power imbalances within relationships, which could shape fertility decision-making and increase modern contraceptive use among refugee adolescents. [ABSTRACT FROM AUTHOR]

Background: Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. Aim: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. Methods: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. Results: The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. Conclusion: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence. [ABSTRACT FROM AUTHOR]

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014–2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014–2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia. [ABSTRACT FROM AUTHOR]

Adolescent girls are at the center of many health development interventions. Based on ethnographic research in rural Malawi, I analyze the design, implementation, and reception of an international non-government organization's project aiming to reduce teenage pregnancies by keeping girls in school. Drawing on Fassin's theorization of culturalism as ideology, I analyze how a tendency to overemphasize culture is inherent to the project's behavior change approach, but is reinforced locally by class-shaped notions of development, and plays out through reinforcing ethnic stereotypes. I argue that culturalism builds upon previous health development initiatives that dichotomized modernity and tradition, and is strengthened by short-term donor funding. [ABSTRACT FROM AUTHOR]

As intermediaries between donors and beneficiaries 'local development brokers' play a crucial role in shaping the implementation of development initiatives. They tie together different interests through acts of translation and organise development interfaces, but also pursue their own ambitions. This article examines junior public servants in Malawi's primary education sector, who as a result of shifting aid modalities and priorities, have become development brokers in the implementation of multiple non-governmental organisation (NGO) projects. Studying their various 'broker' roles provides an analytical lens through which to examine the active co-construction of development initiatives, and how brokering affects their position and the school as a public institution. The analysis is based on ethnographic fieldwork at an under-resourced primary school in Mangochi district and on the implementation of norm-promoting projects aiming to keep girls in school and reduce teenage pregnancies. This article describes how brokers facilitate NGO activities, translate global norms into messages that resonate locally, and strategically present successes in line with project discourses. This article argues that these strategies are intended to sustain the projects to benefit the school, the students and to supplement low salaries, thereby prioritising short-term benefits over the quality of education. Donors' and INGOs' well-intentioned efforts to strengthen country systems, might result in undermining broader educational goals if these attempts come in the form of multiple small-scale NGO projects. These critical reflections do not travel up the aid chain, as brokers are incentivised to produce successes. [ABSTRACT FROM AUTHOR]

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented. This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose. [ABSTRACT FROM AUTHOR]

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented. This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose. [ABSTRACT FROM AUTHOR]

In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented. This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose. [ABSTRACT FROM AUTHOR]

Objectives: We looked at early pregnancy and parenthood as an opportunity to broaden our understanding of the reproductive health education needs met by adolescent girls. Methods: We conducted an in-depth interview study with 12 adolescent mothers. Results: To become a mother at a young age was perceived as meaningful to all the participants. The participants expressed a need to be addressed as adult parents, who want the best for their child. A variety of psychosocial and health needs emerged over a time span ranging from starting to be sexually active to after the child was born. Social isolation was found to be an important factor of vulnerability. Conclusion: The health needs of adolescent mothers extend well beyond counselling around the decision to continue or terminate pregnancy, and subsequent information on contraception methods to avoid further pregnancies. Adolescent mothers need to be supported in their transition to parenthood, and special care should be provided to girls who are socially isolated. Practice implications: We identified several avenues for health education and counselling to adolescent mothers, from primary prevention to reduce incidence of early pregnancies to tertiary prevention to reduce negative health outcomes for both mother and child. [Copyright &y& Elsevier]

Abstract: Objective: To quantify the age related risk of adverse obstetric outcome in primigravid women less than 20 years of age. Study design: The study sample was drawn from Cardiff Births Survey (a computerized maternity information database) comprising 66,271 pregnancies in the South Glamorgan region during 1990–1999. Pregnancy outcomes of primigravid women were compared in age groups less than 20 years (n =4126) and 20 to <35 years (n =17,615). SPSS version 11 was used for statistical analysis. Student''s t-test was used for continuous variables, Chi square, Fishers exact test was used for categorical variables. Results: There was a lower incidence of multiple pregnancies (OR=0.3(0.2–0.4)), spontaneous rupture of membranes >24h (OR=0.7(0.6–0.9)), and pregnancy-induced hypertension (OR=0.8(0.6–0.8)) amongst teenage primigravidae but a higher incidence of anaemia (OR=1.8(1.6–2.0)), and pyelonephritis (OR=1.5(1.1–2.0)). There was a lower incidence of induction of labour (OR=0.7(0.7–0.8)) and use of regional analgesia in the teenage group. Teenage women were more likely to have a spontaneous vaginal delivery (OR=2.1(2.0–2.3)) with a significantly lower incidence of instrumental delivery (OR=0.5(0.5–0.6)), and Caesarean section (OR=0.4(0.4–0.5)). Inspite of a higher incidence of preterm labour (corrected OR=1.4(1.1–1.7)) the perinatal outcome measures between the teenage group and the older group were not significantly different. Conclusion: Teenage primigravidae are more likely to have a spontaneous vaginal delivery, without compromising the maternal or neonatal outcome. [Copyright &y& Elsevier]

Abstract: Introduction: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies. Purpose: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies. Methods: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Örebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained. Results: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group. Conclusion: This study shows that teenagers giving birth constitute a high-risk group for future unintended pregnancies and legal abortion. [Copyright &y& Elsevier]

Objective : To evaluate and characterize the racial/ethnic differences in obstetric outcomes of early and late teenagers in California. Methods : A data-set linking birth and death certificates with maternal and neonatal hospital discharge records in California was utilized to identify nulliparous women (11 to 29 years of age) who delivered between January 1,1992 and December 31,1997. Pregnancy outcomes of early (11-15 year) and late (16-19 year) teenagers were compared to those of a control group of women aged 20-29. Results : Early ( n  = 31 232) and late teens ( n  = 271 470) demonstrated greater neonatal and infant mortality and major neonatal morbidities (delivery < 37 weeks of gestation and birthweight < 2500 g) when compared to pregnancies in the older control women ( n  = 662 752). Ethnicity adversely affected outcome with African-Americans of all ages having worse outcomes than whites. The higher rate of adverse obstetric outcomes among the teenage pregnancies occurred despite a lower cesarean section rate and was consistent across all ethnic groups. Conclusions : When compared to women aged 20-29, all teen pregnancies were associated with higher rates of poor obstetric outcomes. Other factors besides teen pregnancy appear to be responsible for poor outcomes in certain ethnic groups. [ABSTRACT FROM AUTHOR]

This study investigated influences on fertility control and early parenthood among teenage learners from a rural district in Zimbabwe. Data on perceived influences on risks for early parenthood were collected from 1320 female secondary school learners (mean age = 16 years, SD = 1.35) using a semi-structured questionnaire. The data were analyzed descriptively. Teenagers believed to be at risk for early parenthood from early sexual debut, material poverty and peer influences to engage in sexual relationships. [ABSTRACT FROM AUTHOR]