Challenges faced by nurses

Challenges and responsibilities of Nurses in Handling Adolescent and unwed mothers in South East Asia

1. Challenges And Responsibilities Of Nurses In Handling Adolescent And Unwed Mothers in South east Asia

2. Introduction The World Health Organization defines an adolescent as an individual between 10-19 years of age. There are about 350 million adolescents comprising about 22% of the population in countries of the South-East Asia Region (SEAR). They constitute 15%-26% of the population in countries in the Region.

3. Introduction... Adolescence is a period of rapid growth and development in an individual marking a change from childhood to adulthood. New capacities are acquired and new situations are faced as they grow up. These situations create many opportunities for development but also pose risks to their health and well-being.

4. Introduction... The immediate family environment, peers, societal norms, and the environment at school and the workplace influence the development of adolescents’ personality, capacities and vulnerabilities.

5. Introduction... Adolescence is generally perceived to be a healthy period of life since mortality is quite low in this age group. However, this is deceptive since adolescents are faced with several public health challenges that are, of course, different from the ones that they faced when they were children.

6. Key facts ( World’s Scenario) About 16 million girls aged 15 to 19 and some 1 million girls under 15 give birth every year—most in low- and middle-income countries. Complications during pregnancy and childbirth are the second cause of death for 15-19 year-old girls globally.

7. Key facts ( World’s Scenario)... Every year, some 3 million girls aged 15 to 19 undergo unsafe abortions. Babies born to adolescent mothers face a substantially higher risk of dying than those born to women aged 20 to 24.

8. Key facts ( World’s Scenario)... Birth rates Marked, although uneven, decrease in the birth rates among adolescent girls since 1990, but some 11% of all births worldwide are still to girls aged 15 to 19 years old. Majority of these births (95%) occur in low- and middle-income countries.

9. Key facts ( World’s Scenario)... Birth rates The 2014 World Health Statistics indicate that the average global birth rate among 15 to 19 year olds is 49 per 1000 girls. 

10. Demographic situation (SEAR) Early marriage for girls is common in some countries of the Region. More than 66% of girls in Bangladesh, 51% in Nepal, 47% in India and about 22% in Indonesia are married by 18 years. The total fertility rate in the Region contributed by 15-19 year old girls varies from 5%- 20% among member countries.

11. Census 2011 Nepal Data Total adolescence population : 6407404 Male population: 3207821 Female population : 3199583 Source: census 2011

12. Adolescence pregnancy In context to Nepal Most common in Nepal, but the rate of adolescence marriage seems to be increased after the massive earthquake 2015. Almost around 41%of girls and11% of boys marry before 18.

13. Source NDHS 2016

14. Contexts For some adolescents, pregnancy and childbirth are planned and wanted, but for many they are not. Adolescent pregnancies are more likely in poor, uneducated and rural communities. In some countries, becoming pregnant outside marriage is not uncommon. Unwed pregnancy is a major issue among Adolescence.

15. Unwed pregnancy Unwed mother is the lady who has become pregnant without legal justification of physical intimacy between man and women. In the traditional societies like Nepal the physical relationship before marriage or becoming mother before marriage is considered as a sin, which is highly unacceptable.

16. Statistics of unwed pregnancy in Nepal In 2013, 273105 babies were born to girls age below 19 There were 26.5 birth for every 1000 girls 89% of teenage parents were unmarried 77% of teenage pregnancy are unplanned 15% end in miscarriage and 30% teenage pregnancies end in abortion.

17. Causes of Unwed Pregnancy Unwed pregnancy is increasing in the country due to: Improper sex education Prostitution ( presence of Badi group) Teen age mistake Contraceptive failure

18. Challenges OF Adolescence and Unwed Mothers Poor Health Situation Increase rate of unsafe abortion Higher MMR and NMR Poverty and socio -economic deprivation Low birth weight Lack of sex education Vulnerability to STIs and risk of abuse

19. Challenges OF Adolescence and Unwed Mothers... Economic and social consequences - Increase School drop out - Powerlessness Homelessness Stigma Poor nutritional diet Post delivery depression Lack of parenting skill and difficulties with breast feeding

20. Challenges Cont... Adverse Health effects Pregnancy and childbirth complications are the second cause of death among 15 to 19 year olds globally. Some 3 million unsafe abortions among girls aged 15 to 19 take place each year, contributing to maternal deaths and to lasting health problems.

21. Challenges Cont... In South-East Asia maternal causes of death ( haemorrhage , sepsis, abortion complications) account for a higher proportion of deaths among females. Early childbearing is a public health priority in several SEAR countries.

22. Challenges Cont... Early pregnancy has higher chances of adverse reproductive health outcomes like high Maternal Mortality Ratio and Infant Mortality Rate. Neonatal and infant mortality rates are higher among women aged < 20.

23. Challenges Cont... In low- and middle-income countries, babies born to mothers under 20 years of age face a 50% higher risk of being still born or dying in the first few weeks versus those born to mothers aged 20-29.

24. Challenges Cont... The younger the mother, the greater the risk to the baby. Newborns born to adolescent mothers are also more likely to have low birth weight, with the risk of long-term effects.

25. Challenges Cont... Considering that adolescent fertility remains high in some countries and is associated with higher maternal as well as infant mortality, this age group is significantly responsible for contributing to population momentum and a high MMR and IMR in the Region. and to the cycle of ill-health and poverty.

26. Challenges Cont... Lack of sex education Some adolescents do not know how to avoid getting pregnant: sex education is lacking in many countries. They may feel too inhibited or ashamed to seek contraception services. 

27. Challenges Cont... Even when contraceptives are widely available, sexually active adolescent girls are less likely to use them than adults. Girls may be unable to refuse unwanted sex or resist coerced sex, which tends to be unprotected. Thus, leading to vulnerability.

28. Challenges Cont... Economic and social consequences Adolescent pregnancy can also have negative social and economic effects on girls, their families and communities. Many girls who become pregnant have to drop out of school.

29. Challenges Cont... Economic and social consequences A girl with little or no education has fewer skills and opportunities to find a job. Thus leading to powelessness and homelessness. This can also have an economic cost with a country losing out on the annual income a young woman would have earned over her lifetime, if she had not had an early pregnancy.

30. Responsibilities

31. Joint responsibility

32. Ensure universal access to sexual and reproductive health services and rights Responsibilities... Stop child, early and forced marriage Provide Comprehensive sexual education Information, Counselling and services for full range of safe, effective and accessible and affordable contraceptive methods. Pre-pregnancy, pregnancy, birth, post-pregnancy, safe abortion and post abortion care Source: Who. Int infographics

33. Responsibilities...

34. Responsibility of Nurses Encourage for ANC , INC and Postnatal visit. Provide Tender loving care. Provide Sex education and education on contraceptive use Provide opportunities for school education. Provide life skills for independency and improve socio economic status. Encourage social support.

35. Responsibility of Nurses... Home visit by nurses. Information, education and counselling on transition to motherhood and parent child communication Couple counseling. Individual mother and father counseling. School health programme. Act as Rolemodel for behaviour changes

36. Nurses As An advocator  As an advocator, she can advocates the rights of unwed mother and can protect her from further exploitation. She must inform the mother about her legal rights which are provided by government to them so that mother can take benefit of them.

37. Nurses as a Researcher  As a researcher, she should make research in the best preventive measure to avoid the occurrence of unwed mother.

38. References http://who.int/mediacentre/factsheets/fs364/en/ http://apps.searo.who.int/PDS_DOCS/B4771.pdf?ua=1 https://www.childtrends.org/programs/early-intervention-program-for-adolescent-mothers/ https://cwru.pure.elsevier.com/en/publications/care-of-adolescent-parents-and-their-children-3 NDHS 2016 Annual report 2073/74