Teenage pregnancy

1. TEENAGE PREGNANCY ~ Issues & Dilemmas ~ DR ALIFAH O&G Update 2014 Hospital Kapit , Sarawak

2. Scopes… Introduction Problem background in Sarawak What is the dilemma with teenage pregnancy? What are the issues with teenage pregnancy? How to manage teenage pregnancy?

3. INTRODUCTION… WHO defines teenage pregnancy – “aged between 13-19 years old” It is a complex issue Serious problem worldwide It is a health and social problems

4. Anually there are 14-15 million births worldwide to teenage girls, accounts more than 10% births > 90% cases occur in developed countries (WHO 2009) US has the highest teenage pregnancy rate in the developed countries UK has the highest incidence in Europe (24 births per 1000 women)

5. IN MALAYSIA.. The Star Online, 2012

6. 62/1000 in SGH, Kuching (2010-11) Teenage Pregnancy in Sarawak 43.8% unmarried 80% stopped schooling 33% SGA 16.7% preterm deliveries 9.6% nutritional anaemia Muniswaran et.al. Adolescent pregnancies in Sarawak: the unspoken facts. BJOG; 2012. *IN UK 20-30/1000

7. DILEMMA??

8. Dilemma with Teenage Pregnancy ?? Teenage pregnancies are socially & culturally acceptable in Sarawak

9. RISK FACTORS Social culture – early marriage Being a child of teenage mother Learning difficulty Mental health problems Experience of physical or domestic abuse in childhood Low self esteem Not using contraceptive method in the 1 st sexual experience Limited access to contraception

10. BY LAW… STATUTORY RAPE “any sexual intercourse with a girl under 16 years of age is considered rape irrespective of whether victim’s consent was obtained” -The offense in Malaysia is dealt under section 375 of the Malaysian Panel Code

11. Our dilemma Sex education should not be discussed in school Limited or no access for education & information on reproductive sexual health care Policies often restrict adolescent’s access to information & services ( eg contraception)

12. ISSUES??

13. ISSUES ANTENATAL POSTPARTUM INTRAPARTUM SOCIAL OFFSPRING

14. 1.ANTENATAL ISSUES Lack of antenatal care Unsure of date Illegal termination Malnutrition STDs Social issues- smoking/alcohol/drugs PIH/ Eclampsia Anaemia Low birth weight Premature labour

15. 2.INTRAPARTUM ISSUES Pain relief Mode of delivery – CPD due to immature pelvis Issues with spinal or epidural due to developing vertebra

16. 3.POST-PARTUM ISSUES Post-partum blues/ depression Social support Resumption of education Contraception Baby dumping

17. 4.SOCIAL ISSUES Unmarried Unemployed Easily abused Neglected Ill treated Suicidal Poverty Engage in high risk activities Poor school performance Poor reading ability Drop of school

18. 5.OFFSPRING ISSUES Neonatal and post-neonatal mortality Poor development Child abuse & neglect Intellectual, language & socio-emotional delay Poor academic performance Poor reading ability Smoking & consume alcohol Behavioural problems Engage in crimes

19. MANAGEMENT

20. ISSUES ANTENATAL POSTPARTUM INTRAPARTUM SOCIAL OFFSPRING

21. 1.ANTENATAL MANAGEMENT Service should be easily accessible Young-people friendly environment Ensure confidentiality Partner & family involvement Strong referral links with relevant agencies (social worker)

22. Dating the pregnancy Routine antenatal care Provide nutritional advice & supplements Advice on antenatal care Monitor weight gain, BP, fetal growth Encourage smoking, alcohol and drugs cessation Encourage to join antenatal classes and preparation of labour

23. 2.INTRAPARTUM MANAGEMENT Need assessment for CPD Caesarean section for evidence of obstructed labour Need early anaesthetic referral for choice of anaesthesia

24. 3.POST PARTUM MANAGEMENT Advice in hygiene Assist in breast feeding- breast feeding support Assist in child care Infant feeding, growth and safety need to be observed Assessment of post natal depression

25. CONTRACEPTION COCP: failure rate as high as 50% due to non-compliance Implanon (LARC) Failure rate of 0.1% over 3 years Weight gain < 10%, irregular bleeding IUCD (LARC) Failure rate of 0.8% In view of risk of chlamydia infection, advisable to take an endocervical swab & to give antibiotics before fitting IUCD IM Depo Provera Risk of reduced bone mineral density if usage > 2 years Condom - Not safe

26. 4.SOCIAL ISSUES Referral to social worker for financial assistance Ensure family support- baby is at greater risk of inadequate growth & infection Child care/ adoption advice Return to education, training or employement Financial & housing support

27. Take the necessary action according to The Child Act 2001 if the adolescent is suspected to be physically or emotionally abused, neglected, or sexually abused. Refer to child protector and police officer or the doctor should take temporary custody if unable to contact them

28. SCHOOLING Teenagers should always be assisted in returning to school either during pregnancy or after delivery

29. 5.OFF SPRING ISSUES Involvement of child protector If any evidence of child abuse or neglect, JKM have a power to take the baby a place them in a safer place Child for adoption

30. How is Malaysia dealing with this issues? In 2010, first “baby hatch”- a place where mothers can safely and anonymously leave their unwanted child Malacca opened a school for teenage mother “ Sekolah Harapan ”

31. PREVENTIONS NATIONAL STRATEGIES 1.School based health, life, sex & relationship education 2.Campaigns & media 3.Availability of contraception 4.Access to abortion services Co-ordination- national, state, district

32. Recommendations Life skills based health educations Support services for adolescents Involvement of family members Increase access to contraceptive information services, sex education Skilled antenatal & birth care Special sensitivity in dealing with adolescents girls

33. THANK YOU….