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By all indicators, the reproductive health of Americans has been deteriorating since 1980. Our nation is troubled by rates of teen pregnancies and newborn deaths that are worse than almost all others in the Western world.Science and Babies is a straightforward presentation of the major reproductive issues we face that suggests answers for the public.The book discusses how the clash of opinions on sex and family planning prevents us from making a national commitment to reproductive health; why people in the United States have fewer contraceptive choices than those in many other countries; what we need to do to improve social and medical services for teens and people living in poverty; how couples should \"shop\" for a fertility service and make consumer-wise decisions; and what we can expect in the future--featuring interesting accounts of potential scientific advances.

Background Adolescent pregnancy remains a main concern in Sri Lanka, particularly in the Batticaloa District where the rate is nearly double the national average. Adolescent pregnancy has leads to school dropout and long-term socioeconomic disadvantage for teenage mothers. Because there has been minimal research done within a Sri Lankan context, especially in rural area like Batticaloa, the research aimed to assess how social conditions, accessibility of education, and accessibility of health affect the levels of education and the eventual work opportunities of adolescent mothers. Methods A quantitative cross-sectional design was followed with a structured questionnaire being administered among 107 adolescent mothers in Batticaloa who became pregnant between the ages of 15–19 years. The research followed a deductive approach, and data analysis was conducted using Partial Least Squares Structural Equation Modeling (PLS-SEM) with the help of SmartPLS. The model examined the influence of social support, access to education, and access to health on educational attainment and its subsequent influence on labor outcomes. Results Findings indicated that low social support, lack of access to education, and lack of access to healthcare significantly derailed the education of adolescent mothers. Level of education was found to be a significant mediator between the three variables and future job opportunities. The majority of the participants had previously dropped out of school by Grade 10, and merely 10.3% were employed, mostly at low-skilled jobs. Analysis confirmed that derailed education directly limits job opportunities and continues to contribute to economic instability among adolescent mothers. Conclusion The study brings to the forefront the need for comprehensive, context-sensitive interventions among teen mothers. There has to be reintegration of education, adolescent-friendly healthcare, and vocational training. Reducing stigma and economic and social protection can enhance education and labor market outcomes. Intervention in these domains through a multi-sectoral approach is required to interrupt the inter-generational transmission of poverty and promote the long-term well-being of teen mothers in Batticaloa and similar settings.

Twenty-four percent of Ugandan women give birth before the age of twenty, which is the highest proportion in East Africa. Recent literature shows that 65% of the adolescent pregnancies in Uganda are unplanned and unwanted. Due to cultural stigma, these adolescent mothers face significant challenges that may impact their mental wellbeing and their infants' development. To address this gap, Babies and Mothers Alive Foundation collaborated with the Ugandan Ministry of Health to conduct the Mama Ambassador Program (MAP) research study from March 2019 to August 2020. The MAP was a fifteen-session group psychosocial intervention conducted monthly by trained community health workers. The sessions were implemented from the third trimester of pregnancy through twelve months after birth using a curriculum developed from the World Health Organisation (WHO's) Care for Child Development manual, various maternal and infant guidelines and literature. This quasi-experimental study compared mothers and their infants who attended the fifteen-session group psychosocial intervention (group psychosocial support) at Rakai Hospital, with those receiving care as usual (antenatal, intrapartum and postnatal care) at Kalisizo Hospital. The outcomes studied included infant developmental outcomes at ages 2, 6, and 12 months using the Ages and Stages Questionnaire (ASQ) and maternal mental well-being at enrolment, birth, and 6 months post-partum using the WHO Self-Reporting Questionnaire (SRQ). The effect of the intervention was studied using difference-in-difference (DiD) analysis. A total of 789 adolescent mothers (446 in the intervention and 343 in the control group) were enrolled and of these, 84% of the mother-infant pairs completed all study measurements. The DiD estimations revealed that the intervention group outperformed the control group in all five ASQ infant development domains, with statistically significant results (p < 0.01) across 2-12 months: gross motor - mean difference (MD) 10.68 (SE = 1.42), fine motor- MD 8.55 (SE = 1.16), problem solving- MD 11.78 (SE = 1.46), communication- MD 6.05 (SE = 1.53), personal social- MD 15.42 (SE = 1.26). Furthermore, the intervention group showed increasing benefits over time, with scores at 6 months significantly higher than those at 2 months in all domains, and at 12 months, four of the five domains (except communication) showing significant improvements over 6-month scores. Additionally, adolescent mothers in the intervention group had significant improvements in their mental wellbeing towards birth and 6-months post-partum compared to the control group (p < 0.01), with a total reduction of 7.15 points in the mean score of mental health symptoms in the intervention group compared to an increase of 1.36 for those in the control group. In conclusion, a culturally adapted, group-based psychosocial support program targeting pregnant adolescents and implemented by community health workers in a resource-limited setting showed significant benefits for maternal mental wellbeing and infant developmental outcomes.

Background Adolescent girls in Zambia face risks and vulnerabilities that challenge their healthy development into young women: early marriage and childbearing, sexual and gender-based violence, unintended pregnancy and HIV. The Adolescent Girls Empowerment Program (AGEP) was designed to address these challenges by building girls’ social, health and economic assets in the short term and improving sexual behavior, early marriage, pregnancy and education in the longer term. The two-year intervention included weekly, mentor-led, girls group meetings on health, life skills and financial education. Additional intervention components included a health voucher redeemable for general wellness and reproductive health services and an adolescent-friendly savings account. Methods A cluster-randomized-controlled trial with longitudinal observations evaluated the impact of AGEP on key indicators immediately and two years after program end. Baseline data were collected from never-married adolescent girls in 120 intervention clusters (3515 girls) and 40 control clusters (1146 girls) and again two and four years later. An intent-to-treat analysis assessed the impact of AGEP on girls’ social, health and economic assets, sexual behaviors, education and fertility outcomes. A treatment-on-the-treated analysis using two-stage, instrumental variables regression was also conducted to assess program impact for those who participated. Results The intervention had modest, positive impacts on sexual and reproductive health knowledge after two and four years, financial literacy after two years, savings behavior after two and four years, self-efficacy after four years and transactional sex after two and four years. There was no effect of AGEP on the primary education or fertility outcomes, nor on norms regarding gender equity, acceptability of intimate partner violence and HIV knowledge. Conclusions Although the intervention led to sustained change in a small number of individual outcomes, overall, the intervention did not lead to girls acquiring a comprehensive set of social, health and economic assets, or change their educational and fertility outcomes. It is important to explore additional interventions that may be needed for the most vulnerable girls, particularly those that address household economic conditions. Additional attention should be given to the social and economic environment in which girls are living. Trial registration ISRCTN29322231 . Trial Registration Date: March 04, 2016; retrospectively registered.

Despite significant public health emphasis on unintended pregnancy prevention among adolescent girls and young women in Sub-Saharan Africa, there is a gap in understanding how adolescents' own reproductive priorities and the social influences on their decision-making align and compete. We examined the social context of contraceptive decision-making among Kenyan female adolescents. Using community-based sampling, we conducted 40 in-depth interviews and 6 focus group discussions among sexually-active or partnered adolescent girls and young women aged 15-19 in the Nyanza region of Kenya. We analyzed the data in Dedoose using an inductive, grounded theory approach, and developed a conceptual model from the data illustrating social influences on adolescent contraceptive decision-making. Participants viewed adolescent pregnancy as unacceptable, and described severe social, financial, and health consequences of unintended pregnancy, including abortion under unsafe conditions. Yet, their contraceptive behaviors often did not reflect their desire to delay pregnancy. Contraceptive decision-making was influenced by multiple social factors, centering on the intersecting stigmas of adolescent female sexuality, pregnancy, and contraceptive use, as well as unequal power in sexual relationships. To prioritize pregnancy prevention, adolescents must navigate conflicting social norms and power dynamics, and put their perceived future fertility at risk. Contraceptive decision-making among Kenyan female adolescents is strongly influenced by opposing social norms within families, communities, and sexual relationships, which compel them to risk stigma whether they use a contraceptive method or become pregnant as adolescents. These findings put into perspective adolescents' seemingly incongruent pregnancy preferences and contraceptive behaviors. Interventions to address adolescent unintended pregnancy should focus on supporting adolescent decision-making agency, addressing fertility-related contraceptive concerns, and promoting innovative contraceptive access points rather than increasing contraceptive prevalence.

Objectives This study determined the correlates of unwanted pregnancy and induced abortion among sexually active female street-involved adolescents (SIAs) aged 10–19 years in two urban cities in South-west, Nigeria. Methods The data for this study were extracted from a larger mixed-method survey dataset on the sexual and reproductive health (SRH) of 1505 street-involved young people aged 10 to 24 years. For the quantitative data, the explanatory variables were age, history of school attendance, employment status, religion, living arrangement and city of residence. The study outcomes were a history of pregnancy and a history of induced abortion of last pregnancy. Binomial regression analysis was performed to determine the association between the explanatory and outcome variables. For the qualitative data generated through focus group discussions and in-depth-interviews, inductive and deductive approaches were used in conducting a thematic analysis to explore the perspectives and experiences of SIA on pregnancy and induced abortion. Results Of the 424 female SIAs, 270 (63.7%) reported having had sex. Sixty-four (23.7%) respondents had a history of pregnancy, of which 38 (59.4%) gave a history of induced abortion of the last pregnancy. A history of school attendance significantly reduced the likelihood of being pregnant (AOR: 0.42, 95% C.I: 0.19–0.91), while 15–19-years-old SIAs who were pregnant were significantly less likely to abort (AOR: 0.13, 95% C.I: 0.02–0.77). Qualitative reports indicated that unintended pregnancy and induced abortion was a common experience among the sexually active SIAs. Many participants were aware of the methods of, and places to induce abortion. Conclusion A large proportion of SIAs are sexually active with a high incidence of unintended pregnancy and a high rate of unsafe abortion. Access of female SIAs to education can reduce the risk of unintended pregnancy. Attention needs to be paid to how SIAs can have access to contraception.

Background Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse pregnancy outcomes and risk factors associated with adolescent pregnancy in Africa. Method PubMed Central, Science Direct and JSTOR were the main databases for the literature review. Other online sources and experts were consulted for relevant studies. In all, 11,574 records were identified and 122 were considered as full-text studies for evaluation after thorough screening and removal of duplicates. Finally, 53 studies were included in this review for thematic synthesis. Results The 53 studies sampled 263,580 pregnant women, including 46,202 adolescents (< 20 years) and 217,378 adults (> 20 years). Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Factors of poor pregnancy outcomes included low socioeconomic and educational status, poor utilization of antenatal care, risky lifestyles such as alcohol consumption, and unattractive health care factors. Maternal health care utilization was identified as an important factor to improve pregnancy outcomes among adolescents in Africa. Conclusion To prevent adolescent pregnancy, stakeholders need to help lower socioeconomic inequalities, poor utilization of antenatal care, alcohol consumption, and improve adolescents’ health care and their educational status. Issues such as child marriage, abortion, poor health care infrastructure and non-adolescent friendly health facilities need to be addressed.

Background Unintended pregnancy has dire consequences on the health and socioeconomic wellbeing of adolescent girls and young women (AGYW) (aged 15–24 years). While most studies tend to focus on lack of access to contraceptive information and services, and poverty as the main contributing factor to early-unintended pregnancies, the influence of sexual violence has received limited attention. Understanding the link between sexual violence and unintended pregnancy is critical towards developing a multifaceted intervention to reduce unintended pregnancies among AGYW in South Africa, a country with high teenage pregnancy rate. Thus, we estimated the magnitude of unintended pregnancy among AGYW and also examined the effect of sexual violence on unintended pregnancy. Methods Our study adopted a cross-sectional design, and data were obtained from AGYW in a South African university between June and November 2018. A final sample of 451 girls aged 17–24 years, selected using stratified sampling, were included in the analysis. We used adjusted and unadjusted logistic regression analysis to examine the effect of sexual violence on unintended pregnancy. Results The analysis shows that 41.9% of all respondents had experienced an unintended pregnancy, and 26.3% of those unintended pregnancies ended in abortions. Unintended pregnancy was higher among survivors of sexual violence (54.4%) compared to those who never experienced sexual abuse (34.3%). In the multivariable analysis, sexual violence was consistently and robustly associated with increased odds of having an unintended pregnancy (AOR:1.70; 95% CI: 1.08–2.68). Conclusion Our study found a huge magnitude of unintended pregnancy among AGYW. Sexual violence is an important predictor of unintended pregnancy in this age cohort. Thus, addressing unintended pregnancies among AGYW in South Africa requires interventions that not only increase access to contraceptive information and services but also reduce sexual violence and cater for survivors.

Background Adolescent pregnancy has been persistently high in sub-Saharan Africa. The objective of this review is to identify factors influencing adolescent pregnancies in sub-Saharan Africa in order to design appropriate intervention program. Methods A search in MEDLINE, Scopus, Web of science, and Google Scholar databases with the following keywords: determinants, factors, reasons, sociocultural factors, adolescent pregnancy, unintended pregnancies, and sub- Saharan Africa. Qualitative and cross-sectional studies intended to assess factors influencing adolescent pregnancies as the primary outcome variable in sub- Saharan Africa were included. Our search was limited to, articles published from the year 2000 to 2017 in English. Twenty-four (24) original articles met the inclusion criteria. Results The study identified Sociocultural, environmental and Economic factors (Peer influence, unwanted sexual advances from adult males, coercive sexual relations, unequal gender power relations, poverty, religion, early marriage, lack of parental counseling and guidance, parental neglect, absence of affordable or free education, lack of comprehensive sexuality education, non-use of contraceptives, male’s responsibility to buy condoms, early sexual debut and inappropriate forms of recreation). Individual factors (excessive use of alcohol, substance abuse, educational status, low self-esteem, and inability to resist sexual temptation, curiosity, and cell phone usage). Health service-related factors (cost of contraceptives, Inadequate and unskilled health workers, long waiting time and lack of privacy at clinics, lack of comprehensive sexuality education, misconceptions about contraceptives, and non-friendly adolescent reproductive services,) as influencing adolescent pregnancies in Sub-Saharan Africa Conclusion High levels of adolescent pregnancies in Sub-Saharan Africa is attributable to multiple factors. Our study, however, categorized these factors into three major themes; sociocultural and economic, individual, and health service related factors as influencing adolescent pregnancies. Community sensitization, comprehensive sexuality education and ensuring girls enroll and stay in schools could reduce adolescent pregnancy rates. Also, provision of adolescent-friendly health services in schools and healthcare centers and initiating adolescent empowerment programs could have a positive impact.