Unplanned teenage pregnancy prevention. Introduction

1 Unplanned teenage pregnancy prevention Introduction Unplanned Teenage pregnancy is becoming a serious problem in many countries, including Thailand. It creates many related impacts such as health, economic, social and cultural problems. It is surprising that the rate of teenage pregnancy increases each year. According to the records of the Health Department, it shows that the rate of teenage pregnancy in Thailand in April, 2008 had increased to 14.7%, while the World Health Organization recommended that it should be no greater than 7%. The actual rate of teenage pregnancy is still in doubt and difficult to be evaluated as the records of the Health Department consist of only teenage mothers who wish to continue their pregnancy, it does not include the rate of criminal abortion. So the actual rate of teenage pregnancy ought to be greater than the rate in the official report. Therefore it can be stated that unplanned teenage pregnancy is a major problem in Thailand and it needs to be solved. However, unplanned teenage pregnancy CAN BE PREVENTED. The prevention of this situation should be managed urgently. Therefore, this project is proposed to work more on this issue. If this project is successful, it is not only preventing teenagers becoming pregnant or preventing the consequences and problems from their pregnancy, but it can also prevent them from sexually transmitted diseases. In my opinion, even though unplanned pregnancy is a difficult issue to be solved, I believe that it can be solved if we contribute our intention to do so because it has so many factors involved and I will try my best in every way possible to help Thailand solve this problem. So that Thailand will have good human resources to develop our country. I researched the internet, newspapers and television and discovered that unplanned teenage pregnancy has many related problems falling into 3 main topics as follows 1. Health problems: It happens with both teenage mothers and perinatal outcomes. According to Reference NO. 1 3, attached in the page 10, it showed that teenage mothers had rates of anemia in pregnancy, preterm delivery and low birth weight infants greater than other mothers who became pregnant after their twenties. Although the research of Loto OM et. all (1) and the research of Suebnukarn K et. all

2 (2) showed that these increasing risks are associated with non utilization of prenatal care and not because of their chronological age. However I think maybe because of their young age, it made them not get adequate prenatal care, possibly because it was an unintended pregnancy or maybe because they didn t realize how important prenatal care is. It may also due to embarrassment when other people know that they are pregnant during their high school studies. These complications such as anemia in pregnancy, preterm delivery, low birth weight cause a great deal of trouble to teenage mothers. The physical health of teenage mother may not be so serious, just only anemia but I think the psychological impact on teenage mothers is far more serious. Apart from the anxiety during pregnancy, like other mothers, teenage mothers have additional stress regarding their socioeconomic status and the perinatal complication. Preterm delivery is the significant risk factor that increases morbidity and mortality rate in newborns. Preterm delivery increases risk of neonatal jaundice, respiratory distress, necrotizing enterocolitis, intraventricular hemorrhage and low birth weight. These perinatal complications can cause stress to teenage mothers and can bring about psychological health problems. The discussion above addresses only teenage mothers who decide to continue their pregnancy. However, if they decide to terminate their pregnancy themselves, it means that they undergo the criminal abortion, as in Thailand, it is not allowed to do the abortion unless the abortion committee agree to do so. Undergoing criminal abortion increases the risk of septic abortion, bleeding per vagina, and if there is massive bleeding it can cause and result in hypotension, shock and death. As a consequence of unprotected unsafe sex it may not only cause pregnancy but it can also be the cause of sexually transmitted diseases. Some of them are curable, some are not and some can cause vertical transmission to the fetus such as syphilis, hepatitis B infection, HIV infection. These are the health problems in Thailand nowadays. 2. Economic problems : Teenage pregnancy not only causes health problems but it also impacts and effects the economic status. As I discuss above, infants born from teenage mothers have a greater risk of preterm delivery. Preterm infant has many complications and significant risk factors. It may be said that complications in teenage pregnancy takes more courses, longer stay of hospitalization, and the need for more

3 provision of health care. It is unfortunate that if the infants have intraventricular hemorrhage and have subsequent neurological deficits, it means that our country does not have the benefit of one working person and instead has to take care of one disabled person. In addition, if teenage mothers decide to have a criminal abortion and have complications, it means the government has to pay for the course of medical therapy, too. Moreover, if teenage mothers have sexually transmitted diseases, the government also has to pay more on this problem. In addition, if their children were infected vertically, it doubles the course. Some of these diseases can be cured. However, some are chronic diseases, so that means the government have to spend money each year to pay for the course. Apart from the worthiness of economics and human resources, teenage mothers tend to discontinue their study, so it impacts their incomes, as when you have a low level of study, you got paid the lower rates. You will be paid in line with your level of education. This becomes a vicious cycle, when the teenage mothers have low incomes, they can not take enough care of their babies. This may result in a broken family and their children will become teenage mothers and continue this vicious cycle forever. If most Thai teenagers become mothers before they are ready, what will happen to our future? 3. Social and cultural problems: This is an important problem too, as teenagers have less experience, less level of study, less emotional control and maybe less income than adults. If two teenagers decide to build up a family together, they are in greater risk of ending up in a broken family. In my opinion, raising up one child to be a good adult is not easy, it needs warm family, good incomes and good role model. So if the teenage family breaks up, the child will become an orphan and become a social problem, contributing to the vicious cycle again. Teenage mother who break up with her husband, may cause her child to become an orphan and this may lead to becoming a teenage mother again.

4 The problems and statistical report above show that unplanned teenage pregnancy is an important problem for Thailand and needs to be solved. During the past, many organizations have tried to solve it but the fact shows that the rate of teenage pregnancy increases each year. It would therefore suggest that the way we tried to solve this problem in the past is not effective. I searched the internet and found one organization in the United States of America, which is successful in solving this problem. This organization is named Advocates for youth which was established in 1980 as the Center for Population Options. It provides help for young people to make informed and responsible decisions about their reproductive and sexual health. The organization visions are 3Rs as follows. *RIGHTS: Youth has the right to accurate and complete sexual health information, confidential reproductive and sexual health services, and a secure stake in the future. RESPECT: Youth deserves respect. Valuing young people means involving them in the design, implementation and evaluation of programs and policies that affect their health and well-being. RESPONSIBILITY: Society has the responsibility to provide young people with the tools they need to safeguard their sexual health, and young people have the responsibility to protect themselves from too-early childbearing and sexually transmitted infections (STIs), including HIV. * coded from www.advocatesforyouth.org I have chosen this organization to be my role model to solve this problem. Why did I choose Advocates for youth? Because Advocates for youth is the only organization that works both in the United States and in developing countries such as China, Chile, Cameroon, Nigeria, Kenya, Zimbabwe, and Uganda. This organization established science & success which is about programs that work to prevent teenage pregnancy in developing countries in 2005 and it established programs that work to prevent teenage pregnancy in the United States in 2008. This organization also opens the opportunity for internship. *The goal of Advocates' internship program is to provide undergraduate/graduate students with a successful and meaningful opportunity to learn

5 about Advocates' mission and programs, contribute to the work of the organization during a limited time period, and gain meaningful professional experience. *coded from www.advocatesforyouth.org I also have my own project to prevent teenage pregnancy, so I decided to learn about Advocates mission and programs to compare with my project which I want to do in Thailand in the future. Objectives 1. To learn about Advocates mission and programs which help to prevent unplanned teenage pregnancy. 2. To learn about Advocates structure, why this organization is strong and can continue their mission for over 25 years, in order to build up one strong and effective organization to prevent teenage pregnancy in Thailand. 3. To compare my own project with the programs that work to prevent teenage pregnancy, in order to create the most effective program to prevent unplanned teenage pregnancy in Thailand. Methodology to run the Project I will apply for a job in the Advocates for youth organization, to learn about their mission and to learn about their established paper, Science & Success : Programs that work to prevent teenage pregnancy, both in developing countries and in the United States. I will ask for help to create a program which will help to prevent unplanned teenage pregnancy in Thailand. Outcome of the Project 1. To know and understand the structure and the working process of the professional organization which will help in preventing unplanned teenage pregnancy. 2. To build up an organization which will help in preventing unplanned teenage pregnancy in Thailand. 3. To decrease the rate of teenage pregnancy and it s complications.

6 4. Teenagers will have some one who understands and can help them when they are facing sexual problems 5. Teenagers will know the right way to access the various contraceptive methods. 6. Thailand will not have to allocate and pay huge budgets to solve the complications and results of teenage pregnancy. 7. Thailand will have good human resources. Future plan When I return to Thailand, I will start my project to prevent unplanned teenage pregnancy, following the strategies which I have learnt from the Advocates for youth. I will try to ask the government for support to create an organization which pays attention to unplanned teenage pregnancy prevention. I will build up and maintain the connection to the Advocates for youth to ensure achieving better results in teenage pregnancy prevention in the future. About My project I write this project to support the prevention of unplanned teenage pregnancy in Thailand. Objectives 1. To study teenagers sexual behaviors which increase the risk of teenage pregnancy such as unsafe sex, multiple sexual partners. 2. To study the change of teenagers sexual behaviors after they undergo the Educational program (Program that thought to help with preventing unplanned teenage pregnancy) 3. To evaluate the effectiveness of the Educational program Study design : Before After study (Study sexual behaviors before and after receiving educational program) Population and sample group : Population : teenagers whose age between 11 19 years old, who are studying in High school. Sample group : collect from the population by random sampling. Making the equivalent sample size of the early adolescent (11-14-year-old) and the late adolescent (15-19-year-old).

7 Exclusion criteria 1. Unwilling to join this project. 2. Chronically ill people. 3. Pregnancy or have been pregnant before. Research methodology 1. To random sampling the sample group from the population. 2. To explain the objectives of the project and the research methodology to the sample group and the parents, then get the informed consent. 3. To collecting the baseline questionnaires about teenage sexual behaviors. 4. To undergo the Educational program. 5. To follow up 6 months after having undergone the educational program, by using questionnaires to evaluate the sexual behavioral change. 6. To collect data and analysis Outcome The behaviors that thought to help decrease the risks of unplanned teenage pregnancy are 1. To delay first sexual intercourse. 2. To increase the use of contraception. 3. To decrease incidence of unprotected sex. 4. To decrease number of sexual partners. 5. To decrease frequency of sexual intercourse. Educational program The educational program that I think can help prevent unplanned teenage pregnancy consist of 1. VDO about unplanned pregnancy in teenagers. 2. Small group discussion about this topic. 3. CAI (Computer assisted instruction) about unplanned teenage pregnancy. 4. Webboard and e-mail.

8 VDO : unplanned pregnancy in teenagers : This VDO shows the impact of unprotected unsafe sex such as pregnancy and sexually transmitted diseases. The first part shows physiological change in pregnant women such as weight gain, nausea, vomiting, leg swelling, muscle cramps, frequency of urination, nocturia, constipation and etc. The second part shows the reaction of their parents, their boyfriends and their friends and also shows the impact of pregnancy on daily life. The next one shows term pregnancy, labor pain and mode of delivering the baby. The last one shows the brief example about the difficulty of taking care of the infants. I choose VDO for the educational program because I think teenagers can understand well in the objective form. I mean if they see the fact about pregnancy, maybe they change their mind, not to be pregnant. I believe that this VDO could help preventing of unplanned pregnancy. Group discussion : This session is the small group discussion about the unplanned pregnancy in teenagers. This is a good chance that teenagers and health care workers will have the opportunity to exchange this views. In this session, teenagers and health care workers will discuss about the benefits and the complications of unplanned teenage pregnancy and then make the conclusion how to solve this problem. I think this is a good opportunity to know the vision of teenagers about this issue, in order to hit to the point of the problem. CAI (Computer assisted instruction) : This CAI is about unplanned teenage pregnancy. The content of this CAI is similar to the VDO but I think it is more advantage because the teenagers can bring the CAI home and study more by themselves, and if they like, they can study in group with their friends at home. Webboard & E-mail address : Teenagers are now connect together in the internet world, so it is a good chance to get to them by using the webboard and the e-mail address. We will contact each other by using the ID no. It means that you don t have to show yourself. So teenagers can ask whatever they want to know which sometimes they are shy to ask in the class. Webboard and e-mail are the good media that connect teenagers and health care workers together.

9 Data analysis By dividing sample group into two groups, first the early adolescent (age 11 14-year-old) the second is the late adolescent (age 15-19-year-old). Comparing the behavioral change before and after undergo the educational programs within the same group and among two groups. Considering factors that thought to be a preventive factors for unplanned pregnancy are 1. To delay first sexual intercourse. 2. To increase the use of contraception. 3. To decrease incidence of unprotected sex. 4. To decrease number of sexual partners. 5. To decrease frequency of sexual intercourse. I also intend to analyse comments about the educational program too, in order to create the better educational programs, and to know teenagers feeling about it. Benefits Direct benefits 1. To know the actual sexual behavior of teenagers that increase the risk of unplanned pregnancy, in order to be a guideline to create the more effective programs. 2. Teenagers know the right method of contraception, so it implies that the rate of unplanned teenage pregnancy and rate of criminal abortion should be reduced. 3. To decrease the rate of teenage pregnancy, so it will decrease its complication too. 4. The government can safe the budget which was used for this problem. 5. We can maintain our culture, which is not to be pregnant before married. Indirect benefits 1. To decrease the rate of broken family, so the smallest social unit (family) can produce good human resource. 2. Thailand has good quality of next generation human resources because teenagers can continue their study until they finish Bachelor s degree.

10 Reference 1. Poor obstetric performance of teenagers: is it age- or quality of care-related? Loto OM, Ezechi OC, Kalu BK, Loto A, Ezechi L, Ogunniyi SO. J Obstet Gynaecol. 2004 Jun;24(4):395-8. 2. Poor obstetric performance of teenagers: is it age- or quality of care-related? Loto OM, Ezechi OC, Kalu BK, Loto A, Ezechi L, Ogunniyi SO. J Obstet Gynaecol. 2004 Jun;24(4):395-8. 3. The incidence and complications of teenage pregnancy at Chonburi Hospital. Watcharaseranee N, Pinchantra P, Piyaman S. J Med Assoc Thai. 2006 Oct;89 Suppl 4:S118-23 4. http://www.advocatesforyouth.org

11 Questionnaire ID no. - This questionnaire has 2 parts. The first one should be done when you first join this project and then 6 months later you will be asked to complete the second one. Your answers will be kept confidentiality and your name will not be disclosure. We will connect together by using the ID no. Please give the true answer, in order to get the actual data about teenager sexual behaviors. Part I : you will be asked to complete this part when you first join this project 1. Personal data 1.1 Age... years gender female male now studying in grade... 1.2 Have you ever been pregnant before? yes no 1.3 Are you pregnant? yes no 1.4 Are you drink alcohol? yes amount...per month no 1.5 Are you smoking? yes amount /day no 1.6 Do you use any substance abuse? yes (please give detail)... no 2. Sexual behavior 2.1 Have you ever had boyfriends/girlfriends? yes, How many boyfriends/girlfriends you ever had?... no 2.2 Are you having boyfriends/girlfriends right now? yes no 2.3 Have you ever had sexual intercourse with your partner? yes, I had my first sexual intercourse when I was year no, I had never had (Skip 2.4, 2.5 answer no. 2.6) 2.4 Are you now sexually active? yes, and it s about times/month no

12 2.5 Do you have only single sexual partner? yes no, I have (number of sexual partners)..sexual partners 2.6 For non sexually active, do you think you will have sexual intercourse with your boyfriends/girlfriends? Of course, when do you think is the right time to do so? when you are dating for a while whenever your boyfriends/girlfriends ask for when you are sure agree to marry I m not sure Not before I am married 2.7 Have you ever use any contraception before? yes, I used (you can answer more than one choice) oral contraceptive pills post coital pills implant intrauterine device transdermal contraception condom others... no, I ve never used any contraception before. 2.8 What kind of contraceptive methods do you know? oral contraceptive pills post coital pills implant intrauterine device condom transdermal contraception others...

13 2.9 What do you want to know about contraception? (you can answer more than one choice) efficacy of each contraceptive methods. You want to know the efficacy of oral contraceptive pills post coital pills implant intrauterine device condom transdermal contraception others... Side effects of each contraceptive methods. You want to know the side effects of oral contraceptive pills post coital pills implant intrauterine device condom transdermal contraception others... New contraceptive methods I don t want to know about the contraception others...... 2.10 Who are your consultants when you have sexual problems? father mother brothers/sisters friends health care workers others... 2.11 When you have sexual problems, how can you get to your consultants? face to face using the telephone by e-mail by instant message program eg. MSN go to hospital or clinic others...

14 2.12 What is the disadvantage of teenage pregnancy? discontinue studying increase course of living it s a stressor broken up with your boyfriends/girlfriends others...... ***Thank you for your answers, you will be asked to finish part II 6 months later***

15 Part II (You will be asked to finish this part 6 months after you join the project) 1. Sexual behavior during the last 6 months 1.1 During the past 6 months, are you now sexually active? yes, and it s about times/month no 1.2 During the past 6 months, do you have only single sexual partner? yes no, I have (number of sexual partners)..sexual partners 1.3 For sexually active during the past 6 months only, do you use any contraception? yes (you can answers more than one choice) oral contraceptive pills post coital pills implant intrauterine device condom transdermal contraception others... no, why didn t you use any contraception? I want to be pregnant I quit because of the side effects (please give detail).... I don t know any contraceptive methods others... 1.4 For non sexually active in the past 6 months, do you think you will have sexual intercourse with your boyfriends/girlfriends? Of course, when do you think is the right time to do so? when you are dating for a while whenever your boyfriends/girlfriends ask for when you are sure agree to marry I m not sure Not before I am married

16 2. Comments about the educational program 2.1 What do you think about the VDO? it is useful To let you know physiological change of pregnancy To let you know the impact of pregnancy on your daily life To let you know the complication of your infants Others.... it s worthless I haven t seen this VDO before 2.2 What do you think about the group discussion? it is useful To let you know physiological change of pregnancy To let you know the impact of pregnancy on your daily life To let you know the complication of your infants Others.... it s worthless I haven t joined this session 2.3 What do you think about the CAI? it is useful To let you know physiological change of pregnancy To let you know the impact of pregnancy on your daily life To let you know the complication of your infants

17 Others.... it s worthless I haven t had the CAI 2.4 What do you think about the webboard&e-mail? it is useful To share the knowledge and experience To get the consultation from health care providers Others.... it s worthless I haven t been access to the webboard or e-mail before ***Thank you for your answers***