A Study on the Causes of Teenage Pregnancy in Sri Lanka

The goal of this study is to identify the risk factors that contribute to teenage pregnancy at a setting inn Sri-Lanka. The study was carried out in three districts in Sri-Lanka; Colombo, Batticaloa, and Anuradhapura. These districts were selected because they are the ones that represented highest rates of teenage pregnancy. Within each of these districts, the three health administrative areas that had high teenage pregnancies were added in the study. The Medical Officer of Health (MOH) divisions were the target in this case (Mollborn, Dominique and Boardman 4).

The population to be studied comprised of the pregnant females who used to reside in the MOH areas that were selected. These people had not attained the age of 20 at the time they became pregnant, but they had been registered by the Public Health Midwife (PHM) so that they could be provided with antenatal care. Approximately 90 percent of the pregnant women in the region were noted to report their status with the PHM.

The study units that were to be used in the study were not older than three months.

For each pregnant teenager who had been identified, there was non-pregnant teenager who was also identified from the background. Verification documents were the ones that were used to verify the age of the teenagers, and 93 percent of the units in the study managed to provide the documents. In order to verify that the age of conception before attaining the 20th birthday, clinical records were cross checked. 510 pregnant and 508 non-pregnant teenagers were incorporated into the analysis Based on a post-hoc power analysis that was applied to the variable of education level revealed that the size of the sample was appropriate to facilitate in the study (Mollborn, Dominique and Boardman 6).

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The data was gathered by using structured and interviewer administered questionnaires. Before the questionnaires had been developed, a thorough literature review had been carried out in order to help in identifying the potential risk factors to teenage pregnancy, especially in among the Asians. The information from the local was obtained from the information gathered. The risk factors related to teenage pregnancy were grouped into various characteristics, and the questions were formulated thereafter in order to help in gathering the factors associated with teenage pregnancy. A panel of experts in maternal and child health and reproductive health were present in order to help in ensuring the responses that were provided were valid. The panel also assessed whether all the potential risks had been represented in an appropriate manner (Dulitha, Nalika and Upul 4).

The reliability of the questionnaires was determined by adopting the test-retest mechanism. Moreover, informed verbal consent had been obtained from the teenagers and their parents. The teenagers who were aged 20 years and above provided their own informed consent. The interviews were either carried out within the community or in the homes where the participants lived, all measures had been taken in order to ensure that the information the participants presented was private and confident bail (Dulitha, Nalika and Upul 6).

The data collected was analyzed using the Statistical Package for Social Sciences (SPSS). A variable related to the overall knowledge associated with the drawbacks of teenage pregnancy was developed by providing a score to the two questions that were related to the mental and physical unpreparedness of the teenagers towards pregnancy. Those who responded in an accurate manner were described as having good knowledge on the cons of teenage pregnancy. Those who answered either of the two or both questions wrongly were regarded as having poor knowledge regarding the cons of teenage pregnancy (Mollborn, Dominique and Boardman 8).

With respect to univariate analysis, social demography, and other factors that were related to cohabitating, marriage, self-confidence with respect to decision making, traits of the spouse, family support, peer’s support, knowledge regarding reproductive health on pregnancy and contraceptives, were used to help in calculating Odds Ratios (OR), and a 95 percent confidence interval. The Chi-square test would be the one used to help in obtaining the statistical significance for the organization. The multiple logistic regression modelling was used to help in evaluating the adjusted risk factors. All the factors revealed that a significance level of p<0.05 with respect to the univariate analysis had been entered into the model, and that the factors that were not significant (p>0.05) were gotten rid of in a step-by-step manner. The results are revealed in terms of the adjusted Odds Ratios and 95 percent confidence interval (Dulitha, Nalika and Upul 3).

With respect to the pregnant teenagers, 9.8 percent (n=50) were aged 16 years and below, percent (n-240) lie within 17-18 years, while 39 percent (n=199) were aged 19 years, while 4.1 percent (n=21) were at the age of 20 at the time the survey was being carried out. The majority of the population were Sinhalese 52.7 percent (n=269), and the proportion of Tamils and Muslims was 30 percent (n=154) and 17.3 percent (n=87) respectively. Only 1 percent (5n=5) did not have any form of schooling. 9.6 percent (n=49) had undertaken their studies beyond General Certificate of Education.

About 26.1 percent were involved in some form of paid work the previous year, while 9 percent of them were involved in some form of paid work by the time the study was being carried out (Dulitha, Nalika and Upul 7).

Of the teenagers who were pregnant, 8 percent of them revealed that that this was the second time they were pregnant, and 43.9 percent of them were living with a child. None of them reported having more than one pregnancy.

From the study group, 59.6 percent (n=304) revealed that their pregnancy was a planned one, while 40.4 percent (n=206) stipulated that it was not planned. The most common reason that was given with respect to planning for a pregnancy was because the husband wanted a baby (n=243, 79 percent). Out of the unplanned pregnancies (n=206), 31 percent (n=64) used the contraceptive method, where a majority (n=38, 59.4 percento used oral contraceptives. Of the comparison group that comprised of non-pregnant females, 30.5 percent (n=155) were either married or cohabitating at the time the survey was taking place (Dulitha, Nalika and Upul 6).

These are also risk factors that are associated with teen pregnancy. However, when the age at marriage, income of the parents or age at first pregnancy of sister or mother were assessed but they did not serve as potential risk factors to teenage pregnancy. The risk of a teenager becoming pregnant in case the level of regulation and strictness of rules in the family was perceived as ‘not strict’, chances of a teenager becoming pregnant were high as shown; (OR= 2.41, 95 percent CI 1.66-3.51, p<0.001); When the level of family freedom is geared towards discussing problems associated with love affairs (OR= 2.28, 95 percent CI 1.49-3.49, p<0.001); when the level of the family freedom is targeted towards discussing issues related to sexuality; (OR= 3.04, 95 percent CI 1.88-4.91, p<0.001), were perceived by the teenager as being poor and very poor.

There are various aspects in which pregnant teenagers demonstrated higher levels of knowledge. These were as follows; a girl is capable of becoming pregnant at any time after reaching the appropriate age (OR= 1.51, 95 percent CI 1.17-1.96, p=0.002; its possible for a girl to conceive even after engaging in a single sexual intercourse in an unprotected manner (OR= 1.72, 95 percent CI 1.33-2.21, p<0.001; there is a certain period in the menstrual period when it is possible for a girl to become pregnant (OR= 2.09, 95 percent CI 1.61-2.70, p<0.001). However, based on the level of knowledge regarding the cons of teenage pregnancy, it was low in that ‘teenagers who get pregnant do not show signs of preparedness (OR= 1.47, 95 percent CI 1.14-1.89, p=0.003), and that teenage females are not prepared for pregnancy mentally (OR= 1.34, 95 percent CI 1.04-1.73, p=0.023).

Additionally, the knowledge associated with association related to teenage pregnancies and aspects of low weight of children during birth as well as complications related to birth appeared similar in the two groups (Dulitha, Nalika and Upul 8). With regard to all the questions related to cons associated with teenage pregnancy, the teenagers were classified as possessing good level of knowledge if they were able to give correct answers to the four questions asked. Overall, those who demonstrated poor knowledge regarding the cons associated with teenage pregnancy were linked with a higher chance of becoming pregnant (OR= 2.06, 95 percent CI 1.52-2.78, p<0.001). This is illustrated in table 4 in the appendix (Dulitha, Nalika and Upul 8).

While assessing the knowledge associated with contraception, there was a significantly higher number of pregnant teenagers who showed the ability to name at least 4 modern methods of contraception (OR= 1.50, 95 percent CI 1.00-2.25, p= 0.048), as opposed to the non-pregnant teenagers. Moreover, a significantly high number of pregnant teenagers disagreed with the idea of offering special health services in order to young people to obtain contraceptives (OR= 1.51, 95 percent CI 1.12-2.12, p= 0.008. this is as illustrated by table 5 in the appendix (Dulitha, Nalika and Upul 9).

The study also compared how pregnant teenagers perceived the use of contraceptives. In this case, the attitudes appeared similar among the two groups especially with regard to the issue that the children who are born to a family should not be set to the limitations associated with artificial methods, by making use of family planning methods one can harm her chances of getting future pregnancies, making use of a condom significantly bring down pleasure experienced during sexual intercourse, and that the contraceptive methods should not be encouraged to young girls while engaging in sex since this is treated as a sin (Ager, Saltz and Terry 7).

The multiple logistic model is the one that was used in evaluating the adjusted risk factors that lead to teenage pregnancy. All the evaluated factors that demonstrated a significance level of p<0.05 were set into the model, and they are portrayed in table 6 in the appendix. With respect to specific ethnic groups, the risk factors were as follows; Tamil (OR= 3.31, 95 percent CI, 1.83-5.96, p<0.001); Muslim (OR= 1.92, 95 percent CI 1.01-3.66, p<0.04), state of legal marriage (OR= 1.95, 95 percent CI 1.1-3.46, p<0.022), poor overall knowhow regarding the cons of teenage pregnancy (OR3.79, 95 percent CI 2.39-6.04, p<0.001), perception with respect to the level of strictness in the family as ‘not strict’ (OR= 2.01, 95 percent CI 1.08-3.75, p=0.027); perception that the level of support that they realize from their teachers is either poor or very poor (OR= 3.47, 95 percent CI 1.76-6.88, p<0.001), and with respect to the perception of the excellence in self-confidence while making decisions (OR=2.11, 95 percent CI1.34-33.11, p=0.001). These are the risk factors that were identified by the adjusted ORS (Dulitha, Nalika and Upul 10).

By undertaking the community based study, it became possible to compare the groups based on their age and the areas that they resided. As a result, the identified risk factors can be considered to be unaffected by the variations that are experienced as a result of the influence of the social-cultural factors that are specific to the area that one resides (Mollborn, Dominique and Boardman 8).

In the study, the age-pattern revealed that there is a low portion of young teenagers who are pregnant, that is 16 years and below (9.8 percent). The conforming proportion was 27.5 percent, and this was undertaken in a hospital in the Southern part of Sri-Lanka in 2005. The mean age associated with marriage was 15.9 years, and the reports of this issue had originated from rural Nepal, whereby most of the females had ended up with teenage pregnancies. In the US, the 15 to 17 year olds were linked with 25 percent of teenage pregnancies, and 18 percent of the conceptions that had been witnessed in the UK were for girls who were aged 18 years or less (Mollborn, Dominique and Boardman 10).

In the present study, the percentage of young girls who were subjected to teenage pregnancies were 40.4 percent. In a study that was undertaken in Sri-Lanka in2005 revealed there were 54 percent of teenagers who were pregnant, and they were aged below 16 years, while 23 percent were the teenagers who were above 16 years. Nepal indicated a higher figure of 47 percent unplanned, and 34 percent pregnancies that were undesired. The difference in this case could have been that a teenager in Nepal was much younger than a teenager in Sri-Lanka. The studies that have been undertaken in the US and UK, which focus on the rates at which teenagers use contraceptives has ended up being regarded as a form of legal abortion, and is estimated to be approximately 50 percent (Ager, Saltz and Terry 7).

Out of the teenagers who had not planned for any form of not involved themselves with any form of contraceptive use. . This could be an indication of unmet need for the services provided, and this highlighting the fact that a higher proportion of teenagers stipulated that they needed special services to be provided to young people, especially with respect to providing them with a mechanism that can allow them to acquire contraceptives. Additionally, Out of those who were using contraceptives, 59.4 percent indicated that they had conceived while using oral contraceptives, and thus an indication of method failure (Ager, Saltz and Terry 9).

The most common reason why 79.9 percent of the teenagers became pregnant was because their husband wanted a baby. In Nepal, the respondents revealed that authority with respect to the use of contraceptives still remains with the husbands. In the South Asian countries, it is evident that there is a huge imbalance with respect to the roles of gender within a relationship. The idea that most of the teenagers rated themselves as being excellent with respect to decision making, indicates that their husbands played a vital role in terms of influencing their decision to become pregnant. This is an illustration of gender imbalance, and this forces most of the teenagers to give birth before they are emotionally and physically ready (Dulitha, Nalika and Upul 12).

The lack of sufficient education serves as a risk factor that influences teenage pregnancy in the current study. This incidence has long been documented in as a risk factors among teenagers in some of the developed nations such the US, European countries and the South Asian nations. The low socio-economic status is also another factor that is consistent with the issue of teenage pregnancy in the developed nations as well as in the South Asian countries. The study matched a comparison in Sri-Lanka (Ager, Saltz and Terry 6).

The legal age of marriage in Sri-Lanka is 18 years. From the study, 83.4 percent of the respondents claimed that they had been married on legal terms. However, with respect to age distribution, 50 percent of the teenagers who were pregnant had not yet attained the legal age to marry when the survey was being conducted. In Sri-Lanka, most of the underage couples make requests in order for their marriage to be registered (Dulitha, Nalika and Upul 13).

From the paper, it is evident that personal characteristics such as poor supervision by parents, low levels of education, poor teacher support have been identified as the key risk factors attributed to teenage pregnancy. Most of the other identified factors can be modified. In this case, it is recommended for the parents of adolescents to provide their children with longer years of education, as well as improve the communication between the adolescents and themselves. There should be a need for offering parenting education programs into the preventive care services that are offered in the country. Moreover, the identified risk factors should be communicated to the PHM in order to facilitate provision of care to those adolescents that have families in order to bring down incidences of teenage pregnancies and marriages.

Works Cited

1. Ager, Joel, Eli Saltz and Robert Terry. Predicting Teenage Pregancy. New York: US Department of Health and Human Services, 2004. Print.
2. Dulitha, Fernado, Gunawardena Nalika and Senarath Upul. “Risk Factors for Teenage Pregnancies in Sri-Lanka: Perspective of a Community Based Study.” Health Science Journal 7.3 (2013): 269-284. Print.
3. Mollborn, Stefanie, Benjamin Dominique and Jason Boardman. Racial, Socio-Economic, and Religious Influences on School-Level Teen Pregnancy Norms and Behaviors. Colorado: University of Colorado, 2011. Print.