Adolescence can be a time of making irrational, impulsive decisions. It can be a time of living in the now, without consideration for the consequences that may follow. As a result, it is a time in which many teens try drugs and alcohol for the first-time. The average age of substance use initiation is between 13 and 14 years old, in seventh and eighth grade, before one even enters high school. This is a harrowing reality to face.
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Teenage pregnancies and teenage motherhood are a cause for concern worldwide. From a historical point of view, teenage pregnancies are nothing new. For much of human history, it was absolutely common that girls married during their late adolescence and experienced first birth during their second decade of life. This kind of reproductive behavior was socially desired and considered as normal. Nowadays, however, the prevention of teenage pregnancies and teenage motherhood is a priority for public health in nearly all developed and increasingly in developing countries.
For a long time, teenage pregnancies were associated with severe medical problems; however, most of data supporting this viewpoint have been collected some decades ago and reflect mainly the situation of per se socially disadvantaged teenage mothers. According to more recent studies, teenage pregnancies are not per se risky ones. A clear risk group are extremely young teenage mothers younger than 15 years who are confronted with various medical risks, such as preeclampsia, preterm labor, and small for gestational age newborns but also marked social disadvantage, such as poverty, unemployment, low educational level, and single parenting.
In the present study, the prevalence and outcome of teenage pregnancies in Austria are focused on. According to the World Health Organization WHO , about 16 million girls aging between 15 and 19 years and about one million girls younger than 15 years give birth every year [ 1 ].
Nowadays, the vast majority of teenage pregnancies occur in low- and middle-income countries characterized by poor health-care services; therefore, complications during pregnancy, birth, and postpartum phase e. Additionally, it is estimated that some three million teenage girls undergo unsafe abortions, which may result in consecutive reproductive problems or even death [ 1 ].
Although in traditional societies the majority of these pregnancies are socially desired, several studies have pointed out the enormous risks which are associated with teenage pregnancies [ 3 , 4 ], such as anemia, preterm labor, urinary tract infections, preeclampsia, high rate of cesarean sections, preterm birth, and low birth weight infants and even maternal and newborn mortality.
Teenage pregnancies, however, still also occur in high-income countries and despite much better medical care teenage pregnancies are also considered as risky and policy tries to avoid too early motherhood [ 1 ]. This is not only due to medical problems, but first of all the social consequences of teenage motherhood. Therefore, the analyses of causes and consequences of teenage pregnancies have been the topic of much research and debate [ 5 — 7 ].
The present paper focuses on the biological, medical, and social aspects of teenage pregnancies with special respect to the situation of Austria, a country with exceptionally high standards in medical and social care. A girl can conceive from sexual intercourse as early as she started to ovulate. Usually, the first ovulation takes place after the first menstrual bleeding, the menarche [ 8 ].
Girls experience menarche at very different ages and it is quite difficult to estimate the mean age at menarche worldwide, because significant differences between individual countries, but also between subpopulations within a country, are observable [ 9 ]. Commonly, the mean age at menarche is considered as 13 years, the median, however, as 14 years [ 9 ].
Consequently today menarche occurs mainly in the first half of the second decade of life. From the viewpoint of human life history theory, this stage of life is called adolescence: Adolescence starts with pubertal hormonal changes such as the activation of the hypothalamus-pituitary-gonad-axis and can be divided into early and late adolescence. Early adolescence is defined as an age of 15 years and below, late adolescence means an age of 16—19 years. From the viewpoint of evolutionary biology, adolescence seems to be a very recent phenomenon [ 10 ].
It is not found before Homo sapiens and may lead to a fitness advantage because it is a phase of socio-sexual maturation and of acquisition of social and economic skills which may increase reproductive success during later life.
During early adolescence, successful reproduction was and is rare. The years following menarche are often characterized by anovulation and consequently the likelihood of successful conception is quite low [ 11 ].
Furthermore, a mean age of menarche of 13 years is a quite recent phenomenon. Although the reliability of data concerning age at menarche in historical times has to be questioned, it can be assumed that over the past years the age of menarche has fallen substantially across all developed countries [ 9 ]. In the s, the average age at menarche was This decline of menarcheal age is the consequence of the so-called secular acceleration trend, which was induced by improved living conditions, infection control, and an improvement of nutrition [ 13 ].
In the s, the secular trend in menarcheal age had slowed down or ended in many European countries and the United States [ 14 ]. Better living conditions and sufficient food supply, however, resulted not only in earlier sexual maturation but also in an increase in the rate of ovulatory cycles soon after menarche.
In other words, the risk of becoming pregnant shortly after menarche increased too. The secular trend, however, affected not only sexual maturation, on the other hand peak height velocity and the development of secondary sexual characteristics such as breast development take place much earlier and most adolescent girls often look like young ladies, long before they reach mental maturity [ 15 , 16 ].
Consequently, these girls may feel that they are old enough to start with sexual activity. Although sexual freedom and activity patterns among adolescent girls differ markedly according to cultural and religious background, we have to be aware that today nearly half of the global population is less than 25 years old. Even the generation of adolescents, that is, individuals between 10 and 19 years [ 1 ], is the largest in our history.
Teenage pregnancies and teenage motherhood were considered as normal and often socially accepted in previous centuries and even during the twentieth century in Europe. It was absolutely common that first births took place during adolescence for much of human evolution and history. Girls married during adolescence and gave birth during their second decade of life. This kind of reproductive behavior was socially desired and considered as normal [ 17 ].
It is documented that Hildegard of Vinzgouw, the second wife of Charlemagne, was about 14 years old when she delivered her first son in AD. These are only few historical examples; childbirth during the second decade of life is quite common even today. In , there was much debate concerning the teenage motherhood of Bristol Palin, the daughter of Sarah Palin, the Governor of Alaska and vice presidential candidate of the United States.
Pregnancies during early adolescence girls under the age of 15 , however, have always been rare. This was mainly due to the biological fact that menarche and reproductive maturity were experienced much later in historical times than today. Furthermore, sexual activity of girls and young women was mainly related to marriage until the second half of the twentieth century [ 9 ].
Today, the first sexual activity is initiated at a much younger age, and the use rate of contraception among this age group, however, is rather low [ 18 , 19 ]. Therefore, the probability of pregnancies during teenage age increased worldwide during the second half of the twentieth century. Today, teenage pregnancies are a worldwide phenomenon. According to the World Health Statistics , the average global birth rate among 15—19 year olds is 49 per girls, whereas country rates range from 1 to births per girls.
Rates were highest in Sub-Saharan Africa [ 20 ]. In these countries, teenage birth rate births per women aged 15—19 ranges from in Niger to in the Central African Republic. This is mainly due to the fact that childbearing among teenagers is socially desired in some traditional societies and in developing countries [ 22 ]. Therefore, a substantial proportion of teenage pregnancies and births are therefore intended in developing countries.
In developed countries, by contrast, teenage birth rates are quite low and teenage motherhood is discouraged, debated as a public health problem and considered as a societal challenge. Nevertheless, there are considerable differences in teenage pregnancy rates between the different developed nations. However, we have to be aware that contained in all of these data sources the teenage birth rate focused on girls aged between 15 and 19 only. The extremely vulnerable group of teenage mothers younger than 15 years is not accounted for in the majority of statistics quoted.
This social pressure to reproduce as early as possible increases the mortality rate among early adolescent girls such as in Bangladesh where the risk of maternal mortality may increase fivefold among mothers aging between 10 and 14 years in comparison to adult women [ 21 ]. Female reproduction has always been risky and doubtless pregnancies and births are, independent of maternal age, critical phases in the life of mother and fetus. Teenage pregnancies were seen as a special problem because adverse health consequences of teenage pregnancies were solely attributed to the young maternal age for a long time.
Teenage pregnancy is labeled alongside obesity, diabetes, cardiovascular disease, and cancer rates as a major public health problem [ 5 , 7 , 28 ]; the classification of teenage pregnancies as a high-risk category and a major public health concern, however, is debated controversial today.
Adverse medical effects of teenage pregnancies have been reported mainly in quite old studies dated back to the s. At this time, teenage pregnancies were seen as obstetric problems per se, which are associated with an increased risk of anemia, preterm labor, urinary tract infections, hypertension, preeclampsia, a high rate of cesarean sections but also preterm birth, low birth weight, and intrauterine growth restriction [ 5 , 15 , 29 — 35 ].
These observations, however, are based on studies among social-deprived subpopulations and from third-world countries with very poor medical conditions [ 30 , 36 — 38 ]. During the s, this viewpoint of teenage pregnancies changed markedly. Studies from more economically advantaged clinics in developed countries yielded no increased obstetrical problems among teenage mothers compared with older mothers [ 32 , 33 , 39 — 42 ].
A recent study from Austria showed clearly that the obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. Cesarean section rate remained the same in the adolescents during the last 18 years, and the incidence of abnormally adherent or incomplete placentas decreased.
The authors concluded that teenage motherhood is a social problem and not an obstetrical or a clinical one [ 43 , 44 ]. Adverse health consequences and poor pregnancy outcome among teenage mothers seem not to be associated with low gynecological or chronological age of the mothers but with adverse life circumstances [ 4 , 45 ] because the highest proportions of teenage pregnancies occur in most socioeconomically disadvantaged subpopulations or in developing countries.
Therefore, in developed countries teenage pregnancies and teenage motherhood were no longer seen as medical risk but as a social problem because teenage motherhood has numerous deleterious social consequences for mother and child. What remains unknown is the extent to which these poor outcomes result from teenage pregnancies or from per se social disadvantages which affect the teenage mother already before pregnancy.
It is really a chicken-egg debate because it remains unclear if social disadvantage is the reason or the result of teenage motherhood [ 47 ]. Some recent studies have demonstrated that a well-acting social welfare system including appropriate psychosocial support and prenatal care improves the obstetric outcome in teenage mothers significantly [ 48 — 51 ]. In this case, teenage pregnancy outcome may be comparable with, or even better than, that in older mothers [ 4 , 52 ].
The second goal is the efficient reduction of teenage pregnancies per se. The World Health Organization published guidelines in to prevent early pregnancies and reduce poor reproductive outcomes [ 1 ]. The six main objectives were defined as follows:. The main purpose of this program is to avoid getting pregnant. Unfortunately, sex education is lacking in many countries and consequently young girls are not aware about physiological basis of reproduction and contraceptives.
Furthermore, many girls may feel too inhibited or ashamed to seek contraception services. On the other hand, contraceptives are sometimes too expensive or not widely or legally available.
Consequently, the most important strategies to avoid teenage pregnancies are improved education of girls, the introduction or improvement of sexual education, and the availability of cheap and easy to use contraceptives [ 1 , 53 ].
A cornerstone in reducing adolescent sexual-risk behaviors and promoting reproductive health is sex education programs. School-based programs have the potential to reach the majority of adolescents in developed countries and large number of adolescents in countries where school enrollment rates are high [ 54 , 55 ].
It is well documented that sex education programs may increase knowledge of human reproduction and methods of contraception [ 56 ]. Developed countries with the lowest rates of teenage motherhood are characterized by advanced school-based sex education but also broad availability of contraceptives including postcoital emergency contraception, and a liberal abortion law [ 57 — 59 ].
Since not all adolescents are in school especially in developing countries, sex education programs have also to be implemented in clinics, community organizations, and youth-oriented community agencies. According to the Forbes list , Austria is the 12th richest country in the world and according to the gross domestic product GDP per capita the third richest country in the European Union. The standard of living is exceptionally high in Austria; this is especially true of the social welfare system which includes public health service for all inhabitants on nearly equal conditions and universal health insurance coverage.
Furthermore, 9 years of education are mandatory in Austria. After compulsory basic school for 4 years, pupils have the option to visit higher-learning institutions that prepare one for university for 8 or 9 years, or to go on to vocational-preparatory schools for 5 years. Since , sex education is mandatory in all schools and is provided at the age of 10, 14, and 16 years.
Beside school-based sex education programs, special outpatient departments for adolescents such as the so-called first love outpatient department in Vienna were implemented. Adolescents have access to these institutions free of charge.
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Developmental Milestones for Teens
The Healthy Teens Coalition HTC is dedicated to reducing risky behaviors by providing Manatee County youth with the knowledge and skills to make informed choices about their physical, mental, and emotional health and.
Click here for. Teen Health. Educator Program. Go Grrrls. Go Grrrls is a nationally validated therapeutic mentoring program which is offered as a before and after school program, and during the summer, for middle and high school girls. These therapeutic mentoring sessions are facilitated by experienced, dedicated human services professionals.
Sessions are facilitated by experienced, dedicated human services professionals. These Teen Health Educators will focus their peer education on the migrant farmworker and minority teen populations in order to reduce high risk behaviors, including teen dating violence, teen pregnancy and sexually transmitted illnesses.
Local government proclamations : We engage local government entities in recognizing the impact of teen births, including contributing factors and long term implications, in Manatee County, through proclamations, including the Bradenton and Palmetto city councils, the Manatee County Board of Commissioners, and the school board.
We do this in partnership with our Youth Advisory Council. Annual Teen Pregnancy Prevention Awards Reception : The HTC holds a reception to raise awareness and visibility of Teen Pregnancy prevention Month and to recognize local nonprofits, young people, and elected officials who have shown leadership in prevention and intervention strategies.
In the HTC organized and hosted a school board candidate debate to highlight candidate position and ideas on issues impacting our teens. The Healthy Teens Coalition HTC is dedicated to reducing risky behaviors by providing Manatee County youth with the knowledge and skills to make informed choices about their physical, mental, and emotional health and well-being.
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