Adolescent pregnancy is a major public health concern, especially given that the affected girls are too young to deal with the psychological, social, and economic issues surrounding bearing children. According to the Centers for Disease Control and Prevention (CDC) (2019), in the US, the birth rate of women aged between 15 and 19 years is estimated at 18.8 per 1,000 women. However, this problem disproportionately affects minority groups mainly due to the associated health determinants. For instance, in 2017, birth rates among Hispanic and black teens were 28.9 and 27.5 respectively, which was two times higher as compared to the rate for non-Hispanic white teens, which stood at 13.2 (Martin et al., 2018). These numbers underscore the problem of adolescent pregnancies in the US and the various underlying issues that determine who is affected the most. This paper is a case scenario discussing this public health problem involving a pregnant adolescent girl, CT.
Medical and Psychological Concerns
Adolescent pregnancy is associated with a wide array of adverse outcomes including mental health problems, such as post-traumatic stress disorder (PTSD), depression, and substance abuse. According to Corcoran (2016), depression is the most common mental problem associated with adolescent pregnancy. The majority of the risk factors of adolescent pregnancy, such as poverty, lack of parental guidance, low employment and educational levels, and limited social support networks are significant independent causes of depression. Therefore, when it occurs, pregnancy compounds an already existing problem with long-term effects on the affected mothers. SmithBattle and Freed (2016) emphasize that when teens become mothers, “early adversities are further compounded by the stress of parenting, economic hardships, intimate partner violence, and the stigma of early childbearing” (p. 32). Additionally, by being young and inexperienced, pregnant adolescents are prone to psychological distress. The process of carrying a pregnancy to term and delivering is laborious both psychologically and physically even for adults. Therefore, adolescents would be affected more adversely by this process, which ultimately leads to depression and other related mental problems.
The psychological concerns posed by adolescent pregnancy are compounded by the understanding that such individuals rarely seek professional help. According to SmithBattle and Freed (2016), the main barriers to treatment of mental health problems among pregnant adolescents include the stigma associated with such illnesses, lack of financial resources and time coupled with demands of work, school, and parenting together with lack of transportation and trumped self-care. Additionally, mentally ill adolescent mothers fear the possibility of losing their children after seeking treatment. Ultimately, with untreated mental problems, the affected young mothers are likely to resort to substance abuse, which most probably undermines maternal functioning. In addition, the chances of repeat pregnancy are high. Under these circumstances, these mothers might parent their children harshly by being less responsive to cues that are needed for a healthy upbringing. As such, children born under these circumstances are also exposed to the predisposing factors of early pregnancy and the cycle continues to ultimately affect the quality of life of generations.
Additionally, from a clinical perspective, the fact that an adolescent is pregnant points to the possibility of widespread unprotected sex or inconsistent use of protective devices, such as condoms. Consequently, these individuals are exposed to the risk of contracting sexually transmitted diseases, such as syphilis, gonorrhea, and HIV/AIDS among other STIs. Shannon and Klausner point out that the issue of STIs among adolescents is a growing epidemic in the US whereby over 10 million new cases are reported annually among this group of individuals. These diseases are associated with both long-term and short-term adverse health outcomes to both the mother and the child. For instance, syphilis could contribute significantly to miscarriage, stillbirths, or death of infants due to the infection. Additionally, such individuals could resort to unsafe abortions, which could lead to death and other complications.
Adolescent pregnancy negatively affects an individual’s ability to cope with other life issues. The cumulative disadvantage theory “proposes that individuals’ lives interact with structural realities that shape their trajectories over time” (Assini-Meytin & Green, 2015). In this context, adolescent pregnancy would function as a significant life event that advances the trajectories of disadvantage. For instance, the affected young women would have their education interrupted to create time for childbirth and parenting. In some cases, such a student might not resume learning and even in cases of resumption, performance could be affected negatively. Lack of education implies that such an individual would be disadvantaged in the job market, and thus she might become unemployed. Without the needed financial resources, these young women, together with their children, might live in poverty depending on the government for survival. Ultimately, upward social mobility is affected and without timely intervention, people like CT are likely to lead miserable lives.
The psychological and medical concerns highlighted above apply to CT in many ways. First, she does not have a stable family or strong social networks to help her deal with the challenges associated with adolescent pregnancy. Therefore, she is likely to fall into depression and substance abuse. Additionally, she has not been visiting healthcare providers for regular screening of any form of disease, given that she is attending a clinic for the first time in six years. As a freshman without strong family support, CT is likely to drop out of school, which could ultimately affect her ability to cope with other life issues, such as career advancement.
Advanced Nurse Practice
As an APN, I would recommend various resources to CT to help guide decision-making associated with health care and life choices. The first option would be unplanned pregnancy counseling, which could be accessed through adoption agencies and pregnancy health clinics. I would also recommend that she visit local health clinics to access the relevant information and advice concerning the way forward. Adoption agencies for teenagers could also play a significant role in helping CT make the appropriate decisions concerning her condition. Similarly, maternity homes for pregnant teenagers could also be appropriate for CT, especially if breaking the news to her mother would cause a conflict leading to her being kicked out of her home.
The most appropriate method to screen for CT’s health and well-being is pregnancy test counseling. During the therapy sessions, the therapist would be in a position to use various tools to screen for the well-being of the affected adolescent and make the appropriate decisions. Similarly, counseling could also be used to screen adolescents for pregnancy risk. The different tools used for this task would screen for predisposing factors, such as family conflicts, single-parent homes, exposure to sexual activity, use of drugs and alcohol, low self-esteem, race, and ethnicity.
Adolescent pregnancy, like any other health issue, is subject to various social determinants. According to Fuller et al. (2018), the common social determinants to adolescent pregnancy include unemployment among parents, low levels of education and income, lack of strong social support systems, family conflicts, race, and ethnicity. The majority of these factors apply to CT’s case. For instance, she does not have strong social support networks and her mother has never been married to her father. Additionally, her mother works multiple jobs to afford food and shelter, which is a pointer to low levels of income. She is also Hispanic, and according to CDC (2019), Hispanics are twice more likely to have adolescent pregnancy as compared to non-Hispanic whites.
Adolescent pregnancy is a major social problem with many associated social biases. For instance, such individuals are stigmatized and isolated by their peers for their pregnancy. Society often judges these girls as persons of loose morals leading to what Jones et al. (2019) call the “othering”, which is “the simultaneous construction of the self, or in-group, and the other, or out-group, in mutual and unequal opposition” (p. 766). Additionally, pregnant adolescents are likely to have poor education, live in poverty, and engage in risky behaviors, such as drug abuse.
Nurses and other caregivers should educate adolescents about the issue of engaging in early sex. Advocating abstinence is one of the best ways to prevent teenage pregnancies. However, in cases where abstinence is not possible, adolescents should be encouraged to use birth control measures coupled with practicing safe sex by using condoms and other related measures. Ultimately, educating adolescents about sex gives them the relevant information that they could use to protect themselves against unplanned pregnancies. Additionally, contraceptives and protective devices should be made readily accessible to teenagers.
The available data shows that almost 20 percent of adolescent mothers will have a second pregnancy before becoming an adult (Maravilla et al., 2017). This assertion highlights the problems associated with this public health problem. In most cases, adolescent mothers come from disadvantaged backgrounds without proper social support networks. Therefore, without the appropriate support, they are likely to engage in risky behaviors, such as drug abuse, which could easily lead to another pregnancy. Additionally, as indicated earlier, such mothers are prone to depression, which could lead to poor decision-making; hence a second pregnancy. Similarly, social biases discussed earlier contribute significantly to this problem.
Dealing with an adolescent aged 14 years could raise several ethical challenges for APNs. First, the issue of informed consent arises because both federal and state laws do not give clear guidance on this matter. According to Fouquier (2017), “When working with adolescents, the intersection between self-determination and ability of the teen to comprehend information, as it relates to their vulnerability to risks, does not offer a clear path for providers in obtaining informed consent” (p. 2). Therefore, I would be torn on whether to inform CT’s mother about this pregnancy or not, which raises the question of confidentiality. My major concern would be whether CT is mature enough to understand the complex decision-making process to decide what is best for her at her age.
Conclusion
Adolescent pregnancy is a major public health problem in the US, even though such cases have been declining over the last few years. Preventive measures are thus needed to ensure that this problem is addressed sufficiently. CT is likely to suffer from depression and other related mental health conditions because she does not have the needed social support systems to navigate through her pregnancy. However, she could access various resources available to her to make the right decision. Dealing with teenagers raises the ethical concern of informed consent and confidentiality due to the underlying age issues.
References
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CDC. (2019). About teen pregnancy. Web.
Corcoran, J. (2016). Teenage pregnancy and mental health. Societies, 6(21), 1-9.
Fouquier, K. (2017). Legal and ethical issues in the provision of adolescent reproductive health in the United States. Online Journal of Health Ethics, 13(1), 1-7.
Fuller, T. R., White, C. P., Chu, J., Dean, D., Clemmons, N., Chaparro, C., Thames, J. L., Henderson, A. B., & King, P. (2018). Social determinants and teen pregnancy prevention: Exploring the role of nontraditional partnerships. Health Promotion Practice, 19(1), 23–30.
Jones, C., Whitfield, C., Seymour, J., & Hayter, M. (2019). ‘Other girls’: A qualitative exploration of teenage mothers’ views on teen pregnancy in contemporaries. Sexuality & Culture, 23(3), 760-773.
Maravilla, J. C., Betts, K., Couto, E., Cruz, C., & Alati, R. (2017). Factors influencing repeated teenage pregnancy: A review and meta-analysis. American Journal of Journal of Obstetrics and Gynecology, 217(5), 527-545.
Martin, J., Hamilton, B., & Osterman, M. (2018). Births in the United States, 2017. NCHS Data Brief, 318. Web.
Shannon, C. L., & Klausner, J. D. (2018). The growing epidemic of sexually transmitted infections in adolescents: A neglected population. Current Opinion in Pediatrics, 30(1), 137–143.
SmithBattle, L., & Freed, P. (2016). Teen mothersʼ mental health. The American Journal of Maternal/Child Nursing, 41(1), 31-36.