The hidden burden of adolescent pregnancies in rural Sri Lanka; findings of the Rajarata Pregnancy Cohort

Abstract

Background Adolescent fertility is a main indicator of the Sustainable Developmental Goal (SGD) three. Although Sri Lanka is exemplary in maternal health, the utilization of Sexual and Reproductive Health services (SRH) by adolescents is less documented. We describe the hidden burden, associated biological and psychosocial factors and utilization patterns of pre-conceptional services among pregnant adolescents in rural Sri Lanka. Methods The study is based on the baseline assessment of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. Pregnant women newly registered from July to September 2019 were recruited to the study. The period of gestation was confirmed during the second follow-up visit (around 25–28 weeks of gestation) using ultra sound scan data. A history, clinical examination, anthropometric measurements, blood investigations were conducted. Mental health status was assessed using the Edinburgh Postpartum Depression Scale (EPDS). Results Baseline data on gestation was completed by 3,367 pregnant women. Of them, 254 (7.5%) were adolescent pregnancies. Among the primigravida mothers (n = 1037), 22.4% (n = 233) were adolescent pregnancies. Maternal and paternal low education level, being unmarried, and less time since marriage were statistically significant factors associated with adolescent pregnancies (p < 0.05). Contraceptive usage before pregnancy, utilization of pre-conceptional health care services, planning pregnancy and consuming folic acid was significantly low among adolescents (p < 0.001). They also had low body mass index (p < 0.001) and low hemoglobin levels (p = 0.03). Adolescent mothers were less happy of being pregnant (p = 0.006) and had significantly higher levels of anxiety (p = 0.009). Conclusion One fifth of women in their first pregnancy in this study population are adolescents. Nulli-parous adolescents exert poor social stability and compromised physical and mental health effects. The underutilization and/or unavailability of SRH services is clearly associated with adolescent pregnancies.

Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies

“…Apart from a Nepalese context, a case-control study from Sri Lanka [ 28 ] also found that women from a Tamil ethnic background were more prone to adolescent pregnancy compared to those of non-Tamil ethnicity. A cohort study from Sri Lanka [ 15 ] revealed that lower contraceptives use was significantly associated with adolescent pregnancy; in contrast, a cross-sectional study from Bangladesh [ 18 ] found that women who used contraceptives were more predisposed to adolescent pregnancy as compared to those who never used contraceptives. Studies in Nepal [ 11 ] and Bangladesh [ 19 , 21 ] found a higher level of adolescent pregnancies among girls with no access to mass media.…”

“…There have been individual studies reporting the burden and factors associated with adolescent pregnancy in various countries within South Asia [ 11 , 12 , 14 , 15 ]. These individual studies differ in design and methodology, thus making it difficult to make informed intra-regional comparisons and roll out effective initiatives to substantially reduce adolescent pregnancy within the region.…”

Barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda: a qualitative study

“…Four other studies qualified this finding, arguing that previous experience with health workers strongly influences future maternal health care seeking behaviour [ 14 , 21 , 22 ]. Low levels of maternal and paternal education and unmarried mothers are some factors that can lead to discrimination and disrespect in rural settings, and these are significant factors that have been associated with adolescent pregnancy in a study conducted in Sri Lanka [ 23 ].…”

Sociodemographic and gestational factors of adolescent mothers associated with prematurity

“…A baixa escolaridade tem sido fortemente relacionada à gravidez na adolescência, em que muitas adolescentes não frequentam ou desistem da escola em decorrência da gravidez (7,9,(18)(19)(20) . A preocupação em torno disso recai nas consequências futuras que a pouca escolaridade e o baixo nível educacional poderão gerar nas condições socioeconômicas, como menor emprego e renda, bem como limitado acesso à informação e a cuidados de saúde de qualidade, impactando negativamente no crescimento e desenvolvimento infantil.…”