Socio-demographic determinants of teenage pregnancy in the Niger Delta of Nigeria

doi:10.4236/ojog.2012.23049

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Open Journal of Obstetrics and Gynecology, 2012, 2, 239-243 OJOG

http://dx.doi.org/10.4236/ojog.2012.23049 Published Online September 2012 (http://www.SciRP.org/journal/ojog/)

Socio-demographic determinants of teenage pregnancy

in the Niger Delta of Nigeria

Ayuba Ibrahim Isa1*, Ibukun Olugbenga Owoeye Gani2

1Department of Ob s tetrics and Gynaec ology, College of Health Sciences, Niger Delta University, Amassoma, Nigeria

2Department of Community Medicine, College of Health Sciences, Niger Delta Unversity, Amassoma, Nigeria

Email: *[email protected]

Received 27 April 2012; revised 30 May 2012; accepted 13 June 2012

ABSTRACT

Sub-Saharan Africa has the highest rates of maternal

and neonatal mortality worldwide. Young maternal

age at delivery has been proposed as risk factor for

adverse pregnancy outcome, it occurs in all races,

faiths, socioeconomic statuses, and regions. Teenage

mothers are likely to be unmarried, poor and to sac-

rifice education. Isolation, unstable marriages, stress,

and guilt are among many social and psychological

problems. The aim of this study is to determine the

socio-demographic factors associated with teenage

pregnancy in our environment, in order to proffer

measures that can help curtail this continuing socio-

medical problem. The records of all teenage mothers

(aged 13 - 19) who had delivery at the Niger Delta

University Teaching Hospital, Bayelsa State, Nigeria,

over a period of 4 years (January 1 2007 to December

31 2010) were retrospectively reviewed. There were a

total of 1341 deliveries during the study period, out

which 83 were teenagers giving an incidence of 6.2%.

The age of the patients ranged from 14 to 19 years

with a mean age of (28.1 ± 5.7) years. Their parity

ranged from zero to three, with a mean of 2.4 ± 1.9.

About a third (20%/24.1%) were primigr avid ae, 3 3%/

39.9% had at least secondary education and majority

(48%/57.8%) were unbooked, unmarried (60%/72.3%),

unemployed (62%/74.7%) and of low social class.

Majority 71 (85.5%) of the teenage mothers had never

used any form of modern contraceptive method and

45 (54.2%) of them had terminated at least one preg-

nancy in the past. 26 (31.3%) had Caesarean sections,

majority of which were emergencies 22 (84.6%). It

was concluded that teenage mothers in the Niger

Delta tend to have unfavorable socio-demographic

and obstetric factors. Concrete measures must be put

in place to address these.

Keywords: Teenage Pregnancy; Socio-Demographic

Factors; Niger Delta

1. INTRODUCTION

Adolescence, according to WHO refers to the period

between the ages of 10 and 19 years in which the indi-

vidual progresses from the initial appearances of secon-

dary sexual characteristics to full sexual maturity and

during which psychological and emotional processes

develop from those of a child to those of an adult. It also

represents a transition from the state of socio-economic

dependence to one of rela t i ve independence [1,2] .

Adolescent pregnancy is defined as gestation in women

before having reached the full somatic development. The

percentage of childbearing adolescent women is region-

ally highly variable depending on cultural, religious, po-

litical, economic and other factors. Pregnancy in the very

young is generally considered to be a high risk event

because of the additional burden imposed by reproduc-

tion on a still growing body [3-5].

Large epidemiologic studies on this topic were how-

ever largely reported from high or medium income coun-

tries showing conflicting results. Most importantly to

date there is a lack of epidemiologic evidence from Sub-

Saharan Africa [6-10].

Most of the pregnancies result from coitus with their

first only partner, who often times is of similar age and

no more advantaged socially. Adolescent pregnancies

constitute major socio-medical and socio-econ omic prob-

lems in both developed and developing countries and are

becoming more prevalent in recent times [11].

The emergence of this adolescent problem has been

attributed to various factors including early marriage,

social permissiveness favouring early exposure to casual

sexual activity, poor knowledge, availability and use of

contraceptives, maternal deprivation, pre-existing psy-

chosocial problems in the family and general non-func-

tioning family unit among others [12-14].

In many developing countries, lack of resources makes

contraception and reproductive advice inaccessible. This

*Corresponding a uthor.

OPEN ACCESS

A. Ibrahim Isa, I. O. Owoeye Gani / Open Journal of Obstetrics and Gynecology 2 (2012) 239-243

240

situation may be exacerbated by religious beliefs that

disapprove of artificial birth control methods. The result

is that many adolescents, both married and unmarried

find it difficult to locate, or even seek help about sexual

matters. There may be few facilities offering such sup-

port, particularly in remote rural areas. The poorest often

lack the resources to travel to these facilities and any fees

charged for the services on offer would push them even

further out of reach. In some cases, the ante-natal clinic

is the only place where a young woman can obtain re-

productive advice, but pregnancy is a pre-condition.

Contraception may not be offered to married women

until they have born e a child. There is an urgent need for

“youth friendly” health services, as adolescents are

unlikely to seek help about sexual matters from a service

that is unsympathetic to their needs and anxieties. Girls

aged 15 to 19 give birth to 15 million baby a year. Many

of these girls give birth without attending an antenatal

clinic or receiving the help of a professional midwife. It

is essential to devise programs to reach girls in and out of

marriage with reproductive advice and services [15].

Complications seen in adolescents during pregnancy

include anaemia from malaria, infection and inadequate

nutrition, spontaneous abortions, preterm labour and de-

livery, pre-eclampsia and eclampsia, antepartium haem-

orrhage and feto pelvic disproportion with its attendant

risks of high operative intervention rates, obstructed la-

bour and its sequalae notably genital fistulae. In the pu-

erperium, puerperal sepsis, anaemia and other complica-

tions resulting from obstructed labour are common [16,

17]. Evidence shows that infant mortality among the

children is someti mes two times high er than among tho se

of old peers. A stronger likelihood of low birth-weight in

the infant has been recorded among adolescent mothers

than among older peers. This is mainly associated with

poor maternal nutrition. Low birth-weight babies are 5 -

30 times more likely to die than babies of normal weight

[18,19]. If a mother is under 18, her baby’s chance of

dying in the first year of life is 60 per cent higher than

that of a baby born to a mother older than 19. Part of this

heavy toll has more to do with poor socio-economic

status and lack of ante-natal and obstetric care than

physical maturity alone [20].

Cervical carcinoma, which is increasing in incidence

and presenting at a younger age, is directly linked to the

age of first intercourse and to the number of partners, and

the spread of infection by human immunodeficiency vi-

rus (HIV) is also linked to the number of sexual partners.

These medical problems emphasize the risks associated

with teenage intercourse, partic ularly if with a number of

partners, in addition to the risks of the pregnancy itself.

Pregnancy-related deaths are the leading cause of mor-

tality for 15 - 19 year-old girls (married and unmarried)

worldwide. Mothers in this age group face a 20 to 200

per cent greater chance of dying in pregnancy than

women aged 20 to 24 [21]. The socio-economic conse-

quences of adolescen t pregnancy include mor e unwanted

pregnancies and out-of-wedlock children, greater marital

instability, poor education, fewer assets and lower in-

come later in life. The problems associated with adoles-

cent pregnancy can be significantly reduced through sex

education, provision of contraceptive counseling and

services, education of women up to the University level

and medical, social and psychological support for af-

fected adolescents. Provision of good antenatal, intrana-

tal and postnatal care for these adolescents is also em-

phasized [22, 2 3] .

2. MATERIALS AND METHODS

The study is a four year retrospective study of Teenage

pregnancies managed at Niger Delta University Teaching

Hospital (NDUTH) Okolobiri, a tertiary hospital in

Bayelsa State, from January 1, 2007 to December 31,

2010. The sources of information were Antenatal, labour,

and neonatal ward records, theater records, patient’s re-

cords and case notes. The information obtained were

coded and transferred onto a profoma already design for

the study.

Variables relating to the socio demographic character-

istics of the women, antenatal an d intrapartum complica-

tions and neonatal outcome were obtained. Statistical

Analysis: Statistical analysis was performed with Statis-

tical Package for Social Sciences (SPSS version 10).

Ethical Consideration: Approval for this work was

given by the Ethical Committee of the NDUTH.

3. RESULTS

There were a total of 1341 deliveries, during the study

period, out whi c h 83 were te enagers (6.2%) .

The age of the patients ranged from 14 to 19 years

with a mean age of (28.1 ± 5.7) years. Their parity

ranged from zero to three, with a mean of 2.4 ± 1.9.

About a third 20 (24.1%) w ere primigravidae, 33 (39.9%)

had at least secondary education and majority 48 (57.8%)

were unbooked and unmarried 60 (72.3%) (Table 1).

Majority of the patients were of low social class, only

1 (4.3%) patient is of social class one (Table 2).

The three commonest complications are preterm la-

bour (51.8%), postpartum haemmorrhage (34.9%) and

anaemia in pregnancy (22.9%) (Table 3).

26 (31.3%) of the teenage mothers delivered by cae-

sarean section, (p = 0.014) maj ority of which were emer-

gencies 22 (84.6%), 55 (66.2%) had spontaneous vaginal

delivery, while 2 (2.5%) had instrumental vaginal de-

livery (Table 4).

There were 11 perinatal deaths with a perinatal mor-

tality rate of 133/1000. There was no maternal mortality.

A. Ibrahim Isa, I. O. Owoeye Gani / Open Journal of Obstetrics and Gynecology 2 (2012) 239-243 241

Table 1. Soc io-demographic characteristics of the patients.

Characteristics Teenage Mothers Freq (%)

Age (years)

14 - 16 20 (24.1)

17 - 19 63 (75.9)

Total 83 (100)

X + SD 17.8 + 1.3

95% CI 17.5 - 18.1

t = 24.25

Parity

0 20 (24.1)

1 - 3 63 (75.9)

4 - 7 0 (0)

>7 0 (0)

Total 83 (100)

x2= 55.37

Educational Status

Nil 19 (22.9)

Primary 26 (31.1)

Secondary 33 (39.9)

Tertiary 5 (6.1)

Total 83 (100)

x2= 16.29

Booking Status

Booked 35 (42.2)

Unbooked 48 (57.8)

Total 83 (100)

x2= 17.74

Marital Status

Married 23 (27.7)

Not Married 60 (72.3)

Total 83 (100)

x2= 27.2

4. DISCUSSION

The frequency of pregnancy during adolescence is highly

variable in Africa [8-10]. Cultural and religious norms

may be one of the reasons for these demographic differ-

ences. In addition, these cultural factors may modify

Table 2. Social class of patients with teenage pregnancy at

niger delta university teaching hospital (nduth) okolobiri (2007-

2010).

Social Class Frequency

I 1 (4.3)

II 3 (13.1)

III 4 (17.4)

IV 7 (30.4)

V 8 (34.8)

Total 23 (100)

Table 3. Pregnancy complications in teenage mothers.

Complication Teenage Mothers n = 83 Freq (%)

Iron Deficiency Anaemia19 (22.9%)

Preeclampsia 12 (14 .5%)

Aproptio Placenta 5 (6.0%)

Placenta Praevia 0 ( 0%)

Preterm Labour 43 ( 51.8%)

Postpartum Haemorrhage29 (34.9%)

Table 4. Route of delivery.

Teenage Mothers n = 83 Freq (%)

Spontaneous Vaginal Delivery55 (66.2)

Instrumental Delivery 2 (2.4)

Caesarean Section 26 (31.3)

Emergency 22 (84.6)

Elective 4 (15.4)

health care seeking behavior of young pregnant women

and may therefore constitute by themselves confounding

factors for pregnancy outcome as on ly 6.2% of the partu-

rient are teenagers in this study, which is lower than 9%

from Thailand, but higher than 1.7%, and 2.2% from

Benin and Ibadan in Nigeria respectively [22,23].

The review also revealed that, marital status, educa-

tional qualification and unemployment are important

socio-demographic factors contributing to teenage preg-

nancy, furthermore, majority of the patients were of low

social class. The social class of the patients were deter-

mine using the su mmation of the score obtained from the

educational status of the women and the occupation of

their hus bands [24].

Majority of them were single, unemployed, unbooked

with less formal education. This is similar to the finding

A. Ibrahim Isa, I. O. Owoeye Gani / Open Journal of Obstetrics and Gynecology 2 (2012) 239-243

242

from the same region [23]. In a study from Zimbabwe,

transport costs and costs for prenatal services have been

characterized as major factors influencing adolescents

late or non-utilization of prenatal services. In the same

study the limited knowledge of young women about an-

tenatal care programs and the fear of HIV testing have

been further obstacles to efficient antenatal care [25].

Contraceptive utilization among the patients showed

that 85.5% had never used any form of contraceptive.

Other studies had shown that only 3% - 5% of married

couples use a modern contraceptive method and 2% to

6% of the sexually active adolescents practice any form

of contraception [26].

In Nigeria, family planning services are few and pro-

viders tend to ignore or discriminate against single ado-

lescents. 54.2% had the history of at least one previous

termination of pregnancy. This finding is not surprising

because of the significantly low prevalence of contracep-

tive usage in our communities [26].

Anaemia in pregnancy, preeclampsia, preterm labour,

and postpartum haemmoraghe, were some of the obstet-

rics Complications documented among the teenagers

seen in this review. This is similar to findings from pre-

vious studies [5,23] most of these patients were referred

from private and public primary and secondary health

facilities both within and sometimes outside Bayelsa

state.

Several reasons for the high risk of delivering a low

birth weight infant by adolescent mothers have been

discussed in scientific literature. Anatomic immaturity

and continued maternal growth may represent biologic

growth barriers for the fetus. Moreover, adolescent moth-

ers may represent a particularly d isadvantaged risk group

characterized by low socioeconomic status, financial

income and level of education as was found from this

study [3,11, 2 0] .

Vaginal delivery was the major route of delivery in the

study group (66.2%), however, 31.3% had Caesarean

section, of which 84.6% were emergencies, often times,

and they had been in labour for more than 24 hours at

other centres and often referred late in the night with

varied reasons. This is the main reason why emergency

procedures accounted for a larger proportion of the cases.

This is similar to findings from previous studies [5,23].

In conclusion the socio-demographic factors and the

medical problems associated with teenage pregnancy

have been amply documented in this country and also by

this study. Amidst the poor er social segments parenthood

is seen as a sign of social status; however it is associated

with adverse fetal and maternal outcomes. The adverse

outcomes can be ameliorated by free and compulsory

education for the girl child, education of the populace

about the social and medical consequences of teenage

pregnancy, making contraceptives available to teens,

especially emergency contraceptives, quality antenatal

care, and provision of essential obstetric care.

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