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Trends in the prevalence of adolescent births in Antigua and Barbuda
– Reported, February 10, 2012
Pregnancy in adolescence is a significant health problem worldwide. Teenage mothers are likely to remain poorly educated, economically dependent and be at risk for repeated unwanted pregnancies in developed countries . Teenage mothers are more likely to have low birthweight or premature infants in developed countries as well as in the Caribbean . In Antigua and Barbuda in 1996, 15% of babies of teenage mothers were low birthweight (less than 2.5 kilograms) compared with 9% of babies born to mothers 20 years old or more. In Jamaica, teenage mothers are twice as likely to have a baby die of immaturity than mothers over 20 years old and more likely to have a complicated delivery with hypertension or Caesarean section . In Grenada, preterm labour and birth, small for gestational age babies, Caesarean section, perinatal asphyxia and perinatal mortality are all increased in teen pregnancies .
The children of teenage mothers are twice as likely to drop out of school before completing secondary school, twice as likely to be dependent on others financially, two or three times more likely to be teenage parents themselves and two to three times more likely to be involved in crime than children born to mothers 20 years or older in the United States of America [USA]. Social and educational consequences in the Caribbean are also significant and lasting. Teenage mothers in the Caribbean have lower monthly incomes and their children have poorer nutritional status .
This study was undertaken to assess the 35-year trend in births to teenage mothers in Antigua and Barbuda. During this period, 92% of deliveries were performed at Holberton Hospital, the only full service facility in Antigua and Barbuda, serving a population of about 72 310 people in 2000, 90% Afro-Caribbean, 8% mixed ethnicity and others 2%. Antigua and Barbuda had mainly an agrarian economy prior to the 1970s when the economy switched to tourism. The tourist industry accounts for 65 to 70% of the gross domestic product. In 1982, the per capita income was $4228 US, rising to $5189 US in 1990 and to $6054 US in 1998 adjusted for inflation.
Changing economic and social conditions in the emerging small island countries of the Caribbean are having an effect on teen pregnancy but the effects have not been well documented. Over the past 35 years, changing demographic, economic, social, educational and medical conditions may have influenced teenage women in their choosing or not choosing to have children. This study documents the changes in teen births in Antigua over a 35-year period.
This study documents a marked fall in adolescent deliveries over thirty years at Holberton Hospital in Antigua and Barbuda. The impression has been that this is occurring throughout the Caribbean region . Recent data indicate that in Jamaica, 24.6% of deliveries are to teenagers and in Barbados, 18.6% . The most recent figures from Antigua and Barbuda show a rate of 15.9% for the 10-year period ending in 2003. The number in the USA in 1992 was 12.7% of births . Fertility rates were around 150 pregnancies per 1000 women aged 15 to 19 years in Caribbean women in the 1950s . Using 1996 population estimates , the birth rate in Antigua for women 15 to 19 years old was about 67 per 1000 that year. The pregnancy rate in the USA in 1995 was 83.6 per 1000 women 15 to 19 years old but includes abortions. From the fertility rate of about 150 per 1000 in the 1950s, the rate of adolescent pregnancy has fallen to 65 per 1000 in Barbados in 1990 . The teenage pregnancy rate has remained around 110 per 1000 in Jamaica between 1994 and 1997, in contrast to the trends in Antigua and Barbuda, and Barbados . The explanation for this decrease in births to teenage mothers in this retrospective observational report may not be simple. Factors associated with teenage pregnancy and birth might include demographic, economic, social, educational and medical changes.
A fall in teenage births could be due to a fall in the number of young women at risk for pregnancy. Population figures that are available for Antigua and Barbuda suggest a population increase of 16% in the 30-year period covered in this review. No migration of teenage women into or out of Antigua and Barbuda is suspected, so the number of teenaged women probably increased. Gender and age specific population data were first acquired in the 1990s in Antigua. A fall in teen births could reflect a general fall in fertility, but births to mothers 20 years old and older increased 25% during the years of this study. So demographic change does not appear to explain the drop.
Antigua and Barbuda has seen a dramatic change in the economy in the past thirty years. In an agrarian economy, vocational opportunities were limited. With the increase in per capita income of $4228 US to $6054 US (43%) from 1982 to 1998, goods and services were within reach for more nationals. In addition, overseas opportunities for employment increased. Economic or vocational goals are important in decreasing adolescent pregnancy in the USA, Latin America and the Caribbean . Adolescent pregnancy in Brazil was three times as likely in the worst socio-economic areas compared with the best . Being unemployed was associated with adolescent pregnancy in Guyana . Economics may be one of the major explanation for the fall in teen births in Antigua and Barbuda.
Social structures, such as family and church, play an important role in shaping attitudes of teenage girls. Although fathers are becoming more involved in raising children, 70% of the pregnancies in Antigua and Barbuda are out of wedlock. This figure does not appear to have changed much over the years . United Nations figures show that men (age 31.5 years) and women (age 33.2 years) in Antigua and Barbuda are in the top ten countries in the world for marrying late or not marrying at all [men 31.9%, women 37.4%] . Other countries in the top ten in these categories include Jamaica, Barbados, Dominica, St Kitts and Nevis and St Vincent and the Grenadines .
Other social factors, in addition to these cultural ones, may make a difference. Parent-adolescent communication in African American families increased contraceptive and condom use in teenage girls . In Jamaica, absence of a male father figure in the home of urban girls made teen pregnancy 2.7 times more likely . Having close relatives who are teenage mothers is a risk factor . An adolescent who became pregnant in Jamaica was 2.7 times more likely to have a mother who gave birth as an adolescent . The church continues to provide moral guidance but teenagers seldom relate sexual decisions to the preferences of the church . Peer pressure and low self-esteem are important both in the USA and the Caribbean for early sexual activity .
Attention has also been directed toward adolescent fathers, starting with contraception . The sexuality of adolescent men and attitudes toward women are areas needing further exploration . Similar to adolescent women, adolescent men need education in couple relationships and parenting behaviours . These issues could be approached in a family life, male/female responsibility and sex educational course in schools. Recent data suggest that the reasons for becoming teen parents are complex and an individual approach involving motivational interviewing techniques may be necessary for both men and women . Changes in attitudes and social roles (eg more involved fathers) may have contributed to the changes in teen births in Antigua and Barbuda.
Educational changes result from economic development. If education is seen as a method of economic improvement, teenage women will defer pregnancy . For Antiguans, school attendance is mandatory until age 16 years and the literacy rate is 90% . In Brazil, having little formal education was associated with adolescent pregnancy . In Jamaica, a programme to encourage teenage mothers to complete their education led to higher rates of graduation and fewer repeat pregnancies . Having less than a secondary school education was significantly associated with adolescent pregnancy in Guyana . Increased education may also increase correct knowledge and use of contraceptives . Providing access to medical information and establishing educational and vocational goals resulted in the termination of fewer pregnancies in Mexico. Ignorance regarding contraceptive use and side effects limits teenage use . Educational goals and opportunities have probably contributed to the fall in teen births in Antigua and Barbuda.
Availability of contraceptive information through the International Planned Parenthood Association and the Caribbean Family Planning Affiliation provides young women with options regarding childbearing. Confidentiality in adolescent healthcare is important . An Adolescent Health Service Clinic, a public health clinic, was established in Antigua and Barbuda specifically for adolescents. In 1996 and 1997, 153 teenage women accepted contraceptive services, 7% of all women seen at public health clinics . Types of contraception made available included injection, used by 45%; oral contraceptives, used by 40% and condoms used by 13% . The benefits and safety of various contraceptive methods must be explained and a motivational type of interview must be used . Side effects, reported in 48% of women in Jamaica, may limit use of injections or oral contraceptives .
Other barriers to contraceptive use include sexual attitudes, cultural norms and gender-specific issues in the USA as well as in the Caribbean . It is of interest that school based interventions to affect lifestyle change in adolescents were recently shown to be ineffective .
The personal, individual approach may be more effective . Medical factors may shape pregnancy decisions in teenage women. About 32% of teenage pregnancies in the USA end in induced abortion . Although this intervention is less culturally acceptable in Antigua and Barbuda, abortion rates are unknown. In Barbados, 23% of abortions are in teenage women . Increased income also allows for private consultation and treatment, confidentiality being a significant problem on small islands. A parental notification law in the USA requiring women considered minor by law to notify parents prior to an abortion led to a 15% fall in abortions and a 4% rise in births to those aged 17 years . The other medical issue of importance is sexually transmitted disease. The risk of Acquired Immunodeficiency Syndrome (AIDS) may discourage sexual activity. It is interesting that in Antigua and Barbuda, teenage birth rates dropped in the mid 1980s, the onset of the AIDS epidemic.
In conclusion, the rates of teenage deliveries in Antigua and Barbuda, a small island with a growing economy based on tourism and other services including banking and Internet, have decreased dramatically, especially since the mid-1980s. This 42% drop probably exceeds any goals established in the 1970s .The fall of 53% in births to women still in secondary school is especially encouraging. Economic, social, educational and medical changes have probably all played a role in explaining these data. Other small island societies undergoing similar economic, educational and medical change may experience similar outcomes.
Credits: TC Martin, B Doyle and J Raphael
More information at:
http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442008000200004&lng=en&nrm=iso
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