1. TEENAGE
PREGNANCY
~ Issues & Dilemmas ~
DR ALIFAH
O&G Update 2014
Hospital Kapit, Sarawak

2. Scopes…
 Introduction
 Problem background in
Sarawak
What is the dilemma with
teenage pregnancy?
What are the issues with
teenage pregnancy?
 How to manage
teenage pregnancy?

3. INTRODUCTION…
WHO defines teenage pregnancy –
“aged between 13-19 years old”
 It is a complex issue
 Serious problem worldwide
 It is a health and social problems

4.  Anually there are 14-15 million births worldwide to
teenage girls, accounts more than 10% births
 > 90% cases occur in developed countries (WHO
2009)
 US has the highest teenage pregnancy
rate in the developed countries
 UK has the highest incidence in Europe (24 births
per 1000 women)

5. IN MALAYSIA..
The Star Online, 2012

6. Teenage Pregnancy in Sarawak
Adolescent
Birth Rates
62/1000 in
SGH,
Kuching
(2010-11)
43.8% unmarried
80% stopped schooling
33% SGA
16.7% preterm deliveries
9.6% nutritional anaemia
Muniswaran et.al. Adolescent pregnancies in Sarawak: the
unspoken facts. BJOG; 2012.
*IN UK 20-
30/1000

7. DILEMMA??

8. Dilemma with Teenage Pregnancy ??
 Teenage pregnancies are socially & culturally
acceptable in Sarawak

9. RISK FACTORS
 Social culture – early marriage
 Being a child of teenage mother
 Learning difficulty
 Mental health problems
 Experience of physical or domestic abuse
in childhood
 Low self esteem
 Not using contraceptive method in the 1st
sexual experience
 Limited access to contraception

10. BY LAW…
 STATUTORY RAPE
“any sexual intercourse with a girl under 16
years of age is considered rape irrespective
of whether victim’s consent was obtained”
-The offense in Malaysia is dealt under
section 375 of the Malaysian Panel Code

11. Our dilemma
 Sex education should not be discussed in
school
 Limited or no access for education &
information on reproductive sexual health
care
 Policies often restrict adolescent’s access to
information & services (eg contraception)

12. ISSUES??

13. ANTENATA
L
ISSUES
INTRAPARTUM
POSTPARTUM
OFFSPRING
SOCIAL

14. 1.ANTENATAL ISSUES
 Lack of antenatal
care
 Unsure of date
 Illegal termination
 Malnutrition
 STDs
 Social issues-smoking/
alcohol/dr
ugs
 PIH/ Eclampsia
 Anaemia
 Low birth weight
 Premature labour

15. 2.INTRAPARTUM ISSUES
 Pain relief
 Mode of delivery – CPD due to immature
pelvis
 Issues with spinal or epidural due to
developing vertebra

16. 3.POST-PARTUM ISSUES
 Post-partum blues/ depression
 Social support
 Resumption of education
 Contraception
 Baby dumping

17. 4.SOCIAL ISSUES
 Unmarried
 Unemployed
 Easily abused
 Neglected
 Ill treated
 Suicidal
 Poverty
 Engage in high risk
activities
 Poor school
performance
 Poor reading ability
 Drop of school

18. 5.OFFSPRING ISSUES
 Neonatal and post-neonatal
mortality
 Poor development
 Child abuse &
neglect
 Intellectual,
language & socio-emotional
delay
 Poor academic
performance
 Poor reading ability
 Smoking &
consume alcohol
 Behavioural
problems
 Engage in crimes

19. MANAGEMENT

20. ANTENATA
L
ISSUES
INTRAPARTUM
POSTPARTUM
OFFSPRING
SOCIAL

21. 1.ANTENATAL MANAGEMENT
 Service should be easily accessible
 Young-people friendly environment
 Ensure confidentiality
 Partner & family involvement
 Strong referral links with relevant agencies
(social worker)

22.  Dating the pregnancy
 Routine antenatal care
 Provide nutritional advice & supplements
 Advice on antenatal care
 Monitor weight gain, BP, fetal growth
 Encourage smoking, alcohol and drugs
cessation
 Encourage to join antenatal classes and
preparation of labour

23. 2.INTRAPARTUM MANAGEMENT
 Need assessment for CPD
 Caesarean section for evidence of
obstructed labour
 Need early anaesthetic referral for choice
of anaesthesia

24. 3.POST PARTUM MANAGEMENT
 Advice in hygiene
 Assist in breast feeding- breast feeding
support
 Assist in child care
 Infant feeding, growth and safety need to
be observed
 Assessment of post natal depression

25. CONTRACEPTION
 COCP:
− failure rate as high as
50% due to non-compliance
 Implanon (LARC)
− Failure rate of 0.1%
over 3 years
− Weight gain < 10%,
irregular bleeding
 IUCD (LARC)
− Failure rate of 0.8%
− In view of risk of
chlamydia infection,
advisable to take an
endocervical swab &
to give antibiotics
before fitting IUCD
 IM Depo Provera
− Risk of reduced bone
mineral density if
usage > 2 years
 Condom
- Not safe

26. 4.SOCIAL ISSUES
 Referral to social worker for financial
assistance
 Ensure family support- baby is at greater
risk of inadequate growth & infection
 Child care/ adoption advice
 Return to education, training or
employement
 Financial & housing support

27. • Take the necessary action according to The
Child Act 2001 if the adolescent is
suspected to be physically or emotionally
abused, neglected, or sexually abused.
• Refer to child protector and police officer
or the doctor should take temporary
custody if unable to contact them

28. SCHOOLING
 Teenagers should always be assisted in
returning to school either during
pregnancy or after delivery

29. 5.OFF SPRING ISSUES
 Involvement of child protector
 If any evidence of child abuse or neglect,
JKM have a power to take the baby a
place them in a safer place
 Child for adoption

30. How is Malaysia dealing with
this issues?
 In 2010, first “baby hatch”- a place where
mothers can safely and anonymously
leave their unwanted child
 Malacca opened a school for teenage
mother “Sekolah Harapan”

31. PREVENTIONS
 NATIONAL STRATEGIES
1.School based health, life, sex &
relationship education
2.Campaigns & media
3.Availability of contraception
4.Access to abortion services
 Co-ordination- national, state, district

32. Recommendations
 Life skills based health educations
 Support services for adolescents
 Involvement of family members
 Increase access to contraceptive
information services, sex education
 Skilled antenatal & birth care
 Special sensitivity in dealing with
adolescents girls

33. THANK YOU….