"About 34 million adolescents aged 10-19 constitute 21% of total population of Bangladesh. Early marriage is a social norm in Bangladesh. Bangladesh is second only to Niger in having the highest percentage of adolescent brides in the world.[1]. Early pregnancy is common in Bangladesh. An estimated 2 million births (17% of total births) were attributed to adolescents between the age 15 and 19 in a period of 2005-20101.The fertility rate among the 15-19 years old age group is one of the highest rates, in the world. One of the major challenges in achieving MDG 4 is the slow progress in preventing neonatal deaths, which now account for 57 percent of all under-five deaths and 70 percent of infant deaths. There is strong evidence linking early childbearing with higher perinatal and neonatal death rates", states WHO. therefore now it is the prime time to reduce these incidents of dangerous social behaviours to save future generation- Dr Syeda Zerin Imam. (revised in 2020)

1. DETERMINANTS
OF
ADOLESCENT
PREGNANCY AND
MATERNAL MORBIDITY
IN
BANGLADESH
by
Syeda Zerin Imam
Student ID: ***********
DEPARTMENT OF PUBLIC HEALTH
SHANDONG MEDICAL UNIVERSITY
JINAN

2. Submitted
To
THE SUPERVISOR
Professor Chengchao Zhou
DEPARTMENT OF PUBLIC HEALTH
SHANDONG MEDICAL UNIVERSITY
JINAN
CHINA

3. BACKGROUND:
Bangladesh contributes a substantial proportion of adolescent pregnancies to the global
burden of premature motherhood. It is among one of the 10 countries with the highest
prevalence of pregnancy among adolescent girls in both relative prevalence (40%) and absolute
number (nearly 3 million). Bangladesh is a densely populated country and generally child
marriage, social bullying due to poverty, minority, gender disparity, various sexual crime like
rape, sexual abuse, insisted and forced sex, domestic violence, mental problem, poor family
care, bonding and caution towards the teen agers and poor intention to seek health care due
to different reasons are persistent that causing the adolescent pregnancy in the country. The
health and social consequences of adolescent pregnancy is very detrimental. The health
consequences of adolescent pregnancy include the greater risk of anemia, low birth weight,
preterm birth, maternal and neonatal mortality. Adolescent girls also have high rates of
complications from pregnancy, delivery and unsafe abortion. Social consequences include early
school dropout, low empowerment and risk of remaining poor. Pregnancy during adolescence
adds higher nutritional needs to the adolescent as they are still growing and maturing. During
the transitional and vulnerable period of adolescent growth and development, adequate
nutrition plays a vital role in assuring a strong physiological and psychological foundation for
current and future health, well being and productivity of women. But the characteristics of these
young mothers are generally: poor education, rural dwelling and low earnings and these
characters eventually leads to poor knowledge, under build physic and retarded psyche to the
girl.

5. BANGLADESH PROFILE

6. WHO –Key facts
• About 16 million girls aged 15 to 19 and some 1 million girls under 15 give birth every year—
most in low- and middle-income countries.
• Complications during pregnancy and childbirth are the second cause of death for 15-19 year-
girls globally.
• Every year, some 3 million girls aged 15 to 19 undergo unsafe abortions.
• Babies born to adolescent mothers face a substantially higher risk of dying than those born to
women aged 20 to 24.

7. According to UNFPA:
In the year 2018 the total population of the world is 7633 millions.
Adolescent birth rate is 44 in per 1000 who are aged 15 to 19 (2006-2017).

8. HYPOTHESIS
Pregnancy at the adolescent age may be caused by significant determinants and there might
be an extensive possibility of maternal morbidity.
RESEARCH QUESTIONS
1. What are the determinants or circumstances that are responsible for the adolescence
pregnancy ?
2. What are consequences of adolescent pregnancy ?
3. What is the solution of adolescent pregnancy ?

9. OBJECTIVE OF THE STUDY
GENERAL OBJECTIVE
To identify the determinants of adolescent pregnancy and maternal morbidity among
adolescent girls in Bangladesh.
SPECIFIC OBJECTIVES
1. To identify the determinants or the circumstances of adolescent pregnancy in Bangladesh.
2. To identify the consequences of adolescent pregnancy in Bangladesh.
3. To identify the solution of the adolescent pregnancy in Bangladesh.

10. CONCEPTUAL FRAMEWORK

11. Demographic factors
Education
Marital Status
Number of Family Member
Socio- economic Factors
Family Income
Employment Status
Occupation
Cultural Factors
Religion
Ethnicity
Spatial Factors
Urban
Rural
Hill areas
River bank
plane land
Knowledge and attitude related factors
Knowledge about balanced diet
Knowledge about pregnancy
Formal access to health care through
Government Programs
NGO & private Programs
Educational Institution Programs
Mass Media Programs
Health Care During Pregnancy
Age of first pregnancy
Antenatal care (ANC) during pregnancy
Frequency of ANC visits
Consumption of Iron and Folic Acid (IFA) Tablets
Any health complaining during pregnancy
Care during and after delivery
Place of delivery
Type of delivery
Assistance during delivery
Postnatal care (PNC)
Adoption of any family Planning
Pregnancy outcome and child’s health care
Abortion
Any health complication of the new born
New born’s birth weight
Pre-mature baby
Vitamin A capsule supplement
Vaccination status
Sex and pregnancy history
Consensual sex
Non consensual sex
Adolescent
Pregnancy
And Maternal
Morbidity

12. PROBLEM STATEMENT
Teen age pregnancy generally develops in poor, less educated and rural surroundings and occurs
due to various socio economic circumstances which leads to intentional and unintentional
pregnancies. Adolescent mothers are completely immature for the procedure of procreating
another human being inside their physic and it results in formation of defective infants and causes
maternal morbidity and very frequently mortality. Maternal morbidity by pregnancy is
unacceptably high in Bangladesh due to its poor resource setting. And it is an important public
health problem for the country and it should be addressed very minutely for socio-economic
stability and development of the country.
We all can understand that imperfect babies can never be the perfect citizens. In Bangladesh low
birth weight babies are 41.5% of total birth and these babies mostly belong to the adolescent
mothers. Along with this there are still births, different birth complications and maternal and
neonatal mortality. These adverse complications often leads to criminal offence in the family and
eventually these events are creating huge social burden and high economic burden for the
country as well.

13. STUDY DESIGN
The study will be a descriptive cross sectional study.
TARGET POPULATION AND SAMPLE POPULATION
1. Target population of the study will be the
a. adolescent girls aged 13-19 at the time of survey.
b. Adults who have experienced their first pregnancy between the years 13-19
2. Sample population of the study will be the
a. adolescent girls aged 13-19 at the time of survey.
b. Adults who have experienced their first pregnancy between the years 13-19

14. SYUDY SITE AND AREA
The study will be conducted in the capital and rural area of Bangladesh.
in Dhaka : 1. BSMMU (BANGABANDHU SHEIKH MUJIB MEDICAL UNIVERSITY)
2. CMH (COMBINED MILITARY HOSPITAL)
3. DMC (DHAKA MEDICAL COLLAGE)
4. MARIE STOPES CILIC AND METERNITY
5. SSMC (SHAHEED SUHRAWARDY MEDICAL COLLEGE)
In rural area: 5 rural areas will be selected for the data collection
1. Savar
2. Narayangonj
3. Gazipur
4. Mymensing
5. Tangail

15. STUDY PERIOD
Study duration will be 3 months from December 2018 to February 2019
SAMPPLE SIZE
The sample size will be determined by using the formulae:
n=
Zα
2 pq
d2
n= Sample size to be determined
Z= standard normal deviate which cuts the abscissa at 1.96 for 95% confidence level.
p= proportion of adolescents possessing a characteristic which is 33.2 (according to
World Bank collection of Development indicators 2014, compiled from officially
recognized sources)

16. q = 1-p
= 1- 33.2
= 66.8
d = 0.1x p
= 3.32
n =
Zα
2 pq
d2
=
= 8519.746
11.0224
= 772.94
(3.32)
2
(1.96)
2
X (33.2) (66.8)
Considering 10% non- response the ultimate
sample size will be :
= 773 + 77
= 850
But considering the unavoidable dropout and
other circumstances the sample size will be
taken = 1000.

17. DATA COLLECTION
Both primary and secondary data will be collected for this research. Data gathering and analysis
will occur simultaneously. To carry out the research systemic actions will be taken step by step.
Like:
 collection of information
 Data analysis and interpretation
primary and secondary data has different step as both are different. This two are:
 Primary data source: primary data will be collected from field survey with structured
questionnaire.
 Data type: qualitative data
 Instruments: recorder, pen, pencil, structured questionnaire and camera.
 Technique the data collection technique will be face to face interview. Specially structured
interview will be done. Along with that some open questions will be done to get an
inquiry with research topic.

18.  Secondary data source: Secondary data will be collected from the following instruments:
o Bangladesh bureau of Statistics
o Bangladesh demographic health Survey
o Official reports
o Books, newspapers, national and international journals and so on
DATA ENTRY AND DATA ANALYSIS
After collecting data the editing and recording of collected data will be done. After that data will be
entered using SPSS. The rearranging of data, collapsing of data, creating new variables and
necessary merging the categories with negligible frequency will be conducted to prepare the data
for the final analysis.
Analysis will be done using the statistical software SPSS.

19. FLOW CHART OF THE WORK

20. Identification of the problem Topic Selection Objective Selection
Indicator Selection
Study Area Selection
Primary Data Collection
Questionnaire Formation
Discussion
Conceptualization
Literature Review
Data Submission
Data Analysis
Data Presenting
Data Processing
Final Submission
Secondary Data Collection

21. WORK PLAN

22. Activities
September
2018
October
2018
November
2018
December
2018
January
2019
February
2019
March
2019
April
2019
Designing the Study
Review of Literature
Development & approval of
proposal
Development of Data Collection
Tools
Pre testing Questionnaire
Data Collection, Entry & Analysis
Report Writing
Submission & Approval of Thesis
Printing, Binding and
Submission

23. Global Context
Europe
• The regional average rate of births per 1000 females 15–19 years of age is 25,
varying from 4 in Switzerland to 57 in Bulgaria.
• The United Kingdom –In England and Wales in 1988 the adolescent pregnancy
rate (15–19 years) was 45/1000; the abortion rate19/1000; and the birth rate
26/1000 (Wadhera & Millar, 1997).
Middle East and North Africa
• The regional average rate of births per 1000 females 15–19 years of age is 56,
varying from 18 in Tunisia to 122 in Oman.

24. Central Asia
• The regional average rate of births per 1000 females 15–19 years of age is 59,
varying from 19 in Azerbaijan to 152 in Afghanistan (UNICEF).
• Bangladesh – between the ages of 15 and 19 years, 69% of females marry. Most
marriages in the villages occur soon after menarche. These early marriages result
in a high proportion of first pregnancies before the age of 19.
• India – the birth rate per 1000 females (15–19) is 107. There are however
considerable differences between rural and urban regions: in rural areas the
adolescent birth rate is 121/1000 while in Delhi it is 36/1000

25. Latin America
• The regional average rate of births per 1000 females 15–19 years of age is 78, varying
from 56 in Chile to149 in Nicaragua (UNFPA). In some parts of Latin America, 30–40% of
all adolescent females experience motherhood before the age of 18.
Sub-Saharan Africa
• The regional average rate of births per 1000 females 15–19 years of age is 143, varying
from 45 in Mauritius to 229 in Guinea. • This is very high compared to the world average
of 65.

26. Bangladesh:
There is greater likelihood of maternal mortality.
The risk of dying from pregnancy related causes
is twice as high for adolescents aged 15-19

27. Risk factors for teenage pregnancy
• Social deprivation
• Lower socio-economic group
• Low educational achievement
• Having had teen parents
• Being in the care of social services
• Poor transition from school to work at adolescent age
• Sexual abuse
• Mental health problems
• Crime
• Population density

28. • Social deprivation
Teenagers from unskilled manual backgrounds (social class V) are 10 times more
likely to become teenage mothers than those from professional backgrounds
(social class I).
Teenagers from socially deprived areas are up to six times more likely to
pregnant than teenagers from other areas.
• Low educational achievement
Young people scoring below average educational achievement at ages 7 and 16
years are at significantly increased risk of becoming teenage parents. “Both
and effect”

29. • Teenage parents
Women who were themselves children of teenage mothers are more likely to have a
pregnancy compared with those born to older mothers and the offspring are at risk for
becoming teenage mothers or fathers themselves.
Socioeconomic deprivation
There is a strong association between teenage pregnancy and socioeconomic deprivation.
Victims Are usually socially excluded,
Experience domestic violence
poor attenders at antenatal clinic
homeless / the care of social services.

30. Risk associated with teenage pregnancy
1. Preterm labor
2. Anemia
3. Hypertensive disorder of Pregnancy (HDP)
4. Urinary Tract Infection (UTI)
5. Abortion
6. Sextually transmitted disease (STD)
7. HIV
8. Malaria

31. 9. Obstetric Fistulas
10. Puerperal Sepsis
11. Mental illness
12. Suicide
13. Homicide
14. Alcohol and substance abuse and smoking
15. Post delivery depression and difficulties with breast feeding.
16. Risk of being abandoned my her partner and family and be left with no means of
support.

32. • Gynecological immaturity
• Many adolescent girls retain the potential to grow while pregnant.
• Almost 50% of adolescents continue to grow while pregnant. This growth is
with larger pregnancy weight gains, increased fat stores and greater postpartum
retention than in non growing adolescents and mature women.
• Paradoxically, in spite of the changes typically associated with increased fetal size
(larger pregnancy weight gains, increased fat stores), the offspring are smaller in
growing than non – growing adolescents.
• This significant reduction in fetal growth rate is attributed to a competition for
nutrients between the maternal body and the gravid uterus.

33. THE END