Challenges and responsibilities of Nurses in Handling Adolescent and unwed mothers in South East Asia

1. Challenges And Responsibilities
Of Nurses In Handling Adolescent
And Unwed Mothers in South east
Asia

2. Introduction
• The World Health Organization defines an
adolescent as an individual between 10-19 years of
age.
• There are about 350 million adolescents comprising
about 22% of the population in countries of the
South-East Asia Region (SEAR).
• They constitute 15%-26% of the population in
countries in the Region.

3. Introduction...
• Adolescence is a period of rapid growth and
development in an individual marking a change
from childhood to adulthood.
• New capacities are acquired and new situations are
faced as they grow up.
• These situations create many opportunities for
development but also pose risks to their health and
well-being.

4. Introduction...
The immediate family environment, peers,
societal norms, and the environment at school
and the workplace influence the development
of adolescents’ personality, capacities and
vulnerabilities.

5. Introduction...
• Adolescence is generally perceived to be a
healthy period of life since mortality is quite
low in this age group.
• However, this is deceptive since adolescents
are faced with several public health challenges
that are, of course, different from the ones
that they faced when they were children.

6. Key facts ( World’s Scenario)
• 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-
old girls globally.

7. Key facts ( World’s Scenario)...
• 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.
•

8. Key facts ( World’s Scenario)...
Birth rates
• Marked, although uneven, decrease in the birth rates
among adolescent girls since 1990, but some 11% of
all births worldwide are still to girls aged 15 to 19 years
old.
• Majority of these births (95%) occur in low- and
middle-income countries.

9. Key facts ( World’s Scenario)...
Birth rates
• The 2014 World Health Statistics indicate that the
average global birth rate among 15 to 19 year olds is 49
per 1000 girls.

10. Demographic situation (SEAR)
• Early marriage for girls is common in some
countries of the Region.
• More than 66% of girls in Bangladesh, 51% in
Nepal, 47% in India and about 22% in Indonesia are
married by 18 years.
• The total fertility rate in the Region contributed by
15-19 year old girls varies from 5%- 20% among
member countries.

11. Census 2011 Nepal Data
Total adolescence population : 6407404
• Male population: 3207821
• Female population : 3199583
Source: census 2011

12. Adolescence pregnancy In context to
Nepal
 Most common in Nepal, but the rate of
adolescence marriage seems to be increased
after the massive earthquake 2015.
 Almost around 41%of girls and11% of boys
marry before 18.

13. Source NDHS 2016

14. Contexts
• For some adolescents, pregnancy and childbirth are
planned and wanted, but for many they are not.
• Adolescent pregnancies are more likely in poor,
uneducated and rural communities.
• In some countries, becoming pregnant outside
marriage is not uncommon. Unwed pregnancy is a
major issue among Adolescence.

15. Unwed pregnancy
• Unwed mother is the lady who has become pregnant
without legal justification of physical intimacy
between man and women.
• In the traditional societies like Nepal the physical
relationship before marriage or becoming mother
before marriage is considered as a sin, which is highly
unacceptable.
•

16. Statistics of unwed pregnancy in Nepal
 In 2013, 273105 babies were born to girls age below 19
 There were 26.5 birth for every 1000 girls
 89% of teenage parents were unmarried
 77% of teenage pregnancy are unplanned
 15% end in miscarriage and 30% teenage pregnancies
end in abortion.

17. Causes of Unwed Pregnancy
• Unwed pregnancy is increasing in the country due
to:
 Improper sex education
 Prostitution ( presence of Badi group)
 Teen age mistake
 Contraceptive failure

18. Challenges OF Adolescence and
Unwed Mothers
• Poor Health Situation
• Increase rate of unsafe
abortion
• Higher MMR and NMR
• Poverty and socio -
economic deprivation
• Low birth weight
• Lack of sex education
• Vulnerability to STIs and
risk of abuse

19. Challenges OF Adolescence and
Unwed Mothers...
• Economic and social
consequences
-Increase School drop out
- Powerlessness
- Homelessness
- Stigma
• Poor nutritional diet
• Post delivery depression
• Lack of parenting skill and
difficulties with breast
feeding

20. Challenges Cont...
Adverse Health effects
• Pregnancy and childbirth complications are the
second cause of death among 15 to 19 year olds
globally.
• Some 3 million unsafe abortions among girls aged
15 to 19 take place each year, contributing to
maternal deaths and to lasting health problems.

21. Challenges Cont...
• In South-East Asia maternal causes of death
(haemorrhage, sepsis, abortion complications) account
for a higher proportion of deaths among females.
• Early childbearing is a public health priority in several
SEAR countries.

22. Challenges Cont...
• Early pregnancy has higher chances of adverse
reproductive health outcomes like high Maternal
Mortality Ratio and Infant Mortality Rate.
• Neonatal and infant mortality rates are higher among
women aged < 20.

23. Challenges Cont...
• In low- and middle-income countries, babies
born to mothers under 20 years of age face a
50% higher risk of being still born or dying in
the first few weeks versus those born to
mothers aged 20-29.

24. Challenges Cont...
• The younger the mother, the greater the risk to the
baby.
• Newborns born to adolescent mothers are also more
likely to have low birth weight, with the risk of long-
term effects.

25. Challenges Cont...
• Considering that adolescent fertility remains
high in some countries and is associated with
higher maternal as well as infant mortality,
this age group is significantly responsible for
contributing to population momentum and a
high MMR and IMR in the Region.
and to the cycle of ill-health and poverty.

26. Challenges Cont...
• Lack of sex education
Some adolescents do not know how to avoid getting
pregnant: sex education is lacking in many countries.
• They may feel too inhibited or ashamed to seek
contraception services.

27. Challenges Cont...
• Even when contraceptives are widely available,
sexually active adolescent girls are less likely to use
them than adults.
• Girls may be unable to refuse unwanted sex or resist
coerced sex, which tends to be unprotected. Thus,
leading to vulnerability.

28. Challenges Cont...
• Economic and social consequences
 Adolescent pregnancy can also have negative social
and economic effects on girls, their families and
communities.
 Many girls who become pregnant have to drop out
of school.

29. Challenges Cont...
• Economic and social consequences
 A girl with little or no education has fewer skills and
opportunities to find a job. Thus leading to
powelessness and homelessness.
 This can also have an economic cost with a country
losing out on the annual income a young woman
would have earned over her lifetime, if she had not
had an early pregnancy.

30. Responsibilities

31. Joint
responsibility

32. Ensure universal
access to sexual and
reproductive health
services and rights
Responsibilities...
Stop child, early and forced
marriage
Provide Comprehensive sexual
education
Information, Counselling and services
for full range of safe, effective and
accessible and affordable contraceptive
methods.
Pre-pregnancy, pregnancy, birth, post-
pregnancy, safe abortion and post abortion care
Source: Who. Int infographics

33. Responsibilities...

34. Responsibility of Nurses
• Encourage for ANC , INC and Postnatal visit.
• Provide Tender loving care.
• Provide Sex education and education on contraceptive
use
• Provide opportunities for school education.
• Provide life skills for independency and improve socio
economic status.
• Encourage social support.

35. Responsibility of Nurses...
• Home visit by nurses.
 Information, education and counselling on transition to
motherhood and parent child communication
 Couple counseling.
 Individual mother and father counseling.
• School health programme.
• Act as Rolemodel for behaviour changes

36. Nurses As An advocator
 As an advocator, she can advocates the rights
of unwed mother and can protect her from
further exploitation.
 She must inform the mother about her legal
rights which are provided by government to
them so that mother can take benefit of them.

37. Nurses as a Researcher
• As a researcher, she should make research in
the best preventive measure to avoid the
occurrence of unwed mother.

38. References
• http://who.int/mediacentre/factsheets/fs364/en/
• http://apps.searo.who.int/PDS_DOCS/B4771.pdf?
ua=1
• https://www.childtrends.org/programs/early-
intervention-program-for-adolescent-mothers/
• https://cwru.pure.elsevier.com/en/publications/ca
re-of-adolescent-parents-and-their-children-3
• NDHS 2016
• Annual report 2073/74