Adolescent Pregnancy

Adolescent pregnancy is defined as a pregnancy occurring between the ages of 12 and 20 years. In Canada, rates of adolescent pregnancy remain some of the highest among developed countries. Saskatchewan has the highest rate of live births from adolescent pregnancies in Canada (excluding the Canadian territories).

Planned and Unplanned Pregnancies

Adolescent pregnancies include both unplanned/unintentional pregnancies and planned/intentional pregnancies. Unplanned pregnancies may be related to issues with contraception (e.g., inconsistent or incorrect use), lack of knowledge regarding reproduction and pregnancy, lack of planning around contraception and sexual activity, peer pressure to engage in sexual activity, substance use leading to impulsive or impaired decision-making, and/or lack of access to medical services.

Reasons for intentional pregnancies among adolescents may be similar to those cited by adults (e.g., desire to be a parent and finding meaning to life), as well as the phenomenon of ambivalence towards pregnancy. Ambivalence towards pregnancy means that although adolescents understand the potential consequences of sexual activity and know how to prevent pregnancy, they neither actively seek nor actively avoid pregnancy. This often results in a lower likelihood of using contraceptives consistently, increasing the chance of pregnancy.

Adolescent Pregnancy Guidelines

To assist healthcare providers working with and supporting pregnant adolescents, the Society of Obstetricians and Gynaecologists of Canada (SOGC) released the Adolescent Pregnancy Guidelines. The guidelines highlight that adolescent pregnancies are considered high-risk due to poorer pregnancy outcomes (e.g., preterm delivery and low birth weight). The included recommendations focus on providing care during the antepartum period (pregnancy prior to childbirth), the intrapartum period (time during labour and delivery), and the postpartum period (time following birth). These recommendations and accompanying information are summarized below. To access the full guidelines, visit: Adolescent Pregnancy Guidelines.

Antepartum Care

It is important for healthcare providers to be aware that pregnant adolescents may access prenatal care later than pregnant adults and have a significantly lower attendance at prenatal classes. There are a variety of reasons that a pregnant adolescent may delay accessing prenatal care:

Lack of knowledge about importance of prenatal care
Lack of understanding of the consequences of absence of prenatal care
History as a victim of violence
Desire to hide pregnancy
Fear of potential apprehension of the baby
Concerns about lack of privacy or judgemental attitudes from healthcare providers
Financial barriers

Research has shown that standard prenatal care improves pregnancy outcomes. SOGC lists 15 recommendations for working with pregnant adolescents during the antepartum period, including the following:

Use multi-disciplinary approaches
Discuss pregnancy options (abortion, adoption, and parenting) with pregnant adolescents, regardless of age
Test for sexually transmitted infections (STIs) at first prenatal visit and repeat testing in third trimester
Include fathers and partners in pregnancy care and prenatal/infant care
Screen for alcohol use, substance use, and violence during pregnancy
Administer screening and treatment for mood disorders in each trimester and postpartum
Assess nutritional needs and develop a plan to reduce anemia and low birth weight and optimize weight gain during pregnancy
Consult gestational diabetes guidelines and test pregnant adolescents as appropriate
Conduct an ultrasound at 16 to 20 weeks gestation due to increased rates of congenital anomalies

Intrapartum Care

Adolescents have a higher rate of vaginal deliveries than adults. Research shows that adolescents also have a shorter active phase of labour and a lower rate of assisted vaginal deliveries and Caesarean sections.

Postpartum Care

Postpartum care should include a focus on contraception. Research shows that adolescent mothers have a 25% occurrence of a repeat pregnancy within two years of delivery. For a free resource on contraception options for adolescents, please visit: Contraception Options.

Exclusive breastfeeding for the first six months is recommended by the World Health Organization and UNICEF. Adolescents may require additional support for initiation and continuation of breastfeeding. For more information on breastfeeding, please visit: Breastfeeding your baby.

Consequences of Adolescent Pregnancy

Adolescent pregnancy is associated with many consequences for the mother, the father, and the child throughout their lifespans. Some of the potential adverse outcomes include poorer pregnancy outcomes (e.g., pre-eclampsia, low birth weight, preterm delivery), and poorer educational and employment outcomes for both parents. Adolescent pregnancy also has long-term consequences for relationships. Although some adolescent mothers may maintain a long-term relationship with the father of their child, these relationships are more likely to deteriorate over time.

Children of adolescent mothers are likely to have less supportive and stimulating home environments, contributing to lower cognitive development, than children of parents born to older mothers. These children have also been shown to have higher rates of emotional distress and problem behaviour than children of older mothers. Children of adolescent mothers are also at an increased risk of becoming adolescent parents themselves.

Due to the increased risk of these outcomes with adolescent pregnancy, the delay of pregnancy until adulthood is often advantageous for the overall health of both the mother and the child.

For more information about factors associated with adolescent pregnancy, including both protective and risk factors, please visit: Adolescent Pregnancy: Risk and Protective Factors.

Prevention

There are several types of behaviour that help to reduce adolescent pregnancy rates. These include abstaining from sexual activity, reducing the frequency of sex among those who are sexually active, and the use of contraception by those who are sexually active.

Adolescents may know how to prevent pregnancy; however, they are not always consistent in applying this knowledge to their actions. Adolescent pregnancy prevention programs should ensure that adolescents have the skills needed to access contraceptives, deal with embarrassment, and negotiate contraception use with their partners.

Community-specific prevention strategies may be useful for addressing adolescent pregnancy prevention. These could include:

Education and social awareness campaigns regarding sexual health and pregnancy prevention
Involvement of youth in planning and developing prevention programs
Open, honest, and frequent discussions about sexuality and healthy relationships
Support for parents in talking with their children about sexuality and sexual health
Better access to contraception and health services

It is essential that healthcare services within the community work to establish and maintain good relationships with adolescents. Adolescents should feel comfortable accessing these services and should be confident that their information will not be disclosed to others. Healthcare providers can help to ensure that adolescents are receiving correct and appropriate sexual health information, as well as proper and effective contraception when needed.

Research shows that parents talking openly and honestly with their children about sex is associated with less risky sexual behaviour and helps to promote responsible decision-making. Parents are able to share their own values, beliefs, and expectations as part of their communication with their children around sexual health. By providing sexual health information, parents are able to reinforce safer sex-related and pregnancy prevention behaviours (e.g., contraceptive use). For more information on parents as sexual health educators, please visit: Information for Parents.

Support for Pregnant and Parenting Adolescents

Due to the potential adverse outcomes related to adolescent pregnancy and parenting, and in order to reduce the occurrence of these outcomes, it is important that pregnant and parenting adolescents are provided with appropriate resources and support. These supports are important during the pregnancy (e.g., prenatal and parenting classes, help to finish high school, financial support, emotional support), as well as after the pregnancy. Accessible resources and support services that are tailored to adolescents can help to create the best possible outcomes for adolescents and their children. For more information on Saskatchewan resources and supports, please visit: Available Saskatchewan-Based Resources and Supports for Pregnant and Parenting Adolescents.

Resources

App

Booklets

Contraception Options: Finding the Best Method of Birth Control for You

September 17, 2021

Posters

Protect Your Fertility

April 30, 2014

Reports

Available Saskatchewan-Based Resources and Supports for Pregnant and Parenting Adolescents

March 7, 2019