NAMES: MPOLOKENG MOTAKE

STUDENT NUMBER: 202101820

PROGRAM: BACHELOR OF NURSING SCIENCE

COURSE: RESEARCH

SUPERVISOR: MR. SHELILE

RESEACH TOPIC

ASSESSING FACTORS CONTRIBUTING TO TEENAGE PREGNANCY AT

NTS’EKHE HOSPITAL

INTRODUCTION

Teenage pregnancy is defined as pregnancy that occurs in young girls below the age of
twenty, regardless of whether they are married or of adult age (American Pregnancy
Association, 2023:1). Teenage pregnancy has been increasing at an alarming rate especially
in the United States, Africa and United Kingdom. Teenage pregnancy has become a global
concern as many people are affected like the teenager and her family, as well as the society in
general. An increase in teenage pregnancy can lead to increased child poverty as well as
degradation of the child’s well-being as teenage mothers drop out of school to take care of
their children trapping parents and community with them into that cycle (Save the Children,
2021:1). One of the causes of teenage pregnancy is absence of affectionate supervision from
parents or guardians as in the current society, parents are either too busy to take care of the
adolescents children or too permissive (IvyPanda, 2023:1). Another major cause of teenage
pregnancy is peer pressure where a girl maybe pushed by others in having sex in order to fit
well in their group (Lindert, Deijl, Elirehema, Elteren-Jansen, Chitanda & Akker, 2021:1).
Sexual abuse as well as drug and alcohol abuse can also lead to teenage pregnancy as they
may not have an understanding of what they are getting themselves into. Lack of sex
education in schools can also contribute to teenage pregnancy as they might indulge in sexual
activity without understanding the possible effects or not even knowing that there are means
of preventing unintended pregnancy (2023:2). Apart from doing daily health education and
providing family planning services to adolescent, Nts’ekhe Hospital is doing school health
educating teenagers about dangers of teenage pregnancy.
BACKGROUND

According to American Pregnancy Association (2023:1), teenage pregnancy is one that

occurs for a woman under the age of 20. Even though a young woman aged 12 or under who
is pregnant falls under this definition technically she is not a teenager. With over 200000
babies being born to teenage women in the United States, teenage pregnancy is not
uncommon occurrence. However, that does not stop teenage women who are expecting from
feeling daunted by their pregnancy more especially if it was unplanned. Freedman and Jane
(2020:1) added that, despite a successful ten year strategy to reduce teenage pregnancies
implemented by the Labour Government between 1999 and 2010, the United Kingdom still
has one of the highest teenage pregnancy rates in Western Europe. Low educational
attainment is both a cause and consequence of teenage pregnancy (Freedman and Jane
(2020:1).

Furthermore, teenage pregnancies are higher in developing countries than developed

countries, and more so in the sub-Saharan Africa of 28% of adolescents give birth before the
age of 18. 28% of girls in West and Central Africa have had a live birth by the age of 18
while Eastern and Southern Africa has 25% (Nabugoomu, Seruwagi & Hanning, 2020:2). In
Uganda, more than one out of four adolescents aged 15 to 19 become pregnant with higher
rate of 27% in rural areas than urban areas which is 19% and this raises public health concern
(Nabugoomu, Seruwagi & Hanning, 2020:2). Amoadu, Ansah, Assopiah, Acquah, Ansah,
Berchie, Hagan and Amoah (2022:2), continued to say that in developing countries, an
estimated 21 million adolescent girls aged 15 to 19 become pregnant and about 12 million of
them give birth each year. 2.5 million adolescent girls below the age of 16 give birth early
according to the reports. In Ghana, two out of ten girls become pregnant or welcome their
first child before they reach the age of 18years (Amoadu et al, 2022:2).

As indicated by (Ndlovu, 2022:1), the latest adolescent pregnancy data from Statistics South
Africa shows that 90037 girls aged 10 to 19 gave birth from March 2021 to April 2022,
across all provinces. Moreover, Save the Children (2021:1), showed that the number of
children born to teen mothers in South Africa’s most populous province, Gauteng, has
jumped 60% since the start of Covid-19 pandemic, with Save the Children concerned for the
well-being of both mothers and babies. New figures from the Gauteng Department of Health
(2022) show that more than 23000 girls aged under 18 gave birth between April 2020 and
March 2021 of which 934 were aged under 14 compared to 14577 girls aged 19 and under
having babies in the same period a year earlier. Early pregnancy and motherhood in South
Africa forces many girls to drop out of schools, traps many in a cycle of poverty dependant
on public assistance, and leaves many stigmatised by society for being teenage mothers or
forced into early marriage.

According to UNFPA (2021:1), teenage pregnancy remains a challenge in Lesotho. The

adolescent birth rate is high, at 94 per 1000 girls aged 15 to 19 as per 2003 to 2028 statistics.
A 2017 report by the United Nations Education, Scientific and Cultural Organization
(UNESCO) listed Lesotho among the leading countries on early and unintended pregnancies.
60% of girls aged 15 to 19 are mothers or pregnant with their first child, which places
Lesotho second to Namibia which is at 70% for high rates of unintended pregnancies among
the East and Southern African countries.
PROBLEM STATEMENT

According to UNFPA (2021:1-2), teenage pregnancy remains a challenge in Lesotho. The

adolescent birth rate is high, at 94 per 1000 girls aged 15 to 19 as per 2003 to 2018 statistics.
A 2017 report by the United Nations Education, Scientific and Cultural Organization
(UNESCO) listed Lesotho among the leading countries on early and unintended pregnancies.
60% of girls aged 15 to 19 are mothers or pregnant with their first child, which places
Lesotho second to Namibia which is at 70% for high rates of unintended pregnancies among
the East and Southern African countries. Adolescent girls tend to be at greater risk of
complications as their bodies are not yet fully developed. Such complications can be
cephalopelvic disproportion which can lead to caesarean section having to be performed to
deliver the baby safely. In Lesotho, the maternal mortality ratio is high, at 618 deaths per
100000 live births as shown by 2016 census. The study that was done at Quthing hospital in
2021 have shown that 33% of women in Lesotho mostly die of obstetric haemorrhage, 24%
die of hypertension-related conditions and 6% die of puerperal sepsis. Due to high rate of
maternal deaths, UNFPA, the United Nations and reproductive health agency, supports the
government of Lesotho’s efforts to increase access to quality sexual and reproductive health
and rights (SRHR) services that are integrated and youth friendly (UNFPA 2021:2).
Irrespective of any measures taken to overcome teenage pregnancy Nts’ekhe Hospital still
has high rate of teenage pregnancy, therefore the researcher aims to assess factors
contributing to teenage pregnancy at Nts’ekhe Hospital.

.
RESEARCH QUESTIONS

What are the factors contributing to pregnancy among teenagers at Nts’ekhe hospital?

What are the perceived complications of teenage pregnancy among teenagers at Nts’ekhe
hospital?

What strategies can be implemented to overcome teenage pregnancy among teenagers at

Nts’ekhe hospital?

AIM

The aim of the study is to investigate factors contributing to teenage pregnancy and it’s
complications; as it seems like the cases are still high irrespective of other measures that have
been carried out, this will help in looking into other angles within the health system as where
the gaps are and how to fill them up.

OBJECTIVES

To investigate the factors contributing to pregnancy among teenagers at Nts’ekhe hospital.

To identify the perceived complications of teenage pregnancy.

To determine strategies that can be implemented to overcome teenage pregnancy.

SIGNIFICANCE OF THE STUDY

Nursing education

The study will prove that the Structured Teaching Programme regarding the complications of
teenage pregnancy is effective in gaining the knowledge. So this will enhance the students to
appreciate the importance of knowledge regarding complications of teenage pregnancy. The
study will be helpful for the students to realize their role in primary prevention of
complications of teenage pregnancy among adolescent girls. During basic education courses,
students may get education regarding teenage pregnancy and its outcome. Nurse educator
should therefore provide adequate knowledge regarding complications of teenage pregnancy
to the nurse’s students. The health care providers are the key personnel in imparting
education to the adolescent girls regarding complications of teenage pregnancy.
Nursing practice

Teenage pregnancy poses significant concerns not just for young mothers, but also for nurses and
other medical practitioners. For instance, it can create ethical issues related to abortion and
contraception use. Moreover, it affects the health and well-being of the younger population. There
is also increased pressure on nurses to provide pregnant teenagers with necessary care and medical
aid to avoid pregnancy complications and other health consequences. Finally, adolescent
pregnancy increases health care expenditures, which might affect the institutions’ budget and
funding in the long-term. This study will stress that there is a need of involvement of nursing
staff in planning and conducting education programs and also there is need of student nurses
to be involved in the educational programs. Nurses play a major role in the health care
system, they can provide supportive education services will help individuals, families and
communities to obtain restore or recover optimal health. Nurses working in the hospital
setting will be able to find out the high risk population and provide comprehensive health
education about teenage pregnancy, sexuality, and reproductive health.

 
Nursing management/admin

The main task of nursing administration is to organize seminars and workshop and other
educational programmes for adolescent girls as a part of in-service education programme by
which they can gain the knowledge on the complications of teenage pregnancy among
adolescent girls and can provide schools or community based education programmes to the
target population effectively. Nursing administrator should take part in the health policy
making and developing protocols. The nurse administrator should make proper
recommendation to train effectively the nurses in care of teenage mothers.

Nursing research

The study will be valuable reference and pathway for further research as it seems that
complications of teenage pregnancy are more prevalent in girls less than 19 years. There is a
lack of adequate knowledge about complications of teenage pregnancy among adolescent
girls so there is a need for educational programmes in the schools or community to improve
the knowledge regarding complications of teenage pregnancy among adolescent girls.

Community

Culturally it is not easy for parents to talk to their teens about the likes of sex or allowing
them to talk about it, those adolescents who rise such topic are regarded as disrespectful and
this affects the younger population, their parents, the community at large and the health
system negatively as young people end up being involved in peer pressure where they will
get different advises and end up making unhealthy choices with their lives. It is the nurses’
duty to provide comprehensive health education about teenage pregnancy, sexuality, and
reproductive health at community level and that can be achieved by conducting outreaches
for those communities that are far away from the health services and to provide health
education about teenage pregnancy more often at the health facility. School health programs
can be of great help as more young population is found there. The study will therefore benefit
the community in that people will be well informed about teenage pregnancy and can advice
their teen girls accordingly.

VARIABLES

Dependent- teenage pregnancy

Independent- contributing factors

DEFINITION OF CONCEPTS

Teenage pregnancy- Teenage pregnancy is defined as pregnancy that occurs in young girls
below the age of twenty, regardless of whether they are married or of adult age (IvyPanda,
2023:1). In this study teenage pregnancy will mean young girls who encounter unintended
pregnancy along their way of life.

Poverty – is defined as the state of being poor (Allen, 2021:445). In this study poverty will
be regarded as one of the complications of teenage pregnancy.

Factors- defined as those things that affect a situation (Allen, 2021:214). In this study
factors will mean the causes of teenage pregnancy.

SUMMARY
This section introduced what the study will be all about, the background followed and
problem statement was included as well. The research questions were given as well followed
by aim of the study. The objectives, the significance of the study, the variables and definition
of terms are part of the content as well.

LITERATURE REVIEW

Global prevalence of teenage pregnancy in general

According to WHO (2023:1), Every year, an estimated 21 million girls aged 15–19 years in
developing regions become pregnant and approximately 12 million of them give birth.
Globally, adolescent birth rate has decreased from 64.5 births per 1000 women (15–19 years)
in 2000 to 41.3 births per 1000 women in 2023. However, rates of change have been uneven
in different regions of the world with the sharpest decline in Southern Asia (SA), and slower
declines in the Latin American and Caribbean (LAC) and sub-Saharan Africa (SSA) regions.
Although declines have occurred in all regions, SSA and LAC continue to have the highest
rates globally at 99.4 and 52.1 births per 1000 women, respectively, in 2022. There are
enormous differences within regions in adolescent birth rate as well. In the WHO African
Region, the estimated adolescent birth rate was 97 per 1000 adolescent in 2022 compared to
13.1 per 1000 adolescent girls in the European Region. Even within countries, there are
enormous variations, for example in Zambia the percentage of adolescent girls aged 15–19
who have begun childbearing ranged from 14.9% in Lusaka to 42.5% in the Southern
Province in 2018. In the Philippines, this ranged from 3.5% in the Cordillera Administrative
Region to 17.9% in the Davao Peninsula Region in 2017. While the estimated global
adolescent birth rate has declined, the actual number of childbirths to adolescents continues to
be high. The largest number of estimated births to 15–19-year-olds in 2021 occurred in SSA
was 6 114 000, whereas far fewer births occurred in Central Asia became 68 000. The
corresponding number was 332 000 among adolescents aged 10–14 years in SSA, compared
to 22 000 in South-East Asia (SEA) in the same year (WHO, 2023:1).

Factors contributing to teenage pregnancy

There are a number of factors contributing to teenage pregnancy. Inadequate access to

services like contraceptives (source). Contraceptives are not easily accessible to adolescents
in many places (source). Even when adolescents can obtain contraceptives, they may lack the
agency or the resources to pay for them, knowledge on where to obtain them and how to
correctly use them. They may face stigma when trying to obtain contraceptives (source).
Further, they are often at higher risk of discontinuing use due to side effects, and due to
changing life circumstances and reproductive intentions (source). Restrictive laws and
policies regarding the provision of contraceptives based on age or marital status pose an
important barrier to the provision and uptake of contraceptives among adolescents (source).
This is often combined with health worker bias and/or lack of willingness to acknowledge
adolescents’ sexual health needs (WHO, 2023:2).

According to WHO (2023:2), child marriage is another factor contributing to teenage

pregnancy, in many societies, girls are under pressure to marry and bear children. As of 2021,
the estimated global number of child brides was 650 million: child marriage places girls at
increased risk of pregnancy because girls who are married very early typically have limited
autonomy to influence decision-making about delaying child bearing and contraceptive use
(source). Again, in many places, girls choose to become pregnant because they have limited
educational and employment prospects, such girls lack information about sexual and
reproductive health and rights (source). Often in such societies, motherhood within or outside
marriage is valued, and marriage or union and childbearing may be the best of the limited
options available to adolescent girls. As a result, adolescent girls are prone to sexually
transmitted infections as others might be involved in polygamy (source).

Child sexual abuse increases the risk of unintended pregnancies. A WHO report dated 2020
estimates that 120 million girls aged under 20 years have experienced some form of forced
sexual contact. This abuse is deeply rooted in gender inequality as more girls are affected
than boys, although many boys are also affected. Estimates suggest that in 2020, at least 1 in
8 of the world’s children had been sexually abused before reaching the age of 18, and 1 in 20
girls aged 15–19 years had experienced forced sex during their lifetime (source). The WHO
(year) report titled Violence against women prevalence estimates 2018  notes that adolescents
aged 15–19 years (24%) are estimated to have already been subjected to physical and/or
sexual violence from an intimate partner at least once in their lifetime, and 16% of adolescent
girls and young women aged 15–24 have been subjected to this violence within the past 12
months. (WHO, 2023:2).
According to Lindert et al. (2021:1), Poverty and a resulting desire for financial gains also
predisposes young girls to teenage pregnancy. Poverty may lead to a desire to improve the
socioeconomic status so adolescents may display the need for financial and material gains.
Material goods increase the social status of teenagers, also materialism can contribute to
adolescents having sex. The lack of primary needs might generate exploitation to young girls
by those who have power (source). Poor life in general causes girls to find boys, sleep with
them so as to get money. Because of this poor life girls may therefore accidentally become
pregnant (source). Some girls are involved in sexual activity due to peer pressure, if one sees
their peers with nice materials there is that desire to have the same and if cannot afford to buy
such most adolescent girls end up with unhealthy choices to get them (source).

Perceptions of teenage pregnancy

It was discovered that, girls perceive late-night parties and alcohol consumption as major
factors contributing to sexual relationships among adolescents, so some girls disapprove
sexual relations before marriage as that is considered as unacceptable (source). Teenage girls
again perceive premarital sex as harmful, unsafe and dangerous even though other girls
perceive that as acceptable depending on the environment are living in (source). On the other
side some teenage girls perceive premarital sexual activity as a cool practice that proves there
is love in a relationship as long as contraception is used to avoid pregnancy. Girls believe that
if a boy forces them to have sexual activity is proving loving (source). Other adolescent girls
have fear of getting involved in sexual activity believing one sexual intercourse is enough for
one to get pregnant. To add more, some adolescents perceive early marriage and childbearing
as good practices especially those living in rural areas (Panda, Parida, Jena, Pradhan, Pati,
Kaur & Acharya, 2023:1).

According to Lindert et al. (2021:2), perception of teenage girls and local community
members revealed that teenage pregnancy can be influenced by cultural factors like peer
pressure as at this stage individuals act independently making their own decisions. As teenage
girls start developing their ideas, identity and norms, peers are known to be important
influencers and as one wants to fit in the group making unhealthy choice may result (source).
In Sub-Saharan African countries, men are recognized as dominant and initiating sexual
interactions so young women are expected to be submissive and obedient (source). As a
result women are known to be vulnerable to sexual coercion and that leads to more teenage
pregnancies in African settings. This cannot only result into unintended teenage pregnancies
by also into sexually transmitted infections especially where the male partners have other
sexual partners on the side (source).

Strategies to prevent/manage teenage pregnancy

Strategies and interventions related to adolescent pregnancy have focused on pregnancy

prevention (source). However, there is growing attention being paid to improving access to
and quality of maternal care for pregnant and parenting adolescents. Access to quality care
depends on the geographic context and the social status of adolescents (source). Even where
access is not limited, adolescents appear to receive a lower quality of both clinical care and
interpersonal support than adult women do. As a result, WHO works with partners to
advocate for attention to adolescents, build the evidence and epidemiologic base for action,
develop and test programme support tools, build capacity, and pilot initiatives in the small but
growing number of countries that began to recognize the need to address adolescents’ sexual
and reproductive health (source). As a result of these collective efforts, adolescent health has
moved to the centre of the global health and development agenda. In this changed context,
WHO continues its work on advocacy, evidence generation, tool development and capacity
building, while working with partners within and outside the United Nations system to
support countries to address adolescent pregnancy effectively in the context of their national
programmes (WHO, 2023:3).
Summary

This section articulated the global prevalence of teenage pregnancy where studies have
proven that teenage pregnancy is a world-wide problem especially in developing countries
irrespective of all measures taken for prevention. Factors contributing to teenage pregnancy
followed, there are many different contributing factors like peer pressure where young girls
needs approval from their peers and end up with unhealthy choice, poverty is another
contributing factor as young girls fall in a trap of being taken advantage of by those who have
money requesting them for sexual activity in exchange for money or material things and then
teenage pregnancy may result. Perceptions of teenage pregnancy also included whereby
teenage girls believe that if a boy requests for sexual activity that proves love. Furthermore
strategies to prevent teenage pregnancy were discussed, adolescent girls should have access
to quality care and information about health issues so as to take sound decisions with their
lives.
RESEARCH METHODOLOGY

3.1 Introduction

3.2 Research Design

3.3 Place of Study

3.4 Study Population

3.4.1 Target population

3.4.1 Accessible population

3.5 Sample

3.5.1 Sampling Methods

3.5.2 Sample size and its determination

3.6 Selection Criteria

3.6.1 Inclusion criteria

3.6.2 Exclusion Criteria

3.7 Pilot Study

3.8 Data Collection

3.8.1 Data Collection Instrument

3.8.2 Data Collection Process

3.9 Validity and Reliability

3.9.1 Validity

3.9.2 Reliability

3.10 Data Analysis

3.11 Ethical Considerations

3.11.1The principle of Beneficence

3.11.2 Confidentiality

3.11.3 Informed consent

3.11.4 Justice

3.12 Plan for Use of Findings and Results/ Results Dissemination Plan

Chapter outline

The research report will have the following chapters:

Time Table for the Study

DATES ACTIVITIES

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 ‍

Budget

The study will be funded by…..

ITEMS ESTIMATED COSTS

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References

Annexures 1 and 2…….