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Young, and a mum twice over: Study sheds light on successive pregnancies among girls

SINGAPORE – Amid recent court cases of men who got teenage girls pregnant more than once, a recent study by doctors at KK Women’s and Children’s Hospital (KKH) has shed light on the rate of successive pregnancies among girls in Singapore.

Adolescent pregnancies are associated with negative health and social consequences, and the girls are prone to poorer birth outcomes due to biological and socio-economic factors, doctors say.

Adolescent pregnancies are associated with negative health and social consequences, and the girls are prone to poorer birth outcomes due to biological and socio-economic factors, doctors say.

SINGAPORE – Amid recent court cases of men who got teenage girls pregnant more than once, a recent study by doctors at KK Women’s and Children’s Hospital (KKH) has shed light on the rate of successive pregnancies among girls in Singapore.

Nearly one in three girls and young women seen by the hospital’s Clinic for Adolescent Pregnancy had a subsequent pregnancy before the age of 21, reported the doctors, who suggested ways to improve care for pregnant adolescents.

One in five girls seen at the clinic had a subsequent pregnancy within a year, while more than 40 per cent of them had a subsequent pregnancy within two years. The vast majority of babies - more than nine in 10 - were discharged to the care of the mother, while the others were put up for adoption.

The study covered 470 of the 630 cases booked with the clinic from 2008 – the year it was set up – to 2012. The clinic catered to unmarried adolescents who were aged 21 and below at their expected date of delivery, and KKH said more recent figures are not available.

Between 2008 and 2012, a total of 3,334 babies were born to girls aged 19 and below in Singapore, according to the Immigration and Checkpoints Authority’s statistics.

While the number of teenage births has dropped sharply over the years, dipping from 816 in 2008 to 332 in 2016, recent court cases have highlighted the issue of girls having successive pregnancies.

Last month, a 21-year-old man was sentenced to reformative training after he got an underage girl pregnant. He had sex with the girl when she was 14, which led her to give birth in Aug 2015 to a premature baby, whom he placed in an SG50 souvenir bag and left outside his home for his parents to find. They had sex again and she gave birth to another premature baby in Dec 2016.

In another case last December, a 28-year-old man was sentenced to jail for having sex with a minor under 16. His girlfriend was about 15 when she bore their first child without either of them being aware she was pregnant. She became pregnant a second time but miscarried.

 

IDEAS TO TACKLE QUICK SUCCESSIVE PREGNANCIES

Adolescent pregnancies are associated with negative health and social consequences, the KKH doctors noted in their article published in January in the Annals journal of the Academy of Medicine, Singapore. The girls are prone to poorer birth outcomes due to biological and socio-economic factors.

“Short pregnancy intervals drain the already limited resources that adolescents have, and their children, in turn, could be at risk of adolescent pregnancies themselves,” wrote Dr Janice Tung, Dr Kwek Lee Koon, Dr Sadhana Nadarajah and Dr Suzanna Sulaiman.

Those from poorer backgrounds have not have sufficient resources for nutrition or for transport to see a doctor. They may have higher risk of anaemia and delivering smaller babies, and may deliver earlier than expected, Dr Suzanna told TODAY.

Other doctors said the pelvis of some pregnant girls may not be fully developed enough for the baby to pass through.

The KKH doctors concluded that attendance at its clinic was associated with fewer pre-term births and less anaemia, but was unable to prevent quick successive pregnancies.

Suggesting early discussion on contraception - instead of in a girl’s third trimester or after birth - they said an emphasis on long-acting reversible contraception (LARC) could be helpful.

LARC includes the intra-uterine contraceptive device, which can be used for five years, and implanon (a small birth-control implant), which can be used for three years, said Dr Suzanna, who is head and consultant, inpatient service, of KKH’s department of obstetrics and gynaecology.

“Such contraception methods require less active participation on the part of the patient and can be a good option for people who tend to be more forgetful, or find regular pill-taking difficult,” she said.

The reasons for adolescent pregnancies are varied and issues such as self-esteem, fear of rejection or even a history of sexual abuse may be involved, noted Dr Sadhana.

Although teenage pregnancies can happen to any girl, most who turn to teenage pregnancy crisis service Babes are of a lower socio-economic status, said its casework supervisor Azrahayu Ahmad Afandi.

Most of them got pregnant while they were in a relationship, but were often not supported by their partners, who may be as young as them, she said.

“(The girls) learn, know about contraceptives but they did not use it… they think that they won’t do it again or there is not much push from the parents (to get the girls to use contraceptives),” she said.

Less than 10 per cent of more than 500 girls that Babes helped between 2005 and 2017 had subsequent pregnancies while still in adolescence, said Babes executive director Christina Vejan.

It sees fewer than five such cases a year, but Ms Vejan noted not all who got pregnant again would return to the organisation, which helps by providing necessities such as diapers and milk powder, as well as case management and counselling.

Babes has tried visiting secondary schools to raise awareness of the help available but Ms Vejan said it is not always welcome as the schools may not want to be perceived as having higher rates of teenage pregnancies than others.

Babes’ group sessions, where the pregnant girls share their experiences with their peers, have been effective in encouraging them to return for counselling sessions.

Group care was also suggested by the KKH doctors, although Dr Suzanna noted potential challenges as the girls would have to share private details about themselves to a group and be active participants. With the education system encouraging more self-directed learning, it may be timely to explore the model for adolescents and their parents, she said.

At KKH’s clinic, medical social workers conduct assessments of the girls and a mental wellness team follows up on high-risk cases, the authors stated.

The study also found Malays making up more than six in 10 of the 470 cases seen at KKH’s clinic, and Dr Suzanna suggested organisations with strong links with the Malay community could be more active in delivering sexual health education at an earlier stage to the target group.

With the right support, poorer birth outcomes are by no means a foregone conclusion for pregnant teens who are not from privileged backgrounds.

Obstetrician and gynaecologist Christopher Ng once saw a 16-year-old pregnant patient whose family was not well-off, but made sure she turned up for regular check-ups.

“The baby was fine and the girl didn’t have any of the conditions (such as anaemia, post-natal depression or pre-term labour),” said Dr Ng of GynaeMD Women’s and Rejuvenation Clinic.

 

 

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