Essay: Teenage Pregnancy Among Black Minority Ethnic Group In UK - Causes, Consequences, Strategies.

Background

Background

Teenage pregnancy is one of the key health and social issue affecting the global community. Pregnant teenagers are likely to face several health issues along with social stigma. The combined consequences are increasing the health care cost throughout the world. Teenagers, who are under 15 years old, are less likely to sustain a healthy pregnancy or to deliver a healthy baby, due to lack of physical development required to be a mother (Wellings et al. 2016). On the other hand, for the girls, who are 19 years old are associated with socioeconomic factors more compared to the health issues. The teenage pregnancies, leading to child delivery also have fatal consequences for the newborns. Premature labor, low birth weight, anemia, pre-eclampsia are the related with birth age. Several researches has been done for finding the reason behind the high percentage of teenage pregnancy, studies found that the socioeconomic status and educational background plays a key role in influencing teenage pregnancy (McCall et al. 2015). In developed countries teenage pregnancy is associated with social issues, like poverty, educational levels and other negative outcomes throughout the lives. It has been revealed from previous research that native communities, i.e. black minority ethnic group are mostly affected by this issue, one key reason behind the issue is lack of awareness. This research report would help to analyze the issue along with proper recommendation to resolve the issue.  

Aim

The current study aims to investigate the rate of teenage pregnancy among black minority ethnic group in UK and analyze the effect of the issue upon the education and social achievements of those teens.

Objectives

• To investigate the trend of teenage pregnancy from 1996 to 2016
• To identify review the rate of teenage pregnancy among 16-19 years old girls in Newham
• To compare the rate of teenage pregnancy in borough of Newham and Barking & Dagenham
• To understand the negative effects of teenage pregnancy within BME
• To propose a positive solution in term of education and social achievement and culture

Trends of teenage pregnancy between 1996 to 2016

During 1995-1997, the number of conceptions was 17040, with a rate of 50 teenage girls within 15-17 years per 1000 cases, within this rate 51 % was leading to termination. Among the borough of London, Newham had a rate of 63 per 1000 teenagers, which is 69 % in Barking & Dagenham & Dagenham. From 16-19 years women, the number of births was 318 in Barking & Dagenham (Craig et al. 2016). Barking & Dagenham and Dagenham are at the top of the teenage pregnancy rates throughout the capital. In 1996, the number of births from teenager mothers fell from 54000 in 1983 to around 45000 with a rate of 30 in every 1000 teenage girls. During 2001, about 50 % teenagers were shown to be lone parent. During 2001, 2002, 2003, 2004, 2005, 2006, 2007 and 2008, the pregnancy rate per 1000 15-19 years old girls in England/ Wales were 60.8, 60.6, 60.0, 60.3, 60.1, 60.2 and 61.5 respectively (Thomas Farrell et al. 2017). During 2009, the teenage birth rate was 25.3 and abortion rate was 23.8, i.e. 49.1 in total, significantly less than the previous year rates. Birth rate also continued to decrease through the next successive years, for instance, in 2010, birth rate was 23.4, in 2011 it was 21.3, 19.9 in 2012, 17.4 in 2013, 15.6 in 2014, 14.5 in 2015 (McKay and Barrett 2010). Reviewing the trend, it is revealed that the rate of teenage pregnancies and abortion rate has significantly reduced in UK with the implementation of appropriate strategies and policies.

Aim

Teenage pregnancy within black minority ethnic group

It has been revealed from several previous reports that teenage pregnancies are more likely to be in deprived communities, which led to the accumulation of the disadvantages among the society. While searching for the risk factors related to this issue, Ma (2016) reported that not using contraception at first intercourse is highest among 32 % 16-18 years old black African males, 25 % Asian females,  24 % black African females and 23 % black Caribbean males. A survey of adolescents in East London showed the proportion of having sex less than 16 years was far high among Black Caribbean, which is 56 %, followed by black African, i.e. 30 %, followed by white Asians. A study by Sedgh et al. (2015) highlighted that young women are more having unprotected sex compared to young men.

Survey results shown that 10 % young people used double protection, last time when they had sex. On the other hand, the literatures found differences in the use of contraception between ethnic groups (Nichols et al. 2016). For instance, black Caribbean young men were more likely to have sex compared to white British young men. However, it has also found that within an ethnic group, not all had similar attitude or perceptions about contraception. Parental communication and presumed disapproval of sex have a significant impact upon contraceptive use by ethnic groups. Teenagers from non white ethnic groups showed higher likelihood for undergoing unprotected sex, once they undergo a relationship more than 6 months (Brown 2016). These data suggested that Black African and Black Caribbean teenagers are more likely to undergo teenage pregnancy.

Impact of teenage pregnancy upon teenagers

Several impacts of the teenage pregnancies have been documented by previous literature, which included both social and health issues Jonas et al. (2016) reported that at the age of 30, teenage mothers are 22 % more likely to live in poverty, compared to the mothers pregnant after 24 or more. Teenage mothers are 20 % more likely to be employed or living with a partner. In most of the cases, male partners are poorly qualified and experience unemployment at a high rate. It has been revealed that teenage mothers are three times more likely to experience post-natal depression. On the other hand, mortality rate of babies born to teenage mothers is 60 % higher than others. Research through south London teenagers revealed regular smoking, drinking and drug abuse by under 16 teens for both male and female is high among the black minority ethnic groups, i.e. black African and Caribbean. About 7.5 % of abortions under 18 are followed by a previous abortion or pregnancy (Knapp 2015). The proportion has increased to 12 % in London (Shales 2017).

The education and social engagement related factors are investigated in several literatures, which revealed a significant impact on further educational and social development of teenage pregnancy. It has been revealed that probability of teenage pregnancy is far higher among girls with poor educational attainment.  On the other hand, research found that the rate of under 18 conceptions is approximately double in deprived wards with poor levels of educational attainment, compared to similarly deprived wards with better levels of educational attainment. A survey of teenage mothers revealed a high level of disengagement from education prior pregnancy. Approximately half of the population attend school during pregnancy. On the other hand, literatures also found that dislike of school was shown to influence the risk of teenage pregnancy. It has been revealed that among 20 % of most deprived local authorities, a 30% higher rate has been accounted for more than  8 % half days missed, compared to the areas, where less than 8 % of half days missed were accounted (Hadley et al. 2016).

Objectives

A survey revealed leaving school of teenage mothers without any qualification is accounted for about 40 % cases (McCarthy et al. 2014). On the other hand, it has been estimated that 29 % of girls leaving school under 16 with no qualifications become pregnant under 18, among which, 12 % avail an abortion under 18 (Leppälahti et al. 2013). These rates are 1 % and 4 % among girls leaving school after 17 years respectively. Leaving school less than 16 years with no educational achievement is also associated with lack of socialization and social achievements, which are associated with teenage pregnancy. It has also been revealed that many teenage girls come to clinic for abortion, without conveying the issue with their parents, due to the stigma or fear of social exclusion (News.bbc.co.uk 2017).   

Overview

According to Bergh and Ketchen (2011) research methodology chapter helps to conduct the research work in a systematic way. This chapter includes appropriate research tools for obtaining expected outcomes in easy and faster way. The methodology chapter includes the selection of appropriate research philosophy, approach design, data collection and analysis methods as well as ethical considerations. Currently, a primary research is being conducted, according to which, the qualitative data collection tool has been selected here, i.e. the focused group discussion and interview. These data collection methods allowed the in-depth analysis of the study objectives. These aspects have been demonstrated in two parts, section A: study group analysis and section B: data collection and research techniques.

Research philosophy

In the current research, the positivism philosophy has been selected as it promotes a critical and logical investigation of the research topic considering the primary data along with the pre-existing data Bernard (2011). In the current research, teenage pregnancy is a wide research area and a lot of previous scientific literature are there, which would help to analyze primary data collected, thus, selection of positivism philosophy is justified.

Research approach

There are two types of research approaches used in the research work, i.e. the inductive approach and the deductive approach. According to the deductive approach is advantageous in several research, as it promote the in-depth approach of obtaining knowledge, in this context, initially a hypothesis is being made, then the primary data are analyzed, based on which the hypothesis is tested for justifying it at the end of the research. On the other hand, in the case of inductive approach, initially data or information are gathered, based on which new theories or hypothesis are developed at the end of the research. In the current research, the deductive research approach has been selected, as it promote the development of a research hypothesis initially, as done in the research and then analyzing the hypothesis with the primary or secondary data collected through the research (Creswell, 2011). Moreover, as the research topic, i.e. teenage pregnancy is common; no new theory can be developed on this topic. Thus, it can be stated that the selection of the deductive approach is justified for the research.

Literature Review

Research design

In the current research, the descriptive research design has been selected, as it provides the opportunity to use the research tools in a logical and critical way as well as conduct the study in an appropriate and in-depth manner (Crouch and Pearce 2012). Moreover, the design also helps to use both quantitative and qualitative data collection method in the same work. Thus, selection of the descriptive research design is justified for the current study.

The qualitative data have been collected from ‘30’ 16 to 19 years old teenagers living in the borough of Newham and Barking & Dagenham, which are subjected to the non-probability sampling. Three groups have been created with 10 in each group, one group involves BME teenagers in borough of Newham, 2^nd group include BME teenagers in borough of Barking & Dagenham and the 3^rd group represented non-BME teenagers of borough of both Newham and Barking & Dagenham. On the other hand, 3 HSC experts are interviewed, which are also subjected to non-probability sampling. For encouraging their participation, the study group were offered T-shirts to compensate their time for the research.

A holistic approach was undertaken for studying the status of teenage pregnancy among the black minority ethnicity among the borough of Newham and Barking & Dagenham. After identifying the study group, the representatives were selected and trained for conducting effective field work with the minority ethnic groups. The black Carabbien and black Asian group in borough of Newham showed a program, which is responsible for mobilizing Caribbean in the borough. However, black African lacked a formal organizational structure for guiding them towards enhanced awareness on teenage pregnancy, thus, data collection from those groups were difficult.

Information collection regarding the teenage pregnancy among the black minority ethnicity through the borough of Barking & Dagenham and Newham was done with the help of three research tool, i.e. the focused group discussion, interview and the review of existing literatures.

Two types of data collection methods are there, i.e. quantitative and qualitative data collection methods (Crowther and Lancaster 2012). The primary data collection method for this research included qualitative data collection method, which included data collection through two models, i.e. use of world cafe model for focused group discussion with the teenagers and individual interview with the HSC expert. In case of the focused group, open and detailed discussion was carried out and the following ideologies of interest on teenage pregnancy: awareness, barrier, challenges, causes, consequences and interventions. All the participants were female between the age group of 16-19 years. In case of one-on-one interview for HSC experts, a 15 minutes interview was arranged with the 3 in-depth question on the topic, i.e. teenage pregnancy on black minority ethnicity through the borough of Barking and Deganham & Newham.

The review of literature was done through two months period. The information collected from the pre-existing literature was then analyzed with the information collected from the focused group discussion. A wide range of data were collected through grey and scientific literature as well as from the online data revealed from the health ministry of local and national government (Crowther and Lancaster 2012). In addition, from the UK government website, information related to teenage pregnancy were collected and analyzed. The focus group and HSC experts acknowledged the information revealed from these sources. Similarly, additional health information related to teenage pregnancy among the minority ethnic group across in the boroughs of Barking & Dagenham and Newham were collected from the official sources. These resources included local school registers, reports of immigrant’s employment and registers of local physician’s clinics.  

Trends of teenage pregnancy between 1996 to 2016

The collected data has been analyzed through observation, thematic analysis and transcript analysis. In addition, the primary data collected have been analyzed with the pre-existing literatures (Gummerson 2012).

The permission to carry out the research was obtained from the University of EThames GRADUATE SCHOOL with the help of the assessor. Data protection act 1998 has been followed to ensure the ethical considerations during the research (Hesse-Biber 2012). All the personal and professional data are kept confidential. Participants have been provided with the consent forms and the opportunity to leave the participation at any time.

Group 1: 16-19 years old BME teenagers in borough of Newham

In the first group, 10 young girls were asked to discuss about the impact of teenage pregnancy upon their lives. Within 10 girls, 5 were pregnant. Most of them are 17-18 years old. They belongs to black African, black Asians and black Caribbean. Participants highlighted that they are unable to nourish the child. 2 of them have aborted their first child. During the first pregnancy, they experienced several health issues, however, unlikely to seek medical health. They suffer from stress, fatigue and feel socially excluded. While asked about their family background to understand the influencing factors, it was revealed that all of them belong to low socio-economic background and pregnancy will lead to health as well as socio-economic issues. Most of the girls are the daughters of teenage mothers. While asked about their partners, most of them conveyed that their partners are also teenagers; only 3 of them conveyed that they are married to adults, who are employed, whereas other’s partners are not employed. The investigation of their educational status revealed that 6 of them left school before 16 years, 4 of them are continuing their studies, but due to current pregnancy, they are unable to go to school. Finally, when they are asked to discuss about the use of contraceptives, it has been revealed that except only one girl, all of them are aware of contraceptives, but 5 of them have not used it during their first intercourse, others were insisted to use contraceptives by their partners.

Group 2: 16-19 years old BME teenagers in borough of Barking & Dagenham

In the second group, the similar topics were discussed, for the sake of comparison between data. In this context, it was revealed that in this group 7 within 10 girls were pregnant; most of them are 16-17 years old. 3 of them have aborted their first child. They belongs to black African and black Caribbean group. They also belong to low socio-economic background, lives in poverty. 2 of them revealed that they never went to school, both of them are black Caribbean, 6 of them had left school prior their first pregnancy and 2 of them are continuing their school. Most of them belongs to teenage mothers, 6 of them were married. However, partners are either unemployed or recently employed at small firms as labour. While discussing about use of contraceptive, positive outcomes were revealed, many of them have attended contraceptive campaigns and all of them are aware of contraceptives. But, usage is low, when asked about the reason; they highlighted traditional barriers, partner’s unwillingness and fear of side effects. Most of them revealed signs of stress and depression, which are influencing them to smoke and drink alcohol, 2 of them consume drugs. 3 of them have not conveyed their physical status at their home, due to the fear of social exclusion.

Teenage pregnancy within black minority ethnic group

Group 3: 16-19 years old non-BME teenagers in borough of both Barking & Dagenham and Newham

In the third group, all of them are shown to continue their studies. This group include white British, black British and white Asians. 2 of them revealed unprotected sex, others used contraceptives. While discussing about their awareness regarding the contraceptives, 4 of them denied the usage, whereas 6 agreed to use those, all of them shown a well developed knowledge base. While asked about their background, most of them revealed moderate SES status. All of them attended contraceptive and safe sex campaign. They discussed about side effects of contraceptives, which were hindering some of them to use contraceptive, others revealed the benefits of using contraceptive, it protects them to be affected by infectious disease, to be socially excluded and to lead a healthy life.

Q1. What are the negative effects of teenage pregnancy upon teenagers and the infants?

The first HSC expert revealed that several health issues arises in pregnant teenagers, as they are not fully ready to nourish a fetus; these include malnourishment, low birth weight, nausea, low BP, hyperthyroidism, fatigue, muscular cramp and others. The second expert revealed that along with physical health, they suffers from mental stigma due to social exclusion and others social issues, in several cases parents are not supportive and girls lack medical and moral assistance. The third expert revealed that become isolated from society, hindering their further educational development, most of them remain unemployment throughout the life, these teens are also vulnerable to domestic violence.

Q2. How ethnicity affects teenage pregnancy?

The first HSC expert revealed that the black minority ethnic group are mostly affected by this issue, as they belong from poor SES and educational background. The second HSC expert revealed that in most cases, it is a tradition in native residents to get married at an early age; most of the teenage pregnant girls are the daughters of teenage mothers. In half of the cases, teenage pregnancy cases leads to abortion, though the rate has became half within the last 40 years. The third HSC expert revealed that the migrants and native residents are mostly lives in rural areas; most of them have not completed school studies, in addition lack of access to HSC and educational services in these communities are the key reason behind the high prevalence of this issue among them.

Q3. What improvement strategies should be undertaken?

The first expert depicted that several policies and social strategies has been already undertaken by UK and state government, along with the NGOs work to eliminate the issue from the society, which had shown  significant outcomes. Barking & Dagenham is one of the key examples of continuous reduction of the issue. The second expert revealed that community campaigns and health promotion programs are key strategy to enhance awareness among them, which will reduce the occurrence. The third expert suggested increased access to HSC services and implementation of policies related to underage pregnancies by government.

The results revealed from the focused group supported the secondary information revealed from reviewing existing literatures.

Impact of teenage pregnancy upon teenagers

Key findings:

Negative effects of teenage pregnancy

Evaluating the results, it has been found that teenage pregnancy affects the vulnerable population physically, mentally as well as socially. Along with the key health issues, the social stigma is a key cause of influencing mental health issues, which was supported by the literatures found by other authors. In addition, educational and career growth is also hampered. Research found that most of BME teen’s partners are unemployed, making the infant’s future uncertain, thereby enhancing the health care as well as social burden.

Teenage pregnancy is being continuously lowered

Results suggested that since 1996, the rate of teenage giving birth to a child as well as rate of abortion has been significantly lowered, which are the effects of community campaigns related to contraception as well as other government’s initiative to mitigate the issue. However, both the primary data in this research as well as literature suggested that teen pregnancy is more prevalent among the deprived areas, especially in BMEs including black African and black Caribbean, compared to the white and black British population. The reason behind the issue can be interpreted as the less access to education, tradition of early marriage and lack of awareness.

Comparison of teenage pregnancy among borough of Newham and Barking & Dagenham

While comparing the teenage pregnancy among borough of Newham and Barking & Dagenham, it has been found that awareness of contraceptive as well as usage is higher among BME’s in the of Barking & Dagenham, but rate of pregnancy is also high in the borough of Barking & Dagenham. The rate of abortion is also slightly higher among the borough of Barking & Dagenham. Compared to these two groups, non-BMEs have shown far better awareness and low rate of pregnancies. The different is mainly due to the influence of SES background.

It has been revealed from the study that the BME group are deprived of proper educational and social awareness regarding the negative effects of teenage pregnancies, for which a key way to mitigate the issue is health promotional program. Following recommendations would help to mitigate the issue:

• Health promotional campaign- Health promotion program should involve education related to negative effects of teenage pregnancy, importance of using contraceptive and nutritional requirement during pregnancies. HSC worker would need good communication skills for establishing a trustworthy relation with the vulnerable population to motivate them.
• Initiative of schools-Schools should include reproductive health related topics in educational syllabus for improving awareness.
• Policy development-Government should improve the policy initiative steps form improving their efficiency.
• Increased access of HSC services-Heath care access should be increased, especially in remote and rural places, for improving communication and enhancing awareness as well as provide HSC services to BME teenage population.

Conclusion

In conclusion, it can be interpreted that teenage pregnancy is a key health and social issue affecting the society and enhancing health care cost. UK was at the second position regarding this issue throughout the world. Ethnicity has a key role in influencing the issue, which can be mitigated with the help of communication, education and social inclusion of the ethnic minority groups. This study focused on the BME in the borough of Newham and Barking & Dagenham as well as analyzed the overall rate of teenage pregnancies and consequences. Teenage pregnancy is reducing, but more initiative is required to eliminate the issue by making the society aware of its negative impact. However, the study has a small sample size, which hindered the in-depth analysis of data; further research with a wide population would help to analyze the situation more efficiently.

Cook, S.M. and Cameron, S.T., 2015. Social issues of teenage pregnancy. Obstetrics, Gynaecology & Reproductive Medicine, 25(9), pp.243-248.

Methodology

Craig, P., Dundas, R., Leyland, A. and Popham, F., 2016. How successful was the English teenage pregnancy strategy? Brexit—a perspective from the other side of.

Craine, N., Midgley, C., Zou, L., Evans, H., Whitaker, R. and Lyons, M., 2014. Elevated teenage conception risk amongst looked after children; a national audit. Public health, 128(7), pp.668-670.

Hadley, A., Chandra-Mouli, V. and Ingham, R., 2016. Implementing the UK Government's ten-year teenage pregnancy strategy for England (1999-2010): applicable lessons for other countries. Journal of Adolescent Health.

Ross, S., Baird, A.S. and Porter, C.C., 2014. Teenage pregnancy: strategies for prevention. Obstetrics, Gynaecology & Reproductive Medicine, 24(9), pp.266-273.

Skinner, S.R. and Marino, J.L., 2016. England's Teenage Pregnancy Strategy: a hard-won success. The Lancet, 388(10044), pp.538-540.

Wellings, K., Palmer, M.J., Wilkinson, P. and Copas, A., 2016. How successful was the English teenage pregnancy strategy?–Authors' reply. The Lancet, 388(10060), pp.2604-2605.

McCall, S.J., Bhattacharya, S., Okpo, E. and Macfarlane, G.J., 2015. Evaluating the social determinants of teenage pregnancy: a temporal analysis using a UK obstetric database from 1950 to 2010. Journal of epidemiology and community health, 69(1), pp.49-54.

Brown, S., 2016. Teenage Pregnancy, Parenting and Intergenerational Relations. Springer.

Craig, P., Dundas, R., Leyland, A. and Popham, F., 2016. How successful was the English teenage pregnancy strategy?. The Lancet, 388(10060), p.2604.

Hadley, A., Ingham, R. and Chandra-Mouli, V., 2016. Teenage Pregnancy Strategy for England. The Lancet, 388(10044), p.560.

Jonas, K., Crutzen, R., van den Borne, B., Sewpaul, R. and Reddy, P., 2016. Teenage pregnancy rates and associations with other health risk behaviours: a three-wave cross-sectional study among South African school-going adolescents. Reproductive health, 13(1), p.50.

Knapp, R., 2015. The impact of maternal age on midwifery care. The practising midwife, 18(11), pp.16-20.

Leppälahti, S., Gissler, M., Mentula, M. and Heikinheimo, O., 2013. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ open, 3(8), p.e003225.

Ma, R., 2016. England's teenage pregnancy strategy has been a success: now let's work on the rest. The Lancet, 388(10055), p.1981.

McCarthy, F.P., O’Brien, U. and Kenny, L.C., 2014. The management of teenage pregnancy. bmj, 349, p.g5887.

McKay, A. and Barrett, M., 2010. Trends in teen pregnancy rates from 1996-2006: A comparison of Canada, Sweden, USA, and England/Wales. The Canadian Journal of Human Sexuality, 19(1/2), p.43.

News.bbc.co.uk, 2017. BBC NEWS | Health | Black teen pregnancies 'warning'. [online] News.bbc.co.uk. Available at: <https://news.bbc.co.uk/2/hi/health/5202532.stm> [Accessed 21 Mar. 2017].

Nichols, S., Javdani, S., Rodriguez, E., Emerson, E. and Donenberg, G., 2016. Sibling Teenage Pregnancy and Clinic-Referred Girls’ Condom Use: The Protective Role of Maternal Monitoring. Journal of child and family studies, 25(4), pp.1178-1187.

Sedgh, G., Finer, L.B., Bankole, A., Eilers, M.A. and Singh, S., 2015. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. Journal of Adolescent Health, 56(2), pp.223-230.

Shales, M., 2017. Barking and Dagenham has London’s highest teen pregnancy rates. [online] Barking and Dagenham Post. Available at: <https://www.barkinganddagenhampost.co.uk/news/health/barking_and_dagenham_has_london_s_highest_teen_pregnancy_rates_1_3968890> [Accessed 21 Mar. 2017].

Thomas Farrell, C., Clyde, A., Katta, M. and Bolland, J., 2017. The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity?. Culture, Health & Sexuality, 19(1), pp.135-149.

Bergh, D. and Ketchen, D. J. 2011. Research methodology in Strategy and Management, 1^st ed. Bingley: Emerald Group Publishing Ltd

Bernard, H. R. 2011. Research Methods in Anthropology: Qualitative and Quantitative Approaches. 5th ed. Plymouth: Alta Mira Press

Creswell, J. W. 2011. Research design: Qualitative, quantitative, and mixed methods

Crouch, C. and Pearce, J. 2012. Doing Research in Design - Page 68, 2^nd ed. London: Bloomsbury Publishing Plc.

Crowther, D. and Lancaster, G. 2012. Research Methods, 2nd ed. London: Routledge.

Gummerson, E. 2012. Qualitative methods in management research, 5^th ed. Thousand Oaks, Calif.: Sage

Hesse-Biber, S. N 2012. Mixed Methods Research: Merging Theory With Practice, 3ed ed. New York: Guilford Publications