Adolescents, contraception and termination of pregnancy

Abstract

The female adolescent patient has a variety of gynaecological issues which the healthcare practitioner needs to understand and pay particular attention to, ranging from screening for sexual health history, teenage pregnancies, sexually transmitted infections (STI’s), contraceptive needs (both for the prevention of pregnancy as well as for medical indications such as acne, dysmenorrhoea or heavy menstrual bleeding), termination of pregnancy (TOP) and vulnerability to sexual assault, trafficking and rape. Proper management of these issues is crucial in order to promote healthy sexual choices in this age group, because risk-taking behaviours learnt at this stage of development are more than often carried into adulthood. There are approximately 16 million adolescents giving birth each year, and 3 million unsafe TOPs each year, most of which occur in lower- and middle-income countries1. Pregnancy-related complications are the leading cause of death in girls aged 15-19 years in low- and middle-income countries. Teenage pregnancy is also related to higher rates of perinatal deaths and low birth weight. For the pregnant mother there is the threat of social stigma, effects on future marriage proposals, the risk of increased future pregnancies, and a cessation of further education and schooling leading to poverty. Prevention of adolescent pregnancy will thus improve both maternal and fetal outcomes.