Teenage pregnancy is a term used to address girls between the ages of 13-19 years who become pregnant (UNICEF, 2008).Teenage pregnancy and its resultant health issues are of concern worldwide. In Ghana, for example, according Keller, Hilton & Tsumasi-Ankrah (1999), nearly 1/3 of the childbirths recorded in public hospitals occurred to women less than 19 years of age. Meanwhile, Guttmacher (2012) reported that in The United States of America, 750,000 teen pregnancies occur yearly. Health messages are crucial in effecting behavioural change of preventable factors on health (Mokdad et al; 2004). This message is created in an attempt to influence change in behaviour and can as well be used not only for changing adolescents’ sexual health behaviours, but also for informing and educating a larger population.
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This essay will address the following: chosen medium, the rational for the message addressing political issues supporting its use, the underpinning health belief model, ways of evaluating the success of the health message, its impact on a wider population and, the influence of nurses, other health professionals and lay persons on health promotion regarding teenage pregnancy.
According to Guttmacher (2012), 3,312 girls become pregnant every 24 hours. Also, in every 26 seconds a teenage girl becomes pregnant and a child is born to a teen mother every 56 seconds. It is therefore sensible to explore the extent of teenage pregnancy and its impact. De Vienne, Creveuil & Dreyfus (2009), believes that 70,000 teenagers die yearly from obstetrical complications, and 1 million infants born to adolescent mothers die before their first year of life. Although the majority of teenage pregnancies occur in developing countries, one million babies are born annually to teenage mothers in the developed world. According to (Adeyinka, Oladimeji, & Adekanbi, 2010), in 2003 42/1000 births in the US were to adolescents. Furthermore, it has been reported that adolescents are at a higher risk for adverse outcomes such as preterm birth, low birth weight, pre-eclampsia, congenital anomalies, uterine rupture and infant death than their older counterparts (Phipps, Blume & DeMonner, 2002).
In view of the health problems the world is confronted with as a result of teenage pregnancy, this message is aimed at creating awareness of the various causes and outcomes of teenage pregnancy. It also aims at promoting healthy sexual behaviours, to give the youth the skill and knowledge they need to refuse sex, delaying the onset of sex and to practice safer sex and to reduce the number of conceptions among adolescents (Kirby, 2007).The message will also help debunk certain ideologies and myths about sex education such as those with regards to certain words or body part being unmentionable and the taboos of sex education that influence the human sexuality negatively (Adepoju, 2005).
Consequently, advances in communication strategies have changed how individuals access, assess, communicate and use information. Egger et al (1999), stated that health promotions are motivational and informative messages directed to one or more people. The idea of attaining improved health and a better quality of life needs tailoring our educational messages to the particular group of people it is intended for, taken into account the cultural practices of the community as such programmes involve community members who participate to define and solve the problems (Denison et al, 2009)
Cultural, religious and traditional issues influence sexual behaviours. Personally, in my area of practice culturally acceptable sex education is given using, local dialects in folk songs, radio drama and role plays avoiding sexually explicit words. This way community values are respected as well as responded to. In recent years there has been a much stronger religious and political focus on the teaching of sex abstinence in schools than in the past years (Butts & Rich, 2008). This is to add to the existing knowledge that most religious group preach abstinence before marriage e.g. Islam and Catholics even preach against contraception hence telling the youth to abstain from sex (Citizens Budget Commission, 2012). Contrarily, some social customs induce girls to stay out of school and enter into early sexual relationship were girls are given away in marriage at puberty (Keller et al; 1999). These observations considered a health promotion message using role play will inform the adolescents on causes, complications and prevention, of teen pregnancy and motherhood in a non-judgmental approach.
Role play therefore, is considered the appropriate medium as it focuses not on acting but on the actions of the characters. It helps in the process of decision making and clarifies judgments and behaviours and lastly it encourages looking beyond the self and into another person in a close and more intimate manner than reading or lectures allows (Rowles and Russo, 2009). Role play is unscripted and a dramatic technique of message delivery that encourages people to improve behaviours that illustrate expected actions of persons in a defined situation (Lowenstein, 2007).
In the delivery of such messages ethical issues could arise. Everyone needs to have equal access to care, thus the principle of justice must be considered and the nurse is to do good by providing the information and education they need but she has to seek consent from parents before she could go ahead. In developed nations parents can decide they don’t want their wards to sit in for such programs according discussions by fellow students from the UK whereas from experience in Ghana one needs to just tell the head teacher when the nurse is coming. It is important to recognise that in carrying out the principles of beneficence and non maleficence, the question will be how much information is too much? Knowledge of when information given becomes unethical is important. Appropriate information must be presented in an age appropriate manner as there will be potential harm if a wrong and inappropriate message is chosen. An ethical dilemma will arise when a choice has to be made between standardised and acceptable programs that are available (Miller et al; 2011) e.g. teaching abstinence as opposed to safer sex practice. Inappropriate programs for a particular age group could easily be misinterpreted and result in the adolescent being misled as she perceives the information differently from the way the educator intended for the message to be received (Miller et al; 2011).
Promoting the health and wellbeing of adolescents is a vital part of every society including health workers. Teenagers have been recognised to be at high risk of health-damaging behaviours such as teenage pregnancy (Jacobson & Pill, 1997).Similarly, Reeve (2002) in his study revealed that healthcare providers have the potential to strengthen young peoples’ awareness of appropriate sources of help and information, comprehensive sex education programs and advice on sexual health. He also reported that, the introduction of contraceptive services delivered by nurses, as well as trained teenage advisors or lay persons will be associated with an increase in the number of people attending for advice and contraceptives. Contrary to these assertions Thomson & Scott (1991), criticised that sexual health education at school has little or no relationship to the real choices and pressures around sexual health that affects the young women.
Furthermore, Denison et al (2009), proposed that every agent of health care including lay persons/peers can partake in communicating the causes and effects of teen pregnancy by mobilising community members to participate in role plays which will illustrate causes, complications and where to get help whether in the community or the hospital setup.
According to MARIE STOPES INTERNATIONAL (2012), in 1998 in England, the pregnancy of girls under 18years conception rate fell by 13.3% over 5 years. There has also been a shift in society’s views about how best to tackle problems like high teenage pregnancy rates and poor sexual health amongst young people.
Increasingly, from a personal perspective parents and professionals will recognise the need to offer teenagers with opportunities to talk about how they feel openly, skills and self-confidence they need to deal with the situations they face regarding sexuality. Also it will raise awareness in the community and at national levels which will in turn help them to strategise and tailor programs to help the youth to understand the way in which sex is, to help them know that relationships portrayed in the media are not always accurate and the appreciation of the challenges and responsibilities of parenthood. This includes supporting them delay early sex, equipping them to stay safe and healthy when they do become sexually active. Parents will play a more positive role in supporting their children on sex and relationship issues (Primarolo &Merron, 2010). According to Sexual Offences Act (2003), in UK the age of consent for female and their male counterparts is 16 years. This means men who have sexual intercourse with girls below 16years of age will be prosecuted. Meanwhile there are such clear cut age ranges and laws in Ghana expect for rape cases. Also support from national and international agencies may include development of national training standards on relationships and sexual health to provide a constant framework for local workforce development (Primarolo & Merron, 2010).
The evaluation of sexual health promotion programs has to be SMART-Specific, Measurable, Attainable, Reliable and Time bound (Haughey, 2012).
Assessments of sex education programmes can vary from changes in knowledge, attitudes and values to those of behavioural change including initiation of sexual activity and pregnancy rates (Fullerton, 2004). Arguably, initiation of sexual activity cannot easily be evaluated if the adolescent does not openly discuss it. Also clear statements given by students about the outcomes of unprotected sex and how those outcomes could be avoided at the end of the session (Vincent, Geiger, Willis, 1994).
The aims of sex education are often motivational, relating to lifelong quality of relationships, as well as pregnancy and STI prevention (Fullerton, 2004).
Moreover, studies have demonstrated that health decision making is a process in which the individual moves through a series of stages or phases. Interactions with persons or events at each of these stages influence the individual’s decisions and subsequent behaviour (Rosenstock, 2005).
As a matter of fact, behavioural change is a difficult process which starts with enabling change in personal behaviours of individuals by giving them the knowledge to do so through education (Bellamy, 2004). The health belief model posits that people who perceive themselves as susceptible to negative outcomes are more likely to reduce risky behaviours than those who do not see themselves at risk (Janz & Becker, 1984). The model postulates four conditions that predict a health related behaviour; perceived susceptibility, perceived seriousness, perceived benefits and barriers (Janz & Becker, 1984).
Perceive susceptibility refers to one’s perception of the likelihood of contracting a health disease or condition (Witte et al; 1996) or becoming pregnant in this case. It helps individuals to adapt to healthier lifestyles. The more the teenager perceives the outcomes of teenage pregnancy, the more they will try to avoid it.
Witte et al (1996) again stated that perceived severity will be the teenager’s belief about the implications of a health risk. The perception of severity is often based on the health information given or knowledge about the severity of a condition and difficulties it will create on general wellbeing. If she thinks of it as a serious issue she will try to avoid getting pregnant.
Also, the concept of perceived benefits is the teen’s judgments of the value of the action that will lessen the risk of getting pregnant. Usually, teenagers will practice healthier lifestyles when they believe a new behaviour will lessen their chances of getting pregnant and suffering the consequences (Janz & Becker, 1984). This assertion of Janz & Becker is not always the case as some will wait to be in that particular situation before they take action. On the other hand, as most teenagers don’t change their lifestyles easily, perceived barriers are their own assessment of the difficulties in embracing a new behaviour. Amongst all the perceptions, perceived barriers are most important in defining behavioural change (Janz & Becker, 1984) because if they are able to overcome these barriers their behaviours will change.
Cues to action are pieces of information which are given out with the intention of triggering decision-making actions. They could be internal or external e.g. informational flyers, advertisements on television or internal symptoms of an illness (Witte, 1996). Lastly self efficacy, measures the degree of the reaction taken to prevent pregnancy and that they are able to perform the recommended reaction to avert the risk.
Teen pregnancy and motherhood is a serious problem affecting adolescents which can causes health and social problems. With empowering the youth through education, teen pregnancies and its related problems can be prevented. From a personal view point, it will be acceptable to say that proven programmatic answers to this dilemma are likely to be dissatisfactory. The point is not that sexuality education and contraception education cannot be helpful, but that without more help from the society at large, their impact may be small. On the contrary, an intervention that starts by affecting behaviour in a self-effacing way may ultimately generate changes in behaviours. Behaviour is “contagious” and teens, in particular, are extremely influenced by what their friends do or say. This suggests that programs are not to be judged on the basis of their immediate effects only but also on their peer culture reorientation potential.