("Source: Media from Wix").
Adolescent pregnancy is a growing problem world wide and in the Canadian society. A population-based cohort study conducted in Ontario during January 2006 to December 2010 compared adolescent pregnancy with adult women pregnancy and the statistics revealed that 55,1079 singleton births out of which 23,992 (4.35%) were adolescent pregnancies which were associated with an increased rate of smoking as well as substance abuse compared to the adult women. These adolescent pregnancies were also originating from the youth who had poor education and thrived in low income families. Thus, pregnant adolescents have higher sociodemographic risk factors compared to an average adult women and they also tend to seek the appropriate prenatal care at much later stages which increases the poor health outcomes.
In my blog post, I am going to use the social ecological model of health which includes five levels as illustrated in the diagram below. Each level comprises of various components which are the factors that influence an individual's health. An understanding of the social-ecological model through the diagram below is easier to aid one to understand what this model comprises of, the five levels it contains as well as the individual components that influence each level. The five levels of the social ecological model are also interrelated to each other.
("Source: https://www.pinterest.ca/pin/161777811600742085/ ").
Now let's explore how these individual levels of the social ecological model are related to and influence adolescent pregnancy. Individual level The individual level of the social ecological model comprises of attributes such as educational level/knowledge, age, sexual orientation and economic status. In my career as a medical sonographer, adolescent pregnancy has been a predominant issue of concern where I encounter a high volume of teenage girls who lack knowledge of sexual education and hence visit the hospital for multiple abortions. Also, poor economic status is a major factor where most of these young girls from poor neighborhoods are unaware of safe sexual practices and measures to avoid an unwanted pregnancy. As per the Ontario Child Health Study which conducted three surveys on children between 4-16 years of age in the year 1983, 1987 and 2000-2001, the reports showed that the female sex experienced 22.1 % more child sexual abuse compared to 8.3 % of the male sex.
Interpersonal level The interpersonal level which comprises of family, friends and social network plays a crucial role in influencing an individual’s behavior. Occasionally, at work I witness unfortunate cases of abortion caused by family members forcing sexual violence on these young girls. The social network which comprises of family, friends, relatives and social media tend to influence the youth and compels them to involve themselves in sexual activities when they are unprepared and unaware of the consequences.
Organizational level The organizational level which includes school as an essential body is considered a predominant learning source for young minds. A school imparts knowledge to the youth by effectively communicating and explaining them about safe health practices. Some of these young girls and boys are not attending schools due to numerous reasons such as a poor mental/physical health, unhealthy family environment and thus are ignorant of the organizational level of resources that can positively impact their life. Not accessing organizations such as their public schools and counselling services tends to make them uninformed of healthy sexual practices causing unwanted and unhealthy pregnancies. Community level To understand the behavior of adolescents, it is vital to be aware of the community they dwell in. The community level of the social ecological model includes an association between organizations such as schools, parks, churches etc. in their neighborhood .The Ontario Child Health Study demonstrated that dwelling in rural neighborhoods, poverty as well as young maternal age led to the severe category of child physical and sexual abuse. This analysis of the study proved that not just the community but also socio-economic conditions such as lack of funds are intertwined to poor health outcomes.
Public policies
Lastly public policies which includes laws and regulations pertinent to abortion are necessary to assist and prevent teenage pregnancy. In Canada, we have the National Abortion Federation that provides information pertinent to policies, guidelines and coverage for abortion in each province. National Abortion Federation. states that in Canada abortion is free of cost for women as per the Canada Health Act. Abortion is also considered as a safe, legal and an insured procedure which is funded by the provincial and territorial health plans; however the coverage and access of abortion services can vary between provinces. For example, in provinces like Saskatchewan, the government covers the travel cost for women to visit the abortion clinics in Alberta. In Ontario, the abortion service is covered till 24 weeks which is the maximum time compared to smaller provinces which mostly provide services between 12 to 13 weeks. (National Abortion Federation, n.d.)
Strategies to assist and minimize adolescent pregnancies
Adolescent pregnancy is a topic that has been better studied in the Unites States. The American Academy of Paediatrics provides a ‘medical home’ model of care for teenage parents. “This model provides care for both the parent and the child keeping in mind that it is accessible, family-centered, developmentally appropriate, continuous, comprehensive, coordinated, compassionate and culturally sensitive (Paediatric Society, n.d.).” The model of medical home care has been transferred to a few Canadian hospitals and clinics, adolescent parent housing centers and community health centers where besides focusing on the teenage parent and new born, they also focus on addressing the social determinants of health so that health inequities can be minimized. (Paediatric Society, n.d.)
Variation in teenage pregnancy rates in Canadian provinces Teenage pregnancy rates differ not only between individual provinces and territories but also but each nation. Below is table that demonstrates the variation in teenage pregnancy rates of age 15-19 in each Canadian province between the year 2001-2010.
("Source: http://www.sieccan.org/pdf/TeenPregancy.pdf, pg. 165, Table 2").
The table above shows the percentage change in abortion rates in the Canadian provinces between 2001-2005, 2006-2010 and 2001-2010. It is evident that in provinces and territories with a sparse population such as Prince Edward Island, Yukon, Northwest Territories and Nunavut, a slight increase or decrease in the number of births or abortions can lead to significant variants in the abortion rate. From 2001-2005, the abortion rate decreased in each province and the largest decline was seen in Yukon, then Ontario, Manitoba and finally New Brunswick. Beginning 2006 till the end of 2010, the abortion rates decreased in seven provinces namely Northwest Territories, Nunavut, Quebec, Ontario, British Columbia, Prince Edward Island and Saskatchewan. During the time 2006-2010, the abortion rate increased by more than 15.1 % in New Brunswick, Newfoundland, Nova Scotia and Manitoba. Beginning 2001 to 2010, eight out of thirteen provinces had decreased abortion rates, however five provinces had increased abortion rates.
The reason for this variation in the abortion rates in the Canadian provinces is likely due to differences in the determinants of health available in each province such as population, availability of resources, socio-economic conditions, lack of knowledge of pertinent health policies and regulations. Abortion clinics in Canada are mostly situated in large urban areas as opposed to rural areas. Also, abortion procedures after 24 weeks in Canada is very limited and not readily available due to lack of service providers with the specialized skill set to handle complicated abortions cases for advanced pregnancies. As per a recent investigation by Global news, it was revealed that since 2014 more than 100 women had to travel to U.S for abortion due to advanced pregnancies and lack of resources in rural areas. The abortion issue where some Canadians are having to travel to the States is impacting the Canadians living in rural areas emotionally and financially.
Thus, in conclusion, the predominant health-related issues and diseases differ not only between provinces but also countries which have varied cultures, different economic conditions as well healthcare facilities. It is indeed valuable that the healthcare models such as the social ecological model and the associated health determinants impact the major health issues and aid in clear understanding of multiple problems such as adolescent pregnancy, mental health, substance abuse etc.
REFERENCES
Amy. (2017, August 06). Social Ecological Model Offers New Approach to Public Health. Retrieved from https://borgenproject.org/social-ecological-model/
Fleming, N., Ng, N., Osborne, C., Biederman, S., Yasseen, A. S., Dy, J., . . . Walker, M. (2013). Adolescent Pregnancy Outcomes in the Province of Ontario: A Cohort Study. Journal of Pediatric and Adolescent Gynecology,26(2). doi: 10.1016/j.jpag.2013.01.022
Macmillan, H. L., Tanaka, M., Duku, E., Vaillancourt, T., & Boyle, M. H. (2013). Child physical and sexual abuse in a community sample of young adults: Results from the Ontario Child Health Study. Child Abuse & Neglect,37(1), 14-21. doi: 10.1016/j.chiabu.2012.06.005
McKay, A. (2012). Trends in Canadian National and Provincial/Territorial Teen Pregnancy Rates: 2001-2010. The Canadian Journal of Human Sexuality,21(3&4). Retrieved from http://www.sieccan.org/pdf/TeenPregancy.pdf
National Abortion Federation. (n.d.). Retrieved from http://www.nafcanada.org/access-abortion-ca.html
Paediatric Society. (n.d.). Meeting the needs of adolescent parents and their children | Canadian Paediatric Society. Retrieved from https://www.cps.ca/en/documents/position/adolescent-parents
Yourex-West, H. (2019, June 21). 'There is a problem here': Advocates sound alarm over abortion access in Canada. Retrieved from https://globalnews.ca/news/5417539/advocates-abortion-access-canada/
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