Importance of reproductive health services for adolescents during COVID-19

Importance of reproductive health services for adolescents during COVID-19Latest revision | Image Credit: © WindyNight - © WindyNight
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Reproductive health services (RHS) allowed adolescents to receive timely guidance after a reduction in hospital visits caused by the COVID-19 pandemic, according to a recent study published in Digital Health.¹

Adolescent pregnancy is a public health concern worldwide, with the sexual and reproductive health of adolescents facing additional stress following the start of the COVID-19 pandemic. Ten percent to 57% of adolescent mothers are impacted by postpartum depression (PPD), indicating the physical and psychological health burden.

Rates of morbidity and mortality linked to adolescent pregnancy are significantly reduced using RHS.² However, both routine and emergency health care services have been disrupted by the COVID-19 pandemic.¹ This highlights a need to evaluate the use of RHS to manage adolescent pregnancy during the COVID-19 pandemic.

Investigators conducted a study to evaluate characteristics and utilization of RHS among adolescent mothers in Taiwan during the COVID-19 pandemic. Relevant information was obtained from a database provided by the Taipei City Government Health Bureau (TCGHB).

Participants included individuals giving birth while aged under 20 years between 2020 and 2022 at approximately 3 months postpartum and residing in Taipei City during the study period. Those with miscarriage before 20 weeks’ gestation were excluded from the analysis. Demographic, obstetric, and infant-related data were included in the database.

The TCHGB launched an RHS program in July 2020 to support adolescent mothers during the pandemic. This program involved identifying participants through the TCHGB database, training health care providers in reproductive and postpartum care, conducting outreach, delivering service through telephone and in-person visits, and making referrals for further support.

RHS was offered to participants once they provided verbal consent. Those with significant needs such as severe PPD were referred to appropriate mental health or social welfare services, while those requiring additional services such as economic assistance were directed to relevant city departments.

Follow-up occurred at approximately 3 months postpartum and included consultations lasting for 15 to 20 minutes. IBM SPSS Modeler version 18.2 and IBM SPSS Statistics software version 25.0 were used to perform data analysis.

There were 112 participants included in the final analysis, 89.3% of whom were Taiwanese, 80.4% aged 17 to 19 years, 58% legally married, 73.2% unemployed, and 49.1% dropped out of school. Primigravida status was reported in 72.3% and primipara in 85.7%.

Not using contraception before conception was reported in 60.7% of participants, prior abortion in 13.4%, regular prenatal examinations in 83%, and giving birth at a medical center in 42.9%. Most participants delivered through vaginal birth, and PPD rates were low, with 89% having PPD scores below 9. Additionally, most infants were born full-term and healthy.

Postpartum maternal-infant care consultations were the most common RHS type observed among participants, with postpartum health care consultations reported by 24.4%, baby care services by 62.4%, and breastfeeding support by 62.4%. Birth-planning guidance was provided to 42% of participants, and only 1 sought abortion and termination services.

Joint custody was reported by 67.9% of participants and application for maternal grants by 51.8%. In the models predicting RHS utilization, the greatest accuracy reported was 90.91% from the random forest model. Abortion was reported as the most influential factor in predicting RHS when applying the shape algorithm.

An overall predictive rate of 70% was reported. The presence of abortion experience and the odds ratio of indigenous ethnicity significantly impacted acceptance of RHS among adolescents during the COVID-19 pandemic. This included a 9.05-fold increased chance of accepting RHS when being of indigenous ethnicity vs other ethnicities.

These results indicated a decrease in hospital visits for adolescent births during the COVID-19 pandemic, but significant improvements in timely guidance through an RHS program. Investigators concluded these multifaceted issues must be addressed through holistic sex education and improvements in health care provision.

References:

1. Chen CH, Hsiao CH, Liao PH, Hu HW, Wei SJ, Chen SW. Characteristics, utilization of reproductive health services and AI prediction among Taiwanese adolescent mothers during the COVID-19 pandemic. Digit Health. 2024;10. doi:10.1177/20552076241292675
2. Breckenkamp J, Läcke EM, Henrich W, et al. Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany. BMC Pregnancy Childbirth. 2019;19(1):1. doi:10.1186/s12884-018-2145-y

This article was initially published by our sister publication, Contemporary OB/GYN.