FACTORS RELATED TO SUBSEQUENT ADOLESCENT PREGNANCY IN THE DOMINICAN REPUBLIC

Objectives: Adolescents with subsequent pregnancies in the Dominican Republic represent a significant but poorly understood population with little available data to inform health care services. The objective of this exploratory study was to characterize this important cohort. Methods: A survey of demographic items and a sexual and obstetrical history was administered to 50 adolescents with subsequent pregnancies in La Romana, Dominican Republic. Results: Most participants were married (78%) and exclusively economically dependent on their partner (72%) and nearly half (48%) stopped attending school. Twelve percent reported having intended their current pregnancy. Conclusions: Adolescents with subsequent pregnancies were dependent on partners in the form of living conditions and marriage, economic dependence and unemployment, and lack of education. 1 Fay et al.: SUBSEQUENT ADOLESCENT PREGNANCY IN THE DOMINICAN REPUBLIC Published by UTC Scholar, 2020 Adolescent pregnancy rates have declined worldwide in recent decades, but rates in Latin America have declined less rapidly than the rest of the world (Centro de Estudios Sociales y Demográficos [CESDEM], 2014). The Dominican Republic, Nicaragua, and Guatemala have the highest rates of adolescent pregnancy in Latin America with more than 100 births per 1,000 girls aged 15 to 19 years (World Bank, 2012). In the Dominican Republic, one in five girls aged 15 to 19 has been pregnant and 34% of girls has experienced pregnancy before 19 years of age (CESDEM, 2014). In the United States, the National Survey of Family Growth from 2006-2010 showed that 23% of pregnancies were intended for those aged 15-19 years old (Mosher, Jones, & Abma, 2012). Another study showed that one in seven sexually active adolescents aged 15-19 in the United States had a positive pregnancy attitude (Lau, Lin, & Flores, 2014). Pregnancy in this population may present unique health risks, which are particularly important to recognize if pregnancy or parenthood is not a desired at that time. While unintendedness is not by definition negative and there are some girls who have positive associations with their pregnancy, for many, pregnancy presents serious social and health consequences. There is ample evidence that early motherhood comes with health risks and socioeconomic disadvantages. In fact, complications during pregnancy and childbirth are the second leading cause of death for girls aged 15 to 19 worldwide (World Health Organization [WHO], 2015). Teenage mothers experience higher rates of pre-eclampsia, eclampsia, endometritis, and systemic infections than their older counterparts (Ganchimeg et al., 2014). Newborns of adolescent mothers are more likely to be born prematurely, have low birth weight, and experience severe neonatal conditions and death (Ganchimeg et al., 2014). Beyond the health of the mother and child, in the Dominican Republic, 20% of girls aged 15 to 19 stopped attending 2 Journal of Adolescent and Family Health, Vol. 11 [2020], Iss. 1, Art. 8 https://scholar.utc. edu/jafh/vol11/iss1/8 school after becoming pregnant, which may limit their financial stability, career goals, and participation in social life (CESDEM, 2014). Despite a well-established body of literature on adolescent pregnancy, there is a relative dearth of knowledge on adolescent multigravida. On review of the literature, no published data on subsequent pregnancies in adolescents in the Dominican Republic were found. In the United States, one in every five (17%) births by teenage mothers represents a subsequent pregnancy (American College of Obstetricians and Gynecologists [ACOG], 2017). There is considerable variation in the rate of subsequent births based on ethnicity (14.8 to 21.6%) and state (10 to 22%) (Gavin et al., 2013). These births are associated with a greater risk of prematurity and low birth weight and limit the adolescent’s ability to pursue educational or career opportunities (Klerman, 2004; Martin et al., 2012; Pinzon & Jones, 2012). Available data suggest that additional adolescent births compound the socioeconomic hardships of adolescent pregnancy (Pinzon & Jones, 2012). Information on the circumstances associated with subsequent adolescent pregnancies and measures for improved support and health services for young mothers in the Dominican Republic are critically needed. The objectives of this study were as follows: (a) to collect demographic information on adolescents with multiple pregnancies, (b) to gather a sexual and reproductive history, and (c) to explore the knowledge and attitudes of multiparous adolescents regarding motherhood, supportive relationships, and advice for their peers.