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GPs key in managing & preventing teenage pregnancy

Wednesday 3rd June 2020

According to Teenage Pregnancy, published in the Australian Journal of General Practice, GPs have a key role in positively managing teenage pregnancies and promoting contraceptive options to prevent their occurence.

Teenage pregnancy is a global health issue that adversely impacts birth outcomes and can lead to intergenerational cycles of poverty. While for some, a pregnancy in adolescence can have a transformative impact on changing unhealthy behaviours and relationships, for others it is accompanied by negative outcomes.

In all settings, teenage pregnancies are more likely to occur in communities affected by social and economic disadvantage, and in Australia, rates are much higher for those in the Aboriginal and Torres Strait Islander community, or those who live in rural and remote areas.

Clinical Associate Professor Deborah Bateson, co-author and Family Planning NSW Medical Director, says; "Teenage pregnancy rates are falling in many high resource settings, but for those wo do become pregnant as teenagers, the socio-economic and education disadvantage that ensues is often long lasting.

"The pathways that lead to teenage pregnancy are complex and unique for each person and the support teenagers receive from a multidisciplinary health team - including a trusted GP - can go a long way towards mitigating adverse outcomes."

The article, co-authored by Clinical Associate Professor Linda Mann, a GP working in Sydney and Borroloola, and Professor Kirsten Black an obstetrician gynaecologist at the University of Sydney, explains that the social and health implications of teenage pregnancies include increased exposure to domestic and family violence, mental health disorders, substance use, sexually transmitted infections (STIs), financial stress and homelessness.

Higher rates of early delivery and lower birth weight may be associated with pregnancies in this age group.

"Providing quality health care to young women experiencing teenage pregnancy requires an understanding of associated issues and how to manage them", says Clinical Associate Professor Bateson.

"GPs are ideally placed to foster a supportive health environment for these young women by providing regular and reliable care in a non-judgemental approach.

"GPs play an essential role in recognising vulnerability, improving health literacy and providing medical guidance in what is often a scary time, which can enhance the outcomes of pregnancy.

"This will include initiatives such as more frequent STI screening throughout a pregnancy, education on harmful practices such as smoking or substance use, information around pregnancy health and nutrition and signs of early labour."

Components of teenage-friendly health care include providing a welcoming environment, being transparent about confidentiality and its limits, delivering care that is respectful and inclusive, and using an empowering approach that values the role of fathers.

Culturally appropriate programs which support Aboriginal and Torres Strait Islander women in line with Aboriginal controlled models of pregnancy care are also vital.

According to Clinical Associate Professor Bateson, “The role of the GP extends to ensuring young women are informed about their contraceptive options prior to and after delivery.

"Teenage mothers have an elevated risk of rapid repeated pregnancy within two years of their first pregnancy, and if this is something women want to avoid, we need to be proactive in recommending effective contraceptive options that are suitable.

"For many women long acting reversible contraception, including the contraceptive implant and intrauterine devices, is a good choice and can be safely provided soon after birth with no impact on breast feeding or future fertility."

Initiating an active discussion about contraceptive options with teenage patients prior to pregnancy occurring is an important part of care, particularly for those who are considered at elevated risk.

"Although many teenagers source their contraception from pharmacies and supermarkets, a GP visit is an ideal opportunity to provide information about contraceptive options, including LARC methods, and a chance to inform them about emergency contraception.

"Of course, not all teenage pregnancies are unintended or unwanted, but increased education around contraception will help reduce the number of pregnancies which are, and also help build rapport with GPs who can become a trusted source of information for young women and men.

"Addressing teenage pregnancy requires a broad effort that involves the education system, health services and the community.

"GPs are well placed to provide care that helps mitigate adverse outcomes associated with teenage pregnancy and to provide advice which will assist in empowering young women in their reproductive health decision-making," Clinical Associate Professor Bateson said.

The full article is available at this link: https://www1.racgp.org.au/ajgp/2020/june/teenage-pregnancy

1.     Blum RW, Gates WH. Girlhood, not motherhood: Preventing adolescent pregnancy. New York: UNFPA, 2015. Search PubMed

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Media enquiries: Family Planning NSW M: 0402 880 653E: media@fpnsw.org.au W: https://www.fpnsw.org.au

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