Teenage Pregnancy Adverse Reproductive Outcomes Health And Social Care Essay

Teenage Pregnancy Adverse Reproductive Outcomes Health And Social Care Essay Teenage pregnancy is a critical public health issue in both the developing and developed world. It has been thought to have an intrinsic effect on the infant and maternal morbidity and mortality statistics worldwide. In its publication, the State of the Worlds Children report, UNICEF stated that worldwide over 500,00 women of all age groups die yearly and 70000 females aged 15-19 years would die during child birth [1] . Currently, evidence of causal hypothesis is conflicting and inconclusive as to whether adverse outcomes are the result of immaturity of the reproductive system or attributable to other socio-demographic characteristics of adolescents .A study demonstrated that majority of pregnant adolescents had no source of income and lacked health insurance [2] .Teenagers were also found to be more likely to be single, less educated and receive or attend insufficient antenatal care when compared with older mothers [3-5] . Fraser et al conducted a large population-based study which showed that pregnancy in adolescence was associated with an inherently increased risk for obstetric and neonatal outcomes [6] .However, some other studies demonstrated a lack of association attributing the outcome to social factors. This article aims to review, critically appraise, and synthesise evidence from original publications of observational studies on the relationship between teenage pregnancy and adverse reproductive outcomes. It focuses mainly on prematurity, low birth weight and route of delivery as there are a myriad of adverse birth outcomes-maternal: preeclampsia, anaemia, premature rupture of membranes (PROM), perineal tears, instrumental delivery, caesarean delivery and infant-related complications: prematurity, low birth weight, intrauterine growth restriction, small for gestational age, perinatal morbidity- attributable to teenage pregnancy and there is strict limitation on the article word count. Methodology: literature search and selection of studies A literature search on teenage pregnancy and adverse reproductive outcomes of primary studies published in the last 10 years was carried out .Included studies were journal articles published in the English language-this limitation confers some degree of bias to the review. Epidemiological evidence for this review is defined as observational studies- cross-sectional surveys, case-control studies, retrospective cohort studies and prospective cohort studies. Database searching of Medline (U.S. National Library of Medicine, Bethesda, Maryland) and Embase (Elsevier) was conducted using the following keyword phrases and related terms as search terms teenage pregnancy or pregnancies, adolescent pregnancy or pregnancies and pregnancy outcome, adverse reproductive outcomes and related terms(refer appendix 1). The Medline search yielded 110 articles but reviewing the abstracts showed only few of the studies met the inclusion criteria or were readily available online or in print. A similar search conducted on the Embase database yielded less promising results. Additional journal articles were located by reviewing cited references and citation tracking of some of the selected studies. The related article or similar article feature of some journals was used to identify similar studies and their abstracts were reviewed to check if they met the selection criteria. Case studies, case reports, editorials, and reviews were excluded from the search. Selection criteria To be included in this review, the selected studies had to meet the following criteria: -teenage pregnancy is defined as pregnancy in young women under 20 years -women above 35 years old were either excluded from or treated as an independent category in the study as they are known to have high obstetric risks -must demonstrate some statistical description and /or analysis of confounding variables in the association between teenage pregnancy and adverse reproductive outcomes -should have some comparative element in which teenagers are compared with a suitable reference category -outcome measures include at least two of the following: prematurity preterm delivery, Caesarean section (CS), low birth weight (LBW), infant mortality, neonatal mortality, perinatal mortality, maternal mortality, severe anaemia, preeclampsia and eclampsia -a significance assessment can be made either by using p-values or confidence intervals Table 1:Characteristics of selected studies Authors Publication year(Study period) Setting Study design Sample size Age of teenage subjects(years) Outcome measures of interest Confounding variables considered Other study characteristics Ekwo and Moawad [3] 2000(1989-1995) U.S.A Hospital based retrospective cohort 6,072 3 groups-=15,16-17,18-19 20-24 as reference group Preterm birth, low birth weight Maternal smoking, drug abuse, insurance status, adequacy of prenatal care, median family income, marital status Primaparous black women , singleton pregnancies Bukulmez et al [7] 2000(1990-1998) Turkey Hospital-based matched case-control study 4,470(1,490 cases,3980 controls) Cases:15-19 controls:20-34 stratified during analysis as =17,18-19,20-34 Low birth weight, preterm delivery, pregnancy induced hypertension(preeclampsia, eclampsia),LBW, Antenatal care, gravidity, parity, Singleton pregnancies, subjects matched on marital status, socioeconomic class and ethnicity-white married women of high social status Jolly et al [4] 2000(1988-1997) United Kingdom Hospital based retrospective cohort 341,708

Diversity in America Essay

In an ideal world, humanity would understand that all mankind is created equally; that the underlying truth of each of us is goodness, and that through awareness, conscious choice and the willingness to create positive change, we could live in a world where diversity is celebrated. We would leave behind the substantial racist and oppressing patterns that exits in this world, specifically in the United States of America. It is said that the U. S. is a melting pot of cultures, and that we are a country of immigrants existing together as a new culture, living under the values of a democracy based on freedom, liberty and the pursuit of happiness. Yet this policy is completely disregarding the fact that as immigrants, we brutally committed genocide to the Native Americans. The dominant race in the U. S. A. is made up of white Euro-centric people, and looking at the patterns that exist in this culture is important to examine the history, the ways in which racism is alive and how and who is affected. We all must look at how, as an individual and within a community, we can work towards positive change, healing and understanding. As a society, we have committed and perpetuated the oppression of different cultures specifically the Native Americans, the Native Africans and the many immigrants from different countries. In the early history of the U. S. government, it is clear that there was a systematic method that aimed to remove the Native Americans from the land that was desired by the colonists, with the malicious intention to commit genocide. The first example of the patterns of racism that were established is seen in the fabrication of stereotypes onto the Native Americans. It was said that the Natives were â€Å"barbarians† and that they would rape and murder women and children and that they â€Å"served the devil† (Tataki, 1993, p. 41). The whites held the belief that the Natives were occupying land that the colonists felt entitled to. â€Å"White people also justified the genocide by saying that Native Americans died from diseases they were biologically unable to resist† (Kivel, 2002, p.126). It is a known fact that smallpox were given to the Natives as a way to kill them. Multiple examples exist throughout the history of the whites murdering, raping and unjustly exploiting almost every aspect of the Native’s culture. After committing such horrendous violations we are left with the inability to change all that has occurred and a great sadness that produces guilt, blame and anger that often stagnates a healing process and increases denial and avoidance. The Native American population has almost completely been destroyed. â€Å"At the time Columbus arrived in the West Indies there were approximately fifteen million indigenous people†¦ today†¦ the population of native Americans in the United States is around three million according to U. S. government census figures† (Kivel, 2002, p. 124) and the remaining Natives in America are mostly confined to reservations. This small fraction of designated land is no longer their original sacred land but it is being raped for natural resources. White settlers not only committed genocide but they also enslaved the Native Americans. This pattern of entitlement and abuse was continued with the legal capturing and enslavement of people of African decent with as much violence and oppression. The history of slavery in the United States that occurred through 1619 to 1865 began soon after the English colonists first settled in Virginia and lasted until the passage of the thirteenth Amendment to the U. S. Constitution. â€Å"Over the next twenty five years Virginia passed a series of laws that legalized slavery, producing a radically subordinate and stigmatized class below that of all whites† (Kivel, 2002, p.130). Although technically slavery was abolished in1865, a linage of abuse and inhumane treatment was installed and has been carried into this day and age providing a challenge to accept and comprehend the past. In an attempt in understanding black oppression, there are aspects that demonstrate this injustice. They are institutional racism, racist knowledge and power relations that are played out in our culture and in no way have anything to do biology. Individuals and societies have created and used race as a means to oppress and overpower other groups of people. Racial oppression is when a group of people dominates another for their own benefit disregarding justice and respect through the use of violence and defining and discriminating racial differences. This dominant group receives various benefits although in the larger picture all sides loose for the continuation of a pattern of pain and injustice is insured through these actions. African-Americans are a case of this racial oppression. They were turned into slaves because of the color of their skin. It is shocking that it did not start this way and that through the power of the U. S.government slavery laws were passed that enabled the white masters to turn the blacks into slaves. This is an example of the institutional racism used to enslave the blacks. Because of this occurrence, we, as a society, must break down the residual stereotypes that have instilled fear, pain and disconnection between the races, and to change the model that exists even at this point in time. Another example of racism in the U. S. is seen in the treatment of immigrants. This subject is personal, for on my father’s side of my family I am part of the first generation born in American. My father’s parents immigrated to the U. S. , to escape the holocaust and I am sure shared the dreams of the majority of different immigrants who traveled to the â€Å"land of opportunity,† escaping places of war and economic devastation to begin and pursue a new and better life. Through the duration of attending a class studying the diversity in America I have gained painful yet poignant knowledge of the racism that is still perpetrated upon immigrants, specifically on Jewish people. I have recently learned that groups of neo-Nazis congregate and commit acts of violence against Jewish people and immigrating races. This is terrifying to me and feels unacceptable while we live under a constitution that allows personal expression but does not permit such distinct racist and violent behavior. I am grateful and saddened that because I was raised in a protected and privileged community I have rarely experienced oppression and hateful discrimination when it so readily exists in our culture. In the past few months I find myself cycling through heartbreak, anger and disbelief of the injustice that has and still occurs, and then to a yearning for healing and equality for all. I remain in a space of wonderment, questioning the fact that although laws have been installed to prevent the acts of racism, fear, ignorance and violence is bubbling hot under the surface of our society, and we are a long way from a complete shift in humanity that I crave. I do believe there is hope. I believe that in gaining the truth of the past and diminishing ignorance of the harm that was and still is being done we open a door that may aid in the battles that are still being fought. Although the brutality of racism is alive, the potential to fight for the rights of all the people who live upon this American soil is possible, but the truth of the history and the attainment of awareness must be brought to fruition. Reference List Kivel, Paul, (2002). Uprooting racism: How White People Can Work For Racial Justice. Gabriola Island, BC VOR 1X0, Canada: New Society Publishers. Takaki, Ronald, (1993). A Different Mirror: A History of Multicultural America. New York, NY: Time Warner Book Group.

Furthering My Education Furthermore

Throughout my educational experience, writing has never been one of my strong points. I have also found difficulty in to discussing my shortcomings with strangers. For the sake of furthering my education, I will attempt to push these difficulties to the side and live up to my potential as a successful college student and a young mother of two. Allow me to take you through my journey. In the summer of 2004, I was accepted into a â€Å"Groups Program† at Indiana University. I was thrilled to be going to college. All of my family was ecstatic as well since I was the first member of the family to attend.The â€Å"Groups Program† was a program of about 300 minority students from all over the state of Indiana who were guaranteed all four years of college to be paid for if we completed six weeks of classes on campus before the fall semester began. Six weeks? This should be a breeze especially since my best friend, Coyalett, was accepted as well. We would also be rooming togeth er. The problem with that was we had too much fun. We did exactly what we did in Anderson (marijuana), and we were kicked out in two weeks. Dang! So much for making the family proud. Back to Anderson it was, and I was really bummed out.Here I was, a few weeks out of High School, and I already messed up my shot at going to college. I didn’t give up though. I applied to IU on my own, and I could not believe they accepted me to come back in the fall. I felt that I was experiencing some sort of miracle, or it could have been the fact that I graduated high school with a 3. 8. Either way I was excited to have a second chance at obtaining a college degree. My best friend was not so lucky. I believe she ended up doing some schooling via the Internet. Oh well, I was on my way to a better future and nothing or no one was going to stop me.Boy, was I wrong. When I went back to Bloomington, I met another freshman named Heather. We really hit it off. She was extremely nice, and we had a fe w things in common. She was from Muncie (which is not too far from me), we liked the same music, we had the same style, and we liked to smoke weed. We were together every day. Heather did not mind doing it all day long. Since the opportunity to smoke was always there, I did it too. My grades began to slip dramatically. School work and marijuana just does not mix. The times that I did show up to class, I probably was stoned.Drugs and school are a really bad combination, and I had a very hard time juggling the two. Still, I was not going to give up. I’m not really a give-up type of girl. The only problem with that is I didn’t want to give up either of the two. So I made it through the first semester without getting busted or giving up. My GPA was about a 1. 2, and I was placed on academic probation. I stuck around because I was not ready to go home yet. I was having too much fun, and I wanted to finish my education. The spring semester began alright. I was smart enough t o begin my first class at one o’clock in the afternoon.Therefore, I was attending classes more. Only now I had a problem with driving home every weekend to see my boyfriend. This took time away from studying and also cost me a lot of gas money and about $1000 in speeding tickets. During that time, I felt my family and boyfriend were worth all of that. I got my GPA up to about a 2. 5, and in May, I was ready to go home for summer vacation. I did not know that I was a couple weeks pregnant! I found that out about a week or two of being at home. I was disgusted with myself. It took me a few months to actually get excited at the thought of having a baby.I ended up breaking up with my boyfriend during the summer. He was extremely jealous and abusive, and I just had enough. I definitely did not want to raise my son around him. I went back to IU that fall almost five months pregnant, and I remember being ashamed. I wore really big clothes, and I was depressed and afraid. I hated bei ng so far away from home being pregnant and alone. Yet, I still did not want to give up. Especially since I had a huge responsibility coming in a few more months. So I attended all my classes, and I studied more than I did the previous year. It helped that I was not doing drugs anymore, too.I would never do that to my child. So besides feeling so alone, I was doing alright as far as my school work went. Until a day in October when I was rushed to the ER in Bloomington. I had actually just gotten back to Bloomington from a trip home to see my family when I decided to go to Starbucks and get ready to work all night on school work. For no reason at all, I blacked out in the line at Starbucks and hit my head on a counter. I do not remember much but the feeling of people swarming over me and voices that sounded a million miles away. The ride to the emergency room was bumpy, and I was terrified.I have never ridden in an ambulance before under any circumstance, and I had no idea what was g oing on. All I could think about was my unborn child. Was he alright? Did I hurt him in any way when I fell? Is he going to live? When I arrived at the hospital, I never felt so alone in my life. I wanted my mommy. And out of nowhere, a little Japanese lady entered my room and held my hand. She would have to do. She stayed with me the whole time, and I had never seen her a day in my life. She was a friend of a friend of my mother’s. I really did not care at that point. I was just so happy to have someone there by my side.The doctors checked on my baby and ran a few test and released me early the next morning. My child was alright. The doctors had discovered that my iron was really low, and that’s what caused the blackout. The thought of the scariest day of my life repeating itself again was enough to send me packing and on my way back to Anderson. So I got plenty of rest until I delivered my baby on January 11th, 2006. This was the greatest thing that ever happened to me. I had a 6lb 9oz Golden Child, and I was the proudest person alive. Motherhood was nice. I had a job at Wendy’s, and I had my own apartment.I was so busy being a mom that I sort of forgotten about my education. Well, it was put on the back burner of my mind. A day after my son’s first birthday, I found out I was pregnant with my daughter. Wow, two kids and I’m still working the drive-thru at Wendy’s. I was devastated until August 25th, 2007. That’s when I became a mother to the most beautiful baby girl I’d ever rested my eyes upon. I was so proud to be a mother to these two children. Although I was proud, I was extremely busy now. I ended up getting fired from Wendy’s after being there for more than two years.I tried almost everywhere to get a job, and I did not have any luck. After a couple months of this, I decided to get certified as a nursing assistant. I always wanted to be a nurse to begin with, and I figured I could start th ere and work my way up. I also knew that I would not have a problem finding a job once I was certified. I worked really hard during my training, and I passed the class with a 98%. I was proud of myself and amazed that I got back in the rhythm of being a student. I wanted more. I wanted more for my children. Two days after I passed the state test, I began working at a nursing home. I love what I do.I started there in 2008, and I’m still with them today. I’m actually passionate about what I do. The feeling is amazing. After seeing how I could perform in a school setting, I knew I could do it again. After each day of looking in my children’s eyes, I knew I had to do it again. I want a better future for those two. I want a better future for me. I want them to be as proud of me as I am of them. I now understand that the only way to achieve this is by furthering my education. So this is what it feels like to grow up. It took two children to help me realize this, and I wouldn’t trade them in for ten worlds.

The Secret River By Kate Grenville - 1231 Words

The Secret River is written by Kate Grenville, an internationally well-known author. It’s also her most influential magnum opus. Kate Grenville said, her mother’s grandfather was a poor man from London and sentenced to be sent to Australia because of stealing timbers in the early nineteenth century. After arriving to Sidney, he thought presumingly that he finally had his own land. The thing makes Grenville curious is that the land was supposed to belong to aboriginal people but how her grandfather could make a living on this land. It’s important for her to know about if her grandfather dealt with this problem by gun or even gave the exchange to aboriginal people. Therefore, she did a lot of historical researches and wrote novel The Secret River eventually. This is a story about family and Australia. It’s also a story about more than a family that narrates a complicated relationship between Australia’s aboriginal people and white colonists. It happened in the early nineteenth century in England and Australia. William Thornhill, the hero came from a family of little money and suffered from hunger and cold since childhood. Afterwards, Thornhill was apprenticed to Sal’s father and became a capable boatman on the river of Thames, also got married with Sal. However, after Sal’s parents died one after the other, their living got more and more poverty-stricken so that Thornhill had to make a living by stealing. Once during the action, they were being found and his brother wasShow MoreRelatedThe Secret River By Kate Grenville1267 Words   |  6 PagesAttaining an honest and genuine level of self-awareness and knowledge in any walk of life is not a feat easily achieved. In Kate Grenville’s novel The Secret Riv er we see William Thornhill endeavouring to come to grips with his environment and social standing. Subsequently in F Scott Fitzgerald’s The Great Gatsby, Fitzgerald’s titular hero’s internal struggle with persona and ambition; prevent him from realizing such a victory. William Thornhill’s world begins in a Dickensian London, and is thenRead MoreMysteries of Austrailia in The Secret River by Kate Grenville604 Words   |  2 PagesWhat secrets of history dwell rooted in the emotional depths of the muddled Australian river? Kate Grenville, an Australian author delves into the conflicts, encounters and relations between the Indigenous Australians and the European settlers within her novel ‘The Secret River’. The Secret River is part of a trilogy, published in 2005 and is a piece of historical fiction set upon the colonisation of Australia. 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