Efforts to Deal with the Impact of Adolescent Pregnancy through a Holistic Approach: A Literature Review

Teenage pregnancy, occurring at the age of 15-19 years, is a global public health problem with negative impacts for both mother and baby. The purpose of the study is to analyze the efforts that have been made in various countries in dealing with the impact of adolescent pregnancy to obtain strategies and recommendations that have the potential to create positive changes in handling the problem of adolescent pregnancy globally. This research method uses a literature review. The literature search process carried out in this literature review uses the database Scopus with a range of publication years 2019-2023. The search was conducted using several keywords "Teenage pregnancy" AND "impact". The findings of 10 journals show that teenage pregnancy has significant health and social impacts, including the risk of obstetric complications, high rates of maternal and infant mortality, and long-term consequences for mother and child. Factors such as low access to education, lack of knowledge about reproductive health, peer influence, and family problems trigger teenage pregnancy. The importance of a holistic approach involving collaboration between government, religious leaders, families, and educational institutions to prevent teenage pregnancy, increase knowledge of sexual education, and form positive, preventive attitudes needs to be done to reduce the risks and adverse effects associated with teenage pregnancy.


INTRODUCTION
Pregnancy is a natural development in which a woman nourishes and nurtures the fetus that grows in her womb for nine months.This process begins when the sperm fertilize the egg, and the fertilized egg attaches to the uterine lining, eventually forming an embryo (Novelia et al., 2024).Pregnant women may complain of experiencing discomfort that can be annoying such as nausea and vomiting (Hamidah et al., 2022).The pregnancy causes hormonal changes in women due to the increase in estrogen and progesterone hormones and the release of the placental hormone chorionic gonadotropin (HCG) (Azizah et al., 2022).Teenage pregnancy, occurring at the age of 15-19 years, is a global public health problem that harms both mother and baby.Incidence rates tend to be higher in developing countries (Deswinda et al., 2020;Indarti et al., 2020;Nurdiawan et al., 2021;Exarchos et al., 2022;Bitew et al., 2023).Teenage pregnancy is a complex social issue that is influenced by various factors such as education, environment, and cultural norms.(Exarchos et al., 2022).
The prevalence of teen pregnancy varies by country, especially in the Sub-Saharan region and South America, which have the highest rates of teenage pregnancy (Exarchos et al., 2022).In developed countries, the main rates of teenage pregnancy are observed in the United States, the United Kingdom, and Eastern European countries (Bitew et al., 2023).Factors such as immigration, refugee status, living in humanitarian aid settlements, low socioeconomic status, low literacy rates, limited education, and disrupted family structures contribute to teenage pregnancy (Deswinda et al., 2020).In Africa and sub-Saharan Africa, the overall prevalence of teenage pregnancy is 18.8% and 19.3% respectively (Indarti et al., 2020).
The prevalence of teenage pregnancy in Indonesia is quite high compared to other developing countries, with prevalence rates ranging from 0.6% to 15.4% (Deswinda et al., 2020).In a study conducted in Indonesia, the prevalence of teenage pregnancy was found to be 10.05% (Nurdiawan et al., 2021).Another study reported a prevalence rate of 11.40% among teenage pregnancies aged 12 to 19 years (Indarti et al., 2020).These findings suggest that teenage pregnancy is a significant health problem in Indonesia.Teenage pregnancy in Indonesia is associated with higher risks, such as eclampsia, premature birth, anaemia, postpartum haemorrhage, and low birth weight babies (Widyaningsih et al., 2021).
Teenage pregnancies face a range of maternal health challenges, including psychosocial challenges, physical violence, human rights violations, lack of legal and cultural protections, inadequate adolescent-friendly services in health facilities, and lack of birth readiness (Apolot et al., 2020;Lastinger et al., 2023) Poor knowledge of sexual and reproductive health has also been identified as a contributing factor (Munakampe et al., 2021).Low family economic status is associated with a higher risk of teenage pregnancy (Tiwari et al., 2022).Peer influence has also been identified as a factor that increases the likelihood of teenage pregnancy (Moshi and Tilisho, 2023).
Teenage pregnancy has significant negative consequences on the mental and somatic health of adolescents, especially girls.These consequences include an increased risk of mental health problems, somatic diseases, maternal and infant mortality and morbidity, eclampsia, postpartum hemorrhage, birth defects, newborn mortality, disability, and delayed growth and development (Sezgin and Punamäki, 2020;Anggreni, Notobroto and Soedirham, 2023;Yoosefi Lebni et al., 2023), exacerbated by poverty and limited access to maternal and child health care (Shukla et al., 2023).Teenage pregnancy and its impact on schools in rural Zambia is a significant problem.Research shows that adolescent girls in Zambia face barriers to accessing sexual and reproductive health services, leading to adverse consequences such as early pregnancy and school dropout (Munakampe et al., 2021).
Based on this background, globally it harms adolescent pregnancy, so research on handling the impact of pregnancy on adolescents is important to find out what efforts can be made to deal with the impact of pregnancy on adolescents through the literature review method.The literature review literature provides a comprehensive overview and analysis of research on a particular topic.It aims to identify and synthesize information from multiple sources (Widyaningsih et al., 2021), So this study aims to analyze the efforts made in various countries to deal with the impact of teenage pregnancy.By understanding the various approaches and policies implemented, this research can provide insights to form strategies and recommendations that can potentially create positive changes in addressing adolescent pregnancy problems globally.

METHOD
The literature search process carried out in this literature review uses the Scopus database with a range of published years 2019-2023.The search is done using several keywords in English.In a literature search use the keywords "Teenage pregnancy" AND "impact".The article search process begins with the identification of predetermined keywords.In the initial search stage, 3.581 articles were obtained that matched the keywords.The next stage is to conduct a screening with the year of publication by the research criteria.At the screening stage, 71 articles met the research criteria.After that, articles were filtered based on inclusion and exclusion criteria and obtained 37 suitable articles.The next step is to screen articles based on the title, obtaining 27 appropriate results.Furthermore, the screening of abstracts is carried out to focus on articles according to screening research.In this step, 27 articles fit the research criteria.Then, from 27 selected articles, a re-selection of research design, outcomes, and several other criteria that have been determined.Finally, 10 articles are determined that match the research criteria and can proceed to the analysis stage

RESULT
The findings of the research results are described in Table 1 below.The study was conducted retrospectively, using data collected from maternity ward archives.
Teen pregnancies represented 6.7% of all pregnancies recorded in hospitals in 2019.Teen pregnancies have rates of preterm labour.

DISCUSSION
Articles 1,3,6,10 (research at Goa Medical College, Indonesia, Hasan Sadikin Hospital Bandung, Greece) show that teenage pregnancy can cause prematurity due to various factors.Studies have shown that adolescents have a higher rate of preterm labour compared to women of reproductive age (Exarchos et al., 2022).This increased risk of preterm birth among adolescents has been supported by several studies (Deswinda et al., 2020).Other risk factors such as low educational attainment, previous abortions, and previous preterm births have also been found to contribute to a higher incidence of preterm birth in teenage pregnancy (Nurdiawan et al., 2021).In addition, adolescent mothers are more likely to experience complications such as eclampsia, anaemia, and premature birth, which can further increase the risk of prematurity (Indarti et al., 2020).The exact mechanism behind the link between teenage pregnancy and prematurity is not fully understood but is believed to be a combination of biological, social, and behavioural factors (Widyaningsih et al., 2021).Overall, teenage pregnancy poses a higher risk of prematurity, highlighting the importance of prevention efforts and providing appropriate care for adolescent mothers.
Article 7 (research in Indonesia) shows that peer factors can influence teen pregnancy.Peer influence can affect teen pregnancy because peers play an important role in shaping teen sexual behaviour (Widyaningsih et al., 2021).Studies have shown that adolescents who receive negative influences from their peers are more likely to conceive at a young age compared to those who do not receive such influences (Widyaningsih et al., 2021).Peers can influence adolescent attitudes toward pre-marital sexual behaviour, and those with negative attitudes are more likely to have teenage pregnancies.In addition, peer influence can lead to the early debut of sexual intercourse, which increases the risk of teenage pregnancy.Therefore, peer influence on adolescent sexual behaviour and decision-making can contribute to teen pregnancy.
Article 4 (research in South Asia) shows that teenage pregnancy has an impact on psychological problems such as depression, anxiety, and conduct disorders.Studies have shown that adolescent mothers are at higher risk of mental health problems compared to adult mothers.Factors such as the stress of early motherhood, social stigma, lack of support, and financial difficulties contribute to the development of this psychological problem (Deswinda et al., 2020;Exarchos et al., 2022;Bitew et al., 2023).Teenage mothers face challenges in coping with the demands of parenthood can exacerbate psychological distress (Nurdiawan et al., 2021).It is important to address these mental health issues and provide appropriate support and interventions for adolescent mothers to reduce the long-term impact on their well-being and the well-being of their children (Indarti et al., 2020).
Articles 2,5,8 and 9 (research in the Philippines, Indonesia, Bali, Ethiopia) suggest that This comprehensive approach needed to address adolescent pregnancy requires the involvement of multiple stakeholders and the integration of various strategies.Governments play an important role in implementing effective policies and programs that promote comprehensive sexual education, access to contraception, and support for young parents.Religious leaders can contribute by promoting responsible sexual behaviour and providing guidance on reproductive health in the context of their beliefs.Families play an important role in providing support, open communication, and positive role modelling.Educational institutions have the opportunity to incorporate comprehensive sexual education into the curriculum They equip young people with the knowledge and skills to make decisions about their sexual health.By working together, stakeholders can create a supportive environment that reduces the risks and adverse effects associated with teen pregnancy (Horii, 2019;Exarchos et al., 2022;Bitew et al., 2023).
Combined with sexuality and life skills education, it has been found to improve access to education and reduce teen pregnancy and school dropouts (Austrian et al., 2020).It is critical to strengthen strategies that keep girls in school and deliver comprehensive reproductive health interventions that address economic insecurity and access to information (Phiri et al., 2023).In addition, community dialogue programs have been effective in addressing social and cultural norms surrounding teen pregnancy and school dropouts, leading to improved communication about sexual and reproductive health between parents and children (Zulu et al., 2022).
This holistic approach can provide a comprehensive picture of the problem of teenage pregnancy, covering psychological, social, and economic aspects.With a deep understanding, this research has contributed to formulating recommendations for comprehensive improvement of policies and intervention programs.Through analysis of the best strategies from different countries in addressing the impact of adolescent pregnancy, it provides comprehensive guidance for the prevention and management of adolescent pregnancy globally.

CONCLUSION
The results of the literature study showed that teenage pregnancy has significant health and social impacts, including the risk of obstetric complications, high rates of maternal and infant mortality, and long-term consequences for mothers and children.Factors such as low access to education, lack of knowledge about reproductive health, peer influence, and family problems trigger teenage pregnancy.The importance of a holistic approach involving collaboration between government, religious leaders, families, and educational institutions to prevent teenage pregnancy, increase knowledge of sexual education, and form positive, preventive attitudes needs to be done to reduce the risks and adverse effects associated with teenage pregnancy.
Figure 1.Flow Diagram of Analysis Literature