Adolescents aged 10–19 years represent over 16% of the world's population and play a central role in achieving the 2030 Sustainable Development Goals. India has the largest adolescent population in world and is home to 253 million adolescents aged 10–19 years. Despite a substantial decline of 11.6% in adolescent –specific fertility rate in past 2 decades globally, approximately 21 million girls in age-group 15–19 years become pregnant in developing countries (WHO, 2020). Additionally, it is estimated that out of them around 12 million adolescent mothers give birth. Motherhood at an adolescence period is regarded as a major global public health issue owing to the wide range of health effects and socio—economic consequences for mother as well as child. World Health Organization estimates that about 11% of total births occurred to women aged less than 20 years, and 95% of these births occurred in low-and middle- income countries (WHO, 2011), usually among the most disadvantageous adolescents (UNFP, 2015; UNFP, 2016). Further, with an adolescent population of 243 million, an unprecedented opportunity and challenge lies ahead for India. According to the fourth round of National Family Health Survey, an estimated 11.8 million teenager’s pregnancy occurred in India (National Family Health Survey, 2015-16). Further, Medhi and colleagues identify the major responsible factor for the higher rates of adolescent pregnancy to be deeply entrenched practice of child marriage, poor access to health care, poverty, and low literacy levels in India (Medhi et al., 2016).
A number of literatures supports the annotation that birth in teen age is a major risk factor for adverse pregnancy outcomes, it is also documented that teenage childbearing have a significant negative impact on the future well-being of infant as well as the mother (Olausson, 2001; WHO, 2007). The adverse maternal and perinatal outcomes of adolescent pregnancy have been well documented to be associated with low birth weight (Chen et al., 2010; De Vienne, Creveuil, & Dreyfus., 2009; Chen et al., 2007) preterm delivery (Chen et al., 2010; Chen et al., 2007, Conde-Agudelo, Belizan & Lammers., 2005), perinatal death (Mukhopadhyay, Chaudhuri & Paul., 2010) and maternal death (Granja et al., 2001; Conde -Agudelo, Belizan & Lammers., 2005). Further, in number of studies adolescent pregnancy is found to be associated with an increased risk of adverse birth outcomes especially preterm birth, low birth weight, neonatal asphyxia and perinatal death in low- and higher-income countries (Ganchimeg et al., 2014; Kawakita et al., 2016). Findings from a multi country-based study by Neal and colleagues highlight that maternal mortality and morbidity are mainly due to pregnancy and delivery related complications among 15–19 years old (Neal et al., 2012).
Adolescent pregnancy has been shown to be associated with low educational attainment of the mother, single parenthood and welfare dependency (Webb, Marshall & Abel., 2011). Evidence shows that other than the biological factors, socio-economic status is also associated with higher incidence of undesirable outcomes of adolescent pregnancies. There is a continued debate on the association between teenage childbearing and adverse pregnancy outcome i.e., if this is due to socio-demographic conditions of adolescent mothers or attributable to biological immaturity (Taffa & Obare., 2004). Findings from hospital-based studies accentuate that young maternal are alone is casually associated with poor obstetric outcomes such as antenatal delivery by skilled personnel and perinatal death (Wasunna & Mohammed., 2002; Anandalakshmy & Buckshee, 1993). Further, studies could not establish any association between high-quality maternity care provision provided to adolescent mothers and adverse pregnancy outcome among them (Raatikainen et al., 2006; Blomberg, Tyrberg & Kjølhede., 2014).
Pregnancies among adolescent women are documented to have major implications on the ill-health of women, educational opportunity and population growth (Kassa et al., 2018). Additionally, there are evidences that highlight that teenage pregnancy in India has a lifelong and intergenerational health costs, which substantially affect the lives of a major chunk of adolescent girl’s population (Nguyen et al., 2019). Several studies have shown that the rates of maternal and peri-natal morbidity and mortality can be reduced by lowering the high rate of adolescent pregnancy in developing countries (Westoff CF., 2003; Nove et al., 2014). While numerous researches exist on the determinants of adolescent child bearing in the context of developing as well as developed countries, there exists a necessity of in-depth examination into the factors determining the adolescent pregnancy and pregnancy outcomes. Further, in spite of the wide known importance of mortality and severe morbidity associated with the adverse pregnancy outcome, there is no sufficient epidemiological evidence in case of India specially when India has regionally highly variable rates of adolescent pregnancies with an existing multiple risk factors for adverse pregnancy outcomes. Further, insights into correlates of adolescent pregnancy would help in policy formulation and in providing programmatic response while addressing adolescent pregnancies and progress monitoring towards achieving the target 3.1 and 3.7 of Sustainable Development Goals (SDG), (United Nations, 2015). The aim of our study is therefore to investigate the contextual factors which determine and affect pregnancy outcomes among adolescents from Uttar Pradesh and Bihar states which hold a considerably high adolescent population from rest of the Indian states.