Teenage pregnancy and secondary infertility: Existing gaps and public health interventions

Teenage pregnancy has been acknowledged as a global public health concern, especially in low- and middle-income nations[1]. This is predominantly because teenagers are more likely to experience pregnancy complications (viz. anemia, obstructed labour, etc.), higher rates of maternal mortality, and neonatal complications, including mortality[1,2]. It is not unusual that many teen mothers have to experience exclusion from their families and communities, which limits access to quality healthcare services and is a major reason for emotional stress and mental health problems[2]. Further, teenage pregnancy often leads to school dropout, which diminishes their growth as well as vocational opportunities and financial independence in the future[1,2]. In addition, these adolescent mothers lack proper education about reproductive health, including contraceptives, leading to repeated unintended pregnancies[1,2]. The purpose of the current article is to identify existing gaps in teenage pregnancy care that can result to secondary infertility and propose public health measures for addressing secondary infertility in teen mothers. Owing to the high incidence of pregnancy-related complications, untreated infections, and lack of postnatal care, many teenage mothers experience difficulties in conceiving later in their lives[1]. This has been attributed to a wide range of factors, like most existing adolescent programs prioritize prevention of teenage pregnancies, but have no emphasis on how these pregnancies can impact long-term reproductive health[3]. In continuation, postnatal care for adolescent mothers targets immediate maternal and infant health, while no measures are being taken to monitor long-term fertility[1]. Amid the limited access to specialized fertility services for teen mothers, most infections and hormonal imbalances go undiagnosed, augmenting the risk of secondary infertility[4]. In a mixed-method study done among tribal couples suffering with infertility, almost 99% of the study respondents preferred traditional healers than modern healthcare professionals[4]. Further, due to poor awareness, many women fail to recognize the signs of secondary infertility or seek timely help[3]. Acknowledging the magnitude of the problem and the presence of multiple factors, including gaps in the existing reproductive health programs, there is an immense need to adopt a multipronged approach to address the problem effectively[1,3-8]. The primary approach is to incorporate fertility preservation into adolescent reproductive health initiatives, and this must be communicated by healthcare professionals to young mothers (viz. causes of secondary infertility and preventive measures)[5]. The government must take steps to improve access to postnatal and reproductive healthcare, including fertility screening activities by making them accessible, affordable, and through the promotion of routine gynecological checkups to detect underlying problems at the earliest[5,6]. There is a need to expand maternal and child health services by making them holistic rather than focusing just on pregnancy outcomes, and also incorporating mental health support[3]. This must be supplemented with awareness campaigns to educate communities about secondary infertility using social media and through community-based and school-based awareness campaigns[1,7]. The awareness activities must emphasize the importance of maintaining proper nutrition and lifestyle factors (viz. smoking, alcohol, obesity, etc.) that can affect fertility[1,7]. In addition, community leaders can be targeted to reduce stigma about infertility and with the help motivate young mothers to avail reproductive health services[3,4]. Further, healthcare providers should be trained to sensitively deal with young mothers in a non-judgmental manner[8]. In conclusion, teen mothers generally encounter multiple challenges that negatively impact their health, well-being, and future opportunities. Considering the high risk of secondary infertility among them, the need of the hour is to introduce policy reforms, including fertility education, accessible services, and provision of integrated maternal health services. Conflict of interest statement The authors declare no competing interests. Funding The study receives no extramural funding. Authors’ contributions Saurabh RamBihariLal Shrivastava contributed to the conception or design and drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work. Prateek Sudhakar Bobhate contributed to the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work. Mohammed Kamran Shaikh contributed to the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work. Publisher’s Note The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Edited by Lin LY, Lei Y