Adolescent Pregnancy and Syrian Refugees
Özet
This document analyzes the critical public health and social issue of adolescent pregnancy, focusing on the contributing factor of Syrian refugee migration to Turkey. While Turkey's adolescent fertility rate declined to 15‰ by 2020, it remains higher than the European Union average. Key socio-demographic drivers include low educational attainment, traditional customs, and early marriage. Since the 2011 Syrian conflict, Turkey has hosted 3.6 million refugees, introducing a statistically younger pregnant population with unique challenges. Sociocultural barriers, lower literacy rates (8% illiterate, 17% incomplete primary education), and language limitations significantly hinder Syrian refugees' access to public schooling and formal reproductive education. Consequently, war-zone displacements and domestic migration within Turkey disrupt continuity of care. Adolescent pregnancies suffer from delayed or inadequate antenatal care, resulting in significantly heightened risks for maternal and perinatal morbidity. These adverse birth outcomes include increased rates of maternal anemia, premature birth, low birth weight, eclampsia, cephalopelvic disproportion, and infant intensive care admissions. The study concludes that addressing this crisis necessitates multi-sectoral national policies. Recommendations emphasize preventing early marriages, enforcing penal sanctions, ensuring school retention for at-risk girls, providing psychiatric support, and training culturally aligned birth coaches and translators.
Referanslar
Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health. 2018;2(3):223-8.
Blum RW, Gates WH. Girlhood, not motherhood: Preventing adolescent pregnancy: United Nations Population Fund (UNFPA); 2015 [Available from: https://www.unfpa.org/publications/girlhood-not-motherhood.
Macleod C. Adolescent pregnancy: A feminist issue. International handbook of adolescent pregnancy. 2014:129-45.
TURKSTAT Corporate: The Ministry of Interior, General Directorate of Civil Registration and Citizenship Affairs; 2021 [Available from: https://data.tuik.gov.tr/Bulten/Index?p=Birth-Statistics-2020-37229.
Michas F. Adolescent fertility rate in Europe: Statista; 2019 [Available from: https://www.statista.com/statistics/1268233/adolescent-fertility-rate-in-europe/.
Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: Final Data for 2014. Natl Vital Stat Rep. 2015;64(12):1-64.
World Health O. Adolescent pregnancy: factsheet Geneva: World Health Organization; 2014 [Available from: https://apps.who.int/iris/handle/10665/112320.
Julia F. Adolescent fertility rate in Africa by country 2019 | Statista 2021 [Available from: https://www.statista.com/statistics/1234548/adolescent-fertility-rate-in-africa-by-country/.
Adolescent birth rate, leading countries worldwide 2011-2019 | Statista 2022 [Available from: https://www.statista.com/statistics/710712/ranking-of-leading-20-countries-with-highest-adolescent-birth-rate/.
Egypt: adolescent fertility rate 2000-2019 | Statista 2021 [Available from: https://www.statista.com/statistics/1235957/adolescent-fertility-rate-in-egypt/.
Birge O, Serin AN, Kayar İ. Prevalence and cesarean rates of immigrant adolescent pregnancies. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2021;10(4):1292.
Jittitaworn W. Adverse perinatal outcomes and models of maternity care for Thai adolescent pregnant women: A mixed methods study 2019 [Available from: http://hdl.handle.net/10453/135987.
Panna MB, Ara S, Khanam Z, Papri FS. Adolescent Pregnancy: Risk Factors, Outcome and Prevention. Chattagram Maa-O-Shishu Hospital Medical College Journal. 2016;15(1):53-6.
UNHCR. Global Trends Forced Dısplacement in 2020 [Available from: https://www.unhcr.org/statistics/unhcrstats/60b638e37/global-trends-forced-displacement-2020.html.
UNHCR Turkey - Fact Sheet February 2021 [EN/TR] - Turkey 2021 [Available from: https://reliefweb.int/report/turkey/unhcr-turkey-fact-sheet-february-2021-entr.
Bulut O, Sevuk S, Ustun N, Arslanoglu S, Ovali F. Retrospective Evaluation of Perinatal and Early Neonatal Outcomes in Infants of Migrant Mothers: A Case-Controlled Study. Medeni Med J. 2019;34(4):368-73.
Erdoğan MM. Syrians barometer 2019 Ankara: Orion Bookstore; 2020 [Available from: https://www.unhcr.org/tr/wp-content/uploads/sites/14/2020/09/SB2019-SUMMARY-04092020.pdf.
Erdoğan MM. Syrian Refugees In Turkey | Reports 2021 [Available from: https://www.mmuraterdogan.com/raporlar?pgid=k8ypprcv-c680ec23-7da6-11ea-8c85-12879e2400f0.
Gumus Sekerci Y, Aydin Yildirim T. The knowledge, attitudes and behaviours of Syrian refugee women towards family planning: Sample of Hatay. Int J Nurs Pract. 2020;26(4):e12844.
Numbers of Syrians in Turkey July 2020 Refugees Association 2021 [Available from: https://multeciler.org.tr/eng/numbers-of-syrians-in-turkey-july-2020/.
Col M, Bilgili Aykut N, Usturali Mut AN, Kocak C, Uzun SU, Akin A, et al. Sexual and reproductive health of Syrian refugee women in Turkey: a scoping review within the framework of the MISP objectives. Reprod Health. 2020;17(1):99.
Vural T, Golbasi C, Bayraktar B, Golbasi H, Yildirim AGS. Are Syrian refugees at high risk for adverse pregnancy outcomes? A comparison study in a tertiary center in Turkey. J Obstet Gynaecol Res. 2021;47(4):1353-61.
Cetorelli V. The Effect on Fertility of the 2003-2011 War in Iraq. Popul Dev Rev. 2014;40(4):581-604.
Ekmekci PE. Syrian Refugees, Health and Migration Legislation in Turkey. J Immigr Minor Health. 2017;19(6):1434-41.
Cetinkaya S. The Reasons Why Women Prefer C-Sections, Their Knowledge, Behavior and Attitudes towards Abortion. Open Journal of Obstetrics and Gynecology. 2020;10(02):221-36.
Rohwerder B. Syrian refugee women, girls, and people with disabilities in Turkey. 2018.
Fund UNP. Maternal health: UNFPA; 2016 [updated 23 October 2019. Available from: https://www.unfpa.org/maternal-health.
Xie Y, Wang X, Mu Y, Liu Z, Wang Y, Li X, et al. Characteristics and adverse outcomes of Chinese adolescent pregnancies between 2012 and 2019. Sci Rep. 2021;11(1):12508.
Ahinkorah BO. Topic: prevalence and determinants of adolescent pregnancy among sexually active adolescent girls in Niger. Journal of Public Health. 2019;29(3):489-93.
Tetteh J, Nuertey BD, Dwomoh D, Udofia EA, Mohammed S, Adjei-Mensah E, et al. Teenage pregnancy and experience of physical violence among women aged 15-19 years in five African countries: Analysis of complex survey data. PLoS One. 2020;15(10):e0241348.
Turkay U, Aydin U, Caliskan E, Salici M, Terzi H, Astepe B. Comparison of the pregnancy results between adolescent Syrian refugees and local adolescent Turkish citizens who gave birth in our clinic. J Matern Fetal Neonatal Med. 2020;33(8):1353-8.
Keskin U, MF K. Adolesan Dönemi ve Gebelikler. Turkiye Klinikleri Family Medicine-Special Topics. 2018;9(5):33-8.
Di Renzo GC, Spano F, Giardina I, Brillo E, Clerici G, Roura LC. Iron deficiency anemia in pregnancy. Womens Health (Lond). 2015;11(6):891-900.
Lee SH, Lee SM, Lim NG, Kim HJ, Bae SH, Ock M, et al. Differences in pregnancy outcomes, prenatal care utilization, and maternal complications between teenagers and adult women in Korea: A nationwide epidemiological study. Medicine (Baltimore). 2016;95(34):e4630.
McCall SJ, Bhattacharya S, Okpo E, Macfarlane GJ. Evaluating the social determinants of teenage pregnancy: a temporal analysis using a UK obstetric database from 1950 to 2010. J Epidemiol Community Health. 2015;69(1):49-54.
Aslan CetIn B, Aydogan Mathyk B, Turan G, Guralp O, GedIkbasi A. A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies. J Matern Fetal Neonatal Med. 2020;33(24):4037-42.
Fleming N, Ng N, Osborne C, Biederman S, Yasseen AS, 3rd, Dy J, et al. Adolescent pregnancy outcomes in the province of Ontario: a cohort study. J Obstet Gynaecol Can. 2013;35(3):234-45.
Simten G, Çiftçi MA, Cıngıllıoğlu B, Aktürk E, Şahin O, Kükrer S, et al. Adverse obstetric outcomes in early and late adolescent pregnancy. Journal of Experimental and Clinical Medicine.39(1):237-44.
Karacam Z, Kizilca Cakaloz D, Demir R. The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod. 2021;50(4):102093.
de la Calle M, Bartha JL, Lopez CM, Turiel M, Martinez N, Arribas SM, et al. Younger Age in Adolescent Pregnancies Is Associated with Higher Risk of Adverse Outcomes. Int J Environ Res Public Health. 2021;18(16):8514.
Bildircin FD, Kurtoglu E, Kokcu A, Isik Y, Ozkarci M, Kuruoglu S. Comparison of perinatal outcome between adolescent and adult pregnancies. J Matern Fetal Neonatal Med. 2014;27(8):829-32.
Samano R, Chico-Barba G, Flores-Quijano ME, Godinez-Martinez E, Martinez-Rojano H, Ortiz-Hernandez L, et al. Association of Pregestational BMI and Gestational Weight Gain with Maternal and Neonatal Outcomes in Adolescents and Adults from Mexico City. Int J Environ Res Public Health. 2021;19(1):280.
Karatasli V, Kanmaz AG, Inan AH, Budak A, Beyan E. Maternal and neonatal outcomes of adolescent pregnancy. J Gynecol Obstet Hum Reprod. 2019;48(5):347-50.
Turkay U, Aydin U, Salici M, Caliskan E, Terzi H, Astepe BS, et al. Comparison of pregnant Turkish women and Syrian refugees: Does living as a refugee have an unfavorable effect on pregnancy outcomes? Int J Gynaecol Obstet. 2020;149(2):160-5.
de Vienne CM, Creveuil C, Dreyfus M. Does young maternal age increase the risk of adverse obstetric, fetal and neonatal outcomes: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2009;147(2):151-6.
Lewis LN, Hickey M, Doherty DA, Skinner SR. How do pregnancy outcomes differ in teenage mothers? A Western Australian study. Med J Aust. 2009;190(10):537-41.
Kirbas A, Gulerman HC, Daglar K. Pregnancy in Adolescence: Is It an Obstetrical Risk? J Pediatr Adolesc Gynecol. 2016;29(4):367-71.
Vieira CL, Coeli CM, Pinheiro RS, Brandao ER, Camargo KR, Jr., Aguiar FP. Modifying effect of prenatal care on the association between young maternal age and adverse birth outcomes. J Pediatr Adolesc Gynecol. 2012;25(3):185-9.
Torvie AJ, Callegari LS, Schiff MA, Debiec KE. Labor and delivery outcomes among young adolescents. Am J Obstet Gynecol. 2015;213(1):95 e1- e8.
Wilson RE, Alio AP, Kirby RS, Salihu HM. Young maternal age and risk of intrapartum stillbirth. Arch Gynecol Obstet. 2008;278(3):231-6.
Agbonjimi L, Ogunleye A, Oluwadare M, Ayobami AA. Determinants of Increased Prevalence of Teenage Pregnancy Among Female Senior Class Students in Two Selected Secondary School in Sagamu, Ogun State, Nigeria. Middle European Scientific Bulletin. 2022;21:1-17.
