Adolescence is the phase of life between childhood and adulthood and the World Health Organization (WHO) states that adolescence is between the ages of 10–19(1). Pregnancy among adolescents who have not reached physical, psychological, and social maturity in all countries of the world is an important public health problem. In emerging regions, an estimated 21 million girls between the ages of 15 and 19 become pregnant each year, of which about 12 million give birth. Globally, 13% of all births are given by women at the age of 15–19 in emerging countries(2). According to TDHS 2018 data, it has been determined that 15% of young people were married before the age of 18, and 4% of adolescents aged 15–19 got pregnant or gave birth. The pregnancy rate of adolescents was 10.2% in 1993, and it decreased to 4% in 2018 (3). Although the pregnancy rates of adolescents have decreased over the years, the subject maintains its importance when the health and social problems caused by adolescent pregnancy are considered.
Adolescent pregnancy is a factor that causes lifetime health disparities for both mother and child. Compared with non-adolescent mothers, adolescent mothers are more likely to have lower education levels, fewer financial independence, worse mental health, and less social support(4–6). Most of them have not completed their education and have limited capacity to maintain their own and their children's living(7). Thus, all these factors may contribute to the high prevalence of malnutrition in adolescent mothers and their children(8).
Stunting is the impaired growth and development that children experience from poor nutrition, repeated infection, and inadequate psychosocial stimulation. The most important indicator of chronic malnutrition in children is stunting. Children are defined as stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median(9). Studies have shown that factors such as low maternal education level, poor access to health services, inadequate complementary feeding, maternal and child age and poor living conditions are associated with childhood stunting(6, 10).
In the last 20 years, although there has been a 13% decrease in the rate of stunting for children under the age of 5 in the world, differences between regions and within countries maintain(11, 12). In Turkey, the rate of stunting in children under the age of 5 was 12% in 2008, 10% in 2013, and decreased to 6% in 2018(3).
The WHO categorizes adverse birth outcomes in three groups. Low birthweight (LBW) is complex and includes preterm neonates (born before 37 weeks of gestation), small for gestational age neonates at term and the overlap between these two situations – preterm and small for gestational age neonates, who typically have the worst outcomes. These three groups have their own subgroups, with individual components linked to different causative factors and long-term effects, and distributions across populations that depend on the prevalence of the underlying causal factors. Understanding and differentiating the various categories and their subgroups is an essential first step in preventing these conditions(13). Overall, it is estimated that between 15% and 20% of all births worldwide are LBW which points out more than 20 million births per year(13). In Turkey, 12% of the live births whose weight at birth is reported have LBW(3). Data from several studies reported that socioeconomic factors, maternal age, BMI of mother, maternal antenatal care and nutrition are defined as risk factors for LBW (6, 7, 14, 15). In addition to birth spacing < 36 months, maternal height ≤ 145 cm, pre-delivery weight ≤ 55 kg, pregnancy weight gain ≤ 6 kg, exposure to tobacco, inadequate antenatal care, maternal hypertension, low socio-economic status, maternal anaemia and less maternal education were associated with delivery of even term LBW infants(15).
The risk of malnutrition and low maternal weight gain during pregnancy is higher in adolescents(14). As expected, adolescent mothers are at higher risk of some adverse birth outcomes, such as premature birth and low birthweight, compared to mothers over the age of 20, since they generally have worse antenatal care and conditions(7, 16, 17).
Although there are data on the socioeconomic vulnerabilities and health risks of adolescent mothers in Turkey, it is unclear what effect adolescent motherhood has on negative birth outcomes and stunting. In particular, based on the national data of the TDHS it has been attempted to
-compare the frequency of the negative birth outcomes (LBW, preterm birth, term LBW) and the stunting under the age of five in children of adolescent and non-adolescent mothers,
-investigate the sociodemographic factors affecting the negative birth outcomes and the stunting.