Teenage pregnancy in Malta

Sex education is an integral part of the school curriculum in many countries and to be effective must be part of a holistic program for health education, health promotion and life skills. According to the Canadian guidelines for sexual health education published in 2008, the goals should be two fold:

1. To help young people achieve positive outcomes regarding self-esteem, respect for self and others, non-exploitive sexual relations, rewarding human relationships and informed reproductive choices;
2. To avoid negative outcomes such as STDs, HIV, sexual coercion and unintended pregnancies.

Sexual health education methods vary and even in the U.S.A. there has been controversy over abstinence – only programs and abstinence – plus programs. The abstinence – plus program is also called the ABC approach: A- abstinence, B- be faithful and C- use a condom. In some American schools parents are asked to choose which program they would prefer for their children. Educating young people about contraceptives and whether or not these should be freely available is very controversial.

According to the World Bank, the global adolescent fertility rate (births per 1000 women aged 15-19 yrs) has fallen slightly from 46.5 in 2011 to 44.2 in 2015, the rates for Malta were 18 and 16/1000 respectively. The average rate for the E.U. was 13 in 2011 and 10/1000 in 2015. During the same period in the U.K. there was a drop from 20/1000 in 2011 down to 14/1000 adolescent women in 2015, this has been mainly due to better education and improved access to more sophisticated contraception. Due to the fact that the use of the combined oral contraceptive pill and the use of condoms has a significant failure rate amongst certain groups of adolescents, many family planning clinics in the U.K. and the U.S.A. have been promoting the use of long acting reversible contraceptives such as the IUCD and depot progestogen implants.

The availability and use of contraceptives by adolescents is an important issue for health care providers. The most vulnerable adolescents, notably from deprived areas will probably not use contraceptives on a regular basis unless they can get them free of charge, this has been noted both in the U.S.A. and the U.K. Whilst parental consent to prescribe contraceptives is not necessary in many Western countries, in other parts of the world this would be very controversial, more so if the young adolescent develops a complication such as deep vein thrombosis (from COCP) or has a uterine perforation (after insertion of IUCD).

As noted, teenage pregnancies are associated with increased risks for premature delivery, low birth weight and neonatal mortality. Lack of education and a deprived socio-economic background affects so many teenage mothers all over the globe. In Malta, a lot of work is being done to help these young mothers but there is always room for improvement. It is worth remembering that is some countries an unmarried pregnant woman would be considered to have an illegal pregnancy. The implementation of health promotion and sex education is improving but morals and religious beliefs must always be respected.

The article by Grech et al highlights an important problem and encourages further cooperation between the departments of health and education. I look forward to more studies in the future.

Editorial note

For the December 2017 issues and for all of 2018, the Malta Medical Journal and the Malta Medical School Gazette will feature front covers that depict Valletta. This is in honour of Valletta 2018, wherein Valletta will be the European Capital of Culture, with all attendant programmes. The editorial board sincerely hopes that you will appreciate these covers as much as the actual contents.

Prof. Victor Grech

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