Background information to Lesson 9:
Pregnancy 4 Girls and 4 Boys!
1. Introduction
Lesson 8 dealt with sexuality and love outlining what sexuality is and distinguishing it from
sex and enabling learners to define levels of intimacy and relationships. Lesson 9 focuses on
pregnancy both for boys and girls outlining the menstruation cycle, fertility, pregnancy and
contraception. Pregnancy is a beautiful thing if it happens at the right time and in the right
circumstances but can have devastating consequences when the boy and the girl are
unprepared or are unable to deal with the responsibilities of pregnancy. Some of the
immediate consequences may include dropping out of school and or procuring and abortion
under unsafe circumstances. Knowing about pregnancy and how it happens is important
information that can enable youth to make informed healthy decisions about their sexuality.
Lack of information on contraceptive use remains a challenge in promoting youth sexuality in
Kenya and other parts of Africa. As a consequence, unsafe abortion remains a big public
health problem in Kenya accounting for the loss of thousands of lives annually
2. Pregnancy and adolescence
Nowadays adolescent pregnancy is becoming a concern for developing nations like
Ethiopia .Pregnant adolescents were once virtually invisible and unmentionable, shuttled
off to homes for unwed mothers where relinquishment of the baby for adoption was their
own option, or subjected to unsafe and illegal abortion. But, yesterday’s secret has
become today’s dilemma .the exploration of adolescent pregnancy focuses on its
incidence and nature, its consequences, cognitive factors that may be involved
adolescents as parents., and ways in which adolescent pregnancy can be reduced.
Incidence of adolescent pregnancy
Adolescent girls who become pregnant are from different ethnic groups, but their
circumstances have the same stressfulness.
Consequences of adolescent pregnancy
Adolescent pregnancy creates health risks for both the baby and the mother. Infants
born to adolescent mothers are more likely to have low birth weight babies a prominent
factor in infant mortality .Adolescent mothers often drop out of school.
Cognitive factors in Adolescent Pregnancy
Young adolescents may become immersed in a mental world far removed from reality.
They may see themselves as that indestructible and believe that bad things can not
happen to them characteristic of adolescent egocentrism/self centeredness
Importance of sexual literacy and education for adolescents
It is believed that improving education improves the health outcomes of a given society.
The Demographic and Health Surveys conducted at different times have consistently
shown a positive relationship between education and improved health and lowered
fertility.
Schools are a place where children and youth pass a considerable portion of their
development changes both age and cognitive wise. Since RH problems are in this age
group arise mainly due to emotional behavior, peer pressure and lack of experience of
the prevailing social system and its interactions, education enables them to feel
responsible to aspire and/or anticipate for a better future to overcome problems and
hurdles of life and eventually emerge equipped with the necessary knowledge and skills
and to be able to differentiate useful and harmful behavior and practice and to protect
others from danger. In general one can speculate that Reproductive Health education
can impact the RH problems that encounter the young adults today.
3. What is pregnancy?
The state of carrying a developing embryo or fetus within the female body. This condition
can be indicated by positive results on an over-the-counter urine test, and confirmed through
a blood test, ultrasound, detection of fetal heartbeat, or an X-ray. Pregnancy lasts for about
nine months, measured from the date of the woman's last menstrual period (LMP). It is
conventionally divided into three trimesters, each roughly three months long.
How does pregnancy occur?
Fertilization takes place when a male sperm cell meets a female egg. Millions of sperm cells
are deposited into the vagina during sexual intercourse. After the male ejaculates in the
vagina, ejaculated sperm swim up through the cervix into the uterus. The women’s body
helps guide the sperm through the uterus and to the fallopian tubes. If a mature egg is
present, fertilization can take place. Although thousands of sperm may be present, only one
sperm cell can penetrate an egg. Sperm can fertilize an egg up to seven days after
intercourse. If an egg is fertilized, it will move from the fallopian tube into the uterus (womb)
where it will grow.i
Implantation takes place when a fertilized egg attaches itself to the lining of the women’s
uterus. The nutrients in the lining of the uterus are used to support the growth of the egg into
a foetus and then a baby. The woman will not experience periods during pregnancy
because the lining of the uterus, which normally sheds during menstruation, is not shed at
all during pregnancy. The implanted egg grows in the uterus for nine months and becomes a
baby. It then comes out of the mother’s body through the process of childbirth.
Pregnancy
(First, Second, and Third Trimester)
Stages
A normal pregnancy lasts about 40 weeks and is grouped into three trimesters:
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Symptoms of early pregnancy include the absence of menstrual periods, breast
changes, tiredness, nausea, mood swings, or other symptoms.
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A pregnancy test measures the hormone human chorionic gonadotropin in the
urine or blood.
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Symptoms of late pregnancy can include heartburn, difficulty sleeping, swelling of
the ankles or fingers, hemorrhoids, and mild contractions.
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By the end of 37 weeks, a baby is considered full term and its organs are ready to
function on their own.
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As you near your due date, your baby may turn into a head-down position for
birth. Most babies "present" head down.
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Babies at birth typically weigh between 6 pounds 2 ounces and 9 pounds 2
ounces and are 19 to 21 inches long. Most full-term babies fall within these
ranges.
Introduction
Pregnancy lasts about 40 weeks, counting from the first day of your last normal period.
The weeks are grouped into three trimesters (TREYE-mess-turs). Find out what's
happening with you and your baby in these three stages.
What is the first trimester (week 1-week 12)?
During the first trimester your body undergoes many changes. Hormonal changes affect
almost every organ system in your body. These changes can trigger symptoms even in
the very first weeks of pregnancy. Your period stopping is a clear sign that you are
pregnant. Other changes may include:
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Extreme tiredness
Tender, swollen breasts. Your nipples might also stick out.
Upset stomach with or without throwing up (morning sickness)
Cravings or distaste for certain foods
Mood swings
Constipation (trouble having bowel movements)
Need to pass urine more often
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Headache having bowel movements)
Need to pass urine more often
Headache
Heartburn
Weight As your body changes, you might need to make changes to your daily routine,
such as going to bed earlier or eating frequent, small meals. Fortunately, most of these
discomforts will go away as your pregnancy progresses. And some women might not
feel any discomfort at all! If you have been pregnant before, you might feel differently
this time around. Just as each woman is different, so is each pregnancy.
What is the second trimester (week 13-week 28)?
Most women find the second trimester of pregnancy easier than the first. But it is just as
important to stay informed about your pregnancy during these months.
You might notice that symptoms like nausea and fatigue are going away. But other new,
more noticeable changes to your body are now happening. Your abdomen will expand
as the baby continues to grow. And before this trimester is over, you will feel your baby
beginning to move!
As your body changes to make room for your growing baby, you may have:
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Body aches, such as back, abdomen, groin, or thigh pain
Stretch marks on your abdomen, breasts, thighs, or buttocks
Darkening of the skin around your nipples
A line on the skin running from belly button to pubic hairline
Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip.
Patches often match on both sides of the face. This is sometimes called the mask
of pregnancy
Numb or tingling hands, called carpal tunnel syndrome
Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have
nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching.
These can be signs of a serious liver problem.)
Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme
swelling or if you gain a lot of weight really quickly, call your doctor right away.
This could be a sign of preeclampsia.)
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gain or loss
What is the third trimester (week 29-week 40)?
You're in the home stretch! Some of the same discomforts you had in your second
trimester will continue. Plus, many women find breathing difficult and notice they have to
go to the bathroom even more often. This is because the baby is getting bigger and it is
putting more pressure on your organs. Don't worry, your baby is fine and these problems
will lessen once you give birth.
Some new body changes you might notice in the third trimester include:
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Shortness of breath
Heartburn
Swelling of the ankles, fingers, and face. (If you notice any sudden or extreme
swelling or if you gain a lot of weight really quickly, call your doctor right away.
This could be a sign of preeclampsia.)
Hemorrhoids
Tender breasts, which may leak a watery pre-milk called colostrum (kuh-LOSSstruhm)
Your belly button may stick out
Trouble sleeping
The baby "dropping," or moving lower in your abdomen
Contractions, which can be a sign of real or false labor
As you near your due date, your cervix becomes thinner and softer (called effacing).
This is a normal, natural process that helps the birth canal (vagina) to open during the
birthing process. Your doctor will check your progress with a vaginal exam as you near
your due date. Get excited — the final countdown has begun!
How will my baby develop week by week?
First Trimester (week 1-week 12)
At 4 weeks:
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Your baby's brain and spinal cord have begun to form.
The heart begins to form.
Arm and leg buds appear.
Your baby is now an embryo and one-twenty-fifth inch long.
At 8 weeks:
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All major organs and external body structures have begun to form.
Your baby's heart beats with a regular rhythm.
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The arms and legs grow longer, and fingers and toes have begun to form.
The sex organs begin to form.
The eyes have moved forward on the face and eyelids have formed.
The umbilical cord is clearly visible.
At the end of 8 weeks, your baby is a fetus and looks more like a human. Your
baby is nearly 1 inch long and weighs less than 1/8 of an ounce.
At 12 weeks:
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The nerves and muscles begin to work together. Your baby can make a fist.
The external sex organs show if your baby is a boy or girl. A woman who has an
ultrasound in the second trimester or later might be able to find out the baby's sex.
Eyelids close to protect the developing eyes. They will not open again until the
28th week.
Head growth has slowed, and your baby is much longer. Now, at about 3 inches
long, your baby weighs almost an ounce.
Second Trimester (week 13-week 28)
At 16 weeks:
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Muscle tissue and bone continue to form, creating a more complete skeleton.
Skin begins to form. You can nearly see through it.
Meconium (mih-KOH-nee-uhm) develops in your baby's intestinal tract. This will
be your baby's first bowel movement.
Your baby makes sucking motions with the mouth (sucking reflex).
Your baby reaches a length of about 4 to 5 inches and weighs almost 3 ounces.
At 20 weeks:
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Your baby is more active. You might feel slight fluttering.
Your baby is covered by fine, downy hair called lanugo (luh-NOO-goh) and a
waxy coating called vernix. This protects the forming skin underneath.
Eyebrows, eyelashes, fingernails, and toenails have formed. Your baby can even
scratch itself.
Your baby can hear and swallow.
Now halfway through your pregnancy, your baby is about 6 inches long and
weighs about 9 ounces.
At 24 weeks:
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Bone marrow begins to make blood cells.
Taste buds form on your baby's tongue.
Footprints and fingerprints have formed.
Real hair begins to grow on your baby's head.
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The lungs are formed, but do not work.
The hand and startle reflex develop.
Your baby sleeps and wakes regularly.
If your baby is a boy, his testicles begin to move from the abdomen into the
scrotum. If your baby is a girl, her uterus and ovaries are in place, and a lifetime
supply of eggs have formed in the ovaries.
Your baby stores fat and has gained quite a bit of weight. Now at about 12 inches
long, your baby weighs about 1½ pounds.
Third Trimester (week 29-week 40)
At 32 weeks:
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Your baby's bones are fully formed, but still soft.
Your baby's kicks and jabs are forceful.
The eyes can open and close and sense changes in light.
Lungs are not fully formed, but practice "breathing" movements occur.
Your baby's body begins to store vital minerals, such as iron and calcium.
Lanugo begins to fall off.
Your baby is gaining weight quickly, about one-half pound a week. Now, your
baby is about 15 to 17 inches long and weighs about 4 to 4½ pounds
At 36 weeks:
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The protective waxy coating called vernix gets thicker.
Body fat increases. Your baby is getting bigger and bigger and has less space to
move around. Movements are less forceful, but you will feel stretches and
wiggles.
Your baby is about 16 to 19 inches long and weighs about 6 to 6½ pounds.
Weeks 37-40:
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By the end of 37 weeks, your baby is considered full term. Your baby's organs are
ready to function on their own.
As you near your due date, your baby may turn into a head-down position for
birth. Most babies "present" head down.
At birth, your baby may weigh somewhere between 6 pounds 2 ounces and 9
pounds 2 ounces and be 19 to 21 inches long. Most full-term babies fall within
these ranges. But healthy babies come in many different sizes.
What are the changes that happen to a woman's body during the 1st, 2nd, and
3rd trimester of her pregnancy?
Everyone expects pregnancy to bring an expanding waistline. But many women are
surprised by the other body changes that pop up. Get the low-down on stretch marks,
weight gain, heartburn and other "joys" of pregnancy. Find out what you can do to feel
better.
Body aches
During pregnancy, you might have:
As your uterus expands, you may feel aches and pains in the back, abdomen, groin
area, and thighs. Many women also have backaches and aching near the pelvic bone
due the pressure of the baby's head, increased weight, and loosening joints. Some
pregnant women complain of pain that runs from the lower back, down the back of one
leg, to the knee or foot. This is called sciatica (SYE-AT-ick-uh). It is thought to occur
when the uterus puts pressure on the sciatic nerve.
What might help:
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Lie down.
Rest.
Apply heat.
Call the doctor if:
The pain does not get better.
Breast changes
During pregnancy, you might have:
A woman's breasts increase in size and fullness during pregnancy. As the due date
approaches, hormone changes will cause your breasts to get even bigger to prepare for
breastfeeding. Your breasts may feel full, heavy, or tender.
In the third trimester, some pregnant women begin to leak colostrum (coh-LOSS-truhm)
from their breasts. Colostrum is the first milk that your breasts produce for the baby. It is
a thick, yellowish fluid containing antibodies that protect newborns from infection.
What might help:
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Wear a maternity bra with good support.
Put pads in the bra to absorb leakage.
Call the doctor if:
You feel a lump or have nipple changes During pregnancy, you might have:
Many pregnant women complain of constipation. Signs of constipation include having
hard, dry stools; fewer than three bowel movements
per week; and painful bowel movements.
Higher levels of hormones due to pregnancy slow down digestion and relax muscles in
the bowels leaving many women constipated. Plus, the pressure of the expanding uterus
on the bowels can contribute to constipation.
What might help:
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Drink 8 to 10 glasses of water daily.
Don't drink caffeine.
Eat fiber-rich foods, such as fresh or dried fruit, raw vegetables, and whole-grain
cereals and breads.
Try mild physical activity
Call the doctor if:
If constipation does not go away.
Dizziness
During pregnancy, you might have:
Many pregnant women complain of dizziness and lightheadedness throughout their
pregnancies. Fainting is rare but does happen even in some healthy pregnant women.
There are many reasons for these symptoms. The growth of more blood vessels in early
pregnancy, the pressure of the expanding uterus on blood vessels, and the body's
increased need for food all can make a pregnant woman feel lightheaded and dizzy.
What might help:
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Stand up slowly.
Avoid standing for too long.
Don't skip meals.
Lie on your left side.
Wear loose clothing.
Call the doctor if:
You feel faint and have vaginal bleeding or abdominal pain.
5. Contraceptive use among adolescents and youth in Ethiopia
Young adults have a clear preference for modern methods over traditional methods . Among
women, use of modern methods is two-and-a-half time greater than use of traditional
methods. Similarly, young men are ten times more likely to report use of a modern method
than a traditional method. The modern methods most commonly used by young female
users are the pill (2 percent) and injectables (2 percent). Young men are most likely to report
using the condom (7 percent), followed by the pill (2 percent) and injectables (1 percent). As
noted, the largest discrepancy in reported current use of contraceptive methods is with
reference to the condom. Men are eight times more likely to report current use of the
condom than women. This difference could largely be due to men reporting use of condoms with
partners other than their wife. But some of the difference may be due to lack of awareness among
men of their partner’s use of a method, since female methods such as the pill and
injectables are less obvious than male methods such as the condom. Periodic abstinence is
the traditional method most commonly used by both women and men (2 percent each).
There are differences by method in current use between the two age groups (Table 4.4).
Women and men age 20-24 are more than twice as likely to report use of injectables as
those age 15-19. Condom use is noticeably higher among men age 20-24 than among men
age 15-19. At the same time, men age 20-24 are much more likely (more than twice as
likely) to report use of the pill than teenage men. However, there is no difference in the
reported use of the pill by age group among women. Reported use of periodic abstinence is
also higher among women and men age 20-24 than among those age 15-19.
Unmarried sexually experienced young women and men report higher levels of ontraceptive
use than their married counterparts (Figure 4.6). Current use is 43 percent and 17 percent
higher among sexually experienced unmarried women and men than among married
women and men. The most notable difference in method use is with reference to the
condom. Unmarried women and men are three times and ten times more likely to report
current use of the condom, respectively, than married women and men. On the other hand,
married men report greater use of the pill, injectables, and periodic abstinence than
unmarried men.
6.Adolescents and Unsafe abortion in Ethiopia
In an adults is minimal and where knowledge of reproductive health is low, unintended
pregnancies place environment where access to contraceptive knowledge and use by young
young adults in a dilemma. Induced abortions in Ethiopia are legal only under extenuating
circumstances. Most young women who do not want to carry a pregnancy to its full term
resort to unsafe abortions
Five percent of pregnancies to young women ended in a miscarriage or abortion. Pregnancy
terminations are higher in urban (9 percent) than rural areas (5 percent) (Figure 5.6). The
proportion of pregnancies terminated varies by demographic and background
characteristics. Young women are three times (and twice) as likely to experience a
miscarriage (or abortion) when they are under age 15 than when they are age 20-24 (or 1519). Women who have never been married are twice as likely to have terminated a
pregnancy as currently married or formerly married women.
Pregnancy terminations are highest among young women with at least a secondary level of
education |
Pregnancy terminations (miscarriages/abortions)(9 percent) and lowest among women
with primary education (3 percent). Pregnancy terminations also rise with the number of
pregnancies in the preceding five years—from 4 percent among women who have had one
pregnancy to 13 percent among women who have had 3 or more pregnancies. These
results underscore the importance of addressing the unmet need of young adults by
providing access to basic reproductive health information that would enable them to take
control of reproductive health decisions.
Youth Reproductive Health—Some Facts
• More than 1 billion people in the world are between the ages of 15 and 24, and most live in
developing
countries.
• One in every 10 births worldwide and 1 in 6 births in developing countries is to women age
15-19.
• Pregnancy-related health risks are much higher among women under age 18, with girls
age 10-14, five
times more likely to die during pregnancy or childbirth than women age 20-24.
• One in 10 abortions worldwide occurs among women age 15-19; more than 4.4 million
women in this age
group have an abortion every year, and 40 percent of these abortions take place in unsafe
conditions.
• Each day half a million young people are infected with a sexually transmitted disease.
• The majority of sexually active males age 15-19 are unmarried whereas two-thirds of
sexually active young
women in the same age group are married.
• Only 17 percent of sexually active young people use a contraceptive method.
• The highest rate of new cases of HIV transmission occurs among young people age 15-24.
• By the end of 2000, more than 10 million young people were infected with HIV, and nearly
two-thirds
were women.
Source: UNFPA, 2001; UNFPA, 2002
at can schools do?
viding a supportive environment
school environment can be an important arena for reducing stigma and encouraging girls who
ome pregnant to continue with their education.
s and suggestions:
Do not expel pregnant girls from school; they have the right to continue their
cation.
Include girls empowerment in the school curriculum. This could include practicing life
s, such as negotiation and decision-making skills, and exercising and standing up for human
ts. See also Background Information for Lesson 12.
Provide possibilities for empowerment, assertiveness training and self-defence for
and women. See also Background Information for Lesson 12.
chers can help to mobilise the school administration to provide support for students with their own
blems, such as mentoring and counselling as well as references to school-based or communityed health services. In addition, teaching the curriculum effectively requires the school
ministration to bring its teaching methodology in the entire school in line with the principles used in
curriculum. Finally, the school administration should preferably provide supportive facilities, such
nformation in the school library, Internet access for students and possibly condoms and other birth
trol services.
chers can also work in conjunction with the neighbouring health care services that may provide
t Abortion Care (PAC) services where necessary.
Addressing this lesson in the classroom
topic of pregnancy and abortion can be controversial and may be accessioned by individual
udices including personal religious feelings.
s and suggestions:
Be aware of your own views and prejudices regarding teenage sexual activity. Be careful
to pass on any prejudices; however tempting this may be.
Give complete information – only then young people are capable of taking informed
sions.
Be prepared for students who may come to you with personal questions and or problems.
ecessary, refer them to a school counsellor or a health centre nearby.
References:
-Save the Children/USA. 1999. Project proposal baseline survey report on adolescent
reproductive health (ARH) in government high schools of Addis Ababa. Addis Ababa,
Ethiopia.
- Central Statistical Authority (CSA). 1993. The 1990 National Family and Fertility Survey,
Ethiopia.Addis Ababa, Ethiopia: Central Statistical Authority. Central Statistical Authority
(CSA) and