2. Adolescent
pregnancy, Unwedmoth
er,Sexual
abuse,Elderlyprimi and
Substance abuse
By
Prince K Babu

3. Definition
• Adolescent pregnancy is pregnancy in
girls age 19 or younger.

4. ADOLESCENT
PREGNANCY

5. Causes, incidence, and
risk factors
• Adolescent pregnancy and babies
born to adolescents have dropped
since reaching an all-time high in
1990. This is mostly due to the
increased use of condoms.

6. • Adolescent pregnancy is a complex
issue with many reasons for concern.
Kids age 12 - 14 years old are more
likely than other adolescents to have
unplanned sexual intercourse . They
are more likely to be talked into
having into sex.
• Up to two-thirds of adolescent
pregnancies occur in teens age 18 -
19 years old.

7. Risk factors
• Younger age
• Poor school performance
• Economic disadvantage
• Older male partner
• Single or teen parents

8. Symptoms
Pregnancy symptoms include:
• Abdominal distention
• Breast enlargement and breast
tenderness
• Fatigue
• Light-headedness or actual fainting
• Missed period
• Nausea/vomiting
• Frequent urination

9. Signs and tests
• The adolescent may or may not admit
to being involved sexually. If the
teen is pregnant, there are usually
weight changes (usually a gain, but
there may be a loss if nausea and
vomiting are significant). Examination
may show increased abdominal
girth, and the health care provider
may be able to feel the fundus (the
top of the enlarged uterus).

10. • Pelvic examination may reveal bluish
or purple coloration of vaginal
walls, bluish or purple coloration and
softening of the cervix, and
softening and enlargement of the
uterus.
• A pregnancy test of urine
and/or serum HCG are usually
positive.
• A pregnancy ultrasound may be done
to confirm or check accurate dates
for pregnancy.

11. Treatment

12. • All options made available to the
pregnant teen should be considered
carefully, including
abortion, adoption, and raising the
child with community or family
support.
• Discussion with the teen may require
several visits with a health care
provider to explain all options in a
non-judgmental manner and involve
the parents or the father of the
baby as appropriate.

13. • Early and adequate prenatal
care, preferably through a program
that specializes in teenage
pregnancies, ensures a healthier
baby.
• Pregnant teens need to be assessed
for smoking, alcohol use, and drug
use, and they should be offered
support to help them quit.

14. • Adequate nutrition can be
encouraged through education and
community resources.
• Appropriate exercise and adequate
sleep should also be emphasized.
• Contraceptive information and
services are important after delivery
to prevent teens from becoming
pregnant again.

15. • Pregnant teens and those who have
recently given birth should be
encouraged and helped to remain in
school or reenter educational
programs that give them the skills to
be better parents, and provide for
their child financially and emotionally.
• Accessible and affordable child care
is an important factor in teen
mothers continuing school or entering
the work force.

16. Prognosis

17. • Having her first child during
adolescence makes a woman more
likely to have more children overall.
Teen mothers are about 2 years
behind their age group in completing
their education.
• Women who have a baby during their
teen years are more likely to live in
poverty

18. • Teen mothers with a history of
substance abuse are more likely to
start abusing by about 6 months
after delivery.
• Teen mothers are more likely than
older mothers to have a second child
within 2 years of their first child.

19. • Infants born to teenage mothers are
at greater risk for developmental
problems.
• Girls born to teen mothers are more
likely to become teen mothers
themselves, and boys born to teen
mothers have a higher than average
rate of being arrested and jailed.

20. Complications

21. Pregnant teens are at much higher risk
of having serious medical
complications such as:
• Placenta praevia
• Pregnancy-induced hypertension
• Premature delivery
• Significant anemia
• Toxemia

22. • Infants born to teens are 2 - 6 times
more likely to have low birth
weight than those born to mothers
age 20 or older.
• Prematurity plays the greatest role
in low birth weight, but intrauterine
growth retardation (inadequate
growth of the fetus during
pregnancy) is also a factor.

23. • Teen mothers are more likely to have
unhealthy habits that place the
infant at greater risk for inadequate
growth, infection, or chemical
dependence.
• The younger a mother is below age
20, the greater the risk of her infant
dying during the first year of life.

24. UNWED
MOTHER

25. • Unwed mother is the lady who has
become pregnant without legal
justification of physical intimacy
between man and woman .
• In the traditional societies like India
the physical relationship before
marriage or becoming mother before
marriage is considered as a sin.
• Therefore the result of such women
in the traditional societies is very
bad.

26. Cause of
unwed mother

27. Poverty:
• The foundation of unwed mother lies
somewhere in poverty.
• It is well known that very
unfortunate parents due to their
poverty sell their daughter.
• The reality of this statement is well
established by the newspaper and
news telecast on T V .
• Many of these girls end result is
unwed mother.

28. Prostitution :
• Prostitute is an individual who for
sake of some reward engage in illegal
sexual act with various individual
either of same or opposite sex.
• The tragedy of this prostitutes is
also being unwed mother.

29. Teen age mistake:
• Many teen age girls due to inefficient
decision making make a mistake that
make them an unfortunate mother
unwed mother.

30. Improper sex
education:
• Due to lack of improper sex
education among teen agers and
adolescent , the unwanted pregnancy
is an emerging issue.

31. Contraceptive failure:
• Contraceptive failure can also be a
reason of unwed mother.
• If sexual relationship before
marriage is made but used
contraceptives does not work them it
result in an unwanted pregnancy
making the lady an unwed mother.

32. Consequences of
being unwed mother

33. Consequences for
mother:
Being mother before marriage , a
mother has to face great
consequences like unwed mother is
not socially acceptable in our
traditional societies .

34. In traditional society it is believed as
a curse, therefore it brings alot of
personal disorganization in women
who become unwed mother as she
lack a support from the family
, relatives , society which makes her
living quite hard.

35. Consequences for the
family:
• The darkness of being unwed mother
not only remain to mother but her
family also has to face it.
• The society boycott the family of
unwed mother and family loose their
relationship with the society which
leads to isolation and hence result in
psychological trauma on family.

36. Economic problems :
• As unwed mother lacks support from
family and society , therefore she
faces great economic problems.

37. Health problems:
• Both mother and child are at great
risk of serious health problems. This
may be due to lack of support
(emotional , Nutritional) both to
mother and baby, unsafe delivery
practices which are usually
conducted at unhygienic places to
hide unwanted pregnancy from
society or due to improper guidance
for rearing of child.
•

38. Support system
available to unwed
mother
• Support system to unwed mother
is more available in western societies
than traditional one.. For east few
decades the government provides
free food, free medical support
system , jobs to earn income , proper
education facilities to unwed
mothers child.

39. Legal rights of unwed
mothers

40. Establish paternity :
• Unwed mother has a right to raise
the case in the court to establish
paternity for her child against men
who she is expected that he is
father of her child.

41. Support to child :
• Once paternity is established, the
mother can demand the support from
father to raise her child. The
support can be in form of money or
in some other form.

42. Custody of child :
• Even if paternity is established still
has the right to undertake the
custody of her child if she want it.

43. Prevention

44. Peer education :
• peer education should be implanted
to provide education to those who
are not able to go school. Education
regarding sexual and regarding
sexual and reproductive health can
be provided to them by forming a
group of peers.
• .

45. Sex education :
• Well designed and well implemented
sexual and reproductive health
education can be provided to young
people , so that they can engage in a
safe and responsible sexual behavior

46. Supply of
contraceptives :
• Government has made easy access
to contraceptives therefore should
take benefit of it and must take
necessary step to prevent the
occurrence of unwed mother .

47. Abolition of prostitution
• Prostitution mostly result in unwed
mother. So in order to prevent this
the prostitution should be banned
or prostitute should be informed
about the use of contraceptives.

48. Role of a nurse

49. As educator :
• Nurse should play a vital role in
providing sex education to youngster
to prevent occurrence of unwed
mother. Nurse can provide
knowledge to youngster about the
evil effect of being unwed mother.

50. As an advocator :
• As an advocator, she can advocates
the rights of unwed mother and can
protect her from further
exploitation . She must inform the
mother about her legal rights which
are provided by government to them
so that mother can take benefit of
them.

51. As a helper :
• As a helper , she can help the
mother to raise her child in the
society. Nurse must provide free
services to the mothers which are
provided by government agencies to
help them.

52. As a researcher :
• As a researcher , she should make
research in the best preventive
measure to avoid the occurrence of
unwed mother.

53. SEXUAL ABUSE/
SEXUAL VIOLENCE

54. Definition
• Any sexual act , attempt to
obtain a sexual act, unwanted sexual
comments or advances or acts to
traffic , or otherwise directed
, against a persons sexuality using
coercion , by any person regardless o
their relationship to the victim, in
any setting including but not limited
to home and work.

55. • Sexual violence includes rape
, defined as physically forced or
otherwise coerced penetration – even
if slight – of the vulva or anus using a
penis, other body part or an object..
The attempt to do so is known as
attempted rape. Rape of a person by
2 or more perpetrators is known as
gang rape.

56. Forms and contexts
of sexual abuse

57. • Rape within marriage or dating
relationships
• Rape by strangers
• Systematic rape during armed
conflict
• Unwanted sexual advances or sexual
harassment , including demanding sex
in return for favours

58. • Sexual abuse of mentally or
physically disabled people.
• Sexual abuse of children
• Forced marriage or cohabitation
, including the marriage of the
children.
• Denial of the rights to use the
contraception or to adopt other
measures to protect against sexually
transmitted diseases.

59. Types of sexual abuse

60. • Non-consensual, forced
physical sexual
behavior (rape and sexual assault).
• Unwanted touching, either of a child
or an adult.
• Sexual kissing, fondling, exposure of
genitalia, and voyeurism, exhibitionis
m and up to sexual assault.

61. • Exposing a child to pornography.
• Saying sexually suggestive
statements towards a child (child
molestation).
• Also applies to non-consensual verbal
sexual demands towards an adult.

62. • The use of a position of trust to
compel otherwise unwanted sexual
activity without physical force (or
can lead to attempted rape or sexual
assault).
• Incest ( sexual deviancy ).
• Certain forms of sexual harassment.

63. • Spousal sexual abuse is a form
of domestic violence. When the abuse
involves forced sex, it may
constitute rape upon the other
spouse, depending on the
jurisdiction, and may also constitute
an assault.
• Sexual misconduct can occur where
one person uses a position of
authority to compel another person
to engage in an otherwise unwanted
sexual activity.

64. • Sexual harassment in
education might involve a student
submitting to the sexual advances of
a person in authority in fear of being
punished, for example by being given
a failing grade.
• For example, sexual harassment in
the workplace might involve an
employee being coerced into a sexual
situation out of fear of being
dismissed.

65. Child sexual abuse

66. • It is a form of child abuse in which a
child is abused for the sexual
gratification of an adult or older
adolescent. In addition to
direct sexual contact, child sexual
abuse also occurs when an
adult indecently exposes their
genitalia to a child, asks or pressures
a child to engage in sexual
activities, displays pornography to a
child, or uses a child to produce child
pornography

67. Effects of child sexual
abuse

68. It include
• guilt and self-blame,
• flashbacks,
• nightmares,
• insomnia,
• fear of things associated with the
abuse (including
objects, smells, places, doctor's
visits, etc.),

69. • self-esteem issues,
• sexual dysfunction,
• chronic pain,
• addiction,
• self-injury,
• suicidal ideation

70. somatic complaints,
• depression,
• post-traumatic stress disorder,
• anxiety,
other mental
illnesses (including borderline
personality disorder)
propensity to re-victimization in
adulthood, and physical injury to the
child, among other problems.

71. • Victims of child sex abuse are over
six times more likely to attempt
suicide and eight times more likely to
repeatedly attempt suicide.
• The abusers are also more likely to
commit suicide.
• Much of the harm caused to victims
becomes apparent years after the
abuse happens.

72. • Sexual abuse by a family member is a
form of incest, and results in more
serious and long-term psychological
trauma, especially in the case of
parental incest.
• Approximately 15% to 25% of women
and 5% to 15% of men were sexually
abused when they were children.

73. • Most sexual abuse offenders are
acquainted with their victims;
approximately 30% are relatives of
the child, most often fathers, uncles
or cousins; around 60% are other
acquaintances such as friends of the
family, babysitters, or neighbors;
strangers are the offenders in
approximately 10% of child sexual
abuse cases.

74. • Most child sexual abuse is committed
by men; women commit approximately
14% of offenses reported against
boys and 6% of offenses reported
against girls.
• Most offenders who abuse pre-
pubescent children
are pedophiles; however, a small
percentage do not meet the
diagnostic criteria for pedophilia.

75. Sexual abuse of people
with developmental
disabilities
•
People with developmental disabilities
are often victims of sexual abuse.
According to research, people with
disabilities are at a greater risk
for victimization of sexual assault or
sexual abuse because of lack of
understanding (Sobsey &
Varnhagen, 1989).

76. Identifying Abused
Children

77. • No child is psychologically prepared
to deal with ongoing or intensive
sexual stimulation.
• Even very young children, two or
three years old, may sense that the
sexual activity is "wrong," but they
are unable to stop it.
• Children are frequently threatened
that if they tell anyone, they will be
killed or sent away, or their puppy
will be killed; or their whole family
will breakup.

78. • Children subjected to sexual over-
stimulation, with or without
threats, will develop problems.
• Those older than five years of age
become caught between loyalty to or
dependence on the perpetrator, and
shame at doing something "wrong.“
• Over time, the child develops low
self-esteem, feelings of being
worthless or "dirty," and an abnormal
view of sexuality

79. Identifying signs

80. • Withdrawal and mistrust of adults
• Suicidality
• Difficulty relating to others except
in sexual or seductive ways
• Unusual interest in or avoidance of all
things sexual or physical
• Sleep problems, nightmares, fears of
going to bed
• Forcing sexual acts on other children
• Extreme fear of being touched
• Unwillingness to submit to physical
examination

81. • Frequent accidents or self-injurious
behaviors
• Refusal to go to school, or to the
doctor, or home
• Secretiveness or unusual
aggressiveness
• Sexual components to drawings and
games

82. • Neurotic reactions
(obsessions, compulsiveness, phobias)
• Habit disorders (biting, rocking)
• Wears long sleeves in hot weather
(to hide bruises?)
• Unusual sexual knowledge or behavior
• Prostitution

83. Specific physical
indicators of recent
sexual abuse

84. • Difficulty in walking or sitting
• Torn, stained or bloody clothing
• Pain or itching in genital area
• Bruises or bleeding in genital area or
mouth
• Pregnancy or sexually transmitted
diseases, especially in preteens
• Repeated urinary infections or
genital blockages

85. THE ELDERLY
PRIMIGRAVIDA

86. • The elderly primigravida is a patient
going through her 1st pregnancy at or
over the age of 35years.This
definition may be adopted in the
developing countries but it must be
remembered that the reproductive
activity of the women in developing
countries starts at a much earlier
age than that of the women in
developed countries.

87. • Although the age limit is being raised
from 35-40 years in Britain and
other European countries , it may e
wise to regard as an elderly
primigravida, any women who is
pregnant for the 1st time at the age
of 30years or more in developing
countries.

88. complications
• Tendency to abort
• Increased incidence of
hypertension, pre eclampsia. This is
understandable because the older
the women, gets the more likely to
develop hypertension.
• The long period of infertility may
induce the development of uterine
fibroids which may complicate the
pregnancy.
•

89. • Labor tends to be longer in the
elderly primigravida than in the
multipara. Posterior position of the
occiput are also common .Abnormal
uterine action may complicate labor..
• There is increased need for
obstetric intervention because of the
rigid perineum and prolonged labor.

90. The neonatal morbidity and mortality
are increased because of
• prematurity,
• prolonged labor and
• the need to intervene, as well as the
increase evidence of congenital fetal
abnormalities (eg:
mangolism, hydrocephaly, anencephaly
etc. ) with increase maternal age

91. • Maternal morbidity and mortality are
higher in elderly primigravidae than
in young primigravidae is faced the
nurse midwife must refer all elderly
primigravidae to the big hospital for
delivery.

92. SUBSTANCE ABUSE

93. • Substance abuse, also known as drug
abuse, refers to a maladaptive
pattern of use of a substance (drug)
that is not considered
dependent. Substance abuse/drug
abuse is not limited to mood-altering
or psycho-active drugs.

94. • Activity is also considered substance
abuse when inappropriately used (as
in steroids for performance
enhancement in sports).
• Therefore, mood-altering and
psychoactive substances are not the
only drugs of abuse.
• Substance abuse often includes
problems with impulse control and
impulsivity.

95. • The term "drug abuse" does not
exclude dependency, but is otherwise
used in a similar manner in nonmedical
contexts. The terms have a huge
range of definitions related to taking
a psychoactive drug or performance
enhancing drug for a non-therapeutic
or non-medical effect.

96. • Some of the drugs most often
associated with this term include
• alcohol,
• amphetamines,
• barbiturates,
• benzodiazepines (particularlytemaze
pam, nimetazepam, and flunitrazepam
),
• cocaine,
• methaqualone, and
• opioids.

97. • Use of these drugs may lead to
criminal penalty in addition to
possible physical, social, and
psychological harm, both strongly
depending on local jurisdiction.

98. Causes

99. • Family history factors that influence
a child's early development have been
shown to be related to an increased
risk of drug abuse, such as
– chaotic home environment,
– ineffective parenting,
– lack of nurturing and parental
attachment.

100. • Factors related to a child's
socialization outside the family may
also increase risk of drug
abuse, including
– inappropriately aggressive or shy
behavior in the classroom,
– poor social coping skills,
– poor school performance,
– association with a deviant peer group or
isolating self from peers altogether,
– perception of approval of drug-use
behavior.

101. Symptoms and Signs

102. • Depending on the actual
compound, drug abuse including
alcohol may lead to health
problems, social
problems, morbidity, injuries, unprote
cted sex, violence, deaths, motor
vehicle
accidents, homicides, suicides, physic
al dependence or psychological
addiction.

103. Signs to watch
• Giving up past activities such as
sports, homework, or hanging out
with new friends
• Declining grades
• Aggressiveness and irritability
• Significant change in mood or
behavior
• Forgetfulness

104. • Disappearing money or valuables
• Feeling
rundown, hopeless, depressed, or
even suicidal
• Sounding selfish and not caring about
others
• Use of room deodorizers and incense
• Paraphernalia such as baggies, small
boxes, pipes, and rolling paper

105. • Physical problems with unclear cause
(for example, red eyes and slurred
speech)
• Getting drunk or high on drugs on a
regular basis
• Lying, particularly about how much
alcohol or other drugs he or she is
using
• Avoiding friends or family in order to
get drunk or high

106. • Planning drinking in advance, hiding
alcohol, and drinking or using other
drugs alone
• Having to drink more to get the same
high
• Believing that in order to have fun
you need to drink or use other drugs
• Frequent hangovers
• Pressuring others to drink or use
other drugs

107. • Taking risks, including sexual risks
• Having "blackouts," forgetting what
he or she did the night before
• Constantly talking about drinking or
using other drugs
• Getting in trouble with the law
• Drinking and driving
• Suspension or other problems at
school or in the workplace for an
alcohol- or drug-related incident

108. When to Seek Medical
Care

109. • Mild tremors or an alcohol
withdrawalseizure not accompanied
by hallucinations or confusion
• Jaundice (yellow skin and eyes)
• Increasing abdominal girth
• Leg swelling
• Cough that won't go away
• Continuing feelings of sadness or
depression
• Pain at an injection site
• Fever
• Chest pain

110. If any of the following occur, admit
the patient to a near by hospital
immediately:
• Thoughts of harming yourself or
others
• Chest pain, rapid
heartbeat, difficulty
breathing, or lightheadedness
• Severe abdominal pain
• Confusion or ongoing hallucinations
• Severe tremors or recurrent seizure
s

111. • Difficulty
speaking, numbness, weakness, severe
headache, visual changes, or trouble
keeping balance
• Severe pain at an injection site (may
be accompanied by
redness, swelling, discharge, and
fever)
• Dark, cola-colored urine

112. Medical Treatment

113. • Most substances abusers believe
they can stop using drugs on their
own, but a majority who try do not
succeed.
• Research shows that long-term drug
use alters brain function and
strengthens compulsions to use
drugs. This craving continues even
after your drug use stops.

114. • Because of these ongoing
cravings, the most important
component of treatment, also called
recovery, is preventing relapse.
Treating substance abuse depends on
both the person and the substance
being used.

115. • In behavioral treatment, a counselor
provides you with strategies to cope
with your drug cravings and ways to
avoid relapse. Your doctor may
prescribe medications, such as
nicotine patches and methadone, to
control withdrawal symptoms and
drug cravings.

116. • Often, a drug user has an underlying
behavioral disorder or other mental
illness, one that increases risk for
substance abuse. Such disorders
must be treated medically and
through counseling along with
treatment of the drug abuse.

117. Prevention of
Substance Abuse

118. • Substance abuse may start in
childhood or adolescence. Abuse
prevention efforts in schools and
community settings now focus on
school-age groups.

119. • Programs seek to increase
communication between parents and
their children, to
teach resistance skills, and to
provide information in order to
correct children's misperceptions
about cigarettes, alcohol, and drugs
and the consequences of their use.
Most importantly, officials seek to
develop, through education and the
media, an environment of social
disapproval from children's peers and
families.

120. Prognosis of Substance
Abuse
Individuals who suffer from substance
abuse tend to be more successful in
recovery when they are highly
motivated to be in treatment, are
actively engaged in their own
recovery, and receive intensive
treatment services. Prognosis for
substance abuse recovery is further
improved by being able to easily
access community-based social
supports.

121. Negative impact of
drug and alcohol use

122. Crime:
• More than half of the economic cost
of alcohol and drugs is due to crime.
A substance abuser is 18 times more
likely to be involved in illegal activity
than someone in the general
population. Many violent crimes have
been linked to the mind-altering
effects of drugs.

123. Disease:
• Most abused substances have
harmful health effects. For some
substances, such as tobacco, effects
are caused by long-term use. For
other drugs, a single use can cause
death, disability, or significant
disease.

124. Behavior:
• In addition to their direct effects on
health, drugs produce other indirect
effects. Many drugs lessen
inhibitions and increase the likelihood
that a person will participate in risky
behavior.

125. • Studies show that the use of alcohol
and drugs among teenagers increases
chances for teen pregnancy and
contracting HIV/AIDS or
other sexually transmitted diseases.
Any injected drug is associated with
contracting HIV/AIDS and hepatitis
B and C.

126. • Substance abusers often commit
thefts to support their drug habits.
Drugs and alcohol have been linked
to domestic violence and sexual
assault. At colleges, 75% of date
rapes are alcohol-related. Among
jailed sex offenders, 43% say they
were under the influence of drugs or
alcohol at the time of their crime.

127. • Trauma: Up to 75% of injured people
treated at emergency departments
test positive for illicit
or prescription drugs. Alcohol is
strongly associated with both
intentional and unintentional injury.
Drug use also puts people at risk of
violence. Nearly half of assault
victims are cocaine users.