MHM Magazine

Issue 2 | 2023 | MENTAL HEALTH MATTERS | 7 MHM However, the link between ADHD and risk-taking behaviour is not only limited to sexual risk behaviour but, also linked to: higher levels of engagement in other risk-taking behaviours, like, drug and substance use, reckless driving, gambling, tendency for violence. Adolescent females with ADHD are also more likely to engage in risk factors harmful to their pregnancy like smoking during the third trimester, morbid obesity and alcohol or drug abuse. Female ADHD sufferers are therefore an important, underreported group, who have various obstetric risks, comorbid mental and health problems, of which substance use disorder, was the most common. Therefore, females presenting with clinical ADHD symptoms require more support. Contributing factors Various other factors contributing to the high rates of SA teenage pregnancy include lack of access to contraception and proper sex education, resulting in adolescents lacking knowledge of the risks of teenage pregnancy. Poverty contributes significantly to SA teenage pregnancy with many teens unable to purchase contraception or access the necessary health services to obtain contraception. Poverty also has psychological effects like increased stress and feelings of hopelessness. Furthermore, cultural, and social norms may contribute to early sexual activity and a lack of contraceptive use. The impact of teenage pregnancy and ADHD on society The consequences of teenage pregnancy are harsh. Teenage pregnancies are linked to numerous long, as well as short-term, adverse outcomes for young parents and their offspring. Young mothers are more inclined to be school dropouts, resulting in limited job opportunities, perpetuating poverty, causing financial difficulties, and poor socio- economic status. Teen parents risk relying on government social grants and having low levels of education and high unemployment. Risks for children of teen mothers, include perinatal morbidity and mortality, low socioeconomic status, and low quality of life. Children with ADHD often struggle in school and social situations, experiencing relationship problems and low self-esteem. This leads to a higher risk of health and developmental problems, and experiencing poverty and social exclusion. Moreover, the second leading cause of death for girls aged 15–19 globally is from complications during pregnancy and childbirth. Girls younger than 16 years are at a higher risk for maternal mortality and severe morbidity compared with females older than 20 years. The WHO (2022) estimated the risk of death following pregnancy is twice as high for girls aged 15-19 than for women over 20 years. Girls aged 10-14 have a maternal mortality rate five times higher than women aged 20 years and older. Adolescent mothers are more likely to have poor birth outcomes like increased rates of low birth weight and preterm births. Illegal abortion poses further risks for adolescent girls, particularly in Sub-Saharan Africa. Therefore, teenage pregnancy further contributes to the global cycle of poverty and ill-health. Measures to reduce Teenage Pregnancy in ADHD adolescents in South Africa Numerous policies and programs exist aimed at reducing teenage pregnancy and ADHD globally and in SA. The WHO (2017) has realised that investment in adolescent girls results in triple rewards. These are: the immediate outcomes gained during the adolescent phase, during the adult phase and, through their future children’s, wellbeing. Preventing maternal deaths is a target of the sustainable development goals (SDGs 3.1) - to reduce maternal death rates to under 70 deaths for every 100,000 live births by the year 2030. Furthermore, preventing teenage pregnancy can assist in achieving this goal, as it is interlinked to maternal and child health outcomes, and an increased risk of death during teenage pregnancy and childbirth. The SA Department of Basic Education (DBE) developed a policy on the prevention and management of learner pregnancy in schools. Central to the policy’s goal is the protection and promotion of the various rights applied to minors, concerning the Constitution and other legislations. Recommendations Implementing policy, evaluation, and intensive engagement with stakeholders in the sphere of adolescents' sexual and reproductive health are key to ensure the realisation of the Sustainable Development Goal 3 (SDG 3) by 2030. Regarding, ADHD, Schoeman and Liebenberg (2017) found that many SA patients are not provided with access to healthcare and treatment regardless of the known efficacy of treatment, as well as the significant costs of untreated ADHD. Furthermore, at the primary health care level, common mental disorders are inadequately identified and treated, and patients have limited access to specialist resources. The implementation of harm- reduction models, early assessment, and intervention of ADHD, to reduce the risks linked to impulse control and psychosexuality, is advised. Furthermore, sexual education programmes, which are specifically focused on contraceptive use, should be customised to suit teens with ADHD, as these teens may not relate to traditional educational programmes. Conclusion Adolescents with ADHD encounter various challenges, including the increased risk of engaging in risky behaviours which may lead to teenage pregnancy. The effects of teenage pregnancy can be severe and long- lasting, affecting both the child as well as the young mother. It is, therefore, vital that healthcare professionals and policymakers in South Africa prioritise the development of effective interventions to prevent teenage pregnancy in adolescents with ADHD. By providing comprehensive and targeted support to young people with ADHD, we can empower them to make informed decisions about their sexual and reproductive health and ultimately reduce the incidence of teenage pregnancy in South Africa. References available on request.