Perception, practices and understanding of teenage pregnancy among the adolescent girls in India: A scoping review protocol

ABSTRACT

Introduction:

Teenage pregnancy is a subject of concern among adolescents. Inadequate knowledge and misperceptions about pregnancy are major contributing factors to teenage pregnancy. Without a proper understanding, adolescents are involved in unsafe sexual practices, which results in pregnancy. So, perception and understanding are important aspects to explore among adolescents. In this planned scope review, all eligible studies will be identified around the perception, practices, and understanding of teenage pregnancy among married and unmarried adolescent girls.

Methods:

The Arksey and O’Malley (2005) scoping review framework and the Joanna Briggs Institute Reviewers’ Manual (2015) will be used for the planned scoping review. The population, concept, and context strategy (PCC) will be used to develop the research question, search strategy, and eligibility criteria. Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA ScR) will be used for the findings of the study. For the literature search, authors will use Google Scholar, PubMed, and ResearchGate electronic databases with specific words such as “teenage”, “adolescence”, “pregnancy”, “perception”, “knowledge”, “awareness” and “abortion”.

Result:

The planned scoping review will be helpful in addressing the lack of adolescent misperception, malpractices, and misunderstandings regarding teenage pregnancy. It can provide detailed information about teenage pregnancy in the Indian context.

Conclusion:

The evidence synthesis and gap analysis will be helpful in suggesting insights into the issue of teenage pregnancy, which will be helpful in future policies and programs.

Background

The United Nations Children’s Fund (UNICEF) (2022) defines teenagers as belonging to the age group of 13-19 years. A teenager is not even a child or not an adult either, hence this phase of life is very crucial for them.[1] Also, as the phase of adolescence, teenagers face physiological changes and often psychological conflicts.[2,3] As sexual development occurs, teenagers are curious to explore their bodies. Due to a lack of knowledge regarding sexual activity and preventive measures, they often engage in unsafe sex and eventually become pregnant.[4]

Worldwide teenage pregnancy is a matter of concern as approximately 16 million adolescent pregnancy cases are seen yearly, and 9 out of 10 teenage mothers belong to low- and middle-economic countries.[5] According to the World Health Organization (WHO), an estimated 12 million girls aged 15 to 19 and around 777,000 girls under 15 give birth yearly.[6] India has a significant number of teenage pregnancies. According to the National Family Health Survey (NFHS) conducted in 2015-16, around 7.9% of girls aged 15-19 in India had already begun childbearing, either pregnant or with a child. Teenage pregnancy rates can vary across states and regions in India. States with higher rates of teenage pregnancy include Bihar, Jharkhand, Rajasthan and Madhya Pradesh.[7] In India, early marriage, societal pressure and lack of sexual and reproductive health knowledge are risk factors for adolescent pregnancy, in which 31.5 percent of childbirths were seen among married girls aged 15 to 19 years.[7]

Cultural practices, educational qualifications and socioeconomic conditions are major determining factors for teenage pregnancy.[8] Also, early marriage is mainly contributing to the increasing adolescent pregnancy rate, which is mostly determined by the age of acquiring menarche among adolescent girls.[9] In most communities, socio-cultural aspects favour the early marriage of the girl after attaining menarche, which results in early pregnancy before the age of 19 years.[10] Social stigma, lack of knowledge and negative media influence are the significant factors of unprotected sex, unwanted pregnancy and STIs.[11] As an Indian societal framework, talking about sex and its related terms is considered as taboo. So, adolescents get incomplete information through misguided sources that usually reason behind misinformation or misconceptions about contraception and pregnancy within peer groups that can lead to stigmatised beliefs and behaviours.[12] Incomplete understanding leads to unsafe sexual practices that are essential to adolescent pregnancy.[13]

The WHO suggests that sexual involvement that begins in adolescence is not safe and non-consensual.[14] Many studies have shown that in India, 0%-6% of females had sexual intercourse at 15-17 years old.[15,16] In half of the cases, adolescent pregnant girls were sexually involved with their friends or fiancée and close relatives.[17] According to NFHS-3 (2005-2006), 94% of adolescent girls were not aware of contraception in India.[18] Lack of understanding and awareness about the contraceptive method is a significant cause of early pregnancy.[19] In India, only 11.4 percent of married adolescent girls currently use any contraceptive method.[20] Most of the time, teenage pregnancy results in childbirth due to the lack of understanding about abortion, delay in the abortion process and inaccessibility to proper health services.[21,22] Murro et al., 2021 reported more than two million abortion cases per year among adolescents of the 15-19 years age group in India, and 78% of these total abortions are unsafe, which is a considerable worry for the country.[23]

As perceptions and understanding play key roles among adolescents. Although several studies have been presented about teenage pregnancy and its related topics in India, there are limitations to discussing no scoping reviews available that discuss the understanding and perception of pregnancy among adolescent girls in a holistic manner. With our preliminary analysis, we observed that there is a significant gap in evidence synthesis and a comprehensive view of teenage pregnancy in India. So, the planned scoping review will evaluate the existing knowledge and perception related to pregnancy among adolescent girls in India and present the experiences and practices of adolescent mothers on how they deal with pregnancy and its consequences in the early period of their lives.

Objectives of the planned scoping review

• To understand the perceptions and practices among adolescents on early/teenage pregnancy.

• To study the experiences, beliefs and understanding around early pregnancy among married and unmarried adolescents who are already experiencing pregnancy.

Materials and Methods

The scoping review will aim to fulfil the objective of the study by systematically collecting relevant evidence around perceptions, practices, experiences, beliefs and understanding of early pregnancy among adolescent girls. We checked online databases like Figshare and Open Science Framework for any available scoping review on teenage pregnancy among the adolescent population of India. However, no scoping review discussed the topic related to perceptions, practices and understanding of pregnancy among adolescent girls in India in one frame, so this study is designed to establish these aspects systematically in a holistic manner.

Arksey and O’Malley’s (2005) scoping review framework and the Joanna Briggs Institute Reviewers’ Manual will be used for the planned scoping review.[24,25] The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist[26] will be followed to report the scoping review [Supplementary File 1]. The Population, Concept and Context (PCC) strategy will be used to identify the research questions and eligibility criteria. Quality assessment of planned review will be performed through the Mixed Methods Appraisal Tool (MMAT), Version- 2018.[27]

Supplementary File 1.

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist

SECTION	ITEM	PRISMA-ScR CHECKLIST ITEM	REPORTED ON PAGE #
TITLE
Title	1	Identify the report as a scoping review.	1
ABSTRACT
Structured summary	2	Provide a structured summary that includes (as applicable) background, objectives, eligibility criteria, sources of evidence, charting methods, results and conclusions that relate to the review questions and objectives.	1
INTRODUCTION
Rationale	3	Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach.	2
Objectives	4	Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts and context) or other relevant key elements used to conceptualise the review questions and/or objectives.	3
METHODS
Protocol and registration	5	Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and, if available, provide registration information, including the registration number.	N/A
Eligibility criteria	6	Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language and publication status) and provide a rationale.	4-5
Information sources	7	Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed.	5
Search	8	Present the complete electronic search strategy for at least 1 database, including any limits used, so it could be repeated.	5
Selection of sources of evidence	9	State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review.	6
Data charting process	10	Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that the team has tested before their use and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators.	6
Data items	11	List and define all variables for which data were sought and any assumptions and simplifications made.	6
Critical appraisal of individual sources of evidence	12	If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate).	6
Synthesis of results	13	Describe the methods of handling and summarising the data that were charted.	6
RESULTS
Selection of sources of evidence	14	Give the numbers of sources of evidence screened, assessed for eligibility and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram.	This is the protocol; the full study is not completed.
Characteristics of sources of evidence	15	For each source of evidence, present characteristics for which data were charted and provide the citations.	This is the protocol; the full study is not completed.
Critical appraisal within sources of evidence	16	If done, present data on critical appraisal of included sources of evidence (see item 12).	This is the protocol; the full study is not completed.
Results of individual sources of evidence	17	For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives.	This is the protocol; the full study is not completed.
Synthesis of results	18	Summarise and/or present the charting results related to the review questions and objectives.	This is the protocol; the full study is not completed.
DISCUSSION
Summary of evidence	19	Summarise the main results (including an overview of concepts, themes and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups.	This is the protocol; the full study is not completed.
Limitations	20	Discuss the limitations of the scoping review process.	This is the protocol; the full study is not completed.
Conclusions	21	Provide a general interpretation of the results. Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps. questions and objectives, as well as potential implications and/or next steps.	This is the protocol; the full study is not completed.
FUNDING
Funding	22	Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review.	11

From: Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. doi: 10.7326/M18-0850.

The five steps according to Arksey and O’Malley’s framework that will be followed for the planned scoping review are:

1. Identifying the research questions

2. Identifying relevant studies

3. Relevant study selection

4. Charting the available data

5. Collating, summarising and reporting results.

Identifying the research questions

The following research questions are framed according to the PCC strategy:

• What are the perceptions and practices among adolescents about early/teenage pregnancy?

• What are the experiences, beliefs and understanding around early pregnancy among married and unmarried adolescent girls having experience of pregnancy?

Identifying relevant studies

An exhaustive search will be conducted for eligible papers from databases using specific keywords and inclusion and exclusion criteria in this stage of the study.

Eligibility criteria

The inclusion and exclusion criteria will be concluded using the PCC strategy.

Inclusion Criteria:

• Population: Adolescent girls aged from 10 to 19 years.

• Concept: Perception, practices and understanding of teenage pregnancy will be used for adolescents in this scoping review. Perception may be true or false, but it has a potent influence on how to look at reality. So, the perception of adolescents around teenage pregnancy is about sexual contact, sexual relationships, pregnancy and early childbearing, and it also influences their actions. Practices are the application according to general perceptions and understanding, which is reflected in activity among adolescent girls, such as having a sexual relationship, sexual initiation at an early age, use of contraception, family planning, etc., Understanding teenage pregnancy is defined as the knowledge and awareness among adolescent girls about pregnancy, conceptions, contraception, family planning and abortion.

• Context: India.

• Review period: Studies conducted from 2000 to 2021 will be included in the planned review.

• Language of published literature: All the studies published in English will be selected for this planned review.

• Studies with qualitative and quantitative studies have data on the perception, practices and understanding of teenage pregnancy.

• Cross-sectional, interventional, case-controlled studies with study settings like urban, rural and tribal will be included in the review.

• Both hospital-based and community-based articles will be selected for further analysis.

Exclusion criteria:

• Studies before the year 2000.

• Population other than India.

• Studies of target groups younger than 10 and older than 19.

• Adolescent population where male-specific data are present.

Search strategy

Searching for relevant studies for the planned review will be conducted by collecting literature from different online databases such as Google, Google Scholar, ResearchGate, EMBASE, SCOPUS, Web of Science, PubMed, PsycINFO, Shodhganga and Google Scholar, etc., In addition, governmental and non-governmental websites like the WHO, UNICEF, National Family and Health Survey and National Institute of Health and Family Welfare will also be searched for other grey literature in this area. The literature search will be conducted by using various MeSH terms such as “teenage”; “adolescence”; “young youth”, “pregnancy”; “perception”; “knowledge”; “awareness”; “unmarried”, “mother”, “abortion”, etc., Different search terms will be used in each database, and Boolean terms (AND/OR) will be used to separate the keywords in specific databases. The search strategy for PubMed electronic databases is given in Supplementary File 2. Reference lists of included articles will also be screened for eligible inclusion in the planned study.

Supplementary File 2.

Search strategy of PubMed electronic database

M File. Draft of search strategy to be used using PubMed electronic database
Components	Search items	Results
#1	Pregnancy: “pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy’s”[All Fields]	544,651
#2	Teenage: “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager’s”[All Fields] OR “teenages”[All Fields]	1,353,020
#3	Adolescent: “adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent’s”[All Fields]	1,389,779
#4	Mother: “mother’s”[All Fields] OR “mothered”[All Fields] OR “mothers”[MeSH Terms] OR “mothers”[All Fields] OR “mother”[All Fields] OR “mothering”[All Fields]	190,109
#5	India: “india”[MeSH Terms] OR “india”[All Fields] OR “india’s”[All Fields] OR “indias”[All Fields]	595,542
#6	Married: “marriage”[MeSH Terms] OR “marriage”[All Fields] OR “married”[All Fields] OR “marrieds”[All Fields] OR “marries”[All Fields] OR “marry”[All Fields] OR “marrying”[All Fields]	37,849
#7	Unmarried: “single person”[MeSH Terms] OR (“single”[All Fields] AND “person”[All Fields]) OR “single person”[All Fields] OR “unmarried”[All Fields] OR “unmarrieds”[All Fields]	15,141
#8	Abortion: “abort”[All Fields] OR “aborted”[All Fields] OR “aborter”[All Fields] OR “aborters”[All Fields] OR “aborting”[All Fields] OR “abortion’s”[All Fields] OR “abortion, induced”[MeSH Terms] OR (“abortion”[All Fields] AND “induced”[All Fields]) OR “induced abortion”[All Fields] OR “abortion”[All Fields] OR “abortions”[All Fields] OR “abortive”[All Fields] OR “abortively”[All Fields] OR “abortives”[All Fields] OR “aborts”[All Fields]	52,532
#9	Knowledge AND Awareness AND Adolescent ((“knowledge”[MeSH Terms] OR “knowledge”[All Fields] OR “knowledge s”[All Fields] OR “knowledgeability”[All Fields] OR “knowledgeable”[All Fields] OR “knowledgeably”[All Fields] OR “knowledges”[All Fields]) AND (“awareness”[MeSH Terms] OR “awareness”[All Fields] OR “aware”[All Fields] OR “awarenesses”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields])) AND (2000:2022[pdat])	9,441
#10	Practice AND Adolescent ((“practicability”[All Fields] OR “practicable”[All Fields] OR “practical”[All Fields] OR “practicalities”[All Fields] OR “practicality”[All Fields] OR “practically”[All Fields] OR “practicals”[All Fields] OR “practice”[All Fields] OR “practice s”[All Fields] OR “practiced”[All Fields] OR “practices”[All Fields] OR “practicing”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields])) AND (2000:2022[pdat])	131,468
#11	Experiences AND Pregnancy ((“experience”[All Fields] OR “experience s”[All Fields] OR “experiences”[All Fields]) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields])) AND (2000:2022[pdat])	30,208
#12	#2 AND #1 AND #5 ((“adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager s”[All Fields] OR “teenages”[All Fields]) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	1589
#13	#3 OR #2 AND #1 AND #5 ((“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields] OR (“adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager s”[All Fields] OR “teenages”[All Fields])) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	1643
#14	#7 AND #3 AND #4 AND #5 ((“single person”[MeSH Terms] OR (“single”[All Fields] AND “person”[All Fields]) OR “single person”[All Fields] OR “unmarried”[All Fields] OR “unmarrieds”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“mother s”[All Fields] OR “mothered”[All Fields] OR “mothers”[MeSH Terms] OR “mothers”[All Fields] OR “mother”[All Fields] OR “mothering”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	18
#15	#6 AND #3 AND #4 AND #5 ((“marriage”[MeSH Terms] OR “marriage”[All Fields] OR “married”[All Fields] OR “marrieds”[All Fields] OR “marries”[All Fields] OR “marry”[All Fields] OR “marrying”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“mother s”[All Fields] OR “mothered”[All Fields] OR “mothers”[MeSH Terms] OR “mothers”[All Fields] OR “mother”[All Fields] OR “mothering”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	74
#16	# 9 AND #1 AND #5 ((“knowledge”[MeSH Terms] OR “knowledge”[All Fields] OR “knowledge s”[All Fields] OR “knowledgeability”[All Fields] OR “knowledgeable”[All Fields] OR “knowledgeably”[All Fields] OR “knowledges”[All Fields]) AND (“percept”[All Fields] OR “perceptibility”[All Fields] OR “perceptible”[All Fields] OR “perception”[MeSH Terms] OR “perception”[All Fields] OR “perceptions”[All Fields] OR “perceptional”[All Fields] OR “perceptive”[All Fields] OR “perceptiveness”[All Fields] OR “percepts”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	17
#17	#9 AND #6 AND #8 AND #5 (“awareness”[MeSH Terms] OR “awareness”[All Fields] OR “aware”[All Fields] OR “awarenesses”[All Fields]) AND (“marriage”[MeSH Terms] OR “marriage”[All Fields] OR “married”[All Fields] OR “marrieds”[All Fields] OR “marries”[All Fields] OR “marry”[All Fields] OR “marrying”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“abort”[All Fields] OR “aborted”[All Fields] OR “aborter”[All Fields] OR “aborters”[All Fields] OR “aborting”[All Fields] OR “abortion s”[All Fields] OR “abortion, induced”[MeSH Terms] OR (“abortion”[All Fields] AND “induced”[All Fields]) OR “induced abortion”[All Fields] OR “abortion”[All Fields] OR “abortions”[All Fields] OR “abortive”[All Fields] OR “abortively”[All Fields] OR “abortives”[All Fields] OR “aborts”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	8
#18	#10 AND #7 AND #1 AND #5 (“experience”[All Fields] OR “experience s”[All Fields] OR “experiences”[All Fields]) AND (“single person”[MeSH Terms] OR (“single”[All Fields] AND “person”[All Fields]) OR “single person”[All Fields] OR “unmarried”[All Fields] OR “unmarrieds”[All Fields]) AND (“gravidity”[MeSH Terms] OR “gravidity”[All Fields] OR “pregnant”[All Fields] OR “pregnants”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])	1
#19	#10 AND #6 AND #1 AND #5 ((“practicability”[All Fields] OR “practicable”[All Fields] OR “practical”[All Fields] OR “practicalities”[All Fields] OR “practicality”[All Fields] OR “practically”[All Fields] OR “practicals”[All Fields] OR “practice”[All Fields] OR “practice s”[All Fields] OR “practiced”[All Fields] OR “practices”[All Fields] OR “practicing”[All Fields]) AND (“marriage”[MeSH Terms] OR “marriage”[All Fields] OR “married”[All Fields] OR “marrieds”[All Fields] OR “marries”[All Fields] OR “marry”[All Fields] OR “marrying”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	58
#20	#10 AND #7 AND #1 AND #5 ((“practicability”[All Fields] OR “practicable”[All Fields] OR “practical”[All Fields] OR “practicalities”[All Fields] OR “practicality”[All Fields] OR “practically”[All Fields] OR “practicals”[All Fields] OR “practice”[All Fields] OR “practice s”[All Fields] OR “practiced”[All Fields] OR “practices”[All Fields] OR “practicing”[All Fields]) AND (“single person”[MeSH Terms] OR (“single”[All Fields] AND “person”[All Fields]) OR “single person”[All Fields] OR “unmarried”[All Fields] OR “unmarrieds”[All Fields]) AND (“adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent s”[All Fields]) AND (“pregnancy”[MeSH Terms] OR “pregnancy”[All Fields] OR “pregnancies”[All Fields] OR “pregnancy s”[All Fields]) AND (“india”[MeSH Terms] OR “india”[All Fields] OR “india s”[All Fields] OR “indias”[All Fields])) AND (2000:2022[pdat])	8

Study procedure and selection of the studies

All the relevant articles will be primarily screened by title and abstracts, and duplicate studies will be excluded from the review. The authors will follow the inclusion and exclusion criteria for searching relevant literature. The articles which fulfil all the inclusion criteria will be included in the study. The reviewers will screen the abstracts and full-text articles. In the selection procedure, any reviewer disagreement will be resolved by discussing it with the third reviewer. All inclusion and exclusion procedure stages will be presented in the flow diagram as prescribed in Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR).[24]

Charting the data

The relevant data from the literature will be extracted and arranged in the MS Excel spreadsheet [Supplementary File 3]. A key information table will be prepared of data, namely, the title of the article, author’s information, name of the journal, year of the study, regions, age group, sample size, sampling methods, study design, method of data collection, perception and practices of an adolescent girl about teenage pregnancy and experience of a married and unmarried adolescent girl who experience pregnancy like aspects. Feedback from all the authors will be considered before finalising all the relevant data.

Supplementary File 3.

Data extraction proforma

Sl no

Author

Year of Publication

Study title

Journal title

State

Study setting

Study design

Area of residence

Age group

Sample size

Sampling method

Married or unmarried category

Perception and practice of adolescent girls

Experience, and practices married and unmarried adolescent

Remark

Collating, summarising and reporting the results

The proposed scoping review aims to collect all relevant data that satisfies the objectives of the study. The gap analysis will also be an essential aspect of this planned review. After collecting all the data, summarisation and analysis will be done to prepare the final paper. After thematic content analysis, the derived themes will be discussed in the planned review.

Patient and public involvement

No patient involved.

Ethics and dissemination

The planned Scoping review does not require ethical approval because it does not involve collecting any primary data, and it is only a systematic combination of available evidence. This protocol will be the method and procedure for the planned review, and the proposed scoping review will demonstrate the systematic representation of research objectives and possible research gaps around adolescent pregnancy issues in India. The potential gaps will outline new research questions around teenage pregnancy and interventions to improve knowledge and create awareness among adolescents about pregnancy in India.

Discussion

When an adolescent girl becomes a mother at an early age, there is a high chance of posing various medical complications to both mother and the baby, such as preterm birth, low birth weight, anaemia, preeclampsia, gestational diabetes, emotional and mental issues.[28,29,30,31] Although medical conditions are the same, the societal scenario is different in the cases of married and unmarried adolescents. Among married adolescents, family and cultural pressure are the main factors of early childbirth[32], but in unmarried cases, the lack of knowledge about pregnancy, contraception and reproductive health results in unwanted pregnancies. Most pregnancies among adolescents result in childbirth due to a lack of adequate knowledge about abortion and delayed termination of pregnancy.[33]

Teenage pregnancy often affects educational status and employment opportunities and results in an increase in the socioeconomic dependency of adolescent girls.[34] According to WHO guidelines (2022), adolescent pregnancy and its complications can be reduced by preventing early marriage, focusing on educational status, increasing reproductive health education, social and economic support, use of contraception during sexual activity, reducing forced sex, preventing unsafe abortion and increasing prenatal and postnatal care programmes.[35] Also, the Government of India is working towards the prevention of teenage pregnancy through initiatives such as promoting girls’ education, improving access to reproductive healthcare and contraception, raising awareness about sexual and reproductive health, implementing laws and policies to prevent child marriage, providing comprehensive sex education, accessing health care services, adolescent-friendly health clinic, counselling programmes. However, more efforts are needed at the grassroots level to tackle the underlying socioeconomic factors, cultural norms and inequalities contributing to teenage pregnancy in India.

Despite all the policies and programmes, teenage pregnancy is a major health risk behaviour among adolescents. Along with plans and initiatives, teenage pregnancy needs a more detailed research line to derive the underlying cause. The planned scoping review will systematically demonstrate the present scenario regarding the perception and practices of pregnancy and its related themes among adolescent girls. The combined practices and experiences among married and unmarried adolescent girls will be explained in a single framework to better understand adolescent girls’ different perspectives. A number of efforts strived to address teenage pregnancy in the Indian context, but the perceptions, practices and understanding are providing advance details about the actual undercover reasons for higher pregnancy rates.

Strengths and limitations of the study

• This planned scoping review will be the first such study on the topic that emphasises the perception and knowledge among adolescent girls about pregnancy.

• This study also describes psychosocial experiences of pregnancy among adolescent girls.

• This study will help to create awareness among adolescents about pregnancy and mental and physical health supervision necessary for adolescents in their pubertal period.

• This study will be limited to English, which may cause some of the important studies published in other languages to be missed out.

• The study may miss some of the studies published in local and regional journals that are not indexed in major databases.

• Some of the relevant studies may be excluded due to the selected criteria and limited access to those articles.

Conclusion

To summarise, this planned scoping review will map the range of evidence of perception, understanding and experience around all aspects of teenage pregnancy in the Indian context. Evidence synthesis can conclude the research areas around adolescent pregnancy, and derived gaps and limitations from the review can put serious input in further exploration in this field. The key contextual output of information will help address the issue of teenage pregnancy with a new insight and evidential understanding in this field. It can also help provide appropriate recommendations for improving the policy and programmes around teenage pregnancy in India.

Key points

• Teenage pregnancy is a major global health concern, and pregnancies occur in females aged 19 or younger.

• Adolescent pregnancy has significant social and public health issues for pregnant teenagers and their children.

• The planned scoping review systematically and comprehensively summarises the existing literature on perceptions, practices and understanding among adolescent girls.

• This study protocol describes the methods for the planned scoping review, which will use the Arksey and O’Malley (2005) scoping review framework and the Joanna Briggs Institute Reviewers’ Manual (2015).

Financial support and sponsorship

This scoping review received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. However, we acknowledge that the manpower in the research grant received from the Indian Council of Medical Research (ICMR), New Delhi, vide letter number Tribal/122/2020-ECD-II, was utilised for the present scoping review covering one of the aspects for which the grant was received.

Conflicts of interest

There are no conflicts of interest.