A Game of Thrones Chapter Thirty-seven

Bran A light snow was falling. Bran could feel the flakes on his face, melting as they touched his skin like the gentlest of rains. He sat straight atop his horse, watching as the iron portcullis was winched upward. Try as he might to keep calm, his heart was fluttering in his chest. â€Å"Are you ready?† Robb asked. Bran nodded, trying not to let his fear show. He had not been outside Winterfell since his fall, but he was determined to ride out as proud as any knight. â€Å"Let's ride, then.† Robb put his heels into his big grey-and-white gelding, and the horse walked under the portcullis. â€Å"Go,† Bran whispered to his own horse. He touched her neck lightly, and the small chestnut filly started forward. Bran had named her Dancer. She was two years old, and Joseth said she was smarter than any horse had a right to be. They had trained her special, to respond to rein and voice and touch. Up to now, Bran had only ridden her around the yard. At first Joseth or Hodor would lead her, while Bran sat strapped to her back in the oversize saddle the Imp had drawn up for him, but for the past fortnight he had been riding her on his own, trotting her round and round, and growing bolder with every circuit. They passed beneath the gatehouse, over the drawbridge, through the outer walls. Summer and Grey Wind came loping beside them, sniffing at the wind. Close behind came Theon Greyjoy, with his longbow and a quiver of broadheads; he had a mind to take a deer, he had told them. He was followed by four guardsmen in mailed shirts and coifs, and Joseth, a stick-thin stableman whom Robb had named master of horse while Hullen was away. Maester Luwin brought up the rear, riding on a donkey. Bran would have liked it better if he and Robb had gone off alone, just the two of them, but Hal Mollen would not hear of it, and Maester Luwin backed him. If Bran fell off his horse or injured himself, the maester was determined to be with him. Beyond the castle lay the market square, its wooden stalls deserted now. They rode down the muddy streets of the village, past rows of small neat houses of log and undressed stone. Less than one in five were occupied, thin tendrils of woodsmoke curling up from their chimneys. The rest would fill up one by one as it grew colder. When the snow fell and the ice winds howled down out of the north, Old Nan said, farmers left their frozen fields and distant holdfasts, loaded up their wagons, and then the winter town came alive. Bran had never seen it happen, but Maester Luwin said the day was looming closer. The end of the long summer was near at hand. Winter is coming. A few villagers eyed the direwolves anxiously as the riders went past, and one man dropped the wood he was carrying as he shrank away in fear, but most of the townfolk had grown used to the sight. They bent the knee when they saw the boys, and Robb greeted each of them with a lordly nod. With his legs unable to grip, the swaying motion of the horse made Bran feel unsteady at first, but the huge saddle with its thick horn and high back cradled him comfortingly, and the straps around his chest and thighs would not allow him to fall. After a time the rhythm began to feel almost natural. His anxiety faded, and a tremulous smile crept across his face. Two serving wenches stood beneath the sign of the Smoking Log, the local alehouse. When Theon Greyjoy called out to them, the younger girl turned red and covered her face. Theon spurred his mount to move up beside Robb. â€Å"Sweet Kyra,† he said with a laugh. â€Å"She squirms like a weasel in bed, but say a word to her on the street, and she blushes pink as a maid. Did I ever tell you about the night that she and Bessa—† â€Å"Not where my brother can hear, Theon,† Robb warned him with a glance at Bran. Bran looked away and pretended not to have heard, but he could feel Greyjoy's eyes on him. No doubt he was smiling. He smiled a lot, as if the world were a secret joke that only he was clever enough to understand. Robb seemed to admire Theon and enjoy his company, but Bran had never warmed to his father's ward. Robb rode closer. â€Å"You are doing well, Bran.† â€Å"I want to go faster,† Bran replied. Robb smiled. â€Å"As you will.† He sent his gelding into a trot. The wolves raced after him. Bran snapped the reins sharply, and Dancer picked up her pace. He heard a shout from Theon Greyjoy, and the hoofbeats of the other horses behind him. Bran's cloak billowed out, rippling in the wind, and the snow seemed to rush at his face. Robb was well ahead, glancing back over his shoulder from time to time to make sure Bran and the others were following. He snapped the reins again. Smooth as silk, Dancer slid into a gallop. The distance closed. By the time he caught Robb on the edge of the wolfswood, two miles beyond the winter town, they had left the others well behind. â€Å"I can ride!† Bran shouted, grinning. It felt almost as good as flying. â€Å"I'd race you, but I fear you'd win.† Robb's tone was light and joking, yet Bran could tell that something was troubling his brother underneath the smile. â€Å"I don't want to race.† Bran looked around for the direwolves. Both had vanished into the wood. â€Å"Did you hear Summer howling last night?† â€Å"Grey Wind was restless too,† Robb said. His auburn hair had grown shaggy and unkempt, and a reddish stubble covered his jaw, making him look older than his fifteen years. â€Å"Sometimes I think they know things . . . sense things . . . † Robb sighed. â€Å"I never know how much to tell you, Bran. I wish you were older.† â€Å"I'm eight now!† Bran said. â€Å"Eight isn't so much younger than fifteen, and I'm the heir to Winterfell, after you.† â€Å"So you are.† Robb sounded sad, and even a little scared. â€Å"Bran, I need to tell you something. There was a bird last night. From King's Landing. Maester Luwin woke me.† Bran felt a sudden dread. Dark wings, dark words, Old Nan always said, and of late the messenger ravens had been proving the truth of the proverb. When Robb wrote to the Lord Commander of the Night's Watch, the bird that came back brought word that Uncle Benjen was still missing. Then a message had arrived from the Eyrie, from Mother, but that had not been good news either. She did not say when she meant to return, only that she had taken the Imp as prisoner. Bran had sort of liked the little man, yet the name Lannister sent cold fingers creeping up his spine. There was something about the Lannisters, something he ought to remember, but when he tried to think what, he felt dizzy and his stomach clenched hard as a stone. Robb spent most of that day locked behind closed doors with Maester Luwin, Theon Greyjoy, and Hallis Mollen. Afterward, riders were sent out on fast horses, carrying Robb's commands throughout the north. Bran heard talk of Moat Cailin, the ancient stronghold the First Men had built at the top of the Neck. No one ever told him what was happening, yet he knew it was not good. And now another raven, another message. Bran clung to hope. â€Å"Was the bird from Mother? Is she coming home?† â€Å"The message was from Alyn in King's Landing. Jory Cassel is dead. And Wyl and Heward as well. Murdered by the Kingslayer.† Robb lifted his face to the snow, and the flakes melted on his cheeks. â€Å"May the gods give them rest.† Bran did not know what to say. He felt as if he'd been punched. Jory had been captain of the household guard at Winterfell since before Bran was born. â€Å"They killed Jory?† He remembered all the times Jory had chased him over the roofs. He could picture him striding across the yard in mail and plate, or sitting at his accustomed place on the bench in the Great Hall, joking as he ate. â€Å"Why would anyone kill Jory?† Robb shook his head numbly, the pain plain in his eyes. â€Å"I don't know, and . . . Bran, that's not the worst of it. Father was caught beneath a falling horse in the fight. Alyn says his leg was shattered, and . . . Maester Pycelle has given him the milk of the poppy, but they aren't sure when . . . when he . . .† The sound of hoofbeats made him glance down the road, to where Theon and the others were coming up. â€Å"When he will wake,† Robb finished. He laid his hand on the pommel of his sword then, and went on in the solemn voice of Robb the Lord. â€Å"Bran, I promise you, whatever might happen, I will not let this be forgotten.† Something in his tone made Bran even more fearful. â€Å"What will you do?† he asked as Theon Greyjoy reined in beside them. â€Å"Theon thinks I should call the banners,† Robb said. â€Å"Blood for blood.† For once Greyjoy did not smile. His lean, dark face had a hungry look to it, and black hair fell down across his eyes. â€Å"Only the lord can call the banners,† Bran said as the snow drifted down around them. â€Å"If your father dies,† Theon said, â€Å"Robb will be Lord of Winterfell.† â€Å"He won't die!† Bran screamed at him. Robb took his hand. â€Å"He won't die, not Father,† he said calmly. â€Å"Still . . . the honor of the north is in my hands now. When our lord father took his leave of us, he told me to be strong for you and for Rickon. I'm almost a man grown, Bran.† Bran shivered. â€Å"I wish Mother was back,† he said miserably. He looked around for Maester Luwin; his donkey was visible in the far distance, trotting over a rise. â€Å"Does Maester Luwin say to call the banners too?† â€Å"The maester is timid as an old woman,† said Theon. â€Å"Father always listened to his counsel,† Bran reminded his brother. â€Å"Mother too.† â€Å"I listen to him,† Robb insisted. â€Å"I listen to everyone.† The joy Bran had felt at the ride was gone, melted away like the snowflakes on his face. Not so long ago, the thought of Robb calling the banners and riding off to war would have filled him with excitement, but now he felt only dread. â€Å"Can we go back now?† he asked. â€Å"I'm cold.† Robb glanced around. â€Å"We need to find the wolves. Can you stand to go a bit longer?† â€Å"I can go as long as you can.† Maester Luwin had warned him to keep the ride short, for fear of saddle sores, but Bran would not admit to weakness in front of his brother. He was sick of the way everyone was always fussing over him and asking how he was. â€Å"Let's hunt down the hunters, then,† Robb said. Side by side, they urged their mounts off the kingsroad and struck out into the wolfswood. Theon dropped back and followed well behind them, talking and joking with the guardsmen. It was nice under the trees. Bran kept Dancer to a walk, holding the reins lightly and looking all around him as they went. He knew this wood, but he had been so long confined to Winterfell that he felt as though he were seeing it for the first time. The smells filled his nostrils; the sharp fresh tang of pine needles, the earthy odor of wet rotting leaves, the hints of animal musk and distant cooking fires. He caught a glimpse of a black squirrel moving through the snow-covered branches of an oak, and paused to study the silvery web of an empress spider. Theon and the others fell farther and farther behind, until Bran could no longer hear their voices. From ahead came the faint sound of rushing waters. It grew louder until they reached the stream. Tears stung his eyes. â€Å"Bran?† Robb asked. â€Å"What's wrong?† Bran shook his head. â€Å"I was just remembering,† he said. â€Å"Jory brought us here once, to fish for trout. You and me and Jon. Do you remember?† â€Å"I remember,† Robb said, his voice quiet and sad. â€Å"I didn't catch anything,† Bran said, â€Å"but Jon gave me his fish on the way back to Winterfell. Will we ever see Jon again?† â€Å"We saw Uncle Benjen when the king came to visit,† Robb pointed out. â€Å"Jon will visit too, you'll see.† The stream was running high and fast. Robb dismounted and led his gelding across the ford. In the deepest part of the crossing, the water came up to midthigh. He tied his horse to a tree on the far side, and waded back across for Bran and Dancer. The current foamed around rock and root, and Bran could feel the spray on his face as Robb led him over. It made him smile. For a moment he felt strong again, and whole. He looked up at the trees and dreamed of climbing them, right up to the very top, with the whole forest spread out beneath him. They were on the far side when they heard the howl, a long rising wail that moved through the trees like a cold wind. Bran raised his head to listen. â€Å"Summer,† he said. No sooner had he spoken than a second voice joined the first. â€Å"They've made a kill,† Robb said as he remounted. â€Å"I'd best go and bring them back. Wait here, Theon and the others should be along shortly.† â€Å"I want to go with you,† Bran said. â€Å"I'll find them faster by myself.† Robb spurred his gelding and vanished into the trees. Once he was gone, the woods seemed to close in around Bran. The snow was falling more heavily now. Where it touched the ground it melted, but all about him rock and root and branch wore a thin blanket of white. As he waited, he was conscious of how uncomfortable he felt. He could not feel his legs, hanging useless in the stirrups, but the strap around his chest was tight and chafing, and the melting snow had soaked through his gloves to chill his hands. He wondered what was keeping Theon and Maester Luwin and Joseth and the rest. When he heard the rustle of leaves, Bran used the reins to make Dancer turn, expecting to see his friends, but the ragged men who stepped out onto the bank of the stream were strangers. â€Å"Good day to you,† he said nervously. One look, and Bran knew they were neither foresters nor farmers. He was suddenly conscious of how richly he was dressed. His surcoat was new, dark grey wool with silver buttons, and a heavy silver pin fastened his fur-trimmed cloak at the shoulders. His boots and gloves were lined with fur as well. â€Å"All alone, are you?† said the biggest of them, a bald man with a raw windburnt face. â€Å"Lost in the wolfswood, poor lad.† â€Å"I'm not lost.† Bran did not like the way the strangers were looking at him. He counted four, but when he turned his head, he saw two others behind him. â€Å"My brother rode off just a moment ago, and my guard will be here shortly.† â€Å"Your guard, is it?† a second man said. Grey stubble covered his gaunt face. â€Å"And what would they be guarding, my little lord? Is that a silver pin I see there on your cloak?† â€Å"Pretty,† said a woman's voice. She scarcely looked like a woman; tall and lean, with the same hard face as the others, her hair hidden beneath a bowl-shaped halfhelm. The spear she held was eight feet of black oak, tipped in rusted steel. â€Å"Let's have a look,† said the big bald man. Bran watched him anxiously. The man's clothes were filthy, fallen almost to pieces, patched here with brown and here with blue and there with a dark green, and faded everywhere to grey, but once that cloak might have been black. The grey stubbly man wore black rags too, he saw with a sudden start. Suddenly Bran remembered the oathbreaker his father had beheaded, the day they had found the wolf pups; that man had worn black as well, and Father said he had been a deserter from the Night's Watch. No man is more dangerous, he remembered Lord Eddard saying. The deserter knows his life is forfeit if he is taken, so he will not flinch from any crime, no matter how vile or cruel. â€Å"The pin, lad,† the big man said. He held out his hand. â€Å"We'll take the horse too,† said another of them, a woman shorter than Robb, with a broad fiat face and lank yellow hair. â€Å"Get down, and be quick about it.† A knife slid from her sleeve into her hand, its edge jagged as a saw. â€Å"No,† Bran blurted. â€Å"I can't . . . â€Å" The big man grabbed his reins before Bran could think to wheel Dancer around and gallop off. â€Å"You can, lordling . . . and will, if you know what's good for you.† â€Å"Stiv, look how he's strapped on.† The tall woman pointed with her spear. â€Å"Might be it's the truth he's telling.† â€Å"Straps, is it?† Stiv said. He drew a dagger from a sheath at his belt. â€Å"There's ways to deal with straps.† â€Å"You some kind of cripple?† asked the short woman. Bran flared. â€Å"I'm Brandon Stark of Winterfell, and you better let go of my horse, or I'll see you all dead.† The gaunt man with the grey stubbled face laughed. â€Å"The boy's a Stark, true enough. Only a Stark would be fool enough to threaten where smarter men would beg.† â€Å"Cut his little cock off and stuff it in his mouth,† suggested the short woman. â€Å"That should shut him up.† â€Å"You're as stupid as you are ugly, Hali,† said the tall woman. â€Å"The boy's worth nothing dead, but alive . . . gods be damned, think what Mance would give to have Benjen Stark's own blood to hostage!† â€Å"Mance be damned,† the big man cursed. â€Å"You want to go back there, Osha? More fool you. Think the white walkers will care if you have a hostage?† He turned back to Bran and slashed at the strap around his thigh. The leather parted with a sigh. The stroke had been quick and careless, biting deep. Looking down, Bran glimpsed pale flesh where the wool of his leggings had parted. Then the blood began to flow. He watched the red stain spread, feeling light-headed, curiously apart; there had been no pain, not even a hint of feeling. The big man grunted in surprise. â€Å"Put down your steel now, and I promise you shall have a quick and painless death,† Robb called out. Bran looked up in desperate hope, and there he was. The strength of the words were undercut by the way his voice cracked with strain. He was mounted, the bloody carcass of an elk slung across the back of his horse, his sword in a gloved hand. â€Å"The brother,† said the man with the grey stubbly face. â€Å"He's a fierce one, he is,† mocked the short woman. Hali, they called her. â€Å"You mean to fight us, boy?† â€Å"Don't be a fool, lad. You're one against six.† The tall woman, Osha, leveled her spear. â€Å"Off the horse, and throw down the sword. We'll thank you kindly for the mount and for the venison, and you and your brother can be on your way.† Robb whistled. They heard the faint sound of soft feet on wet leaves. The undergrowth parted, low-hanging branches giving up their accumulation of snow, and Grey Wind and Summer emerged from the green. Summer sniffed the air and growled. â€Å"Wolves,† gasped Hali. â€Å"Direwolves,† Bran said. Still half-grown, they were as large as any wolf he had ever seen, but the differences were easy to spot, if you knew what to look for. Maester Luwin and Farlen the kennelmaster had taught him. A direwolf had a bigger head and longer legs in proportion to its body, and its snout and jaw were markedly leaner and more pronounced. There was something gaunt and terrible about them as they stood there amid the gently falling snow. Fresh blood spotted Grey Wind's muzzle. â€Å"Dogs,† the big bald man said contemptuously. â€Å"Yet I'm told there's nothing like a wolfskin cloak to warm a man by night.† He made a sharp gesture. â€Å"Take them.† Robb shouted, â€Å"Winterfell!† and kicked his horse. The gelding plunged down the bank as the ragged men closed. A man with an axe rushed in, shouting and heedless. Robb's sword caught him full in the face with a sickening crunch and a spray of bright blood. The man with the gaunt stubbly face made a grab for the reins, and for half a second he had them . . . and then Grey Wind was on him, bearing him down. He fell back into the stream with a splash and a shout, flailing wildly with his knife as his head went under. The direwolf plunged in after him, and the white water turned red where they had vanished. Robb and Osha matched blows in midstream. Her long spear was a steel-headed serpent, flashing out at his chest, once, twice, three times, but Robb parried every thrust with his longsword, turning the point aside. On the fourth or fifth thrust, the tall woman overextended herself and lost her balance, just for a second. Robb charged, riding her down. A few feet away, Summer darted in and snapped at Hali. The knife bit at his flank. Summer slid away, snarling, and came rushing in again. This time his jaws closed around her calf. Holding the knife with both hands, the small woman stabbed down, but the direwolf seemed to sense the blade coming. He pulled free for an instant, his mouth full of leather and cloth and bloody flesh. When Hali stumbled and fell, he came at her again, slamming her backward, teeth tearing at her belly. The sixth man ran from the carnage . . . but not far. As he went scrambling up the far side of the bank, Grey Wind emerged from the stream, dripping wet. He shook the water off and bounded after the running man, hamstringing him with a single snap of his teeth, and going for the throat as the screaming man slid back down toward the water. And then there was no one left but the big man, Stiv. He slashed at Bran's chest strap, grabbed his arm, and yanked. Suddenly Bran was falling. He sprawled on the ground, his legs tangled under him, one foot in the stream. He could not feel the cold of the water, but he felt the steel when Stiv pressed his dagger to his throat. â€Å"Back away,† the man warned, â€Å"or I'll open the boy's windpipe, I swear it.† Robb reined his horse in, breathing hard. The fury went out of his eyes, and his sword arm dropped. In that moment Bran saw everything. Summer was savaging Hali, pulling glistening blue snakes from her belly. Her eyes were wide and staring. Bran could not tell whether she was alive or dead. The grey stubbly man and the one with the axe lay unmoving, but Osha was on her knees, crawling toward her fallen spear. Grey Wind padded toward her, dripping wet. â€Å"Call him off!† the big man shouted. â€Å"Call them both off, or the cripple boy dies now!† â€Å"Grey Wind, Summer, to me,† Robb said. The direwolves stopped, turned their heads. Grey Wind loped back to Robb. Summer stayed where he was, his eyes on Bran and the man beside him. He growled. His muzzle was wet and red, but his eyes burned. Osha used the butt end of her spear to lever herself back to her feet. Blood leaked from a wound on the upper arm where Robb had cut her. Bran could see sweat trickling down the big man's face. Stiv was as scared as he was, he realized. â€Å"Starks,† the man muttered, â€Å"bloody Starks.† He raised his voice. â€Å"Osha, kill the wolves and get his sword.† â€Å"Kill them yourself,† she replied. â€Å"I'll not be getting near those monsters.† For a moment Stiv was at a loss. His hand trembled; Bran felt a trickle of blood where the knife pressed against his neck. The stench of the man filled his nose; he smelled of fear. â€Å"You,† he called out to Robb. â€Å"You have a name?† â€Å"I am Robb Stark, the heir to Winterfell.† â€Å"This is your brother?† â€Å"Yes.† â€Å"You want him alive, you do what I say. Off the horse.† Robb hesitated a moment. Then, slowly and deliberately, he dismounted and stood with his sword in hand. â€Å"Now kill the wolves.† Robb did not move. â€Å"You do it. The wolves or the boy.† â€Å"No!† Bran screamed. If Robb did as they asked, Stiv would kill them both anyway, once the direwolves were dead. The bald man took hold of his hair with his free hand and twisted it cruelly, till Bran sobbed in pain. â€Å"You shut your mouth, cripple, you hear me?† He twisted harder. â€Å"You hear me?† A low thrum came from the woods behind them. Stiv gave a choked gasp as a half foot of razor-tipped broadhead suddenly exploded out of his chest. The arrow was bright red, as if it had been painted in blood. The dagger fell away from Bran's throat. The big man swayed and collapsed, facedown in the stream. The arrow broke beneath him. Bran watched his life go swirling off in the water. Osha glanced around as Father's guardsmen appeared from beneath the trees, steel in hand. She threw down her spear. â€Å"Mercy, m'lord,† she called to Robb. The guardsmen had a strange, pale look to their faces as they took in the scene of slaughter. They eyed the wolves uncertainly, and when Summer returned to Hali's corpse to feed, Joseth dropped his knife and scrambled for the bush, heaving. Even Maester Luwin seemed shocked as he stepped from behind a tree, but only for an instant. Then he shook his head and waded across the stream to Bran's side. â€Å"Are you hurt?† â€Å"He cut my leg,† Bran said, â€Å"but I couldn't feel it.† As the maester knelt to examine the wound, Bran turned his head. Theon Greyjoy stood beside a sentinel tree, his bow in hand. He was smiling. Ever smiling. A half-dozen arrows were thrust into the soft ground at his feet, but it had taken only one. â€Å"A dead enemy is a thing of beauty,† he announced. â€Å"Jon always said you were an ass, Greyjoy,† Robb said loudly. â€Å"I ought to chain you up in the yard and let Bran take a few practice shots at you.† â€Å"You should be thanking me for saving your brother's life.† â€Å"What if you had missed the shot?† Robb said. â€Å"What if you'd only wounded him? What if you had made his hand jump, or hit Bran instead? For all you knew, the man might have been wearing a breastplate, all you could see was the back of his cloak. What would have happened to my brother then? Did you ever think of that, Greyjoy?† Theon's smile was gone. He gave a sullen shrug and began to pull his arrows from the ground, one by one. Robb glared at his guardsmen. â€Å"Where were you?† he demanded of them. â€Å"I was sure you were close behind us.† The men traded unhappy glances. â€Å"We were following, m'lord,† said Quent, the youngest of them, his beard a soft brown fuzz. â€Å"Only first we waited for Maester Luwin and his ass, begging your pardons, and then, well, as it were . . . † He glanced over at Theon and quickly looked away, abashed. â€Å"I spied a turkey,† Theon said, annoyed by the question. â€Å"How was I to know that you'd leave the boy alone?† Robb turned his head to look at Theon once more. Bran had never seen him so angry, yet he said nothing. Finally he knelt beside Maester Luwin. â€Å"How badly is my brother wounded?† â€Å"No more than a scratch,† the maester said. He wet a cloth in the stream to clean the cut. â€Å"Two of them wear the black,† he told Robb as he worked. Robb glanced over at where Stiv lay sprawled in the stream, his ragged black cloak moving fitfully as the rushing waters tugged at it. â€Å"Deserters from the Night's Watch,† he said grimly. â€Å"They must have been fools, to come so close to Winterfell.† â€Å"Folly and desperation are ofttimes hard to tell apart,† said Maester Luwin. â€Å"Shall we bury them, m'lord?† asked Quent. â€Å"They would not have buried us,† Robb said. â€Å"Hack off their heads, we'll send them back to the Wall. Leave the rest for the carrion crows.† â€Å"And this one?† Quent jerked a thumb toward Osha. Robb walked over to her. She was a head taller than he was, but she dropped to her knees at his approach. â€Å"Give me my life, m'lord of Stark, and I am yours.† â€Å"Mine? What would I do with an oathbreaker?† â€Å"I broke no oaths. Stiv and Wallen flew down off the Wall, not me. The black crows got no place for women.† Theon Greyjoy sauntered closer. â€Å"Give her to the wolves,† he urged Robb. The woman's eyes went to what was left of Hali, and just as quickly away. She shuddered. Even the guardsmen looked queasy. â€Å"She's a woman,† Robb said. â€Å"A wildling,† Bran told him. â€Å"She said they should keep me alive so they could take me to Mance Rayder.† â€Å"Do you have a name?† Robb asked her. â€Å"Osha, as it please the lord,† she muttered sourly. Maester Luwin stood. â€Å"We might do well to question her.† Bran could see the relief on his brother's face. â€Å"As you say, Maester. Wayn, bind her hands. She'll come back to Winterfell with us . . . and live or die by the truths she gives us.†

Adolescent Pregnancy Compilation Notes

Adolescent pregnancy – Overview Alternative Names Teenage pregnancy; Pregnancy – teenage Definition of Adolescent pregnancy: Adolescent pregnancy is pregnancy in girls age 19 or  younger. Causes, incidence, and risk factors: The rate of adolescent pregnancy and the birth rate for adolescents have generally declined since reaching an all-time high in 1990, mostly due to the increased use of condoms. Adolescent pregnancy is a complex issue with many reasons for concern. Younger adolescents (12 – 14 years old) are more likely to have unplanned sexual intercourse and more likely to be coerced into sex. Adolescents 18 – 19 years old are technically adults, and half of adolescent pregnancies occur in this age group. Risk factors for adolescent pregnancy include: * Younger age * Poor school performance * Economic disadvantage * Single or teen parents Adolescent pregnancy Teenage pregnancy; Pregnancy – teenage Last reviewed: September 12, 2011. Adolescent pregnancy is pregnancy in girls age 19 or  younger. 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. 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. Risk factors for adolescent pregnancy include: * Younger age * Poor school performance * Economic disadvantage * Older male partner * Single or teen parents Symptoms Pregnancy symptoms include: * Abdominal distention * Breast enlargement and breast tenderness * Fatigue * Light-headedness or actual fainting Missed period * Nausea/vomiting * Frequent urination 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 t o feel the fundus (the top of the enlarged uterus). 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. Treatment 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. 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. 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. 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. Expectations (prognosis) 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. 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. 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. Complications Adolescent pregnancy is associated with higher rates of illness and death for both the mother and infant. Death from violence is the second leading cause of death durig pregnancy for teens, and is higher in teens than in any other group. Pregnant teens are at much higher risk of having serious medical complications such as: * Placenta previa * Pregnancy-induced hypertension * Premature delivery * Significant anemia * Toxemia 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. 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. It is very important for pregnant teens to have early and adequate prenatal care. Calling your health care provider Make an appointment with your health care provider if you have symptoms of pregnancy. Your health care provider can also provide counseling regarding birth control methods, sexually transmitted disease (STD) prevention, or pregnancy risk. Prevention There are many different kinds of teen pregnancy prevention programs. * Abstinence education programs encourage young people to wait to have sex until marriage, or until they are mature enough to handle sexual activity and a potential pregnancy in a responsible manner. * Knowledge-based programs focus on teaching kids about their bodies. It also provides detailed information about birth control and how to prevent sexually transmitted infections (STIs). Research shows knowledge-based programs help decrease teen pregnancy rates. Abstinence-only education without information about birth control does not. * Clinic-focused programs give kids easier access to information, counseling by health care providers, and birth control services. Many of these programs are offered through school-based clinics. * Peer counseling programs typically involve older teens, who encourage other kids to resist peer and social pressures to have sex. For teens who are already sexually active, peer counseling programs teach them relationship skills and give them information on how to get and successfully use birth control. Teenage pregnancy Teenage pregnancy refers to pregnancy in a female under the age of 20 (when the pregnancy ends). It generally refers to a female who is unmarried and usually refers to an unplanned pregnancy. A pregnancy can take place at any time after puberty, with menarche (first menstrual period) normally taking place around the ages 12 or 13, and being the stage at which a female becomes potentially fertile. Teenage pregnancy depends on a number of societal and personal factors. Teenage pregnancy rates vary between countries because of differences in levels of sexual activity, general sex education provided and access to affordable contraceptive options. Worldwide, teenage pregnancy rates range from 143 per 1000 in some sub-Saharan African countries to 2. 9 per 1000 in South Korea. Pregnant teenagers face many of the same obstetrics issues as women in their 20s and 30s. There are however, additional medical concerns for mothers age 14 or younger. For mothers between 15 and 19, risks are associated more with socioeconomic factors than with the biological effects of age. However research has shown that the risk of low birth weight is connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilisation of antenatal care etc. ). In developed countries, teenage pregnancies are associated with many social issues, including lower educational levels, higher rates of poverty, and other poorer â€Å"life outcomes† in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. Many studies and campaigns have attempted to uncover the causes and limit the numbers of teenage pregnancies. In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within marriage and does not involve a social stigma. Among OECD developed countries, the United States and United Kingdom have the highest level of teenage pregnancy, while Japan and South Korea have the lowest. Teenage pregnancy rates In reporting teenage pregnancy rates, the number of pregnancies per 1000 females aged 15 to 19 when the pregnancy ends is generally used. The rates look at the age at which a pregnancy ends, and not the age when the woman conceives, so that if a woman aborts her pregnancy or misscarries while she is 19, she would be counted, while if she went full term and gave birth at age 20 she would not be counted. According to a 2001 UNICEF survey, in 10 out of 12 developed nations with available data, more than two thirds of young people have had sexual intercourse while still in their teens. In Denmark, Finland, Germany, Iceland, Norway, the United Kingdom and the United States, the proportion is over 80%. In Australia, the United Kingdom and the United States, approximately 25% of 15 year olds and 50% of 17 year olds have had sex. In a 2005 Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported â€Å"being in a relationship where they felt things were moving too fast sexually†, and 24% had â€Å"done something sexual they didn’t really want to do†. Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex. The increased sexual activity among adolescents is manifested in increased teenage pregnancies and an increase in sexually transmitted diseases. The rates of teenage pregnancy vary and range from 143 per 1000 girls in some sub-Saharan African countries to 2. 9 per 1000 in South Korea. The rate for the United States is 52. 1 per 1000, the highest in the developed world – and about four times the European Union average. Care must also be taken of the common actual marriage age in different countries, as in countries where teenage marriages are common can expect to also experience higher levels of teenage pregnancies. In an attempt to reverse the increasing numbers of teenage pregnancies, governments in many Western countries have instituted sex education programs, the main objective of which is to reduce such pregnancies and STD's. Save the Children found that, annually, 13 million children are born to women under age 20 worldwide, more than 90% in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among women between the ages of 15 and 19 in such areas. The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age. In Niger, for example, 87% of women surveyed were married and 53% had given birth to a child before the age of 18. In the Indian subcontinent, early marriage sometimes means adolescent pregnancy, particularly in rural regions where the rate is much higher than it is in urbanized areas. The rate of early marriage and pregnancy has decreased sharply in Indonesia and Malaysia, although it remains relatively high in the former. In the industrialized Asian nations such as South Korea and Singapore, teenage birth rates are among the lowest in the world. The overall trend in Europe since 1970 has been a decreasing total fertility rate, an increase in the age at which women experience their first birth, and a decrease in the number of births among teenagers. Most continental Western European countries have very low teenage birth rates. This is varyingly attributed to good sex education and high levels of contraceptive use (in the case of the Netherlands and Scandinavia), traditional values and social stigmatization (in the case of Spain and Italy) or both (in the case of Switzerland). The teenage birth rate in the United States is the highest in the developed world, and the teenage bortion rate is also high. The U. S. teenage pregnancy rate was at a high in the 1950s and has decreased since then, although there has been an increase in births out of wedlock. The teenage pregnancy rate decreased significantly in the 1990s; this decline manifested across all racial groups, although teenagers of African-American and Hispanic descent retai n a higher rate, in comparison to that of European-Americans and Asian-Americans. The Guttmacher Institute attributed about 25% of the decline to abstinence and 75% to the effective use of contraceptives. However, in 2006 the teenage birth rate rose for the first time in fourteen years. This could imply that teen pregnancy rates are also on the rise, however the rise could also be due to other sources: a possible decrease in the number of abortions or a decrease in the number of miscarriages, to name a few. The Canadian teenage birth has also trended towards a steady decline for both younger (15–17) and older (18–19) teens in the period between 1992 and 2002. The age of the mother is determined by the easily verified date when the pregnancy ends, not by the estimated date of conception. Consequently, the statistics do not include women who became pregnant at least shortly before their 20th birthdays, but who gave birth, experienced a miscarriage, or had a voluntary abortion on or after their 20th birthdays. Similarly, statistics on the mother's marital status are determined by whether she is married at the end of the pregnancy, not at the time of conception. Impact Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers. In a rural hospital in West Bengal, teenage mothers between 15–19 years old were more likely to have anemia, preterm delivery, and low birth weight than mothers between 20–24 years old. Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all. The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to suffer from health issues in childhood or be hospitalized than those born to older women. Young mothers who are given high-quality maternity care have significantly healthier babies than those that do not. Many of the health-issues associated with teenage mothers, many of whom do not have health insurance, appear to result from lack of access to high-quality medical care. Many pregnant teens are subject to nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of fast food. Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries. Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV. The World Health Organization estimates that the risk of death following pregnancy is twice as great for women between 15 and 19 years than for those between the ages of 20 and 24. The maternal mortality rate can be up to five times higher for girls aged between 10 and 14 than for women of about twenty years of age. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa. Risks for medical complications are greater for girls 14 years of age and younger, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by Caesarean section in industrialized nations; however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obstetric fistula, infant mortality, or maternal death. For mothers in their late teens, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology. Psychosocial Several studies have examined the socioeconomic, medical, and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education. In the mother Being a young mother in an industrialized country can affect one's education. Teen mothers are more likely to drop out of high school. Recent studies, though, have found that many of these mothers had already dropped out of school prior to becoming pregnant, but those in school at the time of their pregnancy were as likely to graduate as their peers. One study in 2001 found that women who gave birth during their teens completed secondary-level schooling 10–12% as often and pursued post-secondary education 14–29% as often as women who waited until age 30. Young motherhood in an industrialized country can affect employment and social class. Less than one third of teenage mothers receive any form of child support, vastly increasing the likelihood of turning to the government for assistance. The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women. One study found that, in 1988, 60% of teenage mothers were impoverished at the time of giving birth. Additional research found that nearly 50% of all adolescent mothers sought social assistance within the first five years of their child's life. A study of 100 teenaged mothers in the United Kingdom found that only 11% received a salary, while the remaining 89% were unemployed. Most British teenage mothers live in poverty, with nearly half in the bottom fifth of the income distribution. Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers. Professor John Ermisch at the institute of social and economic research at Essex University and Dr Roger Ingham, director of the centre of sexual health at Southampton University – found that comparing teenage mothers with other girls with similarly deprived social-economic profiles, bad school experiences and low educational aspirations, the difference in their respective life chances was negligible. Teenage Motherhood may actually make economic sense for young women with less money, some research suggests. For instance, long-term studies by Duke economist V. Joseph Hotz and colleagues, published in 2005, found that by age 35, former teen moms had earned more in income, paid more in taxes, were substantially less likely to live in poverty and collected less in public assistance than similarly poor women who waited until their 20s to have babies. Women who became mothers in their teens — freed from child-raising duties by their late 20s and early 30s to pursue employment while poorer women who waited to become moms were still stuck at home watching their young children — wound up paying more in taxes than they had collected in welfare. Eight years earlier, the federally commissioned report â€Å"Kids Having Kids† also contained a similar finding, though it was buried: â€Å"Adolescent childbearers fare slightly better than later-childbearing counterparts in terms of their overall economic welfare. One-fourth of adolescent mothers will have a second child within 24 months of the first. Factors that determine which mothers are more likely to have a closely spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married. In the child Early motherhood can affect the psychosocial development of the infant. Developmental disabilities and behavioral issues are increased in children born to teen mothers. One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs. Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment. Poor academic performance in the children of teenage mothers has also been noted, with many of them being more likely than average to fail to graduate from secondary school, be held back a grade level, or score lower on standardized tests. Daughters born to adolescent parents are more likely to become teen mothers themselves. A son born to a young woman in her teens is three times more likely to serve time in prison. In other family members Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behavior, parenting, and marriage at younger ages; younger brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors. If the younger sisters of teenage parents babysit the children, they have an increased risk of getting pregnant themselves. Causes In some societies, early marriage and traditional gender roles are important factors in the rate of teenage pregnancy. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities compared to the rate in cities. The lack of education on safe sex, whether it’s from parents, schools, or otherwise, is a cause of teenage pregnancy. Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality. Some teens have said to be pressured into having sex with their boyfriends at a young age, and yet no one had taught these teens how to deal with this pressure or to say â€Å"no†. In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy. Most teenage pregnancies in the developed world appear to be unplanned. Sexuality In most countries, most men experience sexual intercourse for the first time before their 20th birthdays. Men in Western developed countries have sex for the first time sooner than in undeveloped and culturally conservative countries such as Sub-Saharan Africa and much of Asia. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality. However, in a Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported â€Å"being in a relationship where they felt things were moving too fast sexually†, and 24% had â€Å"done something sexual they didn’t really want to do†. Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex. Role of drug and alcohol use Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking to teenage pregnancy are alcohol, â€Å"ecstasy†, cannabis, and amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido – it appears that teenage opioid users have significantly reduced rates of conception compared to their non-using, and alcohol, â€Å"ecstasy†, cannabis, and amphetamine using peers. Amphetamines are often prescribed to treat ADHD – internationally, the countries with the highest rates of recorded amphetamine prescription to teenagers also have the highest rates of teenage pregnancy. 2][12][51][52], Leonard Sax, M. D. , Ph. D. , 2005, Doubleday books, p. 128. Lack of contraception Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information. Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government of the United Kingdom set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41. 7 per 1000 women. Young women often think of contraception either as ‘the pill' or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure. In the United States, according to the 2002 National Surveys of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than those of other ages to use contraceptives (18% of 15- to 19-year-olds used no contraceptives, versus 10. 7% average for women ages 15 to 44). More than 80% of teen pregnancies are unintended. Over half of unintended pregnancies were to women not using contraceptives, most of the rest are due to inconsistent or incorrect use. 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor. In a study for The Guttmacher Institute, researchers found that from a comparative perspective, however, teenage pregnancy rates in the United States are less nuanced than one might initially assume. Since timing and levels of sexual activity are quite similar across [Sweden, France, Canada, Great Britain, and the U. S. ], the high U. S. rates arise primarily because of less, and possibly less-effective, contraceptive use by sexually active teenagers. † Thus, the cause for the discrepancy between rich nations can be traced largely to contraceptive-based issues. Among teens in the UK seeking an abortion, a study found that the rate of contraceptive use was roughly the same for teens as for older women. In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly, forget to take oral contraceptives, or fail to use the contraceptives they had previously chosen. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users. Long-acting contraceptives such as intrauterine devices, subcutaneous contraceptive implants, and contraceptive injections (such as Depo-Provera and Combined injectable contraceptive), which prevent pregnancy for months or years at a time, are more effective in women who have trouble remembering to take pills or using barrier methods consistently. Age discrepancy in relationships According to the conservative lobbying organization Family Research Council, studies in the US indicate that age discrepancy between the teenage girls and the men who impregnate them is an important contributing factor. Teenage girls in relationships with older boys, and in particular with adult men, are more likely to become pregnant than teenage girls in relationships with boys their own age. They are also more likely to carry the baby to term rather than have an abortion. A review of California's 1990 vital statistics found that men older than high school age fathered 77% of all births to high school-aged girls (ages 16–18), and 51% of births to junior high school-aged girls (15 and younger). Men over age 25 fathered twice as many children of teenage mothers than boys under age 18, and men over age 20 fathered five times as many children of junior high school-aged girls as did junior high school-aged boys. A 1992 Washington state study of 535 adolescent mothers found that 62% of the mothers had a history of being raped or sexual molested by men whose ages averaged 27 years. This study found that, compared with nonabused mothers, abused adolescent mothers initiated sex earlier, had sex with much older partners, and engaged in riskier, more frequent, and promiscuous sex. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of children born to teenage girls in the United States are fathered by adult men age 20 or older. Sexual abuse Studies from South Africa have found that 11–20% of pregnancies in teenagers are a direct result of rape, while about 60% of teenage mothers had unwanted sexual experiences preceding their pregnancy. Before age 15, a majority of first-intercourse experiences among females are reported to be non-voluntary; the Guttmacher Institute found that 60% of girls who had sex before age 15 were coerced by males who on average were six years their senior. One in five teenage fathers admitted to forcing girls to have sex with them. Multiple studies have indicated a strong link between early childhood sexual abuse and subsequent teenage pregnancy in industrialized countries. Up to 70% of women who gave birth in their teens were molested as young girls; by contrast, 25% for women who did not give birth as teens were molested. In some countries, sexual intercourse between a minor and an adult is not considered consensual under the law because a minor is believed to lack the maturity and competence to make an informed decision to engage in fully consensual sex with an adult. In those countries, sex with a minor is therefore considered statutory rape. In most European countries, by contrast, once an adolescent has reached the age of consent, he or she can legally have sexual relations with adults because it is held that in general (although certain limitations may still apply), reaching the age of consent enables a juvenile to consent to sex with any partner who has also reached that age. Therefore, the definition of statutory rape is limited to sex with a person under the minimum age of consent. What constitutes statutory rape ultimately differs by jurisdiction. Dating violence Studies have indicated that adolescent girls are often in abusive relationships at the time of their conceiving. They have also reported that knowledge of their pregnancy has often intensified violent and controlling behaviors on part of their boyfriends. Women under age 18 are twice as likely to be beaten by their child's father than women over age 18. A UK study found that 70% of women who gave birth in their teens had experienced adolescent domestic violence. Similar results have been found in studies in the United States. A Washington State study found 70% of teenage mothers had been beaten by their boyfriends, 51% had experienced attempts of birth control sabotage within the last year, and 21% experienced school or work sabotage. In a study of 379 pregnant or parenting teens and 95 teenage girls without children, 62% of the girls aged 11–15 years and 56% of girls aged 16–19 years reported experiencing domestic violence at the hands of their partners. Moreover, 51% of the girls reported experiencing at least one instance where their boyfriend attempted to sabotage their efforts to use birth control. Socioeconomic factors Teenage pregnancy has been defined predominantly within the research field and among social agencies as a social problem. Poverty is associated with increased rates of teenage pregnancy. Economically poor countries such as Niger and Bangladesh have far more teenage mothers compared with economically rich countries such as Switzerland and Japan. In the UK, around half of all pregnancies to under 18s are concentrated among the 30% most deprived population, with only 14% occurring among the 30% least deprived. For example, in Italy, the teenage birth rate in the well-off central regions is only 3. 3 per 1,000, while in the poorer Mezzogiorno it is 10. 0 per 1,000. Similarly, in the United States, sociologist Mike A. Males noted that teenage birth rates closely mapped poverty rates in California: County| Poverty rate| Birth rate*| Marin County| 5%| 5| Tulare County (Caucasians)| 18%| 50| Tulare County (Hispanics)| 40%| 100| * per 1000 women aged 15–19 Teen pregnancy cost the United States over $9. 1 billion in 2004. There is little evidence to support the common belief that teenage mothers become pregnant to get benefits, welfare, and council housing. Most knew little about housing or financial aid before they got pregnant and what they thought they knew often turned out to be wrong. Childhood environment Women exposed to abuse, domestic violence, and family strife in childhood are more likely to become pregnant as teenagers, and the risk of becoming pregnant as a teenager increases with the number of adverse childhood experiences. According to a 2004 study, one-third of teenage pregnancies could be prevented by eliminating exposure to abuse, violence, and family strife. The researchers note that â€Å"family dysfunction has enduring and unfavorable health consequences for women during the adolescent years, the childbearing years, and beyond. When the family environment does not include adverse childhood experiences, becoming pregnant as an adolescent does not appear to raise the likelihood of long-term, negative psychosocial consequences. Studies have also found that boys raised in homes with a battered mother, or who experienced physical violence directly, were significantly more likely to impregnate a girl. Studies have also found that girls whose fathers lef t the family early in their lives had the highest rates of early sexual activity and adolescent pregnancy. Girls whose fathers left them at a later age had a lower rate of early sexual activity, and the lowest rates are found in girls whose fathers were present throughout their childhood. Even when the researchers took into account other factors that could have contributed to early sexual activity and pregnancy, such as behavioral problems and life adversity, early father-absent girls were still about five times more likely in the United States and three times more likely in New Zealand to become pregnant as adolescents than were father-present girls. Low educational expectations have been pinpointed as a risk factor. A girl is also more likely to become a teenage parent if her mother or older sister gave birth in her teens. A majority of respondents in a 1988 Joint Center for Political and Economic Studies survey attributed the occurrence of adolescent pregnancy to a breakdown of communication between parents and child and also to inadequate parental supervision. Foster care youth are more likely than their peers to become pregnant as teenagers. The National Casey Alumni Study, which surveyed foster care alumni from 23 ommunities across the United States, found the birth rate for girls in foster care was more than double the rate of their peers outside the foster care system. A University of Chicago study of youth transitioning out of foster care in Illinois, Iowa, and Wisconsin found that nearly half of the females had been pregnant by age 19. The Utah Department of Human Services found that girls who had left the foster care sy stem between 1999 and 2004 had a birth rate nearly 3 times the rate for girls in the general population. Media influence A study conducted in 2006 found that adolescents who were more exposed to sexuality in the media were also more likely to engage in sexual activity themselves. According to Time, â€Å"teens exposed to the most sexual content on TV are twice as likely as teens watching less of this material to become pregnant before they reach age 20†. Prevention Many health educators have argued that comprehensive sex education would effectively reduce the number of teenage pregnancies, although opponents argue that such education encourages more and earlier sexual activity. United Kingdom In the UK, the teenage pregnancy strategy, which was run first by the Department of Health and is now based out of the Children, Young People and Families directorate in the Department for Children, Schools and Families, works on several levels to reduce teenage pregnancy and increase the social inclusion of teenage mothers and their families by: * joined up action, making sure branches of government and health and education services work together effectively; * prevention of teenage pregnancy through better sex education and improving contraceptive and advice services for young people, involving young people in service design, supporting the parents of teenagers to talk to them about sex and relationships, and targeting high-risk groups; * better support for teenage mothers, including help returning to education, advice and support, work with young fathers, better childcare and increasing the availability of supported housing. The teenage pregnancy strategy has had mixed success. Although teenage pregnancies have fallen overall, they have not fallen consistently in every region, and in some areas they have increased. There are questions about whether the 2010 target of a 50% reduction on 1998 levels can be met. United States In the United States the topic of sex education is the subject of much contentious debate. Some schools provide â€Å"abstinence-only† education and virginity pledges are increasingly popular. A 2004 study by Yale and Columbia Universities found that 88% of those who pledge abstinence have premarital sex anyway. Most public schools offer â€Å"abstinence-plus† programs that support abstinence but also offer advice about contraception. A team of researchers and educators in California have published a list of â€Å"best practices† in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to â€Å"instill a belief in a successful future†, male involvement in the prevention process, and designing interventions that are culturally relevant. On September 30, 2010, The U. S. Department of Health and Human Services approved $155 million dollars in new funding for comprehensive sex education programs designed to prevent teenage pregnancy. The money is being awarded â€Å"to states, non-profit organizations, school districts, universities and others. These grants will support the replication of teen pregnancy prevention programs that have been shown to be effective through rigorous research as well as the testing of new, innovative approaches to combating teen pregnancy. † For teens who choose to engage in sexual activity, the primary mode of preventing teen pregnancy becomes correct use of contraceptives. In the States, one policy initiative that has been used to increase rates of contraceptive use is Title X: Title X of the 1970 Public Health Service act provides family planning services for those who do not qualify for Medicaid by distributing â€Å"funding to a network of public, private, and nonprofit entities [in order to provide] services on a sliding scale based on income. Studies indicate that, internationally, success in reducing teen pregnancy rates is directly correlated with the kind of access that Title X provides: â€Å"What appears crucial to success is that adolescents know where they can go to obtain inf ormation and services, can get there easily and are assured of receiving confidential, nonjudgmental care, and that these services and contraceptive supplies are free or cost very little. In addressing high rates of unplanned teen pregnancies, scholars agree that the problem must be confronted from both the biological and cultural contexts. Netherlands The Dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. The curriculum focuses on values, attitudes, communication and negotiation skills, as well as biological aspects of reproduction. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach. Developing world In the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as Sri Lanka have a systematic policy framework for teaching about sex within schools. Non-governmental agencies such as the International Planned Parenthood Federation and Marie Stopes International provide contraceptive advice for young women worldwide. Laws against child marriage have reduced but not eliminated the practice. Improved female literacy and educational prospects have led to an increase in the age at first birth in areas such as Iran, Indonesia, and the Indian state of Kerala. Teenage fatherhood In some cases, the father of the child is the husband of the teenage girl. The conception may occur within wedlock, or the pregnancy itself may precipitate the marriage (the so-called shotgun wedding). In countries such as India the majority of teenage births occur within marriage. In other countries, such as the United States and the Republic of Ireland, the majority of teenage mothers are not married to the fathers of their children. In the UK, half of all teenagers with children are lone parents, 40% are cohabitating as a couple and 10% are married. Teenage parents are frequently in a romantic relationship at the time of birth, but many adolescent fathers do not stay with the mother and this often disrupts their relationship with the child. Research has shown that when teenage fathers are included in decision-making during pregnancy and birth, they are more likely to report increased involvement with their children in later years. In the U. S, eight out of ten teenage fathers do not marry their first child's mother. However, â€Å"teenage father† may be a misnomer in many cases. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of births to teenage girls in the United States are fathered by adult men age 20 or older. The Guttmacher Institute reports that over 40% of mothers aged 15–17 had sexual partners three to five years older and almost one in five had partners six or more years older. A 1990 study of births to California teens reported that the younger the mother, the greater the age gap with her male partner. In the UK 72% of jointly registered births to women under the age of 20, the father is over the age of 20, with almost 1 in 4 being over 25. History Teenage pregnancy was normal in previous centuries. Perhaps the most famous teenage pregnancy in history was Mary, Mother of Jesus. She is generally believed to have been 13 years old when she gave birth to Jesus. Other sources place her age as high as 15 years. Hildegard of Vinzgouw, the wife of Charlemagne was about 14 years old when she gave birth to her first son in 772 CE. The mother of Henry VII of England was 13 years old when she gave birth to him in 1457. Maria of Tver, the wife of Ivan the Great of Russia, gave birth to her first son when she was about 16 years old, in 1458. Empress Teimei of Japan was 16 years old when she gave birth to Hirohito in 1901. Lina Medina of Peru holds the world record for youngest live birth: She was five years, seven months old when she gave birth in 1939. Society and culture Teenage pregnancy has been used as a theme or plot device in fiction, including books, films, and television series. The setting may be historical (The Blue Lagoon, Hope and Glory) or contemporary (One Tree Hill). While the subject is generally treated in a serious manner (Junk), it can sometimes play up to stereotypes in a comic manner (Vicky Pollard in Little Britain). The pregnancy itself may be the result of sexual abuse (Rose in The Cider House Rules), a one-night stand (Amy Barnes in Hollyoaks), a romantic relationship (Demi Miller in EastEnders); (Ronnie Mitchell in EastEnders); or a first time sexual encounter (Sarah-Louise Platt in Coronation Street) unusually, in Quinceanera, the central character becomes pregnant through non-penetrative sex. The drama often focuses around the discovery of the regnancy and the decision to opt for abortion (Fast Times at Ridgemont High), adoption (Mom at Sixteen, Juno, Glee), marriage (Sugar & Spice, Reba and Jeni, Juno) or life as a single mother (Saved! , Where the Heart Is, Someone Like You). In the German play Spring Awakening (and the Broadway musical based upon it), the central female character gets pregnant and dies from a botched abortion. Stephanie Daley deals with the aftermath of a teenage pregnancy that ends with a dead newborn baby. While the pregnant girl herself is normally the chief protagonist, Too Young to Be a Dad centers on a 15-year-old boy whose girlfriend becomes pregnant, while The Snapper focuses on the reactions of the family, particularly the soon-to-be grandfather. Other fiction, particularly in a long-running television series, looks at the long-term effects of becoming a parent at a very young age (Degrassi Junior High). In Gilmore Girls, because Lorelai Gilmore is only 16 years older than her daughter Rory, the two are more like sisters than parent and child. Looking for Alibrandi also features the teenage daughter of a woman who was herself a teenage mother. In The George Lopez Show, Benny Lopez, gave birth to George at 16. In the ABC Family television show The Secret Life of the American Teenager centers on Amy Juergens, a 15-year-old who becomes a teenage mother after a one night stand. In the popular Comedy Central television show South Park the character Carol McCormick was said to have had her sons Kevin McCormick at 13, and Kenny McCormick at 16. In the Japanese drama 14-sai no Haha: Aisuru tame ni Umaretekita, the protagonist Miki Ichinose becomes pregnant with her boyfriend's child at age 14. The show examines the impact of her pregnancy on her, her family, her school life, the life of her boyfriend and his family, and the society in which she resides. Additionally, reality television shows have featured teenage pregnancy stories. MTV launched two reality shows about the topic, 16 and Pregnant and Teen Mom, in 2009. Each show depicts the gritty reality that pregnant teens face from friends and family while going through this life changing event, allowing teens to see what actually happens in this scenario through an outlet other than a scripted plot. Autobiographies that look at the author’s own experience of teenage motherhood include I Know Why the Caged Bird Sings and Gather Together in My Name by Maya Angelou, Coal Miner's Daughter by Loretta Lynn, and Riding in Cars with Boys by Beverly D'Onofrio. Songs about teenage pregnancy include downbeat tales of abuse (â€Å"Brenda's Got a Baby†), poverty (â€Å"In The Ghetto†) and back-alley abortion (â€Å"Sally's Pigeons†), as well as upbeat and defiant tunes such as â€Å"Papa Don't Preach†. American pop singer Fantasia Barrino, who was 17 when she gave birth to her daughter, released a controversial song about single motherhood titled â€Å"Baby Mama†, describing the difficulty of raising a child alone with limited financial and family support. (Many U. S. adio stations would not play the song, ostensibly because it contains a profanity. ) â€Å"There Goes My Life†, a modern country song by Kenny Chesney, focuses on the reaction of the father, who rhetorically asks, â€Å"I'm just a kid myself; how am I going to raise one? † As the daughter grows up, his attitude changes, and the song ends with his tearful farewell as she leaves for college. Due to its implied pro-life message, â€Å"There Goes My Life† was sung at the inauguration of George W. Bush in 2005 Teen pregnancies in the Philippines By Rebecca B. Singson Philippine Daily Inquirer First Posted 00:55:00 06/14/2008 Filed Under: Health, Lifestyle & Leisure, Gender Issues (First in a series) MANILA, Philippines? The sexual revolution has ushered in a period in which the average adolescent experiences tremendous pressures to have sexual experiences of all kinds. Filipino teens get a higher exposure to sex from the Internet, magazines, TV shows, movies and other media than decades ago, yet without any corresponding increase in information on how to handle the input. So kids are pretty much left to other kids for opinions and value formation when it comes to sex. Sexual misinformation is therefore equally shared in the group. Parents at home and teachers in school feel equally inadequate or uneasy to discuss the topic of sex with youngsters. The problem mounts because the barkada (gang) has a more profound influence than parents do and they exert pressure and expect the adolescent to conform to the rest of them. In fact, female adolescents whose friends engage in sexual behavior were found to be more likely to do the same compared to those who do not associate with such peers. If the teen perceives her peers to look negatively at premarital sex, she was more likely to start sex at a later age. Numbers Statistics in the United States show that each year, almost 1 million teenage women? 10 percent of all women aged 15-19 and 19 percent of those who have had sexual intercourse? become pregnant and one-fourth of teenage mothers have a second child within two years of their first. In the Philippines, according to the 2002 Young Adult Fertility and Sexuality Study by the University of the Philippines Population Institute (Uppi) and the Demographic Research and Development Foundation, 26 percent of our Filipino youth nationwide from ages 15 to 25 admitted to having a premarital sex experience. What? s worse is that 38 percent of our youth are already in a live-in arrangement. The 1998 National Demographic and Health Survey (NDHS) reveals that 3. 6 million of our teenagers (that? s a whopping 5. 2 percent of our population! ) got pregnant. In 92 percent of these teens, the pregnancy was unplanned, and the majority, 78 percent, did not even use contraceptives the first time they had sex. Many of the youth are clueless that even on a single intercourse, they could wind up pregnant. Risks There are many reasons teen pregnancies should be avoided. Here? s a low down on the facts: ? Risk for malnutrition Teenage mothers tend to have poor eating habits and are less likely to take recommended daily multivitamins to maintain adequate nutrition during pregnancy. They are also more likely to smoke, drink or take drugs during pregnancy, which can cause health problems for the baby. ? Risk for inadequate prenatal care Teenage mothers are less likely to seek regular prenatal care which is essential for monitoring the growth of the fetus; keeping the mother? s weight in check; and advising the mother on nutrition and how she should take care of herself to ensure a healthy pregnancy. According to the American Medical Association, babies born to women who do not have regular prenatal care are 4 times more likely to die before the age of 1 year. ? Risk for abortion Unplanned pregnancies lead to a higher rate of abortions. In the United States, nearly 4 in 10 teen pregnancies (excluding those ending in miscarriages) are terminated by abortion. There were about 274,000 abortions among teens in 1996. In the Philippines, although abortion is illegal, it would shock you to know that we even have a higher abortion rate (25/1,000 women) compared to the United States where abortion is legal (23/1,000 women). For sure, there are more abortions that happen in our country that are not even reported. Backdoor abortions are resorted to with untrained ? hilots? with questionable sterility procedures, increasing the possibility for tetanus poisoning and other complications. Risk for fetal deaths Statistics of the Department of Health show that fetal deaths are more likely to happen to young mothers, and that babies born by them are likely to have low birth weight. ? Risk for acquiring cervical cancer The Human Papillomavirus (HPV) is a sexually-transmitted, w art-forming virus that has been implicated in causing cancer of the cervix. This is the most common cancer in women secondary to breast cancer. Women who are at increased risk for acquiring this are those who engage in sex before 18, have a pregnancy at or younger than 18, or have had at least 5 sexual partners, or have had a partner with at least 5 sexual partners. If you start sex at an early age, you have a higher likelihood of going through several sexual partners before you settle down, thus increasing your exposure to acquiring the virus and acquiring cervical cancer. The men can get genital warts from this virus and can certainly pass it on to their partners, thus increasing her risk for cervical cancer. Is that something you would want to gift to your wife with on your honeymoon? There is a way to test women (HPV Digene test) but no test for the man so you can? t know if you have it. Using the condom does not confer protection against acquiring this virus since the condom cannot cover the testes where the warts can grow and proliferate. Adolescent Pregnancy: Current Trends and Issues Abstract The prevention of unintended adolescent pregnancy is an important goal of the American Academy of Pediatrics and our society. Although adolescent pregnancy and birth rates have been steadily decreasing, many adolescents still become pregnant. Since the last statement on adolescent pregnancy was issued by the Academy in 1998, efforts to prevent adolescent pregnancy have increased, and new observations, technologies, and prevention effectiveness data have emerged. The purpose of this clinical report is to review current trends and issues related to adolescent pregnancy, update practitioners on this topic, and review legal and policy implications of concern to pediatricians. INTRODUCTION Adolescent pregnancy in the United States is a complex issue affecting families, health care professionals, educators, government officials, and youths themselves. Since 1998, when the last statement on this topic was issued by the American Academy of Pediatrics (AAP), efforts to prevent adolescent pregnancy have increased,and new observations, technologies, and prevention effectiveness data have emerged. The purpose of this clinical report is to provide pediatricians with recent data on adolescent sexuality, contraceptive use, and childbearing as well as information about preventing adolescent pregnancy in their communities and in clinical practice. This report does not address diagnosis of pregnancy or management of the transition to prenatal care. Information about counseling pregnant youth is provided in the AAP policy statement â€Å"Counseling the Adolescent About Pregnancy Options,† and from the Alan Guttmacher Institute, and information about early prenatal care is available from the American College of Obstetricians and Gynecologists SEXUAL ACTIVITY The proportion of American adolescents who are sexually active has decreased in recent years; however, rates are still high enough to warrant concern. Currently, more than 45% of high school females and 48% of high school males have had sexual intercourse. The average age of first intercourse is 17 years for girls and 16 years for boys. However, approximately one fourth of all youth report having had intercourse by 15 years of age. Younger teenagers are especially vulnerable to coercive and nonconsensual sex. Involuntary sexual activity has been reported by 74% of sexually active girls younger than 14 years and 60% of those younger than 15 years. Sexually active youth, similar to older unmarried adults, usually have monogamous, short-lived relationships with successive partners. Current surveys indicate that 11% of high school females and 17% of high school males report having had 4 or more sexual partners. In addition to intercourse, many adolescents report having had oral sex or engaging in kissing, touching, or other mutual stimulation; however, data on these other behaviors are reported rarely. There are several predictors of sexual intercourse during the early adolescent years, including early pubertal development, a history of sexual abuse, poverty, lack of attentive and nurturing parents, cultural and family patterns of early sexual experience, lack of school or career goals, substance abuse, and poor school performance or dropping out of school. Factors associated with a delay in the initiation of sexual intercourse include living with both parents in a stable family environment, regular attendance at places of worship, and higher family income. Recently, parental supervision, setting expectations, and parent/child â€Å"connectedness† have been recognized as clearly associated with decreasing risky sexual behavior and other risky behaviors among adolescents. CONTRACEPTIVE USE Despite increasing use of contraception by adolescents at the time of first intercourse, 50% of adolescent pregnancies occur within the first 6 months of initial sexual intercourse. The human immunodeficiency virus (HIV) epidemic and public health education efforts have led more adolescents to use barrier contraceptives; nonetheless, in 2003, among high school students who reported that they had ever had sexual intercourse, only 63% reported having used a condom the last time they had intercourse. Despite HIV prevention guidelines, initiation of prescription contraceptives is often accompanied by decreased condom use, especially among adolescents who do not perceive themselves to be at risk of sexually transmitted diseases (STDs). Many adolescents who currently report using prescription contraceptives delayed seeing a clinician for a contraceptive prescription until they had been sexually active for 1 year or more. Adolescent women, similar to adult women, have changed contraceptive methods in recent years, with decreases in pill use and increases in injectable contraceptive use. Factors associated with more consistent contraceptive use among sexually active youth include academic success in school, anticipation of a satisfying future, and being involved in a stable relationship with a sexual partner. The Centers for Disease Control and Prevention unambiguously recommends both abstinence and the use of barrier contraceptives for individuals who choose to be sexually active. However, some groups continue to question the effectiveness of condoms. Youth who participated in programs that provided information about abstinence, condoms, and/or contraception; who were engaged in one-on-one discussions about their own behavior; who were given clear messages about sex and condom or contraceptive use; and who were provided condoms or contraceptives have been found to increase consistent condom and contraception use without increasing sexual activity. TRENDS IN ADOLESCENT CHILDBEARING Each year, approximately 900000 teenagers become pregnant in the United States, and despite decreasing rates, more than 4 in 10 adolescent girls have been pregnant at least once before 20 years of age. Most of these pregnancies are among older teenagers (ie, those 18 or 19 years of age). Approximately 51% of adolescent pregnancies end in live births, 35% end in induced abortion, and 14% result in miscarriage or stillbirth. Historically, the highest adolescent birth rates in the United States were during the 1950s and 1960s, before the legalization of abortion and the development of many of the current forms of contraception. After the legalization of abortion in 1973, birth rates for US females 15 to 19 years of age decreased sharply until 1986. Rates increased steadily until 1991; since then, the birth rate among teenagers has decreased every year since 1991. Since 1991, the rate has decreased 35% for 15- to 17-year-olds and 20% for 18- to 19-year-olds. Rates for 10- to 14-year-olds were 1. 4 per 1000 in 1992 and have gradually decreased to 0. 7 per 1000 in 2002. Although birth rates have been decreasing steadily for white and black teenagers in recent years, 1996 is the first year that birth rates decreased for Hispanic teenagers; Hispanic adolescents also have had the highest overall birth rates and smallest decreases in recent years. Once a teenager has had 1 infant, she is at increased risk of having another. Approximately 25% of adolescent births are not first births. ADOLESCENT PARENTS AND THEIR PARTNERS Adolescent childbearing is usually inconsistent with mainstream societal demands for attaining adulthood through education, work experience, and financial stability. Poverty is correlated significantly with adolescent pregnancy in the United States. Although 38% of adolescents live in poor or low-income families, as many as 83% of adolescents who give birth and 61% who have abortions are from poor or low-income families. At least one third of parenting adolescents (both males and females) are themselves products of adolescent pregnancy. Although it is difficult to establish causal links between childhood maltreatment and subsequent adolescent pregnancy, in some studies as many as 50% to 60% of those who become pregnant in early or midadolescence have a history of childhood sexual or physical abuse. The problem of adolescent pregnancy is often assumed to be both an adolescent and an adult problem, because many partners of childbearing youth are adults. The percentage of adolescent pregnancies in which the father is an adult is unclear; studies report a range from 7% to 67%. Adult men having sexual relationships with adolescents is problematic, because many of these relationships may be abusive or coercive. Adolescents who have sex with older men are also more likely to contract HIV infection or other STD. Although more than two thirds of adolescent girls' sexual partners are the same age or within a few years older and the sexual activity is consensual in nature, some partners are more than 4 years older. Sexual relationships between adults and minors may be coercive or exploitative, with detrimental consequences for the health of both the teenager and her children. Although some states and local jurisdictions have changed statutory rape laws and their enforcement, mandated reporting of all sexual activity as statutory rape or as child abuse has not been effective at changing behavior, does not allow for clinical judgment, and has the effect of deterring some of the adolescents most in need from seeking health care. Adolescent fathers are similar to adolescent mothers; they are more likely than their peers who are not fathers to have poor academic performance, higher school drop-out rates, limited financial resources, and decreased income potential. Some fathers disappear from the lives of their adolescent partners and children, but many others attempt to stay involved, and many young fathers struggle to be involved in their children's lives. Current programs in adolescent pregnancy and parenting are exploring ways to r

Top5 current domestic terrorism Thesis Example | Topics and Well Written Essays - 2000 words

Top5 current domestic terrorism threats(i.e.nuclear,bio,chemical,agriculture,etc) - Thesis Example Terrorism – and the threat of terror - can have political, social, and economic ramifications. Politically, terror can sow fear, destabilize governments and provoke various forms of retaliatory measures. States of all stripes – including modern liberal democracies – have responded to terrorist threats through the curtailment of civil liberties (United States post 9/11), the imposition of martial law (Canada during the FLQ crisis of 1970) and the wholesale destruction of communities (Iraq’s genocide of the Kurds in Halabja, 1988). Full-scale retaliatory measures, such as that which was practiced at Halabja using chemical weapons (between 3,000 and 5,000 people were killed one March afternoon), often indiscriminately target, kill and maim entire populations. Terrorists today are unencumbered by geographic boundaries and are able, through the use and abuse of modern technology, to sow damage and fear on a global scale. The terrorist of today is transnational and Al-Qaeda today provides perhaps the best example of a global terrorist network. Terrorism is also inherently destabilizing and wreaks havoc both politically and economically. It remains one of the most sustained and important threats to global security and world peace. Additionally, legal changes often ensue in the wake of terrorist acts and the United States has a history of implementing controversial legislation in the wake of terrorist acts (Chaliand 101-240). What is a terrorist and how does one define terrorism? The age old adage that â€Å"one man’s terrorist is another man’s freedom fighter† (Bergesen & Lizardo 39) remains true and the term terrorist has been notoriously difficult to define. Despite these challenges, a definition of terrorism is integral and must be defined to provide a theoretical basis to this essay. According to Dr. Mia Bloom, terrorism can be defined as â€Å"premeditated, politically motivated violence

Runaway Chemical Reaction and Vapor Cloud Explosion Literature review

Runaway Chemical Reaction and Vapor Cloud Explosion - Literature review Example The drive needs to be sorted before the start of any reaction process to control the explosion incidences. In addition, during the polymerization process, the people concerned should ensure that there is required amount of polymers and monomers to reduce the reaction process. When unequal amounts of polymers and monomers are used, there can be rapid increase in reaction pressure in reactors manways enabling solvent vapor to be forced out as a flammable cloud Carolina (CSB 2007, p. 2). In most cases, it has been noticed that when the ejected vapor comes into contact with the source of ignition, it results in explosion thereby can lead to killing of workers and several harms. Such killings and deaths need to be controlled by the workers themselves and some organization bodies. The Chemical Safety Board (CSB) should ensure the workers are familiar with basic safeguards tips that prevent, detect and moderate runaway reactions. Moreover, the Board should also ensure that all safety management practices are operating all time. Most preferably, people should reside quite distance from main firms that are involved in several reaction tests. During the process of reaction that may at times leads to severe explosions may cause injuries to the nearby homes Carolina (CSB 2007, p. 3). Some blasts may go beyond the borders causing damage of structures of the nearby residents. The most important necessity for all companies that are involved in chemical reaction processes is a quick mode of transport. Ambulances owned by these firms create immediate access to medical checkups. The injured workers can be transported to various hospitals depending on the nature of harm. The burned labors are taken to burn centers for better treatment. In order to get a complete manufacturing cycle, several reaction steps must be followed. All the levels should be monitored by the operators Carolina (CSB 2007, p. 5). In order to achieve appropriate and successful manufacturing cycle, there

English Essay Example | Topics and Well Written Essays - 500 words - 72

English - Essay Example To be specific, the villagers never try to realize that their belief in ‘the lottery’ is false. Instead, the blindly accept the tradition and happen to be the victims of the same. The speaker in the work by Shirley Jackson states that, â€Å"Soon the men began to gather, surveying their own children, speaking of planting and rain, tractors and taxes† (6). Besides, the lottery is used as a tool to sustain orthodoxy, but it brutally punishes individuals. Jackson Bill knows that lottery is not a fortune to his family. Still, he never tries to act against this inhuman custom. As the community members are supposed to follow the orthodoxy, one cannot expect the protagonist (say, Jackson Bill) to act against the same. S.T. Joshi opines that, â€Å"Certainly there is nothing supernatural about â€Å"The Lottery† (1948), whose impact rests on the very possibility of its occurrence† (13). From a different angle of view, the author makes use of the helpless cha racters to expose the inhuman aspects of orthodoxy. On the other side, the villagers still believe that sacrifice can result in fortune (say, good harvest). The author makes use of Tessie as the tool to proclaim the need to discard orthodoxy. Tessie is portrayed as the victim of orthodoxy, but she does not try to subdue to the same. Instead, she tries to express her views on forced human sacrifice. Still, this does not change the villagers’ attitude because their belief is blind. They never try to go beyond orthodoxy because their community never allows it. James Hugh Toner makes clear that, â€Å"By custom, others in the family join in to kill the lottery â€Å"winner†Ã¢â‚¬  (9). Bill knows that he cannot save his wife. Still, he does not try to save his wife. On the other side, Tessie tries to educate the villagers on their inhuman orthodoxy, but for no use. So, the author expects that Tessie’s fate will create awareness among the mass on the need to discard inhuman rituals