Background: Following the mass migration in the 1970’s a young urbanised Pacific population has emerged in New Zealand (NZ), with Pacific people now an integral part of the cultural fabric. Teenage pregnancy (births, terminations and miscarriages of women <20 years) is a topic widely publicised over the decades. In the literature teenage pregnancy is associated with belonging to a minority population, being a solo parent, economic deprivation, unemployment and lack of education. In the Industrialised world, New Zealand teenage births (33.4 per 1,000) are second only to the United States of America (U.S.A) (55.6 per 1000), with Pacific teenage pregnancy rates being twice as high as for European women. While ethnic differences in teenage birth rates have been documented through the Pacific reports published by the New Zealand Child and Youth Epidemiology Services (NZCYES), little is known about the variations between Pacific groups and data on terminations or the father of the baby is sparse. Life experiences of Tongan adolescent mothers living in Tonga and New Zealand have not been documented, including what teenage mothers perceive to be the risk and protective factors for teenage pregnancy pre conception or how policy influences the decisions they make. The aims of this thesis are to - • Explore the demography of Pacific teenage births using different ethnicity classifications (prioritised, multi and sole Pacific ethnicity). • Describe variations in teenage births by, level of deprivation, and paternal age and ethnicity in New Zealand. • Identify variations in termination rates among Pacific adolescents (Samoan, Cook Island Māori, Tongan and Niuean). • Use Tongan teenage mothers as a case study t o understand the experiences of Tongan teenage mothers relating to conception, pregnancy and birth. • Offer policy recommendations addressing the needs of Pacific (Tongan) teenage mothers. Method: A mixed methods approach was used to maximise the information available on Pacific teenage (<20 years) pregnancy in New Zealand. Using the New Zealand Birth Registration Dataset (BRD) and the Abortion Supervisory Committee dataset, ethnic specific birth and termination rates were calculated. Multivariable analysis (BRD only) using SAS was also used in the quantitative part of this thesis. From 2000 to 2012 there were 146,860 births to teenage mothers. In addition there were 90,880 terminations to teenage mothers during the same period. Outcomes of interest included Pacific teenage births and terminations with explanatory variables including maternal age socioeconomic deprivation (using the NZ Deprivation Index), paternal ethnicity and paternal age group. Older maternal age groups (20-24 years, 25-29 years, 30-34 years, 35-39 years and 40+ years) were also analysed to assess whether socio-demographic characteristics and birth outcomes varied by age. Qualitative analysis was undertaken during 2009 involving 18 semi-structured faceto- face interviews with Tongan Teenage mothers in New Zealand and Tonga. Tongan literature including poetry by three eminent Tongan poets was used to shed light on variations in the experiences of participants, triggered by the influence of societal norms (religious, cultural and political beliefs) in shaping the way women perceive themselves and the situations that they find themselves in. A unique model entitled the Mo’ui’anga Model (Life Source Model) was developed which weaves findings from the quantitative and qualitative components of the thesis using the analogy of the fetal and post natal infant life, intertwined with the mother’s life to describe the holistic understanding of Pacific teenage pregnancy. In this model facets in an individual’s life (family, culture, physical, societal, mental, spiritual) do not stand alone but are interrelated and relevant for the nurturing of both mother and child pre and post conception. Results: Teenage (<20 years) birth rates were higher for Cook Island Māori and Niuean women, than for Samoan or Tongan women. Yet, teenage (<20 years) termination rates were higher among Samoan, Tongan and Cook Island Māori women compared to Niuean women. Trend analysis showed changes in teenage pregnancy rates in New Zealand over time, with a decline in teen birth and termination rates from 2008 to 2012. When examining birth and termination outcomes by maternal age, findings were similar for women <20 years and 20-24 years. Using the Tongan population as a case study, a young women is considered a youth until she i s married, raising questions around what we consider youth and the delivery of services for young adults. The academic literature emphasises teenage mothers conceiving to older men. However when examining maternal and paternal age, across all age groups a similar pattern was shown with most partners being either in the same age group or the next age group up as the mother. Twenty percent of teenage mother’s did not provide paternal details in the quantitative analysis. Qualitative results show the importance placed on how anga fakatonga (Tongan way) influences the way expectant mothers view themselves and how they are viewed and treated by others. Family was consistently mentioned as the most important support mechanism with a family (of the young woman) breakdown noted as a trigger for early onset of sexual activity in a number of cases. Noticeable lack of knowledge relating to both reproductive issues and sex was also associated with unplanned sexual intercourse and teenage pregnancy. Discussion: Using the Mo’ui’anga Model the interplay of the quantitative and qualitative factors, including the fundamental aspects of a young woman’s life were brought to light. Reproductive differences between Pacific ethnic groups are revealed (birth and termination) that need further attention (policy, services, adequate resources). In the academic literature, Pacific people are largely identified as a homogenous group with an assumption that their experiences are shared. However through the quantitative and qualitative analysis of teenage pregnancy, unique new findings show that this is not necessarily the case, with differences found in births and termination rates between and within Pacific groups. Focussing on one Pacific group (namely Tongan) the adolescents in the study noted exposure to significant socioeconomic deprivation, and a lack of awareness of where to gain financial assistance. A unifying theme in the qualitative analysis is the importance of family connection with those with adequate family support better adapted to becoming teenage mothers. This is a finding which has significant policy implications, if the on-going wellbeing of these young mothers and their babies is to be ensured. From 2008, New Zealand has seen a decline in both birth and termination rates among teenage women. This is likely due to policy change around the availability of newer forms of contraception, and whether they are free for adolescents. Lack of knowledge, the need for improved access and adequate delivery of information are factors that could also be influenced by policy change. In the literature there is a l s o a focus on absent fathers. While the quantitative section provides statistics relating to the proportion of men who fathered babies to teenage mothers, the qualitative section shows that among the adolescents in the study, for some men, the option of being present in the lives of the child was denied. As well as having policy implications, using the Mo’uianga model, this would also impact the overall wellbeing of the child in the future. Limitations: Though this thesis provides unique findings, limitations highlight the need for further research involving other Pacific groups. The qualitative part of this thesis specifically focusses on the Tongan population. Whether findings can be generalised to other Pacific ethnic groups is not clear. A comparative study may clarify this aspect. A limitation of the quantitative findings was the limited number of variables routinely collected in the Birth Registrationdataset. A more detailed dataset would provide a better understanding of the determinants and impact of teenage pregnancy. For example, age at first birth, would be informative to understand the reproductive history of teenage mothers. Within the termination data there is no information collated on the men who fathered babies to teenage mothers. This would have been helpful in comparing findings for births and terminations. Recommendations: Exploration of the current sexual and reproductive health syllabus is urgent to address issues raised by teenage mothers ensuring information on sexual reproductive issues is age and culturally appropriate. Exploration of financial assistance for younger teenage mothers (<18 years) need to be further investigated so that conditions do not take them away from their support system.