Teenage pregnancy

Teenage pregnancy is defined in the United States as an underaged girl becoming pregnant. However, in the United Kingdom , there is a legal definition whereby a woman is considered to be a pregnant teenager if she falls pregnant before her 18th birthday. The term in everyday speech usually refers to women who have not reached legal adulthood, which varies across the world, who become pregnant.

The average age of menarche (first menstrual period) in the United States is 12.5, though this figure varies by ethnicity^[1] and weight, and first ovulation occurs only irregularly until after this. The average age of menarche has been declining and is continuing to do so. Whether fertility leads to early pregnancy depends on a number of factors, both societal and personal. Worldwide, rates of teenage pregnancy range from 143 per 1000 in sub-Saharan Africa to 2.9 per 1000 in South Korea.^[2][3]

Pregnant teenagers face many of the same obstetrics issues as women in their 20s and 30s. However, there are additional medical concerns for younger mothers, particularly those under 15 and those living in developing countries.^[4] For mothers between 15 and 19, age in itself is not a risk factor, but additional risks may be associated with socioeconomic factors.^[5]

Data supporting teenage pregnancy as a social issue in developed countries include lower educational levels, higher rates of poverty, and other poorer "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. For these reasons, there have been many studies and campaigns which attempt to uncover the causes and limit the numbers of teenage pregnancies.^[6] In other countries and cultures, particularly in the developing world, teenage pregnancy is usually within marriage and does not involve a social stigma.^[7]

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Global incidence

Main article: Global incidence of teenage pregnancy

A report by 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.^[4] The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age.^[2] In Niger, for example, 87% of women surveyed were married and 53% had given birth to a child before the age of 18.^[9] In South Africa, it is believed that this problem of teenage pregnancies is the result of introducing child support grant in 1999.^{[citation needed]}

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 industrialized Asian nations such as South Korea and Singapore, teenage birth rates are among the lowest in the world.^[10]

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. The United Kingdom, which has the highest teenage birth rate in Europe, also has a higher rate of abortion than most European countries. In contrast, most continental Western European countries have very low 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 Italy and Spain) or both (in the case of Switzerland).^[3]

The teenage birth rate in United States is the highest in the developed world, and the teenage abortion rate is also high.^[3] However, the teenage pregnancy rate has been decreasing significantly in recent years, particularly since the early 1990s. This decline has manifested across all racial groups, although teenagers of African-American and Hispanic descent retain 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.^[11] 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 1992-2002.^[12]

Causes of teenage pregnancy

In some societies, early marriage and traditional gender roles are important factors in the rate of teenage pregnancy. For example, in sub-Saharan Africa, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility.^[9] In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities compared to the rate in cities.^[10]

In societies where adolescent marriage is uncommon, an early age at first intercourse and lack of contraceptive use may be factors.^[3][13] Most teenage pregnancies in the developed world appear to be unplanned.^[13][14]

Adolescent sexual behavior

See also: Adolescent sexuality

According to information available from the Guttmacher Institute, sex by age 20 is the norm across the world and countries with low levels of adolescent pregnancy accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality.^[15]

However, in a Kaiser Family Foundation study, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported "being in a relationship where they felt things were moving too fast sexually", and 24% had "done something sexual they didn’t really want to do".^[16] Inhibition-reducing drugs and alcohol may encourage unintended sexual activity.^[3][17][16] According to Leonard Sax (a physician and writer about sex differences), girls often become intoxicated before engaging in sexual activities because it "numbs the experience for them, making it less embarrassing and less emotionally painful."^[18]

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.^[19][20] However, some recent studies have found that the rate of contraceptive use among teenage girls is roughly the same as that among older women.^[21]

In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly or forget to take oral contraceptives. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users.^[17] Longer term methods such as injections, subcutaneous implants, the vaginal ring, or intrauterine devices last from a month to years and may prevent pregnancy less effectively in women who have trouble following routines, including many young women. The use of more than one contraceptive measure decreases the risk of unplanned pregnancy, and if one is a condom barrier method, the transmission of sexually transmitted disease is also reduced. A recent study in the U.S found that 25% of teenage girls with previous abusive relationships, say their partners actively tried to get them pregnant by manipulating condom use, sabotaging birth control, or explicitly saying they want them to become pregnant.[3]

Sexual abuse

Rape is a majority factor in pregnancies under age 15 and a minority factor above age 15.^{[3] [17] [16]} Studies have found that between 11% and 20% of pregnancies in teenagers are a direct result of rape, while about 60% of teenage mothers claimed their pregnancies were preceded by unwanted sexual experiences.^[22][23] Before age 15, a majority of first intercourse experiences among females are reported to be non-voluntary.^[13]The Guttmacher Institute found that 60% of girls who had sex before age 15 were coerced by males an average of six years their senior.^[24] Multiple studies have indicated a strong link between early childhood sexual abuse and subsequent teenage pregnancy in industrialized countries.^[25][26]

In many countries, sexual intercourse with a teenager and an adult is not treated as consensual because the teenager is said to lack the maturity and knowledge to make an informed decision to engage in fully consensual sex with an adult and to understand the repercussions thereof. Sex with a minor in industrialized countries is treated as statutory rape though this differs according to the jurisdiction. For example in the United Kingdom it is illegal for a man to have sex with a girl under 16, but in Italy it is not illegal unless she is under 14, or Spain and Netherlands if she is under 12 (see age of consent).

Socioeconomic factors

  Poverty is associated with increased rates of teenage pregnancy.^[17] Economically poor countries such as Niger and Bangladesh have far more teenage mothers compared with economically rich countries such as Switzerland and Japan.^[8]

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.^[27] In Italy, the teenage birth rate in the well-off central regions is only 3.3 per 1,000, but, in the poorer Mezzogiorno it is 10.0 per 1000.^[3] Sociologist Mike A. Males noted that teenage birth rates closely mapped poverty rates in California:^[28]

* per 1000 women aged 15-19

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.^[14]

Age discrepancy in relationships

Studies indicate that an important contributing factor is an age discrepancy between the teenage girl and the man who impregnates her. Teenage girls with older partners are more likely to become pregnant than those with partners closer in age, and are also more likely to carry the baby to term rather than receive an abortion.^[29] 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.^[30][31]

Childhood environment

Women exposed to abuse, domestic violence and family strife in childhood are more likely than those without such experiences to have a teenage pregnancy, and the risk 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 "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. ^[32]

Studies have also found that girls whose fathers left the family earlier 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, with lowest rates 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 experience an adolescent pregnancy than were father-present girls. ^[33][34]

Low educational expectations have been pinpointed as a risk factor.^[35] A girl is also more likely to become a teenage parent if her mother or older sister gave birth in her teens. ^[36][37]

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 communities 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 system between 1999 and 2004 had a birth rate nearly 3 times the rate for girls in the general population.^[38]

Commentator opinion

Experts in the area and other commentators have offered varying opinions on the root causes of teenage pregnancy.

According to Gill Francis, of the National Children's Bureau, "There are four main reasons why girls in Britain become pregnant. We don’t give children enough information; we give them mixed messages about sex and relationships; social deprivation means girls are more likely to become pregnant; and girls whose mothers were teenage mums are more likely to do the same".^[19]

Laurence Shaw, a UK fertility specialist, has suggested that, despite the social stigma attached to teenage pregnancy, it is a natural biological adaptation to begin reproducing during the peak fertile period of the late teens and early twenties. This is the period of time when the fecundity rate (a measure of fertility) is highest, nearing 30%.^[39]

According to Gracie Hsu of the Family Research Council, "contrary to the common perception that teenage sex and pregnancy typically stem from two teenagers getting caught up in the heat of the moment, new research reveals that many teenage girls are being sexually exploited and impregnated by adult men." She also highlights family breakdown, fatherless families, lack of parental supervision, cultural influences, and erosion of legal protections such as statutory rape laws.^[40]

Public opinion

Opinion polls have also attempted to determine what some of the root causes of teenage pregnancy might be:

• Peer pressure: 76% of girls and 58% of boys in a 1996 Seventeen magazine survey reported that teenage females had sexual intercourse in response to their boyfriend's desire for it.^[20] A 2003 Kaiser Family Foundation poll found that one in three young men aged 15-17 said they had felt pressure from male friends to have sex. ^[41]
• Contraceptive use: In a 1996 Kaiser Family Foundation study, 46% of adolescents surveyed said that they believed teenage pregnancy resulted from the failure to keep contraception at the ready. 23% of sexually active young women the 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who eschewed the use of a condom.^[20] 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor. ^[20]
• Parental relationship: 66% of girls in the 1997 PARADE survey said that the likelihood becoming pregnant as a teen increased if one had parents who were inattentive, unloving, or failed to instill moral values.^[20] 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.^[20]
• Mass media: In the 1997 PARADE survey, 57% replied that sexualized content in film, 55% in television, and 44% in music helped to influence teenagers to engage in sexual activity before they are ready.^[20] A 1996 U.S. News & World Report poll, which asked about how television programs might contribute to the incidence of teenage pregnancy, found that 46% thought TV played a large role, 30% that it had some effect, 14% that it had little effect, 9% that it had none.^[20]
• 36% in the 1997 PARADE survey said they believed that an adolescent might become pregnant to satisfy a desire for unconditional love. 24% said they believed that a girl might also become pregnant in an attempt to retain or win back a boyfriend.

Limiting teenage pregnancies

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.

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 Education and Skills, 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.

In the United States the topic of sex education is the subject of much contentious debate. Some schools provide "abstinence-only" education and virginity pledges are increasingly popular. Most public schools offer “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 "best practices" in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to "instill a belief in a successful future", male involvement in the prevention process, and designing interventions that are culturally relevant.^[42]

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.^[43]

In the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as Indonesia and Sri Lanka have a systematic policy framework for teaching about sex within schools.^[10] Non-governmental agencies such as the International Planned Parenthood Federation 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.

Medical outcomes

Maternal and perinatal 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.^{[6][44] [5]} Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all.^[5] 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.^[45]

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.^[46]

Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries.^{[47] [48]} 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.^[4] 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.^[9]

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.^[4] 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.^[5]

Socioeconomic and psychological outcomes

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 can use family and community support, social services and child-care support to continue their education and get higher paying jobs as they progress with their education.

Impact on 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.^[6] 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.^[49]

Young motherhood in an industrialized country can affect employment and social class. The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women.^[6] One study found that, in 1988, 60% of teenage mothers were impoverished at the time of giving birth.^[50] Additional research found that nearly 50% of all adolescent mothers sought social assistance within the first five years of their child's life.^[6] A study of 100 teenaged mothers in the United Kingdom found that only 11% received a salary while the remaining 89% were unemployed.^[51] Most British teenage mothers live in poverty, with nearly half in the bottom fifth of the income distribution.^[52]

One-fourth of adolescent mothers will have a second child within 24 months of the first. Factors that determine which 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.^[53]

There is evidence in the U.S. that with emotional and practical support – for example, good access to education and childcare – teenage mothers can catch up by the age of 30 with the average outcomes for their age group and social-economic background. In the UK, researchers have found that if you compare 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 is negligible.^[54]

Impact on the child

Early motherhood can affect the psychosocial development of the infant. The occurrence of developmental disabilities and behavioral issues is increased in children born to teen mothers.^[55][56] 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.^[55] Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment.^[57]

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. ^[6] Daughters born to adolescent parents are more likely to become teen mothers themselves.^[37][6] A son born to a young woman in her teens is three times more likely to serve time in prison.^[58]

Impact on other family members

Teen pregnancy and motherhood can have an influence upon younger siblings. One study found that the little sisters of teen mothers were less likely to place emphasis on the importance of education and employment and more likely to accept sexual initiation, parenthood, and marriage at younger ages; little brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors.^[59] An additional study discovered that those with an older sibling who is a teen parent often end up babysitting their nieces and nephews and that young girls placed in such a situation have an increased risk of getting pregnant themselves.^[36]

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 and Greece, the majority of teenage births occur within marriage.^[3][10]

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.^[3][60] In the UK, half of all teenagers with children are lone parents, 40% are cohabitating as a couple and 10% are married.^[61] 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.^[62]

However, "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.^[63][64] The Guttmacher Institute reports that over 40 percent 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.^[65] A 1990 study of births to California teens reported that the younger the mother, the greater the age gap with her male partner.^[66] 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.^[67]

In the arts, films and literature

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) 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) or a romantic relationship (Demi Miller in EastEnders); unusually, in Quinceañera, the central character becomes pregnant through non-penetrative sex. The drama often focuses around the discovery of the pregnancy and the decision to opt for abortion (Fast Times at Ridgemont High), adoption (Mom at Sixteen, "Juno"), marriage (Reba and Jeni, Juno) or life as a single mother (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.

Songs about teenage pregnancy include downbeat tales of abuse ("Brenda's Got a Baby"), poverty ("In The Ghetto") and back-alley abortion ("Sally's Pigeons"), as well as upbeat and defiant tunes such as "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 entitled "Baby Mama", describing the difficulty of raising a child alone with limited financial and family support. (Many U.S. radio stations would not play the song, ostensibly because it contains a profanity.) "There Goes My Life", a modern country song, focuses on the reaction of the father, who rhetorically asks, "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, "There Goes My Life" was sung at the inauguration of George W. Bush in 2005^{[citation needed]}.

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.

See also

References

• Luker, Kristin. (1996). Dubious Conceptions: The Politics of Teenage Pregnancy. Cambridge, MA: Harvard University Press. ISBN 0-674-21702-0

Articles

• "Reducing Teenage Pregnancy" by Deborah Weiss
• "I Want It Now!, or Why Becoming a Parent Should Never be Rushed" by Heather Corinna
• Congressional Research Service (CRS) Reports regarding Teen Pregnancy

Forums & support sites

• Teenage pregnancy forum
• The Young Mommies Help Site
• StandUpGirl : young mothers and pregnant teen peer support.
• Girl-Mom: online community for young mothers.
• Young Mums To Be: educational program from British teens.
• YWCA England & Wales: Respect Young Mums