JOURNAL - International Childbirth Education Association

STATIS-
by Dale King
Teenage Pregnancy
A recent report from the Center for Disease Control and
Prevention (1998) indicates that teenage pregnancy in
the United States has decreased since the beginning of
the 1990s. The 1996 birth rate among teenage mothers,
the number of births per 1,000 teenage women, fell 3
to 8% depending on the age specific subgroup. Among
teenage women 15 to 19 years of age, the 1996 birth rate
fell 4% from the previous year and 12% from 1991. The
decline in the American teenage birth rate was pervasive,
occurring in all of the fifty states, the Virgin Islands, and
the District of Columbia. In only three states, Delaware,
Rhode Island, and North Dakota, was the decline statistically
insignificant. This decline follows the sharp increase
in the birth rate that occurred from 1986 to 1991 when
the teenage birth rate increased 24%.
Between 1995 and 1996, teenage birth rates declined
for all racial and ethnic groups with the exception of the
Cuban teenage birth rate which increased from 29.2 to
34.0 births per 1,000 Cuban teenage women. The greatest
decline from 1991 occurred among non-Hispanic black,
Puerto Rican, and other Hispanic teens. These groups
experienced a decline in the birth rate of approximately
20%.
Despite recent declines in the teenage birth rate, it
is still true that more than one million teenagers in the
United States become pregnant each year. In recognition
of this fact, the American Academy of Pediatrics reiterated
their 1989 statement on Counselling the Adolescent About
Pregnancy Options (1998). The statement is intended to
serve as an objective guide to the pediatrician who must
diagnose and then counsel the pregnant adolescent.
Counselling must be comprehensive as to the adolescent’s
alternatives and throughout the counselling the pediatrician
must not impose his own beliefs and values. If the
pediatrician feels that he cannot objectively present an
alternative to the adolescent, he should refer the adolescent
to other experienced professionals. Adolescents have legal
rights protecting their privacy and the pediatrician must be
aware of and respect those rights. Confidentiality laws may
vary depending on the locality, and the pediatrician should
be informed of these laws. The law allows the pediatrician
to inform the appropriate government agency when he
suspects sexual abuse. Widom and Kuhns (1996) studied
the impact of early childhood victimization on teenage
pregnancy, subsequent prostitution, and promiscuity. Using
1967 through 1971 criminal court records from a Midwest
jurisdiction, the authors were able to identify 908 cases of
the abuse or neglect of a child 11 years old or younger.
The 908 cases of abuse or neglect were matched with a
control group based on race, gender, and age. Identification
of the members of the control group was achieved
by reviewing county birth records. The final stage of the
study, occurring as much as 20 years after the incident of
abuse or neglect, was to contact and interview members
of both groups to determine their subsequent sexual and
obstetric history. Contrary to other studies, the authors did
16 • IJCE Vol. 13 No. 4
not find early childhood victimization to be a precursor
to teenage pregnancy. In their concluding discussion, the
authors argue that teenage pregnancy may be the result
of other factors such as family size, income, and parental
education and employment status. Thus, determining the
factors that tend to cause teenage pregnancy depend
upon the design of the study. Secondly, the authors
caution that their study may underestimate the extent of
teenage pregnancy since it did not include pregnancies
that ended in abortion or miscarriages. The birth record
data and the final interviews may not have provided this
information.
Brown-Peterside and Laraque (1997) describe a New
York City hospital-based educational program designed
to increase teenage awareness of contraception and the
impact of pregnancy on the teenager’s life. The first step
was to build a coalition of community groups that would
serve as a working group to guide the program and
sponsor a series of workshops. The workshops featured
community speakers who provided neighborhood adolescents
information on health-related topics. Over 1,000
flyers were distributed to adolescents informing them of
services provided within the hospital. A centerpiece of
the program was a computer game designed to entertain
and instruct the players about the realities of teenage
pregnancy. Based on a questionnaire, the researchers were
able to determine that 91% of the adolescents participating
in the program demonstrated increased awareness of
the costs of having a child and were more likely to value
contraception. The working group was able to achieve
sufficient success that it received the Community Access
to Child Health grant to establish an adolescent health
center and increase its provision of services. The Center
for Disease Control and Prevention report indicates good
news — teenage pregnancy is on the decline after having
increased sharply. What caused the initial increase and
the subsequent decline may not be completely known
and will have to be left for further research. Perhaps, one
way of preventing an unwanted teenage pregnancy is to
educate the adolescent before she becomes sexually active.
In many cases, education is the key to guiding human
behavior and teenage sexuality and pregnancy may be
one of these behaviors.
References
American Academy of Pediatrics, Committee on Adolescence. 1998.
Counselling the adolescent on pregnancy options. Pediatrics 101,
no. 5: 938-940.
Brown-Peterside, P., and D. Laraque. 1997. Notes from the field. A
community research model: A challenge to public health. American
Journal Of Public Health 87, no. 9: 1563-1564.
Ventura, S., J. Martin, S. Curtin, and T. Matthews. 1998. Report of final
natality statistics, 1996. Monthly Vital Statistics Report 46, no. 11.
Hyattsville, Maryland. National Center For Health Statistics.
Widom, C., and J. Kuhn. 1996. Childhood victimization and subsequent
risk for promiscuity, prostitution, and teenage pregnancy;
a prospective study. American Journal Of Public Health 86, no. 11:
1607-1611.