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ADOLESCENT PREGNANCY AND CHILDBEARING:
AN EMERGING RESEARCH FOCUS
Cheryl D. Hayes
In the past decade, teenage pregnancy and childbearing have become
issues of broad public concern. Approximately 1 million adolescent
girls become pregnant in the United States every year. While about
400,000 of them obtain abortions, nearly half give birth. The majority
of these births are to unmarried mothers, nearly half of whom are under
age 18.
The United States leads all other Western developed countries in its
rates of adolescent pregnancy, abortion, and childbearing, even though
the age of initiation and rates of sexual activity in these countries
are comparable. The difference is most striking among the youngest
teenagers, those under age 15, who are more than five times as likely
to give birth as girls in any other developed country of the world.
Almost any newspaper or popular journal reminds one of these
disturbing facts. The news media has stressed the epidemic nature of
adolescent pregnancy. Despite the fact that birth rates among
teenagers have actually declined somewhat since 1970, policy makers,
professionals, parents, and researchers have debated the meaning of
these social and demographic trends and have repeatedly called for
immediate responses to the "impending crisis." As a result, the past
decade has witnessed an enormous growth in efforts to understand these
changing social and demographic patterns. Policies and programs to
prevent untimely and unintended pregnancies among teenagers and to
overcome the frequently negative social, economic, and health
consequences of early childbearing and parenting have also expanded.
The process has been iterative. In some cases knowledge has spurred
public decision making and the initiation of interventions; in others,
the need for action has highlighted and motivated the need for more and
better information about factors affecting these behaviors and their
outcomes.
Efforts to increase knowledge in these areas have been supported
both by federal agencies as well as private foundations. In the
mid-1970s, the Center for Population Research within the National
Institute of Child Health and Human Development (NICHD) targeted
adolescent pregnancy as a priority for research support. Over the past
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decade, the center has administered a broad program of research,
including the collection of national survey data on adolescent
sexuality, contraceptive use, and pregnancy resolution, as well as
analyses of the antecedents and outcomes of these sensitive behaviors.
Since 1982, the Office of Adolescent Pregnancy Programs (OAPP) has also
supported an array of studies of familial, institutional, and societal
influences on early sexual behavior and adoption, as well as the
provision of services to pregnant and parenting teenagers. Notably
absent from the OAPP agenda, however, have been studies of factors
affecting contraceptive use and ways to encourage more diligent use
among teenagers who are sexually active.
Several private foundations have also played a key role in research
and development to address the problems of adolescent pregnancy and
childbearing. The Ford Foundation, with a commitment to reduce poverty
and ameliorate its devastating effects on minority populations, began
in the late 1970s to support several studies of black-white differences
in teenage sexual and fertility behavior, the link between early
childbearing and welfare dependence, and international comparisons. In
partnership with the U.S. Department of Labor, the Ford Foundation
initiated a comprehensive services model to enhance the employability
and economic self-sufficiency of teenage mothers. The Rockefeller
Foundation and the Hewlett Foundation, because of their strong interest
in international family planning issues, also began to support research
and demonstration activities aimed at exploring factors affecting
teenage fertility and ways of enhancing young people's knowledge and
use of contraception. Similarly, the Charles Stewart Mott Foundation,
because of its commitment to improving the plight of disadvantaged
groups, targeted teenage parents as a population in need and
established its Too Early Childbearing network of innovative
community-based programs to enhance the well-being of teenage mothers
and their children. More recently, the W.T. Grant Foundation, because
of its interest in adolescent development, the Robert Wood Johnson
Foundation, the Glenmede Trust, and the Kaiser Family Foundation,
because of their interests in health promotion, and the Carnegie
Corporation, because of its interest in the prevention of harm to
children, have initiated and supported a variety of research and
demonstration activities aimed at pregnancy prevention.
In addition, in the past several years, a number of local
foundations, sometimes independently and sometimes in partnership with
larger national foundations, have supported the initiation of a variety
of community-based programs to help reduce the incidence of pregnancy
among teenagers and to support the special needs of pregnant and
parenting teenagers. Recently, many of these have been specifically
aimed at strengthening state and local responses.
As a result of these public and private initiatives, there has been
a significant expansion of knowledge about adolescent pregnancy and
childbearing from a variety of sources. Despite some inconsistencies
among these data sets, we now have generally reliable estimates of
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sexual activity, including age of initiation, frequency of intercourse,
and partners. Similarly, knowledge of contraceptive use has also
increased, including the timing of initiation, methods chosen, patterns
of use, and contraceptive failure. Information concerning pregnancies
and abortions is believed to be less reliably reported in surveys than
that concerning sexual activity and contraception, and therefore
estimates of these behaviors should be viewed with greater caution.
Data on births, including the type of delivery and the health status of
mother and baby, are highly reliable, as are data concerning marriage,
educational attainment, and employment status. In contrast,
information concerning adoption appears to be the largest gap, since
there is currently no national reporting system to collect data on
adoptions, including characteristics of the biological mother and
father. Although other problems affect current understanding of
adolescent pregnancy and childbearing, including the lack of
consistency with regard to race and ethnicity across data sources and
the difficulty of obtaining information about males and very young
teenagers, knowledge about trends in teenage sexual and fertility
behavior has greatly improved over the past decade.
Similarly, the number and sophistication of studies concerning the
consequences of early pregnancy and childbearing have increased
dramatically. The variety of social, economic, and health outcomes
have been carefully and convincingly documented. We know with
certainty that, for the majority of teenage parents and their children,
the prospects of a healthy and independent life are significantly
reduced. In the absence of adequate nutrition and appropriate prenatal
care, teenage mothers are at a heightened risk of pregnancy
complications and poor birth outcomes. They are also at a heightened
risk of experiencing a subsequent pregnancy and birth while still in
their teens. The infants and young children of teenage mothers
experience greater health and developmental risks, for example low
birthweight, infant mortality, disease and accidents, low IQ, poor
school performance, and a variety of social and emotional problems.
Teenage marriages, when they occur, are characterized by a high degree
of instability. Teenage parents, both male and female, all too often
suffer reduced educational attainment and a related limitation of
career opportunities. They are at a heightened risk of becoming
dependent on public assistance and remaining dependent for longer
periods than their peers who delay childbearing into their twenties.
And perhaps most disturbing of all, the children of teenage mothers are
themselves more likely to become pregnant and give birth as teenagers.
Society's economic burden in maintaining these families is
substantial--an estimated $16.65 billion in federal outlays for Aid to
Families With Dependent Children (AFDC), food stamps, and Medicaid
alone in 1985.
Knowledge of the antecedents of early pregnancy and childbearing has
also grown. A variety of conditions and circumstances have been shown
to be associated with these behaviors. Among the most significant are
social and economic disadvantage. Young people growing up in families
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that have known sustained poverty, whether in urban ghettos or rural
areas, become sexually active at a younger age and are therefore at
heightened risk of early pregnancy. Those who have grown up in
fatherless families and those whose mothers began their own
childbearing as a teenager are at a heightened risk of experiencing an
untimely and unintended pregnancy. Those who attend racially isolated
schools and live in poor, segregated neighborhoods in which early
childbearing and single parenthood are familiar patterns are more
likely to become sexually active at a young age and experience a
pregnancy than are young people living and going to school in more
prosperous and racially diverse environments. Moreover, teenage girls
who are experiencing academic problems, who have low academic and
career expectations, and particularly those who have dropped out of
school, appear to be at a heightened risk of becoming pregnant. The
younger an adolescent girl is at the time of sexual initiation, the
more likely she is to experience a pregnancy as a teenager, both
because her exposure to the risk of pregnancy is more prolonged, and
because she is more likely to delay obtaining a contraceptive method
and less likely to use it effectively, if at all.
In the growing number of studies of factors affecting the initiation
of sexual activity and contraceptive use, these antecedent conditions
have frequently been shown to be associated with teenage pregnancy.
But correlation does not establish causation. Although we know with
certainty that they go hand in hand, we do not have sufficient evidence
to declare that poverty, poor school performance, growing up in a
fatherless family, or having a mother who had her first baby as a
teenager is a direct cause of adolescent pregnancy.
Knowledge of how to reduce the incidence of early, unintended
pregnancy and of how to overcome the negative effects of an early birth
is far less firm than knowledge of the antecedents and consequences of
teenage pregnancy and parenting. The number and variety of preventive
and ameliorative interventions has increased dramatically since the
mid-1970s. Yet knowledge of what works, for whom, under what
circumstances, with what effects, and at what costs has not kept pace
with understanding of the behaviors these programs are intended to
influence.
In part this is because many programs have been launched by creative
and enthusiastic service providers who lack the necessary research
skills and financial resources to include evaluation in their program
design. In addition, the evaluation of human service programs poses
numerous theoretical, methodological, and practical problems that
inhibit researchers and affect the quality of the results that are
obtained. Program evaluations have been scarce, and studies have often
failed to identify and examine the range of relevant direct and
indirect outcomes. Thus, for example, we don't know the effects on
teenage pregnancy rates of interventions to boost school achievement,
because fertility outcomes typically have not been studied in assessing
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education programs. In addition, the quality of the results obtained
from evaluations of adolescent pregnancy programs has been highly
variable, and few impact studies, even those that have been
methodologically strong, have been continued over a sufficient period
of time to reveal long-term outcomes. As a result, this body of
research has frequently failed to yield a firm scientific base on which
to build policies and programs. The costs, effects, and effectiveness
of few interventions have been clearly demonstrated, although there are
two notable exceptions: programs to encourage contraceptive use among
sexually active teenagers have been shown to reduce the rate of
pregnancy among program participants; and programs to provide prenatal
care to pregnant teenagers have been shown to reduce the incidence of
pregnancy complications and to improve birth outcomes for young mothers
and their babies.
Yet program research has provided numerous insights concerning
interesting and potentially promising approaches to prevent untimely
and unintended pregnancies and to enhance the well-being of adolescent
parents and their children that merit further development and
evaluation. Among the most promising are programs to enhance life
options, those intended to motivate teenagers to avoid pregnancy and
parenting at this stage in their lives, by enhancing their academic
performance, employability, and goal setting skills. Programs to
encourage teenagers to delay sexual initiation similarly require
further development and evaluation as a basis for future policy
decision making.
The chapters of this volume contain the background papers that
informed the deliberations of the Panel on Adolescent Pregnancy and
Childbearing and support many of its conclusions concerning the current
state of knowledge. Chapters 1 through 4 present detailed reviews of
the research on factors affecting adolescent sexual decision making,
including the initiation of sexual activity, contraceptive use, and
pregnancy resolution. Chapters 5 through 8 review the scientific
evidence on the short-term and long-term social, economic, and health
consequences of early sexual activity, pregnancy, childbearing, and
parenting. Chapters 9 and 10 review evidence concerning the costs,
effects, and effectiveness of alternative programs. The tables
referred to in Chapters 1-10 are found in the statistical appendix.
Each of these chapters presents an analytic overview and summary of
the available research. Each also includes a critique of the research,
speculations about its meanings, and suggestions for needed research,
as well as some implications of findings for policies and programs.
The authors were selective in their presentation and review of
studies. Some, including published articles and books, were judged to
be methodologically inadequate, and their inclusion was deemed
inappropriate.
The appendix to the volume contains a detailed statistical
compilation of data on adolescent sexual and fertility behavior from a
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variety of sources. Many of these tables have been published
elsewhere; others present special analyses of existing data
commissioned by the panel to answer key questions that arose in the
course of its study. Each table is accompanied by a brief narrative
highlighting the key points that emerge from the data.
Taken together, these papers and the statistical appendix represent
a valuable resource for researchers, policy makers, and program
designers, who regularly need information on trends in teenage sexual
and fertility behavior, on the antecedents and consequences of
pregnancy and childbearing among teenagers, and on the costs, effects,
and effectiveness of alternative programmatic strategies.
Representative terms from entire chapter:
sexual activity
