: Teenage pregnancies end in an increasing number of abortions, a declining number of placements in adoptive homes, and an increasing number of children born to unmarried teens with large public expenditures for welfare and medical care. A study estimated that the public cost of a family started by a 1st birth to a teenager in 1979 would amount to $18,710; and all such families would cost $8.3 billion to taxpayers. Children of teenage parents face poorer infant health, lower academic achievement, greater risk of socioemotional problems, and a greater probability of becoming teen parents themselves. A recent New York City study indicated that 86% of homeless families were female-headed households, 83% received public assistance, and the likelihood of their genesis from a teenage birth was high. Over the past 10-15 years US culture has become more sexualized; as a result 7 million males and 5 million females are sexually active among 26 million young people aged 13-19, and fewer than 9% of them are married according to 1981 data. By 1979, 1/3 of white and 1/2 of black unmarried 16-year old girls had experienced sexual intercourse. Only 1/3 of sexually active teenagers use contraception consistently, and only 1/2 of them used any contraception at 1st intercourse. 20% of teen pregnancies occur within 1 month of 1st intercourse and 50% occur within the 1st 6 months. Fewer than 10% of teenagers receive a comprehensive sex or family life education course in high school. Cost-effective primary prevention activities focus on delay or abstention from sexual activity, or make contraceptives available. Expensive secondary prevention programs influence teenager's decision about whether to abort, carry the pregnancy to term, or place the baby up for adoption; they attempt to prevent various negative consequences of teenage pregnancy, including low birth weight, out-of-wedlock parenting, and educational and employment disadvantages.
Researchers analyzed longitudinal data on 445 13-17 year old female teenagers who attended 1 of 9 federally funded family planning clinics in and around Philadelphia, Pennsylvania to examine individual, social, and behavioral factors of effective contraceptive use. Adolescents who effectively used birth control had already practiced effective use of contraception before coming to the clinic, were in a monogamous relationship, and performed well in school, or at least deemed themselves to be cautious if school performance was low (p=.05). Unlike results of other studies, family structure, religiosity, education level, age, career ambitions, and support of friends or family members had no significant effect on effective contraceptive use. Teenagers who stopped taking the contraceptive shortly after the 1st clinic visit had poorly used contraceptives before the clinic visit and experienced their 1st sexual intercourse at an early age (p=.05). The results indicated that clinic services which support contraception in the 1st 3-6 months after 1st visit help the adolescents to surmount difficulties in establishing successful use. Social and performance factors had more of an effect on adolescents who had constantly used contraception for =or 6 months. They tended to have infrequent intercourse, dated occasionally, and, for those who did not do well in school, considered themselves to be risk takers. Favorable attitudes toward contraception were positively associated with continuous contraceptive use (p=.05). Identifying factors of effective contraceptive use helps professionals to evaluate an adolescent's risk status.
Of more developed nations, the US is unique in its problem with high rates of teen pregnancy. At the heart of our failure to check teen pregnancy may lie the country's poor sexual climate, a lack of government commitment, poor health system performance, local barriers to the provision of quality sex education, and/or lack of access to contraception. Potential solutions to reduce teen pregnancy are equally wide-ranging. Programs may aim to provide better and more health and sex education, improve decision making skills, improve access to contraception and abortion, improve life opportunities as alternatives to pregnancies, restructure welfare, and/or encourage youths to refrain from premarital sex. This essay presents and discusses major prevention efforts which seem to have the highest probability of reducing pregnancy rates, and especially childbearing rates among young, unmarried teens. Literature on program successes, agency reports, and program observations are reviewed, and include programs of sex education and skills enhancement, those helping sexually active youths become better contraceptors, and those which offer life option alternatives. In the area of improving access to contraception, school-based clinics, condom distribution, and other male-oriented programs are covered. Major social structural change is, however, called for with a view to promoting equity in education, housing, and jobs. Short of such change, interventions may target school-based populations, as well as community centers to reach dropouts. Early intervention and collaboration to bolster health, social, and recreational services for children and adolescents is urged.
Contraceptive methods have helped to reduce the incidence of unwanted pregnancies among married women over the past few decades. Rates for teenagers have not, however, declined commensurately. Instead, greater premarital sex has led to more conceptions and births among teens. Developmental hypotheses suggest that poor teenage contraceptive use stems from characteristics intrinsically related to young age. Situational hypotheses, however, posit that life conditions complicate and impede the adoption of an effective contraceptive program. Social proscriptions against teen sex, the sporadic, unplanned, nature of teen sexual encounters, limited knowledge at the onset of 1st sex, and limited mobility and access to contraception are such life conditions. This essay considers both developmental and situational interpretations of teen contraceptive practice. Factors discussed related to contraceptive use include race and socioeconomic status, marital status, educational aspirations, religion, knowledge of fertility and contraception, attitudes and beliefs about contraception, personality factors, influence of parents, peers, and partners, and age. Adults and teens are found to have similar determinants of contraceptive behavior. Contraceptive use behavior differences between adults and teens may therefore exist because sexually active teens are disproportionately represented in demographic groups most likely to take risks. Adolescents being generally single, of low personal income, and increasingly members of single parent homes, share demographic circumstances of adults who are also more prone to risk-taking behavior. Limited knowledge of contraceptives and comparatively high levels of sex guilt further predispose youths to taking risks. Teenagers are therefore more likely to experience as a group those factors predisposing them to early sexual initiation and poor contraceptive use, thereby suggesting a situational interpretation of age differentials in contraceptive use. Adults similar to teens in adult life are similarly likely to take contraceptive risks.
The Project Redirection demonstration, designed and managed by the Manpower Demonstration Research Corporation (MDRC), shows that comprehensive programs for disadvantaged school-age mothers can make a difference in improving employment, welfare, and child-related outcomes. During the main research phase. Project Redirection operated at four locations across the country, serving an ethnically mixed group of pregnant teenagers and mothers who were 17 or younger, lacked a high school diploma, and were receiving or eligible for AFDC. The program linked enrollees with existing educational and health services and supplemented these with workshops on parenting, employ ability, and life management, and with group and individual counseling. It also paired teens with adult “community women”, who were mentors, role models, and friends. The study entailed a relatively large sample, carefully chosen comparison group, and efforts to survey program dropouts as well as enrollees. At the 5-year point, when sample members were almost 22 years old on average. Project Redirection participants were more likely to be employed than members of the comparison group (34% vs. 59%). In addition, participants showed increased parenting skills, and their children experienced cognitive gains and exhibited fewer behavioral problems. However, at the 5-year mark, fewer than half the Project Redirection participants had a high school diploma, half were receiving AFDC, and only a third were working. Equally disheartening is the fact that household income averaged only $737 a month, and the majority were living in poverty. While comprehensive programs can help young mothers move toward self-sufficiency, further interventions are needed if more young mothers are to attain that goal, and to ensure a decent standard of living for themselves and their children.
