Teenage pregnancy

Teenage pregnancy occurs when women under the age of 20 become pregnant. Barring both medical and physical concerns, problems of teenage pregnancy arise from individual, familial, and social factors. These include but are not limited to: culture, religion, moral values and beliefs, law, education, economic circumstances, lack of support structures such as finding access to health care, contraception, and other resources, and mental and emotional well-being.

Data supporting teen 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. Many believe that teenagers should not engage in getting pregnant until after marriage. Teenage pregnancy in developed countries is usually outside of marriage, and, for this reason, it carries a social stigma in many communities and cultures.

Global incidence

Industrialized and developing countries have distinctly different incidences of teenage pregnancy. In developed regions, such as North America and Western Europe, teen parents tend to be unmarried and adolescent pregnancy is seen as a social issue.

By contrast, teen parents in developing countries are often wed, and their pregnancy may be welcomed by family and society. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems. A report by Save the Children found that, annually, 13 million children are born to women under age 20 worldwide. More than 90% of these births occur to women living in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among girls between the ages of 15 and 19 in such areas. Mayor, Susan. (May 15, 2004). "Pregnancy and childbirth are leading causes of death in teenage girls in developing countries." British Medical Journal, 328 (7449), 1152. Retrieved July 7, 2006.

Africa

The highest incidence of teenage pregnancy in the world — 143 per 1,000 girls aged 15-19 years — is in sub-Saharan Africa. Treffers, P.E. (November 22, 2003). Teenage pregnancy, a worldwide problem. Nederlands tijdschrift voor geneeskunde, 147(47), 2320-5. Retrieved July 7, 2006. Women in Africa, in general, get married at much earlier ages than women elsewhere — leading to earlier pregnancies. In Niger, according to the Health and Demographic Survey in 1992, 47% of women aged 20-24 were married before 15 and 87% before 18. 53% of those surveyed also had given birth to a child before the age of 18. Locoh, Therese. (2000). "Early Marriage And Motherhood In Sub-Saharan Africa." WIN News. Retrieved July 7, 2006.

A Save the Children report identified 10 countries where motherhood carried the most risks for young women and their babies. Of these, 9 were in sub-Saharan Africa, and Niger, Liberia, and Mali were the nations where girls were the most at-risk. In the 10 highest-risk nations, more than one in six teenage girls between the ages of 15 to 19 gave birth annually, and nearly one in seven babies born to these teenagers died before the age of one year. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries

Asia

In South Asia, premarital sex is uncommon, but an early age at marriage means that adolescent pregnancy rates are high. 26% of Indian women aged 20-24 were married by age 15 and 71% by age 20, with a median marriage age of 16.1. The incidence of early marriage is much higher in rural India than it is in urbanized areas of the country. Knowledge and use of contraceptive methods among young married women in southern Asia is generally low. Fertility rates in South Asia range from 71 to 119 births per 1000 women aged 15-19. In India, 30% of all induced abortions are performed on women who are under 20, most of these being done in the second trimester (older women tend to have abortions in the first trimester).

Other parts of Asia have shown a trend towards increasing age at marriage for both sexes. In South Korea and Singapore, marriage before age 20 has all but disappeared, and, although the occurence of sexual intercourse before marriage has risen, rates of adolescent childbearing are low at 4 to 8 per 1000. The rate of early marriage and pregnancy has decreased sharply in Indonesia and Malaysia; however, it remains high in comparison to the rest of Asia.

Surveys from Thailand have found that a significant minority of unmarried adolescents are sexually active. Although premarital sex is considered normal behavior for males, particularly among sex workers, it is not always regarded as such for females. Most Thai youth reported that their first sexual experience, whether within or outside of marriage, was without contraception. The adolescent fertility rate in Thailand is relatively high at 60 per 1000. 25% of women admitted to hospitals in Thailand for complications of induced abortion are students. The Thai government has undertaken measures to inform the nation's youth about the prevention of Sexually transmitted diseases and unwanted pregnancy.

According to the World Health Organization, in several Asian countries including Bangladesh and Indonesia, a large proportion (26-37%) of deaths among female adolescents can be attributed to maternal causes. Mehta, Suman, Groenen, Riet, & Roque, Francisco. United Nations Social and Economic Commission for Asia and the Pacific. (1998). Adolescents in Changing Times: Issues and Perspectives for Adolescent Reproductive Health in The ESCAP Region. Retrieved July 7, 2006.

Europe

Some figures for European countries (1998):

Country	Birth rate*	Abortion rate*	% married teenage mothers
Switzerland	5.5	(not available)	61%
Netherlands	6.2	3.9	35%
Sweden	6.5	17.7	18%
Italy	6.6	6.7	55%
Spain	7.9	4.9	40%
Denmark	8.1	15.4	23%
France	9.3	13.2	15%
Belgium	9.9	5.2	42%
Greece	11.8	1.3	80%
Germany	13.1	5.3	39%
Czech Republic	16.4	12.4	47%
Ireland	18.7	(not available)	4%
Poland	18.7	(not available)	60%
Portugal	21.1	(not available)	45%
Hungary	26.5	30.2	36%
United Kingdom	30.8	21.3	10%

* per 1000 women aged 15-19

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. However, in the past, teenage mothers in Europe tended to be married, and therefore were less likely to be perceived as a social issue. Some countries, such as Greece and Poland, retain a traditional model of births to married mothers in their late teens.

The rates of teenage pregnancy may vary widely within a country. For instance, in the United Kingdom, the rate of adolescent pregnancy in 2002 was as high as 100.4 per 1000 among young women living in the London Borough of Lambeth, and as low as 20.2 per 1000 among residents in the Midlands local authority area of Rutland. In Italy, the teenage birth rate in central regions is only 3.3 per 1,000, but, in the Mezzogiorno it is 10.0 per 1000.

The U.K, which has the highest teenage birth rate in Europe, also has a higher rate of abortion than most European countries. 80% of young Britons reported engaging in sexual intercourse while still in their teens, although a half of those under 16, and one-third of those beteen 16 to 19, said they did not use a form of contraception during their first encounter. Less than 10% of British teen mothers are married and a relatively high proportion of them are under the age of 16. Adolescent pregnancy is viewed as a matter of concern by both the British government and the British press.

In contrast, the Netherlands has a low rate of births and abortions among teenagers.Compared to countries with higher teenage birth rates, the Dutch have a higher average age at first intercourse and increased levels of contraceptive use (including the "double Dutch" method of using both a contraceptive pill and a condom). Nordic countries, such as Denmark and Sweden, also have low rates of teenage birth, but their abortion rates are higher than those of the Netherlands.

In some countries, such as Italy and Spain, the low rate of adolescent pregnancy may be attributed to traditional values and social stigmatization. These countries also have low overall fertility rates.

Teenage birth is associated with disadvantages in later life. Across 13 nations in the European Union, women who gave birth as teenagers are twice as likely to be living in poverty, in comparison to those who wait until they are over 20. UNICEF. (2001). A League Table of Teenage Births in Rich Nations. Retrieved July 7, 2006.

North America

The United States, at 48.8 births per 1,000 women aged 15–19 in 2000, has the highest teen birth rate in the developed world. The rate of abortion among American adolescents is also high. If all pregnancies, including those which end in termination, are taken into account, then the total rate is 83.6 pregnancies per 1,000 girls. However, the trend is decreasing: in 1990, the birth rate was 61.8, and the pregnancy rate 116.9 per thousand. 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 Caucasians. The Guttmacher Institute attributed about 25% of the decline to abstinence and 75% to the effective use of contraceptives. Wind, Rebecca. The Guttmacher Institute. (February 19, 2004). "U.S. Teenage Pregnancy Rate Drops For 10th Straight Year." Retrieved July 7, 2006.

The Canadian rate in 1998 was 20.2 per 1000. A League Table Of Teenage Births In Rich Nations

Oceania

In 1998, Australia had a teenage birth rate of 18.4 per 1000, with only 9% married at the time of birth. New Zealand, with teenage birth rate of 29.8 per 1000, has one of the highest in the industrialized world. The rate of adolescent pregnancy is much higher among members of the Māori community at 74 births per 1000 young women. A League Table Of Teenage Births In Rich Nations

Information on sexual behaviour in the Pacific Islands is scarce. However, teen pregnancy is considered an emerging problem. In some Pacific island nations, more than 10% of the total births are among teenage mothers. Adolescents In Changing Times: Issues And Perspectives For Adolescent Reproductive Health In The ESCAP Region United Nations Social and Economic Commission for Asia and the Pacific

Causes of teenage pregnancy

Sexual intercourse between teenagers often occurs without the use of contraception. Besharov, Douglas J. & Gardiner, Karen N. (1997). Trends in Teen Sexual Behavior. Children and Youth Services Review, 19 (5/6), 341-67. Retrieved July 13, 2006. Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, perhaps because they're too embarrassed to seek it. Slater, Jon. (2000). "Britain: Sex Education Under Fire." The UNESCO Courier. Retrieved July 7, 2006. The National Campaign to Prevent Teen Pregnancy. (1997). What the Polling Data Tell Us: A Summary of Past Surveys on Teen Pregnancy. Retrieved July 13, 2006

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. More “foolproof” measures, such as Norplant, have higher preventative success rates. The use of more than one contraceptive measure decreases the risk of unplanned pregnancy significantly.

Sex among teenagers might occur under the influence of illicit drugs or alcohol; it may also be non-consensual.

Poverty is associated with increased rates of teenage pregnancy. A girl is more likely to become a teenage parent if her mother or older sister gave birth in her teens. East, P.L., & Jacobson, L.J. (2001). The younger siblings of teenage mothers: a follow-up of their pregnancy risk. Developmental Psychology, 37 (2), 254-64. Retrieved May 27, 2006. Furstenberg, F.F., Jr, Levine, J.A., & Brooks-Gunn, J. (1990). The children of teenage mothers: patterns of early childbearing in two generations

According to Jill 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".

Laurence Shaw, a U.K. fertility specialist, has suggested that, despite the social stigma attached to teenage pregnancy, women are evolutionarily-hardwired to begin bearing children during the peak fertile period of their late teens and early twenties. Lessware, Jonathan. (June 19, 2006). Pregnancy in teenage girls 'all part of nature's law'. The Scotsman. Retrieved July 13, 2006.

In some societies, early marriage and traditional gender roles are important factors in the incidence of teenage pregnancy.

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. 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. Allen, Colin. (May 22, 2003). "Peer Pressure and Teen Sex." Psychology Today. Retrieved July 14, 2006.
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 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. 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor.
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. 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.
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. 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.
36% in the 1997 PARADE survey said that an adolescent might become pregnant to satisfy a desire for unconditional love. 24% said that a girl might might also become pregnant in an attempt to retain or win back a boyfriend.

Limiting teenage pregnancies

Health educators have long argued that sex education would effectively reduce the number of teenage pregnancies. Countries that do use progressive sex education at a young age, such as the Netherlands, tend to have a much lower rate of teenage pregnancy than the United States and the United Kingdom. However, there are many confounding factors such as ethnicity, available social support systems and contraception, and so forth that make comparisons difficult. Proponents of progressive sex education hold that providing young girls with sexual information allows them to make their own choices about whether or not to get pregnant. Opponents argue that such education encourages immorality and that sexual abstinence is a more reliable way of preventing pregnancy.

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 and some argue that it has been a dismal failure. However, although teenage pregnancies have fallen overall, they have not fallen consistently in every region, and in some areas they have increased. There are also questions about whether the 2010 target of a 50% reduction on 1998 levels can be met.

Moves to increase the participation of teenage mothers in education, training or work have also met with mixed success. Schemes such as Care to Learn, which pays for childcare for teenage mothers in education, and Sure Start Plus, which provides every teenage mother in the pilot areas with a dedicated personal advisor, have been popular and have been successfully evaluated.

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. Moncloa, Fe, Johns, Marilyn, Gong, Elizabeth J., Russell, Stephen, Lee, Faye, & West, Estella. (2003). Best Practices in Teen Pregnancy Prevention Practitioner Handbook. Journal of Extension, 41 (2). Retrieved July 7, 2006.

The Dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. Subsidised by the government, the “Lang leve de liefde” (“Long Live Love”) sex education package aims to give teenagers the skills to take their own decisions regarding health and sexuality. 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. Valk, Guus. (2000). The Dutch Model. ''The UNESCO Courier. Retrieved July 7, 2006.

In the developing world, programs of reproductive health aimed at teenagers are often small scale and uncoordinated, although some countries such as Indonesia and Sri Lanka have a systematic policy framework for teaching about sex within schools. 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.

Experience of teen parenthood

Being a teenage mother can be difficult. Many face prejudice and stigma from their communities. In the United Kingdom, most teenage mothers live in poverty, and nearly half are in the bottom fifth of the income distribution. 90% of teenage parent families live on state benefits [http://www.dfes.gov.uk/teenagepregnancy/dsp_showDoc.cfm?FileName=teenpreg.pdf, but teenage mothers are entitled to approximately £20 less per week than mothers over the age of 25.

There is little evidence to support the common belief that teenage mothers become pregnant to get benefits and a 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. ^*

Being a teenage mother may be difficult, but can be successful. Teenage parents can use social services and child-care support to continue their education and get higher paying jobs as they progress with their education. Teen parents can continue their education part-time and over time "catch up" with their counterparts. Not all teen parents stay on public assistance forever. They can get educated and continue to live a "normal life".

Teenage fatherhood can also be a challenge. Many feel obliged to support their child, but due to the low levels of state benefits awarded to such couples, in addition to the low quantity of money that they often earn due to their age, are unable to do so fully. Another addition is that being a teenage father is sometimes looked down upon by society, and fellow peers.

Impact of adolescent pregnancy and parenthood

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.

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. The National Campaign to Prevent Teen Pregnancy. (2002). Not Just Another Single Issue: Teen Pregnancy Prevention's Link to Other Critical Social Issues. Retrieved May 27, 2006. Scholl, T.O., Hediger, M.L., & Belsky, D.H. (1994). Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis. The Journal of Adolescent Health, 15 (6), 444-56. Retrieved May 29, 2006. Makinson, C. (1985). The health consequences of teenage fertility. Family Planning Perspectives, 17 (3), 132-9. Retrieved May 29, 2006. Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all. 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. Guttmacher Institute. (1999, September). Teen Sex and Pregnancy. Retrieved May 29, 2006.

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. Gutierrez, Y., & King, J.C. (1993). Nutrition during teenage pregnancy. Pediatric Annals, 22 (2), 99-108. Retrieved May 29, 2006. Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries. Sanchez, P.A., Idrisa, A., Bobzom, D.N., Airede, A., Hollis, B.W., Liston, D.E., Jones, D.D., et al. (1997). Calcium and vitamin D status of pregnant teenagers in Maiduguri, Nigeria. Journal of the National Medical Association, 89 (12), 805-11. Retrieved May 29, 2006. Pena, E., Sanchez, A., Solano, L. (2003). Profile of nutritional risk in pregnant adolescents. Archivos Latinoamericanos Nutricion, 53(2), 141-9. Retrieved May 29, 2006.

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. Pregnancy and childbirth are leading causes of death in teenage girls in developing countries

Young women aged 14 and under face greater risks 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. For mothers in their late teens, age in itself is not a risk factor, and poor outcomes are associated with socioeconomic factors rather than biology.

Socioeconomic and psychological outcomes

Being a young mother can affect one's education. Teen mothers are more likely to drop out of high school. 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. Hofferth, Sandra L., Reid, Lori, Mott, & Frank L. (2001). The Effects of Early Childbearing On Schooling over Time. Family Planning Perspectives, 33 (6). Retrieved May 27, 2006.

Young motherhood can effect employment and social class. The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women. One study found that, in 1988, 60% of teenage mothers were impoverished at the time of giving birth. Levine Coley, Rebekah & Chase-Lansdale, Lindsay. (1997). Adolescent Pregnancy and Parenthood: Recent Evidence and Future Directions. American Psychologist. Retrieved May 29, 2006. Additional research found that nearly 50% of all adolescent mothers sought social assistance within the first five years of their child's life. A study of 100 teenaged mothers in the United Kingdom found that only 11% received a salary while the remaining 89% were unemployed. Social Exclusion Unit. (1999). Teenage Pregnancy. Retrieved May 29, 2006.

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 . Kalmuss, D.S., Namerow, P.B. (1994). Subsequent childbearing among teenage mothers: the determinants of a closely spaced second birth. Family Planning Perspectives, 26 (4),149-53, 159. Retrieved May 27, 2006.

Early motherhood can effect the psychosocial development of the infant. The occurrence of developmental disabilities and behavioral issues is increased in children born to teen mothers. American Academy of Pediatrics. (2001). Care of Adolescent Parents and Their Children. Pediatrics, 107 (2), 429-434. Retrieved May 29, 2006. Hofferth, Sandra L. & Reid, Lori. (2002). Early Childbearing and Children's Achievement And Behavior over Time. Perspectives on Sexual and Reproductive Health, 34 (1). Retrieved May 29, 2006. 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. Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment. Crockenberg, S. (1987). Predictors and correlates of anger toward and punitive control of toddlers by adolescent mothers. Child Development, 58 (4), 964-75.'' Retrieved May 29, 2006.

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. Daughters born to adolescent parents are more likely to become teen mothers themselves. A son born to a young woman in her teens is three times more likely to serve time in prison. Maynard, Rebecca A. (Ed.). (1996). Kids Having Kids. Retrieved May 27, 2006.

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 tolerent of non-marital and early births, in addition to being more susceptible to high-risk behaviors. East, Patricia L. (1996). Do Adolescent Pregnancy and Childbearing Affect Younger Siblings?. Family Planning Perspectives, 28 (4). Retrieved May 27, 2006. 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.