In societies where girls in their early teens are given by their parents to be married to older men, teen pregnancy is not considered a problem. However, often, these girls have too-early pregnancies that result in severe damage to sexual and internal organs.
The problem of teen pregnancy is also not as troubling in Nordic countries or in the Netherlands where a strong healthcare system guarantees confidentiality, a non-judgemental approach, and support. Among developed nations, the highest teen pregnancy rates are in the United Kingdom and the USA and the lowest in Japan and South Korea. In the United Kingdom, poverty is a prominent factor, as about one-half of all teen pregnancies occur in the 30% most deprived families while 4% occur among the least deprived (http://wikipedia.org/wiki/Teenage/pregnancy). In the USA, 85% of teen pregnancies are unplanned. Rape in war-torn regions is often a deliberate act of armed aggressors that results in teen pregnancy. In South Africa, 11–20% of teen pregnancies are reported to occur as a direct result of rape. Schooling suffers, as about 50% of US teen mothers get a high school diploma by age 22, compared with 90% of girls who do not give birth. Costs to taxpayers are in the billions each year as the children are more likely to be born prematurely, do poorly in school, to drop out, and about 30% more likely to become teen parents themselves (http://blog.rwjf.org/public health).
What other factors are associated with high teen pregnancy? What are the risks and consequences for the mother and for the child? Are the risks of adolescent pregnancy the same for all teen parents? What supports and social policies are needed that could reduce rates of teen pregnancy? So many questions!
Media, peer, and family influences as risk factors
Media portrayals influence teen sexual behaviours. Glamorous television and magazine shots of ‘famous’ pregnant teens influence teens to engage in sexual activity and become pregnant themselves. Some teens decide to get pregnant so they can drop out of school. Girls who have lived in foster care have double the teen pregnancy rate of peers outside the foster care system. Girls whose fathers are in the home as they grow up are less likely to become teen parents. Ignorance of effective contraceptives leads to teen pregnancy. Some teens get pregnant in order to force a sexual partner into more commitment. Some are defiantly rebelling against what they perceive as overly strict parental rules. Some are engaged in sexual behaviours but lack knowledge about how to obtain contraceptives to prevent pregnancy, while others are pressured by their sexual partners not to use condoms.
Thus, many factors are involved in teen pregnancy and many strategies need to be considered in attempts to decrease rates (Honig, 1984Honig, A.S. 1984. Developmental effects on children of pregnant adolescents [research review]. Day Care and Early Education, 12(1): 36–42.). The biggest risk for teen mothers is delaying prenatal care. In the USA, ‘7.2% received no care at all’ (Weiss, 2011Weiss, R.E. (2011, December 22). Teen pregnancy. Retrieved fromhttp://pregnancy.about.com/od/teenpregnancy/A Teen-Pregnancy.htm). Some reasons for lack of care are teen denial of the pregnancy and fear of telling parents. Very young teens have a higher chance of pregnancy and birth complications. So do teens who smoke, since birth weights are lower for smoking mothers. In a UK study, mothers who smoked prenatally had children with lower reading scores in the fourth grade; and the more packs smoked during pregnancy, the stronger the difficulties later on. Drug use is another high-risk factor for difficulties in birth outcomes for pregnant women. The Kaiser Permanente Early Start programme in California helps women stop substance abuse during pregnancy and estimates that such prenatal intervention programmes could save $2 billion annually (http://www.drugfree.org/join-together/addiction/program-for-pregnant-women-at risk).
Vignettes of teen pregnancy
Betty, 15 years old, was never given much adult supervision. Her mother was busy with her own life and boyfriends, who came and went in the apartment. One summer night in a local park, Betty had sex with an older boy who said ‘Oh Baby, you're the best. I'm so hot for you!’ Betty believed all the ‘wonderful’ sayings and found herself pregnant while still in junior high school. Frightened, she hid the pregnancy from her mother until it was too late. She felt totally unprepared to care for a baby. One weekend, she left her baby at her mother's apartment and went off with an older boy who had a car and promised her a good time. During that weekend, someone raped the five-month-old. Social Services was called in. Nobody would tell exactly what had happened, and the baby was removed into foster care.
Ginny had her baby while she was still in high school. Her worried parents did everything they could to care for the baby so that Ginny could finish school and get a high school diploma. Ginny resented their ‘taking over’ her baby, even though she was in school all day and also had lots of homework assignments. Ginny longed for a baby who would ‘love me more than anyone’. She became pregnant again and explained defiantly: ‘This next baby will be mine, not theirs!’
Tanisha started to have sex quite early in high school. However, she and her boyfriend were using condoms. Yet, when a condom broke, Tanisha became pregnant. Worried about her need to finish school and feeling not ready at all to care for a baby, Tanisha decided to have an abortion and she prayed that her mother would give consent.
Carol had her baby while in high school and felt lucky that during the day there was a nursery right on the school grounds that cared for babies of students and of teachers. Carol lived with her boyfriend but complied bitterly that she had to ‘get after him’ all the time because he would not change diapers or get up at night to give the baby a bottle. They fought a lot and her boyfriend went out most nights to drink beer with friends and escape what he called her ‘nagging’. The relationship was rocky. A school programme for pregnant and parenting teens was helpful in giving Carol more ‘talking tools’ to learn how to communicate her needs and the baby's needs with her boyfriend.
Alana and Hugo had been dating in high school. She got pregnant a few months before graduation. Because her parents were supportive, Alana was able to get help with her baby and enrolled in a community college as well as working in a part-time job. She felt fortunate, because Hugo had already gone off to college and met another lady to love.
Mary, age 20, told me that years ago her mother had said she ‘would kill me if I got pregnant.’ Mary revealed that she did not know as a very young teenager that the ‘fooling around’ she and her boyfriend were doing could cause pregnancy. And she had a baby at 13 years. Mary's mother had never told her about human sexuality or pregnancy. She could have explained about sexual matters calmly to her daughter. She might have lightened her talk with a humorous observation that human females are so often fertile, unlike a baboon. This primate nurses her baby for two years and does not develop the large red rear end that signifies to a male baboon her fertility and readiness for mating until those two years are completed.
What aspects of adolescent thinking lead to unplanned pregnancy?
Piaget theoretically explained that, by the age of puberty, adolescents are capable of operating at the stage he called ‘formal operational thinking’. Piaget defined this stage as one where a person becomes increasingly capable of engaging in logical thought, able to make hypotheses, able to think about abstract ideas as well as concrete objects, able to classify symbols now as well as objects, and able to reason hypothetically, such as: ‘If I give in and have unprotected sex with Jim, then I might get pregnant’. Adolescents in this stage should be able to look ahead and think through multiple outcomes to a given course of action, and this should enable them to make wiser choices.
Yet many adolescents are far from being able to engage in formal reasoning about their sexual lives and urges or their social interactions. They spend hours on tweets and twitters and send frequent text messages. Teens struggle to adjust to the amazing sexual changes in their bodies as the voice deepens, hair grows near the genitals and sexual fantasies and interest in sexual ventures pervade thoughts daily. The Kinsey report years ago taught that the peak age for orgasm for males is during the late adolescent years, although the peak age for females was reported as age 29. A disconcerting difference!
Further, egocentrism takes centre-stage in adolescent lives. A teenager agonises over some pimples on his face while believing that the whole world is noticing these and will be laughing at him. This fantasy of an ‘Imaginary Audience’ is particularly strong during the teen years. A girl might obsess about her weight or her breast size; a boy may spend hours re-combing his wavy locks in front of a mirror. A teen may feel that other people are as concerned or even more interested in his or her appearance as is the teen. Obsessed about being a ‘Queen bee’ in her school, one girl explained that she wanted to have sex with the guys in her school who are sport ‘jocks’, as she would then be the envy of all the most glamorous girls in her school.
Another teen fantasy is called ‘The Personal Fable’. Teens think of themselves as impervious to the ills of others. They can show off and take risks, both physical and sexual, that lead to distressing, dangerous, even fatal, consequences. And yet teens still believe that they are invulnerable. They drink and then drive fast without believing that they would ever be killed in a car crash. Teens assume that sexually transmitted diseases and unwanted pregnancies are something that happens to others but not to them. They feel invincible and invulnerable.
What can parents and schools do?
Provision of sexuality information
Children need ‘askable’ adults in their lives! From an early age, parents often avoid even labelling sexual parts. Sitting in the bath tub, young children hear parents label face, tummy, arms and toes as they are washed. But the parent neglects ever to give a name to a child's testicles, vulva, nipples, penis, or scrotum as body parts. From an early age, children should become comfortable with the names of all their body parts and also become comfortably knowledgeable about body part similarities and differences between boys and girls (Gordon, 1983Gordon, S. 1983. Girls are girls and boys are boys: So what's the difference?, Fayetteville, NY: Ed-U Press.; Honig, 1978Honig, A.S. 1978, April. What we need to know to help the teenage parent. The Family Coordinator, 27: 113–119.).
Children do not become sexually active earlier from knowing the correct names of body parts and functions. Indeed, they seem to accept those names as naturally as they accept the names of other parts of the body. An example: once, while caring for a friend's older toddler and after I had put her to bed, the child climbed out of her crib and came into the living room. She informed me indignantly ‘I hurt my 'gina climbing out!’. I soothed her feelings, said I was sorry she had hurt her vagina, explained it was bedtime, and helped her to get back to sleep peaceably.
Alcohol and teen pregnancy
Heavy drinking can lead to teen pregnancy. Teachers in a health course for teens need to explain clearly how different the brain is when a teen drinks heavily. Weekend drinking contests are frequent for some teens. The teenage brain seems to be less reactive to alcohol's short-term effects. Yet, for teens, alcohol impairs the memory system in the hippocampus and severely limits the ability of the frontal lobes to carry out thoughtful and logical thinking. ‘Without mature frontal lobes, young people are less able to weigh negatives consequences and inhibit impulsive behavior like binge drinking … Binge drinking can lead to unsafe sex and unwanted pregnancy’ (Paturel, 2011Paturel, A. 2011/12, December/January. Buzz kill. How does alcohol affect the teenage brain?. Neurology Now, : 23–28./12, pp. 24 and 26). A teen couple came to ask me whether the beer party they had attended a few weeks before where they had more than 12 beers each would affect the embryo of an early pregnancy they now found themselves facing, a few weeks after that party.
Adolescent hormonal changes
As children approach puberty, adults need to talk with them honestly about the surges of hormones they experience, the strong emotions and sexual feelings and thoughts that feel so invasive at times. Schools need to develop honest and matter-of-fact courses on human relationships that include sexuality topics. Such courses can become a vehicle for helping to decrease the rate of adolescent unwanted pregnancies. In these classes, respect for each person's ‘private parts’ and personal decisions would be emphasised along with specific information about sexuality and pregnancy.
Young teens believe seductive ‘lines’ that lead to unprotected sex. Teachers in health and in social studies classes need to discuss openly the ‘lines’ (which may well be lies) that a teen gives a peer to pressure her for unprotected sex (e.g. ‘Baby, show me that you really love me’). Youth need to role play how to respond to such pressures. Teens also need clear and specific understandings of how the reproductive system works, what contraceptives are, and what is the efficacy of each contraceptive method. This teaching can be done in a climate where teachers do not speak either for or against premarital sex, but do present knowledge that every concerned and responsible citizen should know.
Teachers need to answer questions about masturbation honestly. Some parents have told kids that they will ‘go blind’ if they masturbate. Dr Alfred Kinsey, who pioneered books on sexual behaviours of adults in the USA, related, in his autobiography, the sadistic ways his father had treated his body in response to finding out about young Kinsey's masturbation. Teachers need to make clear that masturbation is natural, ubiquitous, and a far safer way to relieve sexual tensions than casual unprotected sex. Of course, teachers and mentors also need to be alert to the finding that compulsivemasturbation may well be a signal of children having been sexually violated earlier (Honig, 2002Honig, A.S. 2002. Secure relationships: Nurturing infant/toddler attachment in early care settings, Washington, DC: National Association for the Education of Young Children.).
Attention is required for teen fathers
Teen fatherhood is rarely discussed. Many adolescent fathers do not stay with the teen mother. This leads to an aching void in the lives of many children who feel the longing for a father's nurturing presence (Honig, 2010Honig, A.S. 2010. Little kids, big worries: Stress-busting tips for early childhood classrooms, Baltimore, MD: Paul H. Brookes.). Even more worrisome is the finding, in the USA, that for almost two-thirds of teen births the father is an adult man 20 years or older. Some programmes do address the problem of teen fatherhood (National Campaign to Prevent Teen & Unplanned Pregnancy, n.d.National Campaign to Prevent Teen and Unplanned Pregnancy. (n.d.). Teen pregnancy and responsible fatherhood. Retrieved fromhttp://www.thenationalcampaign.org/why-it-matters/pdf/fatherhood.pdf). Teachers need to choose a course name that is attractive to adolescent males as well as females. One teacher called her class ‘How to keep a bachelor pad’. That title attracted males as well as females into the class.
Early sexual abuse and later teen pregnancy
Sexually abused children are more likely to become pregnant as teens. Some children, long before puberty, have unfortunately experienced sex from pressuring and predatory older adults who threaten them to secrecy. One client told me that her older cousin had sexually abused her from age five to 11 and threatened her never to tell her parents or they would be harmed. Her parents were educated, kind people. But her fear and ignorance kept the child from telling of those violations for years. Teachers of young children would do well to select appropriate book materials that explain sexual differences in boys and girls (Gordon, 1983Gordon, S. 1983. Girls are girls and boys are boys: So what's the difference?, Fayetteville, NY: Ed-U Press.; Gordon & Gordon, 1974bGordon, S. and Gordon, J. 1974b. Did the sun shine when you were born?, Fayetteville, NY: Ed-U Press.). They also need to select books that can help children who may have been violated sexually find the courage to ask for help from trusted adults, such as a school nurse (Gordon & Gordon, 1974aGordon, S. and Gordon, J. 1974a. A better safe than sorry book, Fayetteville, NY: Ed-U Press.).
Early prevention: encourage early parental nurturing care
Nurturing, affectionate relationships between very young children and their special adults provide an inner sense of positive self-worth (Honig, 2002Honig, A.S. 2002. Secure relationships: Nurturing infant/toddler attachment in early care settings, Washington, DC: National Association for the Education of Young Children.). Children who have been tenderly cared for and had their distress signals promptly and accurately attended to during the early years are then less likely as teens to be vulnerable to pressures for unwanted/ unsafe sex. Secure early attachments to parents and other special adults protect children against later feelings that lead them desperately to seek ‘love’ from casual sexual encounters that may result in pregnancy. Teens need to feel loved just as much as younger children! Feeling unloved, with too-busy parents, a teen may readily accept the advances of a male seeking a ‘hook-up’ – as teens often call a ‘casual’ sexual occurrence – and then she may find herself with an unwanted pregnancy. The growth of a trusting relationship with open communication between children and parents makes it easier for a child to share worries about pressures for early sex or unwelcome behaviours by others. Newspapers and magazines often have columns addressing concerns of lovelorn adults. They also need columns advising parents to keep open genuinely caring communication channels with children at all ages. Teenagers who have open communication with their parents are more likely to delay the onset of sexual activity, more likely to use birth control, and to have fewer sexual partners (National Campaign to Prevent Teen Pregnancy, 2003National Campaign to Prevent Teen Pregnancy. (2003, September). Teen parents most influence their sexual decisions. New polling data and ‘Tips for parents’ released. Retrieved fromhttp://www.Teenpregnancy.org.about/announcements/pr/2003/release9_30_03.asp).
The media and promotion of teen sexuality
Cyberspace access has increased worrisome behaviours. Bullying of teens in schools over sexual orientation or actions has led to teen suicide and coercions for sex (Garbarino & DeLara, 2002Garbarino, J. and DeLara, E., eds. 2002. And words can hurt forever. How to protect adolescents from bullying harassment and emotional violence, New York: Free Press.). In some schools, girls are targeted in texting as ‘sluts’ and worse. Fake nude photographs are sent to smear some teens by female as well as male youth. Yet in that same school, girls who circulate these vicious text messages may engage in fierce competition for who can sexually entice ‘hot’ male students. Double standards are rampant! School principals need to enforce firm anti-bullying codes with specific attention to actions of sexual bullying.
Work to prevent and decrease teen pregnancy needs to be multifaceted. This work is the responsibility of families, of schools, and of community agencies. Changes in media emphasis on sexuality may not be feasible. But teachers can be in the vanguard of awakening teen understanding of the power of television, Facebook, Twitter, and other electronic communication modes to glamorise promiscuous sexuality. Students can bring into class examples of television shows that seek to promote ‘fabulous’ sex without a hint of the heartbreak of unwanted pregnancy. Students can role play creative communication techniques that could keep them safe in dating relationships. They can learn specifics about body functions and contraception in biology and health classes. Invite teens to think about personal future plans and the ways they could work toward those career goals better if they are prudent about teen pregnancy. In one intervention project, teen mothers who realised that they did not want their babies to suffer the same inappropriate parenting as they had experienced in childhood, were able to become more nurturing toward their own infants. Reflectivity helps (Brophy-Herb & Honig, 1999cBrophy-Herb, H. and Honig, A.S.1999c. Reflectivity: Key ingredient in positive adolescent parenting. The Journal of Primary Prevention, 19(3): 241–250.)! Invite Planned Parenthood clinic counsellors and school district nurses to provide outreach work in classes to discuss prevention of sexually transmitted diseases and to discuss options for unwanted teen pregnancies. Promoting awareness, understanding, and dialogue are jobs that trained adults such as nurses, psychologists, and social workers can carry out with adolescents (Brophy-Herb & Honig, 1999aBrophy-Herb, H. and Honig, A.S.1999a. Adolescent mothers; Perceptions of birthtime care: Potential implications for infant development and education. International Journal of Early Childhood Education, 4: 89–108., 1999bBrophy-Herb, H. and Honig, A.S.1999b. Quality of adolescent mother–infant interactions and clinical determinations of risk status. Early Child Development and Care, 152: 17–26.). A bit of humour helps. Dr Sol Gordon created a comic book called ‘Ten Heavy Facts About sex’ that has characters with visual appeal for teenagers.
Courses that include knowledge of developmental norms for infants and young children are important particularly when a school establishes a childcare facility to serve parenting teens attending the school. Many teens have no clue about stages of child development. They do not realise, for example, when sphincter control becomes possible. Some enraged parents severely beat a young toddler who has a toileting accident or they slap a loudly crying baby hard, creating brain damage (‘shaken baby syndrome’).
Invite a volunteer parent on a regular basis to bring a baby into school, so that teens learn how to babble delightedly back and forth with a baby, how to diaper a baby, how to sing to, read to, and play with a baby with appropriate toys and games. The video ‘Oh, Boy, Babies!’ depicts how successful this effort was in a private school for teen boys. A sleeping baby looks adorable. But childcare is hard work and many teens have no realisation of how intensive and all-consuming is the job of parenting.
Government and private agencies need to reach out actively and join together with Parent Involvement programmes. The first line of prevention is to support parental skills. Preventing teen pregnancy needs to be a multifaceted societal collaboration. Agencies that coordinate their services can best ensure that pregnant teens receive early and excellent prenatal care and ongoing, sustained support for nurturing babies and young children. Major collaborative efforts are needed for teen pregnancy prevention. Also, major collaborative efforts are needed to assist pregnant and parenting teens with healthcare, provision of jobs, housing, education continuance, and psychological supports for their life decisions.
Source: Alice Sterling Holing
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