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Adolescents’ pregnancy intentions
JOURNAL OF ADOLESCENT HEALTH 1999;24:313–320
ORIGINAL ARTICLE
Adolescents’ Pregnancy Intentions Relations to Life Situations and Caretaking Behaviors Prenatally and 2 Years Postpartum VALERIE RUBIN, M.D., AND PATRICIA L. EAST, Ph.D.
Purpose: This study explores if and how adolescents’ pregnancy intentions relate to life situations and healthrelated behaviors prenatally and up to 2 years postpartum. Methods: Adolescent girls who reported that they had “wanted a baby” (n 5 75) as their reason for pregnancy were compared with those who reported that the pregnancy “just happened” (n 5 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy. Results: Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child. Conclusion: Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years
From the Department of Pediatrics, University of California, San Diego Medical Center, San Diego, California. Address reprint requests to: Patricia East, Ph.D., UCSD Medical Center, 200 West Arbor Drive, Department of Pediatrics, San Diego, CA 92103-8449. Manuscript accepted April 10, 1998.
postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby. © Society for Adolescent Medicine, 1999 KEY WORDS: Adolescent pregnancy Unintended pregnancies Childbearing intentions Child abuse/neglect
Often in describing adolescent pregnancy, terms such as “unintended” or “out-of-wedlock” are used. Although these concepts can be related, there is no basis for assuming that all adolescent pregnancies are unwanted, unintended, or even mistimed (1–5). Studies that assess the complexity of what motivates teenagers’ reproductive patterns find that many teens report either ambivalence when it comes to postponing sexual activity and childbearing (2,3,5) or a clear desire to become pregnant (1,6 –9). A few studies have examined what might predispose a teenage girl to want a baby. Both race and age seem to play a part, with Hispanic girls indicating that their pregnancies were wanted more often than girls of other races (9), and blacks least likely to indicate that their pregnancies were wanted (10,11). Other characteristics associated with reports of wanted pregnancies include older age (11), higher gravida but with fewer previous therapeutic abortions (12), higher income (10), and having dropped out of school prior to conception (8). Those who were
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married, engaged, or lived with the father of the baby were also happier to become pregnant (3,8), as were those who knew the father longer than 6 months (8). Finally, although girls may not openly admit their own desire for childbearing, they frequently state that their partners wanted them to conceive (5). Few studies have examined how a teen’s childbearing intentions might relate to later living situations or behaviors, although two studies have shown that those who wanted their first birth were more likely to have a repeat pregnancy at 24 and 36 months postpartum (11,12). Among adult women, intention status has been found to relate to early prenatal care, a greater likelihood of quitting smoking, decreased caffeine consumption, and an increase in daily vitamin use (13,14). Two theories that address the significance of adolescents’ pregnancy intentions were used to guide this study. These are the Social Norm Theory (15–17) and a Life Options Theory (18 –22). The Social Norm Theory derives from the family life-course perspective and states that the scheduling of life-course events associated with the transition to adulthood (e.g., getting married, having a child) is relatively well defined within specific communities, socioeconomic classes, and races and ethnicities. For example, the different sexual, marital, and fertility patterns of blacks and whites have been well documented, with first intercourse occurring earlier among blacks than whites, and with childbearing in the absence of marriage more common (23,24) and more accepted (25,26) among blacks than whites. Moreover, in ethnographic studies of black urban and rural families (27,28), authors have discussed the strong community and racial/ethnic norms for early childbearing as powerful socialization pressures, with “early childbearing often considered a necessary activity” (28, p. 159). Similarly, a Life Options Theory asserts that teens who live in communities with a dearth of opportunity for positive future employment, educational advancement, or economic self-sufficiency have little incentive to try to prevent early pregnancy or childbearing (18 –22). Thus, girls who state that their pregnancies “just happened” adopt this passive approach because they have a very low locus of control and live within a depressed and hopeless environment. Consistent with a Life Options Theory is that girls who desire to become pregnant and bear children may be pursuing one the few positive life options they perceive as available to them. The current study explores how adolescents’ preg-
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nancy intentions relate to both prenatal and postpartum outcomes by examining whether and how teens who claimed that they “wanted a baby” differ from those who reported that their pregnancies “just happened.” By comparing teens who demonstrate high childbearing intention (the “wanted” group) with teens who demonstrate low or passive childbearing intention, the relevance of the preceding theories can be assessed.
Methods Subjects Participants in this study were recruited through the Teen Obstetric (OB) Clinic at the University of California, San Diego Medical Center (n 5 109) and from four surrounding community prenatal clinics in San Diego (n 5 99). The former were inducted into the study at their first prenatal visit and those recruited at the community clinics were recruited at varying stages of their pregnancies. All teens had decided to carry their pregnancies to term. The study was described to be one of adolescent pregnancy and parenting. Rates of participation were comparable at the various sites, with 98% of teens from the Teen OB Clinic and 80% of teens from the community clinics agreeing to participate. The teens from the different sites displayed some demographic differences, but these disappeared once racial effects were taken into account (e.g., the community clinics had a higher percentage of Hispanic teens). The only persistent difference was a statistically significant older mean age of clients at the community clinics when compared with the Teen OB clinic (17.4 and 17.0 years, respectively). At the time of recruitment into the study, teens completed a face-to-face interview of 213 questions. Teens were asked: “What is the reason for your pregnancy?” Response options included: “wanted a baby,” “it just happened,” “accident/thought safe,” “contraceptive failure,” “to escape home environment,” “rape/forced intercourse,” or “other.”“ Seventy-nine teens reported that the pregnancy just happened, 75 reported that they wanted a baby; 46 considered the pregnancy an accident or thought they had been safe; 5 attributed the pregnancy to contraceptive failure; 1 became pregnant to escape the home environment; 1 was raped; and 2 gave another reason. The 154 teens who selected the first two responses were compared in this study. An equivalent number of teens from each recruitment site were represented in the “wanted” group
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and in the “just happened” group. This subsample had a mean age of 17.2 years (age range 14 –18.9 years) and was ethnically diverse: 42% were Hispanic (includes Mexican Americans and Puerto Ricans), 31% were black, 19% were white, and 9% were of another racial/ethnic background (e.g., Native American or various Asian populations). Participants were economically poor, with 39% receiving Aid to Families with Dependent Children (AFDC) at intake, 24% receiving food stamps, and 49% receiving aid through Supplemental Income for Women, Infants, and Children at intake. (These values may somewhat underestimate the poverty of the sample, given the large percentage of Hispanic teens, some of whom were likely to have been undocumented immigrants and therefore ineligible for governmental financial assistance). For 74% of the sample, this was their first pregnancy and most were single (78%), although a sizable percentage were married to the fathers of their babies (21%) at the time of intake into the study.
Data Collection All questions had multiple choice response options, with some responses including an “other” and “refuse to answer” option. All participants were assured of the confidentiality of their responses, and the study protocol was approved by the university’s human subjects committee. Follow-up rates for the subsample used in the current study were 75% at 6 months and 69% at 24 months, and follow-up did not differ significantly for the “wanted a baby” group and the “it just happened” group. Intake interviews were conducted individually in a private room at the clinic site by an experienced and trained physician, nurse, or social worker, and lasted approximately 1 h. Teens at the community clinics and at the university Teen OB clinic knew the interviewer equally well. Follow-up interviews lasted approximately 45 min and were conducted at the teen’s home at her convenience. Teens who had a repeat pregnancy by 18 months postpartum were interviewed again briefly at that time. For these teens, the pregnancy was confirmed by review of the medical record.
Data Analysis The “wanted” group and the “just happened” group were compared along multiple variables, using the chi-square test for categorical variables and an anal-
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ysis of covariance (ANCOVA) for continuous variables. Whenever possible, categorical variables were dichotomized (with “yes” 5 1 and “no” 5 0) so that the more statistically powerful ANCOVA could be used. When variables offered a wide array of responses, the responses were combined into logical groupings for ease of comparison (e.g., “living with mother” or “living with father” were combined into the category “living with parents”). When logical groupings were not possible, specific answer choices with a very small response were omitted so that meaningful statistical evaluations could be performed.
Results Differences between the pregnant teens who stated that they “wanted a baby” and those who stated that their pregnancy “just happened” on variables assessed at the prenatal intake are shown in Table 1. Teens who claimed that they wanted a baby were older and were more likely to be Hispanic and less likely to be black than teens who claimed that the pregnancy just happened. Because these two groups differed significantly by race and age, and because these characteristics may be related to the study outcomes, race and age were statistically controlled in all analyses whenever possible. This was done using ANCOVA for all continuous outcome variables and for all dichotomous variables that could be logically recoded as continuous variables. As a control variable, race was coded as “1” 5 black and “0“ 5 nonblack because the composition of blacks in the “wanted” and in the “just happened” groups was most discrepant. For the categorical variables, where a Chi-square was computed, race and age were not controlled. Results shown in Table 1 generally support the hypotheses generated using the Social Norm Theory, with girls who said that they wanted this pregnancy more likely to be living with the father of the baby at the time of conception (as opposed to living alone or with friends), more likely to be married, and more likely to be financially dependent on the father of the baby than teens who claimed that the pregnancy “just happened.” In contrast, the “just happened” group was more likely, relative to the “wanted” group, to be receiving their primary financial support from parents, relatives, or public assistance and to be receiving AFDC. Although the groups did not differ on several measures of social milieu (e.g., whether their parents were currently living together,
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Table 1. Intake Variables in Relation to Teens’ Reason for Pregnancy Variable
“Wanted”
“Just Happened”
Test Statistic
n
Age (yr) Race Caucasian Hispanic Black Other Where living at conception Family or relatives Father of child With friends or alone Married to FOB1 Primary financial support Father of child Parents or relatives Public aid Receiving AFDC?1 Parents currently together?1 Sum of household social problems2 Runaway in past?1 Teen’s mother’s age at first pregnancy Friend with early pregnancy?1 Dropped out of school No Yes Timing of school dropout Before pregnancy After pregnancy Frequency of intercourse prior to conception3 Teen’s gravidity Sum of drug use during pregnancy4 Trimester sought prenatal care No. of prenatal visits
17.4
17.0
t 5 2.05* x2 5 14.74**
154
45% 63% 28% 64%
55% 37% 72% 36%
29 64 47 14 x2 5 16.09***
36% 68% 27% 0.35
64% 32% 73% 0.08
70% 29% 34% 0.25 0.42 1.41 0.26 17.8 0.56
30% 71% 66% 0.52 0.22 1.71 0.45 18.2 0.71
41% 56%
59% 44%
F 5 12.83*** x2 5 19.56***
F 5 4.20* F 5 2.09 F 5 0.56 F 5 8.66** F 5 1.15 F 5 2.30 x2 5 3.60
77 65 11 151 59 34 50 152 119 130 127 118 154 71 80
x2 5 6.04* 65% 34% 0.81 1.41 0.32 2.07 9.94
35% 66% 0.54 1.23 0.52 2.30 8.40
57 23 F 5 7.97** F 5 4.19* F 5 0.58 F 5 1.77 F 5 2.58
150 154 107 114
1
Response options were “yes,” coded as 1, and “no,” coded as 0. Cumulative index of the following: any family member drinks alcohol excessively, has a major illness or incapacity, is mentally retarded, has trouble with the law, or is mentally ill or disabled; any child in household is neglected or abused; there are multiple out-of-wedlock children; and there is overcrowded or dilapidated housing. 3 Coded as “0” 5 ,2 times/month; “1” 5 once a week, and “2” 5 more than once a week. 4 Cumulative sum of smoking cigarettes; drinking alcohol; or using marijuana, cocaine, crystal, and crack. If used, then coded “1” for each substance; if not used, then coded as “0”. * p , .05; ** p , .01; *** p , .001. 2
the number of household–social problems, mothers’ age at first pregnancy, having a friend who has been pregnant), girls who said that their pregnancy “just happened” were significantly more likely to have run away from home than girls who wanted their pregnancy. In addition, although dropping out of school was not related to pregnancy intention, among girls who dropped out, those who wanted a baby were more likely to have dropped out of school before than after the pregnancy. Girls who stated that they “wanted a baby” had sex significantly more frequently than the “just happened” group. Finally, teens’ prenatal health behaviors did not differ between the two intention groups (e.g., drug use during pregnancy, trimester in which prenatal care was
sought, number of prenatal visits), but the teens who wanted a baby were more likely to have higher gravidity status than teens who said that their pregnancies “just happened.” At the 6-month follow-up, in which the two groups were compared along several life situation and preventive health behavior variables, very few differences emerged between the two groups. Consistent with the study findings at other time points, teens who reported their pregnancy as wanted were more likely to have the fathers of their children as their primary means of financial support compared to teens who reported that their pregnancies “just happened,” who were more likely to be financially self-reliant.
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Table 2. Characteristics at 24 Months Postpartum in Relation to Teens’ Reason for Pregnancy Variable Current living situation Family, relatives Father of child With friend or alone Currently married1 Primary financial support Father of child Self Public aid Working/seeking work1 School enrollment/completion2 Lactation3 Well-baby visit within 6 mo1 Baby had full DPT series1 Baby had PPD at 1 year1 Study child in hospital in last 6 mo No. of days child in hospital in last 6 mo Child care help from4 Father of child Mother of teen Baby not kept by teen1 Abuse/neglect report filed1
“Wanted”
“Just Happened”
Test Statistic
n
x2 5 6.46* 45% 56% 21% 0.42
55% 44% 79% 0.05
68% 17% 42% 0.29 0.42 1.15 0.93 0.95 0.43 8% 0.09
32% 83% 58% 0.50 0.58 0.53 0.83 0.86 0.36 20% 0.44
F 5 4.69* F 5 1.63 F 5 15.54*** F 5 2.40 F 5 3.51 F 5 0.32 x2 5 3.59† F 5 5.77*
0.63 0.40 0.04 0.01
0.39 0.52 0.07 0.05
F 5 7.90** F 5 1.65 F 5 0.37 F 5 0.43
F 5 19.19*** x2 5 9.97**
42 39 19 99 28 12 53 104 105 97 94 82 79 98 98 89 106 104
1
Response options were “yes,” coded as 1, and “no,” coded as 0. Coded “1” if teen enrolled in or completed high school, GED, or a vocational education program. Coded “0” if teen not in school or a GED or a vocational education program. 3 Coded “0” if no attempt at lactation, “1” if attempted but stopped, and “2” if breastfed desired period. 4 Response options were none (coded as “0”), some (coded as “1”), and a lot (coded as “2”). * p , .05; ** p , .01; *** p , .001; † p , .10. 2
Table 2 compares the two groups at 24 months postpartum while controlling for subjects’ race and age. At this time point, the groups demonstrated different profiles which are statistically significant. Similar to life situations while pregnant, the teens who stated that their pregnancies were wanted were more likely to be living with the father of the baby, more likely to be primarily financially supported by him, and more likely to be married. Teens who described their pregnancy as something that “just happened” were more likely to be working or seeking work, but no differences were noted for current school enrollment or school completion between the two groups. With regards to positive preventive health care for the baby, the girls who reported that their pregnancies were wanted were much more likely to breastfeed their babies for a desired period of time, but were not more likely to have taken their child to a well-baby visit in the preceding 6 months, to complete the DPT immunization series, or to have PPD placement at 1 year of age. [Of note, the DPT series completion rate within this sample was very high (.90%), while the PPD placement rate was less than one half.] Interestingly, babies whose mothers reported that the pregnancy “just happened” were
slightly more likely to be hospitalized within the past 6 months, and if hospitalized, to be hospitalized for a greater number of days. Teens who wanted the pregnancy received significantly more child care assistance from the father of the baby, but not from the teen’s mother, than did teens whose pregnancies “just happened.” Finally, very few babies were not being cared for by their own mothers at this time point, and very few child abuse or neglect reports were claimed to have been filed. No statistically significant differences emerged for these variables; yet the precise numbers are interesting. Six teens reported that their babies were being kept by someone else: Four of these were from the “just happened” group. There were five reports of abuse/ neglect, with four of them from the “just happened” group. Table 3 displays the characteristics of teens who had a repeat pregnancy by 18 months postpartum in relation to the teens’ reason for the previous pregnancy. The incidence and timing of a repeat pregnancy within 18 months postpartum did not differ between the two intention groups, with 37% (28/75) of the “wanted” group and 42% (33/79) of the “just happened” group becoming pregnant again by 18
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Table 3. Characteristics of Teens With Repeat Pregnancies in Relation to Teens’ Reason for (Prior) Pregnancy Variable Incidence of repeat pregnancy No repeat Repeat pregnancy Mo postpartum repeat pregnancy conceived Living with at repeat conception Family Father of study child Self or friend Married to father of repeat pregnancy at conception1 Father of repeat pregnancy same as father of study child1 Repeat pregnancy aborted1 If repeat pregnancy carried to term: Month prenatal care sought No. of well-baby checkups2 Sum of drug use during repeat pregnancy3 1 2
“Wanted”
“Just Happened”
Test Statistic
n
x2 5 0.32 63% 37% 8.04
58% 42% 7.61
93 61
20% 59% 36% 0.33 0.85 0.30
80% 41% 64% 0.09 0.47 0.75
F 5 7.34** F 5 9.39** F 5 4.82*
15 32 11 59 59 48
4.1 3.1 0.33
5.4 2.3 0.77
F 5 2.72 F 5 1.50 F 5 1.30
36 28 28
F 5 0.19 x2 5 6.80*
Response options were “yes,” coded as 1, and “no,” coded as 0. Includes checkups at 2 weeks, 1 month/6 weeks, 2 months, and 4 months. All infants included in this analyses were at least 6 months
old.
3 Cumulative sum of smoking cigarettes; drinking alcohol; or using marijuana, cocaine, crystal, and crack. If used, then coded “1” for each substance; if not used, then coded as “0.” * p , .05; ** p , .01.
months postpartum. As found at intake and at 24 months postpartum, however, among the subset of teens with a subsequent pregnancy, the ones who stated that the previous pregnancy was “wanted” were more likely to be living with the father of the study child, to be married to the father of the repeat pregnancy, and to have had the same father as for the previous pregnancy. In addition, those to whom the study pregnancy “just happened” resolved more of their repeat pregnancies with a therapeutic abortion (e.g., 75% of this group aborted the repeat pregnancy, compared to 30% of the “wanted” group). Finally, for those teens who carried their (repeat) pregnancies to term, no differences were found between the two groups with regard to the month they sought prenatal care for the repeat pregnancy, the number of well-baby checkups at that time, or drug use during the repeat pregnancy. Although the numbers are too small to be statistically evaluated, it is interesting to note that of the 38 repeated births by 18 months postpartum, only four were not kept by the mother. In all four cases, the mother reported her previous pregnancy as “just happened.”
Discussion Comparing childbearing teens by their self-reported reason for pregnancy reveals many initial and subsequent differences between the two groups. Many of the differences are consistent with the Social Norm Theory, in that those who wanted a baby were from
slightly less chaotic environments in terms of: lower receipt and/or dependence on welfare, greater likelihood of being married to the father of the baby, and lower chance of living alone or with a friend or having run away from home. The teens who wanted their babies were also more likely to have dropped out of school before conception [which is similar to earlier findings (8)], and which can be interpreted as having chosen a life trajectory of childbearing, rather than school achievement. However, there does not appear to be more social-environmental support for a life choice of early childbearing for those in the “wanted” group, as evidenced by no differences between the two groups for mother’s age at first pregnancy and having a friend who was pregnant. Nor did teens in the “wanted” group display preventive health behaviors in the prenatal period to a greater extent than teens in the “just happened” group. Although no differences between the two groups were found for preventive health care at the 2-year follow-up, teens who reported that they wanted a baby were more likely to breastfeed their babies for a desired period of time and to be better able to keep their babies from needing to be hospitalized. This is consistent with adult women who intend to become pregnant and who have more healthy pregnancy-related behaviors compared to women whose pregnancies were unintended (13,14). The two intention groups also showed a strong difference by race. As found in previous studies (2,9,10), Hispanic teens were most likely and black
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teens least likely to report their pregnancies as wanted. This study controlled for effects owing to race and age whenever possible when comparing the two groups. Therefore, the differences between the two intention groups appear to demonstrate a true pattern as opposed to one masking racial or age differences. On the whole, 36% of this sample of pregnant teens said that they wanted their pregnancy. This is contrary to the often-held assumption that teenage pregnancies are unwanted or unintended (3). Moreover, the teens who wanted their pregnancy showed evidence of having made more rational decisions for their lives’ directions rather than merely allowing events to “happen” to them. In some ways, their lives were less bleak: they were more likely to be married, their parents were more likely to be together, and they were less likely to have run away and to be receiving welfare. However, this stronger decision making did not translate into better health-related behaviors as found in adult women (13,14), except for the very important difference of a higher likelihood of completing the desired length of time breastfeeding. It appears, then, that teens who want to become pregnant establish marital or marital-like relationships earlier and direct their life course in such a manner as to put childbearing and mothering first, while postponing school and work-related roles. This timing of events may be perceived as completely normative and acceptable by them, their communities, and their families. Although the relationships between the teen mothers and the fathers of their babies appear supportive in this study, it is unclear whether these relationships will remain beneficial. In the short run, this study and others show that fathers can provide needed financial support, preventing teen mothers’ dependency on government subsidies and providing some independence from parents (3,29). The common alternative, living with the teen’s family of origin and receiving major financial support from the teen’s parents, can be stressful and can detract from the teen’s confidence in and commitment to her own parenting responsibilities (30). However, teens who are married or who live with the father of their babies have been shown to be less likely to return to school and to complete educational milestones, providing long-term shortcomings for the mother in the all too frequent event of divorce or abandonment by the father (3,29). Studies show a link between early childbearing and marital instability (3,29), with 70% of marriages
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involving teen mothers ended by the time the child is a teenager (31). Several limitations of this study warrant specific comment, the most significant of which was this study’s ability to assess teens’ true intentions with regard to their pregnancy. The one question used in this study was obtained by self-report, and there was no probing to detect possible ambivalence, as has been done in other studies (2,5). In addition, all of the teens in this study had already demonstrated some childbearing intention in that they had decided to continue with their pregnancies and had decided not to abort. This study also assessed pregnancy intention or “wantedness” only after the teens learned that they were pregnant, and did not assess their intentions at the time of conception. Teenagers’ retrospective and prospective motives could potentially be quite different. Finally, it is possible that the teens who wanted a baby possessed more favorable characteristics before they became pregnant than the teens whose pregnancy “just happened.” Certainly, assessment of prepregnancy attributes would have been enlightening in this study. These limitations notwithstanding, “wantedness” of the pregnancy differentiated teens on many prenatal and postpartum characteristics and provided some insight into the life circumstances of an ethnically diverse, economically deprived group of young mothers. The findings further suggest that early childbearing is not inadvertent or unintentional for many young women but, rather, it may be perceived as a normative and wanted event. Teenagers who want to become pregnant appear to fare better in terms of their financial status and their relationship with the father of the baby than teens who take a passive approach to the pregnancy and claim that it “just happened” to them. This research was funded by a grant from the Office of Adolescent Pregnancy Programs (APH-000-150) to Dr. Marianne Felice and Dr. Patricia East. The authors thank Dr. Felice for her direction of the project from which the data reported here were drawn. The work of Dr. Rubin was supported by National Institutes of Health Training Grant NHLBI-HL-07491 to the School of Medicine, University of California, San Diego. Dr. East’s work was supported by Grant R29-HD29472 from the National Institute of Child Health and Human Development.
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3. Furstenberg FF. Unplanned Parenthood. New York: Free Press, 1976. 4. Trent K, Crowder K. Adolescent birth intentions, social disadvantage, and behavioral outcomes. J Marr Fam 1997;59:523–35. 5. Zabin LS, Astone NM, Emerson MR. Do adolescents want babies? The relationship between attitudes and behavior. J Res Adolesc 1993;3:67– 86. 6. Zabin LS, Stark HA, Emerson MR. Reasons for delay in contraceptive clinic utilization. J Adolesc Health 1991;12:225– 32. 7. Zabin LS, Hirsch MB, Boscia JA. Differential characteristics of adolescent pregnancy test patients: Abortion, childbearing, and negative test groups. J Adolesc Health Care 1990;11:107– 13. 8. Stevens-Simon C, Kelly L, Singer D, et al. Why pregnant adolescents say they did not use contraceptives prior to conception. J Adolesc Health 1996;19:48 –53. 9. Smith PB, McGill L, Wait RB. Hispanic adolescent conception and contraception profiles. J Adolesc Health Care 1987;8:352– 55. 10. Ford K. Second pregnancies among teenage mothers. Fam Plann Perspect 1983;15:268 –72. 11. Mott FL. The pace of repeated childbearing among young American mothers. Fam Plann Perspect 1986;18:5–12. 12. Matsuhashi Y, Felice ME, Shragg P, et al. Is repeated pregnancy in adolescents a “planned” affair? J Adolesc Health Care 1989;10:409 –12. 13. Kost K, Landry DJ, Darroch JE. Predicting maternal behaviors during pregnancy: Does intention status matter? Fam Plann Perspect 1998;30:79 – 88. 14. Hellerstedt WL, Pirie PL, Lando HA, et al. Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies. Am J Pub Health 1998; 88:663– 6. 15. Elder GH. Age differentiation and the life course. Annu Rev Sociol 1975;1:165–90. 16. Haraven TK. Transitions: The Family and the Life Course in Historical Perspective. New York: Academic Press, 1978.
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17. Marini MM. Age and sequencing norms in the transition to adulthood. Soc Forces 1984;63:229 – 43. 18. Dryfoos, JG. A new strategy for preventing unintended childbearing. Fam Plann Perspect 1984;16:193–5. 19. Geronimus AT. Teenage childbearing and social and reproductive disadvantage: The evolution of complex questions and the demise of simple answers. Fam Rel 1991;40:463–71. 20. Geronimus AT. Teenage childbearing and social disadvantage: Unprotected discourse. Fam Rel 1992;41:244 – 8. 21. Moore DA, Simms MC, Betsey CL. Choice and Circumstance: Racial Differences in Adolescent Sexuality and Fertility. New Brunswick, NJ: Transaction Books, 1986. 22. Musick JS. Young, Poor, and Pregnant. New Haven: Yale University Press, 1993. 23. Alan Guttmacher Institute. Sex and America’s Teenagers. New York: Alan Guttmacher Institute, 1994. 24. Centers for Disease Control. Childbearing patterns among selected racial/ethnic minority groups–United States, 1990. MMWR 1993;42:398 – 403. 25. East PL. Racial and ethnic differences in girls’ sexual, marital, and birth expectations. J Marr Fam 1998;60:150 – 62. 26. Smith EA, Zabin LS. Marital and birth expectations of urban adolescents. Youth Soc 1993;25:62–74. 27. Burton LM. Age norms, the timing of family role transitions, and intergenerational caregiving among aging African American women. The Gerontologist 1996;36:199 –208. 28. Stack CB, Burton LM. Kinscripts. J Comp Fam Stud 1993;24: 157–70. 29. Roye CF, Balk SJ. The relationship of partner support to outcomes for teenage mothers and their children: A review. J Adolesc Health 1996;19:86 –93. 30. East PL, Felice ME. Adolescent Pregnancy and Parenting. Mahwah, NJ: Erlbaum, 1996. 31. Furstenberg FF, Brooks-Gunn J, Morgan SP. Adolescent Mothers in Later Life. New York: Cambridge University Press, 1987.
ORIGINAL ARTICLE
Adolescents’ Pregnancy Intentions Relations to Life Situations and Caretaking Behaviors Prenatally and 2 Years Postpartum VALERIE RUBIN, M.D., AND PATRICIA L. EAST, Ph.D.
Purpose: This study explores if and how adolescents’ pregnancy intentions relate to life situations and healthrelated behaviors prenatally and up to 2 years postpartum. Methods: Adolescent girls who reported that they had “wanted a baby” (n 5 75) as their reason for pregnancy were compared with those who reported that the pregnancy “just happened” (n 5 79) at four separate time periods: prenatally, at 6 and 24 months postpartum, and at 18 months postpartum for teens who became pregnant again subsequent to the study pregnancy. Results: Those who stated that they wanted a baby were more likely to be Hispanic, married, and out of school before becoming pregnant. They were less likely to receive welfare as their primary means of support and to have run away from home in the past than teens who stated that their pregnancy just happened. Self-reported reason for pregnancy was unrelated to repeat pregnancy by 18 months postpartum, but those who had wanted the study baby were less likely to undergo elective termination of a subsequent pregnancy and less likely to become pregnant by a different partner. The groups diverged at 24 months postpartum when those who wanted a baby were more likely to be married to the father of the baby, be financially supported by him, receive child care assistance from him, and have attempted or succeeded at breastfeeding the study child. Conclusion: Self-reported reason for pregnancy reveals many important characteristics of pregnant adolescents both at the time of presentation and up to 2 years
From the Department of Pediatrics, University of California, San Diego Medical Center, San Diego, California. Address reprint requests to: Patricia East, Ph.D., UCSD Medical Center, 200 West Arbor Drive, Department of Pediatrics, San Diego, CA 92103-8449. Manuscript accepted April 10, 1998.
postpartum. Young women in this study who reported intentional pregnancy seem to fare better with regard to their financial status and their relationship with the father of the baby. © Society for Adolescent Medicine, 1999 KEY WORDS: Adolescent pregnancy Unintended pregnancies Childbearing intentions Child abuse/neglect
Often in describing adolescent pregnancy, terms such as “unintended” or “out-of-wedlock” are used. Although these concepts can be related, there is no basis for assuming that all adolescent pregnancies are unwanted, unintended, or even mistimed (1–5). Studies that assess the complexity of what motivates teenagers’ reproductive patterns find that many teens report either ambivalence when it comes to postponing sexual activity and childbearing (2,3,5) or a clear desire to become pregnant (1,6 –9). A few studies have examined what might predispose a teenage girl to want a baby. Both race and age seem to play a part, with Hispanic girls indicating that their pregnancies were wanted more often than girls of other races (9), and blacks least likely to indicate that their pregnancies were wanted (10,11). Other characteristics associated with reports of wanted pregnancies include older age (11), higher gravida but with fewer previous therapeutic abortions (12), higher income (10), and having dropped out of school prior to conception (8). Those who were
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married, engaged, or lived with the father of the baby were also happier to become pregnant (3,8), as were those who knew the father longer than 6 months (8). Finally, although girls may not openly admit their own desire for childbearing, they frequently state that their partners wanted them to conceive (5). Few studies have examined how a teen’s childbearing intentions might relate to later living situations or behaviors, although two studies have shown that those who wanted their first birth were more likely to have a repeat pregnancy at 24 and 36 months postpartum (11,12). Among adult women, intention status has been found to relate to early prenatal care, a greater likelihood of quitting smoking, decreased caffeine consumption, and an increase in daily vitamin use (13,14). Two theories that address the significance of adolescents’ pregnancy intentions were used to guide this study. These are the Social Norm Theory (15–17) and a Life Options Theory (18 –22). The Social Norm Theory derives from the family life-course perspective and states that the scheduling of life-course events associated with the transition to adulthood (e.g., getting married, having a child) is relatively well defined within specific communities, socioeconomic classes, and races and ethnicities. For example, the different sexual, marital, and fertility patterns of blacks and whites have been well documented, with first intercourse occurring earlier among blacks than whites, and with childbearing in the absence of marriage more common (23,24) and more accepted (25,26) among blacks than whites. Moreover, in ethnographic studies of black urban and rural families (27,28), authors have discussed the strong community and racial/ethnic norms for early childbearing as powerful socialization pressures, with “early childbearing often considered a necessary activity” (28, p. 159). Similarly, a Life Options Theory asserts that teens who live in communities with a dearth of opportunity for positive future employment, educational advancement, or economic self-sufficiency have little incentive to try to prevent early pregnancy or childbearing (18 –22). Thus, girls who state that their pregnancies “just happened” adopt this passive approach because they have a very low locus of control and live within a depressed and hopeless environment. Consistent with a Life Options Theory is that girls who desire to become pregnant and bear children may be pursuing one the few positive life options they perceive as available to them. The current study explores how adolescents’ preg-
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nancy intentions relate to both prenatal and postpartum outcomes by examining whether and how teens who claimed that they “wanted a baby” differ from those who reported that their pregnancies “just happened.” By comparing teens who demonstrate high childbearing intention (the “wanted” group) with teens who demonstrate low or passive childbearing intention, the relevance of the preceding theories can be assessed.
Methods Subjects Participants in this study were recruited through the Teen Obstetric (OB) Clinic at the University of California, San Diego Medical Center (n 5 109) and from four surrounding community prenatal clinics in San Diego (n 5 99). The former were inducted into the study at their first prenatal visit and those recruited at the community clinics were recruited at varying stages of their pregnancies. All teens had decided to carry their pregnancies to term. The study was described to be one of adolescent pregnancy and parenting. Rates of participation were comparable at the various sites, with 98% of teens from the Teen OB Clinic and 80% of teens from the community clinics agreeing to participate. The teens from the different sites displayed some demographic differences, but these disappeared once racial effects were taken into account (e.g., the community clinics had a higher percentage of Hispanic teens). The only persistent difference was a statistically significant older mean age of clients at the community clinics when compared with the Teen OB clinic (17.4 and 17.0 years, respectively). At the time of recruitment into the study, teens completed a face-to-face interview of 213 questions. Teens were asked: “What is the reason for your pregnancy?” Response options included: “wanted a baby,” “it just happened,” “accident/thought safe,” “contraceptive failure,” “to escape home environment,” “rape/forced intercourse,” or “other.”“ Seventy-nine teens reported that the pregnancy just happened, 75 reported that they wanted a baby; 46 considered the pregnancy an accident or thought they had been safe; 5 attributed the pregnancy to contraceptive failure; 1 became pregnant to escape the home environment; 1 was raped; and 2 gave another reason. The 154 teens who selected the first two responses were compared in this study. An equivalent number of teens from each recruitment site were represented in the “wanted” group
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and in the “just happened” group. This subsample had a mean age of 17.2 years (age range 14 –18.9 years) and was ethnically diverse: 42% were Hispanic (includes Mexican Americans and Puerto Ricans), 31% were black, 19% were white, and 9% were of another racial/ethnic background (e.g., Native American or various Asian populations). Participants were economically poor, with 39% receiving Aid to Families with Dependent Children (AFDC) at intake, 24% receiving food stamps, and 49% receiving aid through Supplemental Income for Women, Infants, and Children at intake. (These values may somewhat underestimate the poverty of the sample, given the large percentage of Hispanic teens, some of whom were likely to have been undocumented immigrants and therefore ineligible for governmental financial assistance). For 74% of the sample, this was their first pregnancy and most were single (78%), although a sizable percentage were married to the fathers of their babies (21%) at the time of intake into the study.
Data Collection All questions had multiple choice response options, with some responses including an “other” and “refuse to answer” option. All participants were assured of the confidentiality of their responses, and the study protocol was approved by the university’s human subjects committee. Follow-up rates for the subsample used in the current study were 75% at 6 months and 69% at 24 months, and follow-up did not differ significantly for the “wanted a baby” group and the “it just happened” group. Intake interviews were conducted individually in a private room at the clinic site by an experienced and trained physician, nurse, or social worker, and lasted approximately 1 h. Teens at the community clinics and at the university Teen OB clinic knew the interviewer equally well. Follow-up interviews lasted approximately 45 min and were conducted at the teen’s home at her convenience. Teens who had a repeat pregnancy by 18 months postpartum were interviewed again briefly at that time. For these teens, the pregnancy was confirmed by review of the medical record.
Data Analysis The “wanted” group and the “just happened” group were compared along multiple variables, using the chi-square test for categorical variables and an anal-
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ysis of covariance (ANCOVA) for continuous variables. Whenever possible, categorical variables were dichotomized (with “yes” 5 1 and “no” 5 0) so that the more statistically powerful ANCOVA could be used. When variables offered a wide array of responses, the responses were combined into logical groupings for ease of comparison (e.g., “living with mother” or “living with father” were combined into the category “living with parents”). When logical groupings were not possible, specific answer choices with a very small response were omitted so that meaningful statistical evaluations could be performed.
Results Differences between the pregnant teens who stated that they “wanted a baby” and those who stated that their pregnancy “just happened” on variables assessed at the prenatal intake are shown in Table 1. Teens who claimed that they wanted a baby were older and were more likely to be Hispanic and less likely to be black than teens who claimed that the pregnancy just happened. Because these two groups differed significantly by race and age, and because these characteristics may be related to the study outcomes, race and age were statistically controlled in all analyses whenever possible. This was done using ANCOVA for all continuous outcome variables and for all dichotomous variables that could be logically recoded as continuous variables. As a control variable, race was coded as “1” 5 black and “0“ 5 nonblack because the composition of blacks in the “wanted” and in the “just happened” groups was most discrepant. For the categorical variables, where a Chi-square was computed, race and age were not controlled. Results shown in Table 1 generally support the hypotheses generated using the Social Norm Theory, with girls who said that they wanted this pregnancy more likely to be living with the father of the baby at the time of conception (as opposed to living alone or with friends), more likely to be married, and more likely to be financially dependent on the father of the baby than teens who claimed that the pregnancy “just happened.” In contrast, the “just happened” group was more likely, relative to the “wanted” group, to be receiving their primary financial support from parents, relatives, or public assistance and to be receiving AFDC. Although the groups did not differ on several measures of social milieu (e.g., whether their parents were currently living together,
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Table 1. Intake Variables in Relation to Teens’ Reason for Pregnancy Variable
“Wanted”
“Just Happened”
Test Statistic
n
Age (yr) Race Caucasian Hispanic Black Other Where living at conception Family or relatives Father of child With friends or alone Married to FOB1 Primary financial support Father of child Parents or relatives Public aid Receiving AFDC?1 Parents currently together?1 Sum of household social problems2 Runaway in past?1 Teen’s mother’s age at first pregnancy Friend with early pregnancy?1 Dropped out of school No Yes Timing of school dropout Before pregnancy After pregnancy Frequency of intercourse prior to conception3 Teen’s gravidity Sum of drug use during pregnancy4 Trimester sought prenatal care No. of prenatal visits
17.4
17.0
t 5 2.05* x2 5 14.74**
154
45% 63% 28% 64%
55% 37% 72% 36%
29 64 47 14 x2 5 16.09***
36% 68% 27% 0.35
64% 32% 73% 0.08
70% 29% 34% 0.25 0.42 1.41 0.26 17.8 0.56
30% 71% 66% 0.52 0.22 1.71 0.45 18.2 0.71
41% 56%
59% 44%
F 5 12.83*** x2 5 19.56***
F 5 4.20* F 5 2.09 F 5 0.56 F 5 8.66** F 5 1.15 F 5 2.30 x2 5 3.60
77 65 11 151 59 34 50 152 119 130 127 118 154 71 80
x2 5 6.04* 65% 34% 0.81 1.41 0.32 2.07 9.94
35% 66% 0.54 1.23 0.52 2.30 8.40
57 23 F 5 7.97** F 5 4.19* F 5 0.58 F 5 1.77 F 5 2.58
150 154 107 114
1
Response options were “yes,” coded as 1, and “no,” coded as 0. Cumulative index of the following: any family member drinks alcohol excessively, has a major illness or incapacity, is mentally retarded, has trouble with the law, or is mentally ill or disabled; any child in household is neglected or abused; there are multiple out-of-wedlock children; and there is overcrowded or dilapidated housing. 3 Coded as “0” 5 ,2 times/month; “1” 5 once a week, and “2” 5 more than once a week. 4 Cumulative sum of smoking cigarettes; drinking alcohol; or using marijuana, cocaine, crystal, and crack. If used, then coded “1” for each substance; if not used, then coded as “0”. * p , .05; ** p , .01; *** p , .001. 2
the number of household–social problems, mothers’ age at first pregnancy, having a friend who has been pregnant), girls who said that their pregnancy “just happened” were significantly more likely to have run away from home than girls who wanted their pregnancy. In addition, although dropping out of school was not related to pregnancy intention, among girls who dropped out, those who wanted a baby were more likely to have dropped out of school before than after the pregnancy. Girls who stated that they “wanted a baby” had sex significantly more frequently than the “just happened” group. Finally, teens’ prenatal health behaviors did not differ between the two intention groups (e.g., drug use during pregnancy, trimester in which prenatal care was
sought, number of prenatal visits), but the teens who wanted a baby were more likely to have higher gravidity status than teens who said that their pregnancies “just happened.” At the 6-month follow-up, in which the two groups were compared along several life situation and preventive health behavior variables, very few differences emerged between the two groups. Consistent with the study findings at other time points, teens who reported their pregnancy as wanted were more likely to have the fathers of their children as their primary means of financial support compared to teens who reported that their pregnancies “just happened,” who were more likely to be financially self-reliant.
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Table 2. Characteristics at 24 Months Postpartum in Relation to Teens’ Reason for Pregnancy Variable Current living situation Family, relatives Father of child With friend or alone Currently married1 Primary financial support Father of child Self Public aid Working/seeking work1 School enrollment/completion2 Lactation3 Well-baby visit within 6 mo1 Baby had full DPT series1 Baby had PPD at 1 year1 Study child in hospital in last 6 mo No. of days child in hospital in last 6 mo Child care help from4 Father of child Mother of teen Baby not kept by teen1 Abuse/neglect report filed1
“Wanted”
“Just Happened”
Test Statistic
n
x2 5 6.46* 45% 56% 21% 0.42
55% 44% 79% 0.05
68% 17% 42% 0.29 0.42 1.15 0.93 0.95 0.43 8% 0.09
32% 83% 58% 0.50 0.58 0.53 0.83 0.86 0.36 20% 0.44
F 5 4.69* F 5 1.63 F 5 15.54*** F 5 2.40 F 5 3.51 F 5 0.32 x2 5 3.59† F 5 5.77*
0.63 0.40 0.04 0.01
0.39 0.52 0.07 0.05
F 5 7.90** F 5 1.65 F 5 0.37 F 5 0.43
F 5 19.19*** x2 5 9.97**
42 39 19 99 28 12 53 104 105 97 94 82 79 98 98 89 106 104
1
Response options were “yes,” coded as 1, and “no,” coded as 0. Coded “1” if teen enrolled in or completed high school, GED, or a vocational education program. Coded “0” if teen not in school or a GED or a vocational education program. 3 Coded “0” if no attempt at lactation, “1” if attempted but stopped, and “2” if breastfed desired period. 4 Response options were none (coded as “0”), some (coded as “1”), and a lot (coded as “2”). * p , .05; ** p , .01; *** p , .001; † p , .10. 2
Table 2 compares the two groups at 24 months postpartum while controlling for subjects’ race and age. At this time point, the groups demonstrated different profiles which are statistically significant. Similar to life situations while pregnant, the teens who stated that their pregnancies were wanted were more likely to be living with the father of the baby, more likely to be primarily financially supported by him, and more likely to be married. Teens who described their pregnancy as something that “just happened” were more likely to be working or seeking work, but no differences were noted for current school enrollment or school completion between the two groups. With regards to positive preventive health care for the baby, the girls who reported that their pregnancies were wanted were much more likely to breastfeed their babies for a desired period of time, but were not more likely to have taken their child to a well-baby visit in the preceding 6 months, to complete the DPT immunization series, or to have PPD placement at 1 year of age. [Of note, the DPT series completion rate within this sample was very high (.90%), while the PPD placement rate was less than one half.] Interestingly, babies whose mothers reported that the pregnancy “just happened” were
slightly more likely to be hospitalized within the past 6 months, and if hospitalized, to be hospitalized for a greater number of days. Teens who wanted the pregnancy received significantly more child care assistance from the father of the baby, but not from the teen’s mother, than did teens whose pregnancies “just happened.” Finally, very few babies were not being cared for by their own mothers at this time point, and very few child abuse or neglect reports were claimed to have been filed. No statistically significant differences emerged for these variables; yet the precise numbers are interesting. Six teens reported that their babies were being kept by someone else: Four of these were from the “just happened” group. There were five reports of abuse/ neglect, with four of them from the “just happened” group. Table 3 displays the characteristics of teens who had a repeat pregnancy by 18 months postpartum in relation to the teens’ reason for the previous pregnancy. The incidence and timing of a repeat pregnancy within 18 months postpartum did not differ between the two intention groups, with 37% (28/75) of the “wanted” group and 42% (33/79) of the “just happened” group becoming pregnant again by 18
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Table 3. Characteristics of Teens With Repeat Pregnancies in Relation to Teens’ Reason for (Prior) Pregnancy Variable Incidence of repeat pregnancy No repeat Repeat pregnancy Mo postpartum repeat pregnancy conceived Living with at repeat conception Family Father of study child Self or friend Married to father of repeat pregnancy at conception1 Father of repeat pregnancy same as father of study child1 Repeat pregnancy aborted1 If repeat pregnancy carried to term: Month prenatal care sought No. of well-baby checkups2 Sum of drug use during repeat pregnancy3 1 2
“Wanted”
“Just Happened”
Test Statistic
n
x2 5 0.32 63% 37% 8.04
58% 42% 7.61
93 61
20% 59% 36% 0.33 0.85 0.30
80% 41% 64% 0.09 0.47 0.75
F 5 7.34** F 5 9.39** F 5 4.82*
15 32 11 59 59 48
4.1 3.1 0.33
5.4 2.3 0.77
F 5 2.72 F 5 1.50 F 5 1.30
36 28 28
F 5 0.19 x2 5 6.80*
Response options were “yes,” coded as 1, and “no,” coded as 0. Includes checkups at 2 weeks, 1 month/6 weeks, 2 months, and 4 months. All infants included in this analyses were at least 6 months
old.
3 Cumulative sum of smoking cigarettes; drinking alcohol; or using marijuana, cocaine, crystal, and crack. If used, then coded “1” for each substance; if not used, then coded as “0.” * p , .05; ** p , .01.
months postpartum. As found at intake and at 24 months postpartum, however, among the subset of teens with a subsequent pregnancy, the ones who stated that the previous pregnancy was “wanted” were more likely to be living with the father of the study child, to be married to the father of the repeat pregnancy, and to have had the same father as for the previous pregnancy. In addition, those to whom the study pregnancy “just happened” resolved more of their repeat pregnancies with a therapeutic abortion (e.g., 75% of this group aborted the repeat pregnancy, compared to 30% of the “wanted” group). Finally, for those teens who carried their (repeat) pregnancies to term, no differences were found between the two groups with regard to the month they sought prenatal care for the repeat pregnancy, the number of well-baby checkups at that time, or drug use during the repeat pregnancy. Although the numbers are too small to be statistically evaluated, it is interesting to note that of the 38 repeated births by 18 months postpartum, only four were not kept by the mother. In all four cases, the mother reported her previous pregnancy as “just happened.”
Discussion Comparing childbearing teens by their self-reported reason for pregnancy reveals many initial and subsequent differences between the two groups. Many of the differences are consistent with the Social Norm Theory, in that those who wanted a baby were from
slightly less chaotic environments in terms of: lower receipt and/or dependence on welfare, greater likelihood of being married to the father of the baby, and lower chance of living alone or with a friend or having run away from home. The teens who wanted their babies were also more likely to have dropped out of school before conception [which is similar to earlier findings (8)], and which can be interpreted as having chosen a life trajectory of childbearing, rather than school achievement. However, there does not appear to be more social-environmental support for a life choice of early childbearing for those in the “wanted” group, as evidenced by no differences between the two groups for mother’s age at first pregnancy and having a friend who was pregnant. Nor did teens in the “wanted” group display preventive health behaviors in the prenatal period to a greater extent than teens in the “just happened” group. Although no differences between the two groups were found for preventive health care at the 2-year follow-up, teens who reported that they wanted a baby were more likely to breastfeed their babies for a desired period of time and to be better able to keep their babies from needing to be hospitalized. This is consistent with adult women who intend to become pregnant and who have more healthy pregnancy-related behaviors compared to women whose pregnancies were unintended (13,14). The two intention groups also showed a strong difference by race. As found in previous studies (2,9,10), Hispanic teens were most likely and black
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teens least likely to report their pregnancies as wanted. This study controlled for effects owing to race and age whenever possible when comparing the two groups. Therefore, the differences between the two intention groups appear to demonstrate a true pattern as opposed to one masking racial or age differences. On the whole, 36% of this sample of pregnant teens said that they wanted their pregnancy. This is contrary to the often-held assumption that teenage pregnancies are unwanted or unintended (3). Moreover, the teens who wanted their pregnancy showed evidence of having made more rational decisions for their lives’ directions rather than merely allowing events to “happen” to them. In some ways, their lives were less bleak: they were more likely to be married, their parents were more likely to be together, and they were less likely to have run away and to be receiving welfare. However, this stronger decision making did not translate into better health-related behaviors as found in adult women (13,14), except for the very important difference of a higher likelihood of completing the desired length of time breastfeeding. It appears, then, that teens who want to become pregnant establish marital or marital-like relationships earlier and direct their life course in such a manner as to put childbearing and mothering first, while postponing school and work-related roles. This timing of events may be perceived as completely normative and acceptable by them, their communities, and their families. Although the relationships between the teen mothers and the fathers of their babies appear supportive in this study, it is unclear whether these relationships will remain beneficial. In the short run, this study and others show that fathers can provide needed financial support, preventing teen mothers’ dependency on government subsidies and providing some independence from parents (3,29). The common alternative, living with the teen’s family of origin and receiving major financial support from the teen’s parents, can be stressful and can detract from the teen’s confidence in and commitment to her own parenting responsibilities (30). However, teens who are married or who live with the father of their babies have been shown to be less likely to return to school and to complete educational milestones, providing long-term shortcomings for the mother in the all too frequent event of divorce or abandonment by the father (3,29). Studies show a link between early childbearing and marital instability (3,29), with 70% of marriages
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involving teen mothers ended by the time the child is a teenager (31). Several limitations of this study warrant specific comment, the most significant of which was this study’s ability to assess teens’ true intentions with regard to their pregnancy. The one question used in this study was obtained by self-report, and there was no probing to detect possible ambivalence, as has been done in other studies (2,5). In addition, all of the teens in this study had already demonstrated some childbearing intention in that they had decided to continue with their pregnancies and had decided not to abort. This study also assessed pregnancy intention or “wantedness” only after the teens learned that they were pregnant, and did not assess their intentions at the time of conception. Teenagers’ retrospective and prospective motives could potentially be quite different. Finally, it is possible that the teens who wanted a baby possessed more favorable characteristics before they became pregnant than the teens whose pregnancy “just happened.” Certainly, assessment of prepregnancy attributes would have been enlightening in this study. These limitations notwithstanding, “wantedness” of the pregnancy differentiated teens on many prenatal and postpartum characteristics and provided some insight into the life circumstances of an ethnically diverse, economically deprived group of young mothers. The findings further suggest that early childbearing is not inadvertent or unintentional for many young women but, rather, it may be perceived as a normative and wanted event. Teenagers who want to become pregnant appear to fare better in terms of their financial status and their relationship with the father of the baby than teens who take a passive approach to the pregnancy and claim that it “just happened” to them. This research was funded by a grant from the Office of Adolescent Pregnancy Programs (APH-000-150) to Dr. Marianne Felice and Dr. Patricia East. The authors thank Dr. Felice for her direction of the project from which the data reported here were drawn. The work of Dr. Rubin was supported by National Institutes of Health Training Grant NHLBI-HL-07491 to the School of Medicine, University of California, San Diego. Dr. East’s work was supported by Grant R29-HD29472 from the National Institute of Child Health and Human Development.
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