Teen Pregnancy: The Tangled Web
O, what a tangled web we weave, when too soon we practice to conceive!
(With apologies to Sir Walter Scott)
May 1, 2009—It was the summer of 2008. As school doors across America closed behind hordes of scattering students, the principal of a high school in Gloucester, Massachusetts, made a comment that would launch his community into the media spotlight overnight. The remark (that his school’s recently discovered pregnancy boom was due to a “pact” between seven or eight girls who wanted to have babies and raise them together) was made to a reporter from Time magazine. At the moment he spoke, the principal couldn’t have known how explosive the story would prove to be.
As the media converged on the town immediately afterward, Gloucester found itself the center of decidedly unwelcome attention. The following Monday the town’s mayor held a press conference denying that there was any evidence of such a pact and sparking a media discussion about reporting ethics. Reporters, it was said, shouldn’t have repeated the principal’s comments without verifying them as fact.
Although it eventually came out that some of the pregnant students may indeed (at least initially) have welcomed their pregnancies, for a short time attention was successfully deflected from the real issue: that unmarried teen pregnancy is harmful to young mothers, their children and their communities (see “Stork Realities”). But the topic continued to resurface over the next several months as subsequent events reminded the media that teenage pregnancy is not confined to one New England town, or even to three English-speaking countries—America, New Zealand and Britain—widely considered as having the highest teen pregnancy rates among developed nations.
The problem, in fact, is a global one. Nations with even higher rates than America’s include Venezuela, Mexico, Argentina and South Africa. When nations that might be designated “lesser developed” are included in the reckoning, those three English-speaking countries come out looking relatively clean-cut and freshly washed: rates found in some areas of Latin America and Africa reach levels two, three and four times that of the United States.
But how much do statistical comparisons between nations really tell us? Even if analysts could be certain about whose statistics most bear looking at, making enough sense of the numbers to adequately address the problem presents a different challenge. It’s a tangled web. First, it must be understood that “birth rates” and “fertility rates” are not quite the same thing as “pregnancy rates.” A nation may have high teenage pregnancy rates, but if offset by high numbers of abortions, the resulting low birth rate may give the false impression that fewer teens become pregnant there. Further clouding the issue, some countries prefer not to report abortion rates, and others can’t—because, for various reasons, they don’t know what they are.
Another difficulty is that many nations don’t separate pregnancy statistics by marital status. This means that in some cases the numbers may be skewed by a significant percentage of 18- and 19-year-olds who are married; in some cultures, these young women have the benefit of extended and supportive family. Therefore they are not subject to the same risks as single teens, whose lives will be much more seriously impacted by the struggle to raise a child alone in harsh economic circumstances. This is an important distinction, as studies have consistently demonstrated that children who are raised by both parents enjoy higher standards of well-being by almost all measures. Certainly even married teen parents will face challenges, but especially in cultures where extended family is routinely present, these may be overcome more easily.
The only possible conclusion is that cold statistics say very little about how to address this issue. The words of prominent British statistician Major Greenwood were brought to mind in a comment by Yale professor Colin White in the December 1964 issue of The American Statistician: “The rich drama of birth, life and death becomes, in the hands of the statistical sociologist, a report on ‘marriages, babies dead, broken lives, men gone mad, labor and crime, all treated in bulk, with the tears wiped off.’”
Bill Albert of the National Campaign to Prevent Teen and Unplanned Pregnancy in the United States agrees with White’s sentiment. “I think that’s true,” he says. “We’re often very good at issuing reports. We’re not very good at telling stories.” (For more of the interview, see “ Teens, Parents, and Teen Parents.”) He believes it’s the stories that give a real sense of what needs to change, particularly the stories of what teens miss out on when they find they must defer their own childhood for the sake of someone else’s. But there are other stories teens need to hear—stories about the hopes and dreams that parents have for their children; stories about the relevance of the child’s own ideals and aspirations; stories about realities such as how premature parenthood will affect a teen’s ability to provide for his or her family’s future, or about the realities of infant care.
School administrators do their best to fill the educational void, but school policies often limit them to disseminating technical information, and students may be left to discover the real stories the hard way. In that vein, Juanita Felice-Zwaryczuk, a high school teacher from Long Island, New York, told Vision: “In my high school classes, the pregnant moms are all aglow before, but shell-shocked after the birth of their child. I haven’t had a single one of them recommend the experience afterward. Even so, many of the other girls envy them. I try, within the constraints of district policy, to help the girls find the self-esteem to want more of a future than such early parenthood ensures them, but it is an uphill battle.”
Indeed, it hardly seems the responsibility should fall solely on public educators. Albert acknowledges that schools do have an important role to play in educating children toward minimizing the risks of teen pregnancy, but he also cautions that the most important stories are the ones children hear at home. “To put these issues in the context of your own family’s values is not the school’s job,” he says. “If kids are growing up in a warm, supportive, loving family with clear rules and clear expectations—you could call them the familiar grandmother rules—the research seems to suggest that they’re better off.”
Unfortunately, however, it isn’t unusual for public administrators to minimize the important contributions to be made by families. For instance, Britain’s official Teenage Pregnancy Strategy, which undertook a campaign to “halve the under-18 conception rate by 2010,” doesn’t say much about plans for parental involvement even though the government says the strategy will require the “active engagement of all of the key mainstream delivery partners who have a role in reducing teenage pregnancies”; but it identifies these partners as “health, education, social services, youth support services, and the voluntary sector.” One can only hope that the strategy statement leaves out parents and families because their status as “key delivery partners” is taken for granted.
The reality is that defining the role of parents and healthy family relationships in reducing teen pregnancies requires taking a closer look at the knotty problem, and it’s at this point in the process that the finger-pointing generally begins. Parents blame schools and media, media professionals throw responsibility back onto the shoulders of parents and schools, and many of those involved hold government ultimately responsible. It’s as though probing the elements of this problem is a zero-sum blame game.
But the interest in examining the factors behind teen pregnancy is not about assigning blame. Nor is it true that if one factor is found to contribute to the problem, others are therefore absolved. In fact, uncovering the origin of any problem requires examining each of the relevant influences in the wider context of how the factors interrelate. And in this case, they twine into a gnarled mess.
This is well illustrated by a study undertaken by behavioral scientist Anita Chandra and her colleagues at RAND, the independent international research corporation. Published in the November 2008 issue of the journal Pediatrics, it addresses a link between television and teen pregnancy. The researchers found that teens who watched high levels of sexual content on television were twice as likely to become parents within the subsequent three years. As they monitored the study’s subjects, the research team measured exposure to sexual content based on very detailed methods of categorizing individual scenes in order to rate the 23 different programs that were selected for the research.
“Our results indicate that frequent exposure to sexual content on television predicts early pregnancy, even after accounting for the influence of a variety of other known correlates of each,” said the RAND team. In addition, Chandra and her colleagues noted that television shows typically send teens the message that sex carries few risks or responsibilities. What this means for parents should be obvious: although the researchers weren’t suggesting a causal link between television viewing and teen pregnancy, the correlation does indicate a need to monitor and restrict what teens watch.
But this may not always be as easy as it sounds. The RAND research also acknowledged other factors that are known to increase pregnancy risk for teens. “Living in a single-parent household, low parent education, limited teen educational or career aspirations and ambivalent or positive attitudes toward pregnancy have been identified as critical influences of the timing of sexual initiation and first pregnancy,” they said. “There is also evidence that teen pregnancy risk is greater among teens with lower grades and those who engage in delinquent behaviors.” Previous studies have also uncovered cultural differences in rates of early pregnancy. According to the most recent figures available from the U.S. Centers for Disease Control (CDC), Latino teens have about three times the pregnancy rate of Caucasian teens, while African-American teens have more than twice the rate of Caucasians.
Obviously the variables listed here are so intertwined as to be almost impossible to disentangle. Latino and African American teens are also more likely to live in disadvantaged communities and to have more positive views of early parenthood. They are more likely to live in single-parent homes where the father is the absent parent; and of course, father absence has also been shown to increase the risk of early pregnancy—just as it has been shown to increase other risk factors such as low grades and delinquent behavior.
Following the thread of father absence leads to the further acknowledgment that working single mothers are challenged not only when it comes to monitoring the TV habits of their children but also when it comes to their earning potential, especially if they don’t have the support of extended family. Stretched and stressed with the sole responsibility for feeding and clothing her children, a single mother’s greatest challenge may be to give her children the attention they need.
Another issue is that her daughters tend to enter puberty earlier than their peers. A 2004 study by the University of Chicago’s Institute for Mind and Biology was not the first to make the connection between early menarche and absent fathers, but it contributed to the existing research by finding that girls with early menarche and absent fathers showed a significantly higher interest in infants than did their later-maturing peers.
A few months later, the Journal of Adolescent Health published a study by researchers at the University of North Carolina showing a link between early puberty and an earlier interest in viewing sexual content in the media. The trouble is, these early-developing girls were also more likely than their peers to come away from their viewing with the idea that these media messages constituted tacit approval of teen sex.
“Given that content analyses have found that the media do tend to portray sexual behavior as normative and risk free,” said the researchers, “we might expect that all girls would perceive the media as giving them sexual permission. However, in this study the younger earlier maturing girls were the most likely to interpret media content as sexually permissive.”
The researchers referred to the mass media as a “sexual super-peer” for early-maturing girls. “It may be,” they speculated, “that the earlier maturing girls are looking for information and norms in the media because their real-life peers are not as interested as they are in sex and sexuality.”
The contribution of father absence to teen pregnancy doesn’t end there. In fact, this thread could actually be one of the longest and stickiest in the web. Absent fathers (or mothers) also leave children vulnerable to sexual abuse in the home, the highest risk of which is from males placed in a caretaking role over children or cohabiting with a single mother.
How child sexual abuse contributes to teen pregnancy goes well beyond the obvious. In a 1999 study published in the journal Adolescence, researchers Nancy D. Kellogg, Thomas J. Hoffman and Elizabeth R. Taylor examined this question among a diverse group of teen mothers enrolled in a school-age parenting program in Texas after finding that more than half of the girls (53 percent) had suffered an unwanted sexual experience prior to their first pregnancy.
For 13 percent of the abused teens, the pregnancy was a direct result of that violation. But there were just as important indirect results among the rest: for instance, the earlier an unwanted sexual experience occurred, the earlier the teen sought an intentional experience. Some responded to the misuse by running away, or by trying to obliterate the experience through self-medicating with alcohol or drugs. All of these behaviors are well known to increase the likelihood that girls will end up further exploited and, eventually, pregnant.
Girls who were sexually abused often endured physical violence as well. Other family dysfunctions such as alcohol and drug abuse often (but not always) coexisted with the sexual abuse. Worse, a large number of the girls (60 percent) went to adults for help, but according to the study, only half of these adults intervened in any way.
Hoffman’s research convinces him that any approach to the prevention of teen pregnancy requires addressing foundational family dysfunctions. “There would be a relationship between many of these factors: alcohol abuse, substance abuse and sexually acting out,” he told Vision. “The sexual acting out comes from being sexualized at an earlier age through unwanted sexual experiences.” But, says Hoffman, “there’s a long list of risk factors with regard to sexual abuse that can be conceptualized in terms of family. First—and primary—would be the presence of a stepfather or other father figure who is not the father. Other factors include mother absence, lack of maternal education (the mother didn’t finish high school), presence of an emotionally distant or sexually repressive mother, or presence of a physically distant (unaffectionate) father.”
Hoffman explains why physical closeness is a protective factor in father-daughter relationships: “A father who is involved in the physical nurturing of the child as an infant—in terms of changing diapers, feeding the infant daughter and expressing physical affection—is less likely to abuse than a father who doesn’t participate in those nurturing activities. To be able to abuse someone, the abuser needs to do a certain amount of objectifying. When the father is engaged in the day-to-day care of his daughter, it’s hard to objectify her.”
But it isn’t only girls who are at risk. Hoffman points out that males who have been sexually abused are also more likely to contribute to the teen pregnancy problem. Either way, he says, “someone who has been abused is more likely to be sexually active earlier.”
And then there’s the self-esteem factor for girls, beyond the possibility that they may simply be looking for a source of male attention. Unfortunately, this can set a girl up to be vulnerable for a second pregnancy. “When a girl is pregnant she suddenly moves to center stage,” says Hoffman. “Everyone wants to know how she’s doing—which is tremendous positive reinforcement for being pregnant. Once she has the baby, of course, the special attention begins to drop off rather quickly. After a while it disappears completely and she wants to recapture it.”
Hoffman cautions that this cycle is not universal by any stretch. If young mothers are encouraged to continue their academic education and are also educated about the kind of nurturing care and parenting that infants and toddlers require, they begin to develop the self-esteem they’re missing—the kind that isn’t based on being pregnant or dependent on finding an outside source of attention.
This is precisely the kind of self-esteem that Martin E.P. Seligman, often called the father of positive psychology, says comes from “doing well” as opposed to just “feeling good.”
As early as 1967, University of California–Davis psychologist Stanley Coopersmith set out to discover what kinds of parenting practices contributed to this kind of self-esteem and published a compilation of his studies on the topic, titled The Antecedents of Self-Esteem. His findings echo Albert’s comment about “the familiar grandmother rules.” While Coopersmith noted that parental acceptance of children was positively associated with high self-esteem, he added that “the belief that parents who are accepting are necessarily permissive, democratic, and nonpunitive appears to be an obscuring overgeneralization, and one that has repeatedly been demonstrated to be false.”
In contrast, Coopersmith found that children whose parents established well-defined and extensive limits and were consistent about enforcing them with positive techniques had much higher self-esteem than those who had poorly defined limits and experienced greater permissiveness.
Though self-esteem is only one of the many threads to sort out in the teen pregnancy knot, what produces self-esteem would seem to be the same as what protects teens from other threats to their well-being. Few if any of the factors considered here—alcohol and drug abuse, delinquency, acting out, etc.—are immune to the influence of what Coopersmith summarizes as “parental warmth,” “clearly defined limits,” and “respectful treatment.”
A DIFFERENT WEB
This line of inquiry leads to what may be the single most important concept that cuts through the web of factors influencing teen pregnancy: if children are to develop the skills they will need to make responsible decisions as teens, they require the support and concern of involved adults who are committed to nurturing, teaching and guiding them from infancy through adolescence and into adulthood. Unfortunately, even with two parents they might not be guaranteed this basic requirement, and even seemingly perfect families encounter challenges.
This is where extended family and community relationships become important. Perhaps, in this sense, it really does take a village to raise a child. After all, even when adults become parents they need physical help, emotional support and a high capacity for personal resilience and self-sacrifice. Ideally, parenthood would not be undertaken alone, and especially not by someone too young to handle the stressful demands that come with the territory.
It’s not only the welfare of the young single mother at stake. When young mothers don’t understand the needs of infants or have difficulty meeting those needs because they lack sufficient support, the crucial bond that needs to be created between parent and infant suffers. As a result, the next generation may also find itself looking for acceptance through risky behavior.
For this reason, when all preventive measures have failed, says Hoffman, “it’s very important not to make these girls pariahs.” With a new life to be concerned for, the family’s obligation is as binding as ever. One can only hope that in such a case families and communities would turn their collective attention to weaving a web of support to provide for the physical and emotional needs of the newest family member.
And attention is the key word. As Albert points out, there are certain stories teens desperately need to hear, and it’s never too late for parents to tell these stories.
“Sometimes after a teenager experiences one pregnancy, she ends up pregnant again within the next couple of years,” says Hoffman. “And then pregnant again after that—not necessarily marrying the father, or even setting up a household with the father or fathers. So the story isn’t over once a teen gets pregnant the first time. There is still a need for education.” Sometimes, perhaps, parents need to be educated as much as teens.
In any case, it seems Albert has sliced through to the core of the problem: as parents, we need to become better at telling our children the important stories, and telling them often. Stories about goals and aspirations, values and expectations—realities and truths about the consequences of poor choices. As those stories are told, the unspoken message teens will hear is that they are important enough to parents to warrant the investment of their time.
1 Robert Coles, ed., The Erik Erikson Reader (2000). 2 Stanley Coopersmith, The Antecedents of Self-Esteem (1967). 3 Annette U. Rickel, Teen Pregnancy and Parenting (1989). 4 Lee SmithBattle, “Gaining Ground From a Family and Cultural Legacy: A Teen Mother’s Story of Repairing the World,” in Family Process (Vol. 47. No. 4, 2008). 5 Jane Waldfogel, What Children Need (2006).
As parents and teachers know (but many teens don’t), parenthood is not all fun and games and cuddly babies who chortle happily in their prams. How can parents explain the "stork" reality to their teens?
Bill Albert is chief program officer for the National Campaign to Prevent Teen and Unplanned Pregnancy, a private nonprofit, nonpartisan organization in Washington, D.C. In May of 2008, Gina Stepp spoke with him about teen pregnancy and the complex associated issues.
This infographic from the National Campaign to Prevent Teen and Unplanned Pregnancy bears good news: but the U.S. still claims highest rates among Western nations.