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ARTICLE |
a Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital
b Departments of Obstetrics and Gynecology and Community Health, Women & Infants’ Hospital, Brown University School of Medicine, Providence, Rhode Island
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
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METHODOLOGY. This is a qualitative study of 247 pregnant adolescents recruited during their first prenatal health care visit to a women's primary care clinic in Providence, Rhode Island. Participants responded in writing to open-ended questions assessing their ideas about what was advantageous and disadvantageous about having an infant during their teen years rather than waiting until they were older. Themes and patterns in responding were coded, and subgroup differences based on age, ethnicity, intendedness of current pregnancy, and pregnancy/parenting history were assessed.
RESULTS. Themes related to advantages of teen pregnancy included enhancing connections, positive changes/benefits, and practical considerations. Themes related to disadvantages included lack of preparedness, changes/interference, and others’ perceptions. Differences among groups based on age, ethnicity, intendedness of the current pregnancy, and pregnancy/parenting history were examined and noted.
CONCLUSIONS. Pregnant adolescents do not represent a homogeneous group. Considering differences in how pregnancy and childbearing are conceptualized along developmental, cultural, attitudinal, and experiential lines will strengthen our ability to tailor pregnancy-prevention messages.
Key Words: teenage childbearing • attitudes • pregnant adolescents • qualitative analysis
Although teen pregnancy rates have dropped in recent years, in 2000, more than 800000 girls under 20 years of age became pregnant in the United States, 478000 of whom gave birth.1 Fifty-six percent of teen pregnancies result in live births, and 1 in 4 teenage mothers have another child within 2 years.2–4 Overall, more than three quarters of teen pregnancies are considered unplanned or unintended, with more than a third of all teen pregnancies ending in abortion.3 In addition, between 40% and 60% of births to teen mothers are considered the result of unintended pregnancies.2,3,5–7
In recent years there has been a strong emphasis on developing and evaluating programs to prevent first and subsequent pregnancies among adolescents. However, little work has focused on what teenagers believe about teen pregnancy. Understanding their concepts of the advantages and disadvantages of teen childbearing may point to ways in which pregnancy-prevention efforts can be enhanced and tailored to subgroups of teenagers.
Quantitative research on adolescents’ attitudes toward pregnancy/parenthood suggests a number of important antecedents, a continuum of negative-topositive attitudes, and several potential behavioral outcomes. For example, Jaccard et al8 found that adolescent girls’ discussions with their mothers about the negative consequences of pregnancy, stronger maternal disapproval of teen pregnancy, and greater adolescent satisfaction with mother-daughter relationships were all associated with more negative attitudes toward pregnancy among adolescent girls. Another recent study found that although a majority of nonpregnant adolescents reported consistently negative attitudes toward pregnancy (eg, "getting pregnant at this time in my life is one of the worst things that could happen to me"), there was a sizable minority who reported ambivalent or even positive attitudes toward pregnancy. In this study, adolescents’ ambivalent attitudes toward pregnancy were associated with becoming pregnant within 1 year.9 Another longitudinal study found variation in nonpregnant adolescent girls’ pregnancy attitudes and an association between pregnancy attitudes and intentions to become pregnant within the next 6 months. In this study, nonpregnant adolescents’ pregnancy intentions predicted suspected pregnancies and positive pregnancy test results at 6-months’ follow-up.10
Understanding adolescents’ attitudes toward teen pregnancy has significant clinical application. Adolescent pregnancies are often characterized by delayed initiation of prenatal care, poor prenatal health behaviors, and low birth weight infants.11–13 Recent work also suggests that even healthy infants born to teenage mothers are at increased risk of postneonatal death.14 Clearly, understanding adolescents’ attitudes toward and motivations for pregnancy may aid in efforts to educate adolescents regarding the realities of teen pregnancy/parenting and reduce the negative health consequences of teenage childbearing in the United States.
To supplement the knowledge derived from quantitative methods that have been applied to the question of adolescent attitudes toward pregnancy, we undertook the current qualitative study to explore what pregnant adolescents view as the advantages and disadvantages of having an infant during their teen years. Open-ended questions were posed to pregnant adolescent girls who were attending their first prenatal health visit. They were asked to provide written answers to questions regarding the advantages and disadvantages of having an infant at this time in their lives instead of waiting until later. Themes were identified and patterns were examined in responses that were associated with age (12–15 years old, 16–17 years old, and 18–19 years old), ethnicity (Hispanic versus non-Hispanic), intendedness of current pregnancy (intended versus unintended), and reproductive experience factors (previous pregnancy versus no previous pregnancy and children versus no children).
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METHODS |
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Procedures
As part of a larger study examining pregnant adolescent girls’ pregnancy intentions, participants were asked to provide written answers to open-ended questions regarding their attitudes and motivations about being pregnant. The larger study was initially approved by the Women & Infants’ Hospital Institutional Review Board in December 2001. During their first prenatal visit, a research nurse or trained research assistant interviewed participants by using a structured questionnaire. The questionnaire included items measuring demographics, pregnancy intentions, feelings/reactions about their pregnancy, birth control use, decision-making process regarding pregnancy, support system, living situation, sexual experiences, school and extracurricular involvement, reproductive health history, substance use behaviors, and abuse history. After the interview was completed, participants were asked to fill out the 1-page open-ended questionnaire.
Measures
Demographics
Participants were asked their age, ethnicity (Hispanic or non-Hispanic), and race.
Pregnancy Intention and Reproductive History
Participants were asked to answer the question, "Think back to the time just before you found out you were pregnant, and how you felt about pregnancy at that time. When did you want to be pregnant?" Participants who indicated "Immediately (now)," "In the next few months," or "In the next year" were characterized as having "intended" the current pregnancy. Those who indicated "More than a year from now" or "I did not want to get pregnant" were characterized as having "unintended current pregnancies." Participants were also asked to indicate (1) if they have ever been pregnant before and (2) how many children they have. Those who indicated they had been pregnant previously were also asked if they had ever had an abortion and/or ever had a miscarriage (separate questions).
Advantages/Disadvantages of Teen Pregnancy
The qualitative aspect of the study involved open-ended questions to which participants were asked to write down their answers. The questions appeared in the same order for all participants:
Coding and Analysis
In the first round of qualitative analysis, responses were organized15 by a research assistant, and preliminary codes were generated on the basis of occurrence of themes or identification of patterns in the responses. In the second round of qualitative analyses, the study's principal investigator (M.G.P.) and coinvestigator (C.R.) reviewed all data, generating additional codes to represent both a priori and emergent themes. Data were entered into NVIVO 6.0 software (QSR International Pty Ltd, Victoria, Australia) and coded per the resulting coding scheme. The software allows for the organization and examination of coded responses on the basis of different groupings of participants. The coding group met regularly throughout the process to discuss coding, modifying the coding scheme and maintaining fidelity to coding scheme, until consensus was reached. Group-level differences in themes and patterns were identified and reported here.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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Teen Pregnancy Advantages
The main themes found in the responses to the question regarding advantages include denial of any advantages; connections; benefits and positive changes; and practical considerations related to their being young and concerns about the future. The upper half of Table 1 summarizes the advantage themes, subthemes, and dimensions.
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"I don't know of any good things or advantages of having a baby this young" (17-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"I don't think there are any. I feel teens should wait" (17-year-old, non-Hispanic, unintended pregnancy, previous pregnancy, 1 child).
"there is no advantages I can think about right now" (19-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
Connections
Those who indicated the positive impact on building a family and enhancing relationships because of having an infant now instead of waiting until they were older focused on their love of infants; possessing something; having someone to love and be loved by; benefits related to being closer in age with their child; and having more family/partner support at this time in their lives. Quotes that reflect this theme include:
"[G]onna get your own family and stuff like that" (12-year-old, Hispanic, intended pregnancy, no previous pregnancy).
"An advantage is that I feel a baby will make me and my boyfriends relationship closer" (14-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
"being able to play along with your child not only being his/her parent but being a friend" (13-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"The good things are I no [sic] I have way more support. If I were older I'd be expexted [sic] to take way more responsibility" (18-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
Benefits/Positive Changes
Girls who focused on the positive changes that they associate with having an infant during their teens, rather than waiting until later, commented on how it would require them to grow up and take more responsibility in their lives, as well as the benefits of being a young mother and growing up along with their child and providing themselves with purpose for their lives. Examples of these sentiments include:
"I will have more responsibilities in my life. I will have to be more mature" (14-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"I think that it will keep me away from doing bad things like drinking alcohol and/or doing drugs. It will make me be more responsible and I'll learn how to depend on myself more" (18-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"the good thinks [sic] are that I have someone to live for" (15-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
"theres [sic] not 2 [sic] many good things. Except now Im [sic] gonna have a huge responsibility and have to love and care for something. [T]o me thats [sic] a good thing" (15-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
Practical Considerations
Pregnant teens whose responses emphasized the theme of practical considerations focused on the advantages of being young and how the timing would be beneficial for them in their futures. Some also mentioned concerns about their future fertility. Quotes that reflect this theme include:
"[S]till look young when I'm 25—you figured it out—the baby will be going on 10" (15-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"[A]lso if I have a infant now later on when I want to become a lawyer my baby will be old enough" (15 non-Hispanic, unintended pregnancy, no previous pregnancy).
"The good things are that there are some people that can't have a child because of something they have and I'm happy for that case [sic] I can have a child" (18-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
Teen Pregnancy Disadvantages
The main themes found in the responses to the question regarding disadvantages included denial of any disadvantages; a sense of not being ready; reflections of how having an infant will change things and interfere with important aspects of their lives; and how being pregnant as teenagers will change the way that others see them. The lower half of Table 1 summarizes the disadvantage themes, subthemes, and dimensions.
No Disadvantages Noted
Many pregnant teens were unable to generate disadvantages to being a teen mother or felt that having a child as a teenager was no different from waiting until they were older. Quotations that reflect this include:
"I dont [sic] regret that about having a baby. I dont [sic] think is nothing rong [sic] with it" (14-year-old, Hispanic, unintended pregnancy, previous pregnancy, no children).
"I don't really think there are any disadvantages in having a baby now, I am completely ready for this responsibility" (17-year-old, non-Hispanic, intended pregnancy, previous pregnancy, no children).
"I have no bad thoughts on having a baby now instead of waiting the only difference is I'm 17" (17-year-old, Hispanic, intended pregnancy, previous pregnancy, no children).
Lack of Preparedness
Those adolescent girls who indicated lack of preparedness as a disadvantage emphasized different areas in which they were not ready, including being too young and lacking stability. Excerpts that illustrate this include:
"I feel as though Im to [sic] young and im [sic] scared of being alone taking care of a baby on my own. I feel as if I was older I would know of what was going to happen more" (17-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"1. No job to support me and my baby[.] 2. Im [sic] not out of school" (14-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"[F]inancial problems. Not waiting until I was married because I'm not sure if the father is always gonna be there" (17-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"[N]ot having more life experience or education. Not fully having my life together before trying to raise another life" (19-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
Changes/Interferences
Those who emphasized the interference and changes that result from teen pregnancy as disadvantages focused on how the experience would require them to put their lives on hold, revise their life goals, make their daily lives more difficult/challenging, and make them miss out on important teenage experiences. The changes that were emphasized included physical changes and the requirement of taking on additional responsibilities. Excerpts that illustrate this theme are:
"[W]hen I have to wake up in the middle of the night on school days to take care of my babies [sic] cry" (14-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
"[Y]ou can't work because your [sic] pregnant. You have to be out of school while you have your [b]aby. You also might have to drop out" (16-year-old, Hispanic, unintended pregnancy, no previous pregnancy).
"The disadvantages of having a baby now instead of until I get older are the things I can't do anymore. I won't have free time for myself or friends. I have to stay home and take care of my baby. It's going to be hard to focus on school" (18-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
"[N]ot being able to go out and do normal teenage things and not being able to do what i want when i want to" (13-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
Others’ Views
There were also teens who mentioned the negative effects of how others might view them because they had an infant during their teen years instead of waiting until they were older. Examples of these sentiments are:
"Sometimes I feel like I should be ashamed of myself for having a baby at such a young age. Or I feel like if other people say things when they see me. It sometimes puts me down because I start to wish that I should've done something different" (16-year-old, Hispanic, unintended pregnancy, previous pregnancy, one child).
"The things are that people might look at me differently and I have to change my whole lifestyle" (13-year-old, non-Hispanic, unintended pregnancy, no previous pregnancy).
Identification of Themes Among/Between Different Subgroups
Age
Examining the themes that were identified by participants from different age groups (12–15, 16–17, and 18–19 years) demonstrates the differences in how, at different developmental stages, pregnancy is viewed (see Table 2). Teen pregnancy was seen as enhancing connections with others more often by those in the younger age groups (12–15 and 16–17 years), whereas practical considerations associated with teen motherhood were most often identified by the oldest teens (18–19 years). Both of these variables seemed to have an age-graded continuum. With respect to the disadvantages identified, it seems as though older teens are more able to recognize (or acknowledge) their lack of preparedness but less likely than the youngest teens to emphasize changes and interference with life goals.
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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It is particularly noteworthy that participants were able to generate more disadvantages than advantages. Disadvantage themes were almost always emphasized by larger percentages of the sample than advantage themes. Advantage themes were often unrealistic and sounded as though participants were striving to support their decisions to keep the pregnancy. Alternatively, society provides far more negative messages regarding adolescent pregnancy, thus making disadvantages more salient to these teenagers. They may not be used to thinking about what is positive or good (ie, an advantage) about their pregnancy.
It is clear from these data that pregnant adolescents are not a unitary or homogeneous group with respect to their views on teen childbearing. Differences in themes identified by girls at different ages, from different ethnic backgrounds, and with different ideas about the intendedness of their current pregnancies demonstrate the varying potential intervention targets on the continuum of pregnancy prevention, prenatal and postpartum care needs, evidenced within these different groupings.
Our descriptive analyses of the larger data set revealed significant demographic, health-characteristics, and contraceptive-choice differences between pregnant teens within the age groups of 12 to 15, 16 to 17, and 18 to 19 years (M.G.P., C.R., S.W., A.M., L.P., and Z. Billinkoff, unpublished data, 2006). Not surprisingly, the advantages/disadvantages of teen pregnancy and childbearing also differed among these groups, which may guide intervention strategies appropriate for each group. For example, perhaps assisting the youngest teenagers in identifying other ways of enhancing their connections with others as well as helping them to realistically assess their preparedness for motherhood and capitalizing on their concerns about how parenthood might require major changes and interfere with important goals might help in preventing pregnancy.
The recent decline in teenage childbearing has not been uniform across racial and ethnic lines. From 1991 to 2002, birth rates among non-Hispanic white, American Indian, and Asian/Pacific Islander adolescents, 15 to 19 years old, declined 33% to 36%. Among non-Hispanic black teenagers (15–19 years), pregnancy rates have plummeted by more than half. In contrast, the birth rate among Hispanic adolescents declined only 20%.16 To develop effective sexual-health and pregnancy-prevention programs, we need to understand the possible reasons behind this differential decline. Our data suggest potential targets for intervention. For example, including ideas for enhancing relationships with others, capitalizing on lower expectations for positive changes and benefits, and enhancing realistic assessments of preparedness may enhance current strategies used for preventing pregnancies and/or preparing for healthy pregnancies and infants among Hispanic teens.
Perhaps the most interesting differences in the themes identified came in comparing those teenagers who reported that they intended the current pregnancy compared with those who reported that the current pregnancy was unintended. Enhancing connections, benefits/positive changes, and practical considerations were all more likely to have been noted by those with intended pregnancies. Even more striking were the number (almost one third) of those who intended their pregnancy who indicated no disadvantages to teen pregnancy and childbearing. Although it is difficult to measure pregnancy intentions after an individual has already become pregnant, the 58 participants who indicated that they desired a pregnancy immediately, within the next few months, or within a year certainly seem to view teen pregnancy differently, particularly the advantages.
Finally, it was instructive to examine the manner in which teen pregnancy/childbearing was viewed by those with previous pregnancy experience and by those who already had children. The differences identified here may help us to identify ways of reducing repeat pregnancy and childbearing in adolescents. Again, with both groups, it is important to discuss the perception that teen pregnancy/childbearing enhances connections/relationships with others and assist these teens to identify other means of connecting with others in their lives. It is also important to capitalize on their identification of change/interference as disadvantages of adolescent pregnancy and childbearing in assisting them to protect themselves from subsequent pregnancies, if that is consistent with their desires.
Our study is not without limitations. Ours was a convenience sample of pregnant adolescents who were attending their first prenatal visit; therefore, we are not able to generalize our findings to nonpregnant teens or pregnant teens who decided not to continue their pregnancy, who did not seek prenatal care at all, or who sought care elsewhere. However, qualitative research seeks to identify the range of responses that individuals can offer to a particular question or issue rather than apply their findings to larger populations from which samples are drawn, so the representativeness of the sample is less of a concern for our project. We must also acknowledge that our requirement of written responses may have biased our results in that participants might have provided more information and more detailed responses if the questions had been posed face-to-face by interviewers; however, in an effort to increase open and honest responses, we elected to use the written format.
Future research ought to pose these same questions to broader samples of teens, including male adolescents, to explore potential differences in themes that might be identified by those who are not already facing a pregnancy to tailor pregnancy-prevention messages to these teens as well. Additional studies might expand on our qualitative approach beyond brief open-ended questions to include in-depth interviews or focus groups. Such work might help us to understand how concepts of advantages and disadvantages of teen pregnancy/childbearing are weighed by individuals and how these deliberations influence decisions regarding preventing pregnancy, as well as termination of pregnancy or carrying a pregnancy to term.
Our project extends our understanding of adolescents’ views of how pregnancy during their teen years can provide advantages and pose disadvantages/challenges. The variety of themes identified illustrates the range and complexity of their thinking about this topic during the beginning of their pregnancies. Of particular note was the strong emphasis placed on the advantages of teen pregnancy in enhancing connections with others. As teens are assisted in identifying other means of connecting with the important others in their lives, rates of teen pregnancy may decline even further. Our findings challenge the notion that pregnant teens can be thought of as a homogeneous group with whom we can approach and intervene with the same, undifferentiated messages. Consideration of developmental, cultural, and experiential differences among these teenagers will assist us to better match our intervention and prevention strategies to their ideas and needs.
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FOOTNOTES |
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Address correspondence to Cynthia Rosengard, PhD, MPH, Rhode Island Hospital, DGIM, Multiphasic Building 1, 593 Eddy St, Providence, RI 02903. E-mail: crosengard{at}lifespan.org
The authors have indicated they have no financial relationships relevant to this article to disclose.
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REFERENCES |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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This article has been cited by other articles:
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  D. F. Schwarz and A. L. O'Sullivan State of the Art Reviews: Intervening to Improve Outcomes for Adolescent Mothers and Their Children American Journal of Lifestyle Medicine, December 1, 2007; 1(6): 482 - 489. [Abstract] [PDF]
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 L. Feldman-Winter and U. Shaikh Optimizing Breastfeeding Promotion and Support in Adolescent Mothers J Hum Lact, November 1, 2007; 23(4): 362 - 367. [Abstract] [PDF]
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