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Teenage parenthood is by no means a new social phenomenon. Historically, women have tended to begin childbearing during their teens and early twenties. During the past two decades the U. S. teenage birthrate has actually declined (Polit and others, 1982). In the late 1950s, 90 out of 1000 women under 20 gave birth as compared with 52 out of 1000 in 1978.
Several factors contribute to the current attention focused on teenage pregnancy and parenthood. There is currently a large number of young women in the 13 to 19 age range, so that while the birthrates are declining, the absolute number of teenagers is increasing. These statistics do not distinguish between intentional and unintentional pregnancies, or pregnancies occurring in or out of wedlock. From the 1978 figures, only one in six pregnancies concluded as births following marriage, and eight in ten premarital teenage pregnancies were unintended. The declining birthrate is not consistent for all teenagers: among those 14 or younger, the birthrate is increasing. These trends are occurring at a time when contraceptives are increasingly available to teenagers as a means of avoiding unwanted pregnancy.
The evidence documenting the unfavorable consequences of unintended teenage pregnancy and teenage parenthood, whether intended or not, has continued to mount. There is an unmistakable and dramatic trend away from teenagers giving their children up for adoption. Teenage Pregnancy RateOf the 29 million young people between the ages of 13 and 19, approximately 12 million have had sexual intercourse. Of this group, in 1981, more than 1.1 million became pregnant; three- quarters of these pregnancies were unintended, and 434,000 ended in abortion (What Government Can Do, 1984). The number of pregnancies increased among teenagers in all age groups during the 1970s, but among those who were sexually active the pregnancy rate has been declining.
Because of increased and more consistent use of contraceptives by teenagers, the rate of pregnancy among them has been increasing more slowly than their rate of sexual activity. Although the number of teenagers who are sexually active increased by two-thirds over the 1970s, over half of U.S. teenagers are sexually inactive (Teenage Pregnancy, 1981). Teenage BirthrateAbout five percent of U. S. teenagers give birth each year.
A recent study by the Alan Guttmacher Institute showed teen birthrates here to be twice as high as Canada, England, and Wales, three times as high as Sweden, and seven times higher than the Netherlands. Out of Wedlock BirthsAlthough slowed because of the availability of legal abortion, the rise in the out-of-wedlock birthrate has continued among almost all groups of teenagers. The rise has been steepest among 15- to 17-year-old whites. The number of premaritally conceived births legitimated by marriage has been Adoption and Care by Others. Almost all unwed teenage mothers keep their children in the household with them. Ninety-six percent of unmarried teenage mothers-90 percent of white and virtually all of black mothers-keep their children with them (although in many cases, grandparents or other relatives help take care of the baby).
Repeated Unintentional PregnanciesAs might be expected, 78 percent of births to teenagers are first births. However, 19 percent are second births, and four percent are third or higher order births. The sooner a teenager gives birth after initiation of intercourse, the more likely she is to have subsequent births while still in her teens. Teenage ContraceptionReasons for NonuseNearly two-thirds of unwed teenage women report that they never practice contraception or that they use a method inconsistently. According to the Guttmacher Institute (Teenage Pregnancy, 1981), only nine percent of unmarried teenagers surveyed said that they did not use a method of contraception because they were trying to become pregnant or were already intentionally pregnant. Forty-one percent thought they could not become pregnant, mainly because they believed, usually mistakenly, that it was the wrong time of the month.
Of those who had realized they could get pregnant, the major reason given for not using a method was that they had not expected to have intercourse. Of the 15 percent who did not practice contraception because they were pregnant, the overwhelming majority were pregnant unintentionally. About eight percent said that they had wanted to use a method but 'couldn't under the circumstances,' or that they did not know about contraception or where to get it. Relationship to PregnancyThe relationship between pregnancy and contraceptive use is dramatic: about 62 percent of sexually active teenagers who have never used a method have experienced a premarital pregnancy, compared to 30 percent of those who have used a method inconsistently, 14 percent of those who have always used some method (including withdrawal), and just seven percent of those who have always used a medically prescribed method (the pill, IUD, or diaphragm). The Health Belief ModelCurrent research has examined the Health Belief Model (Zellman, 1984), a value-expectancy approach to explaining and predicting health behaviors that goes beyond straight information giving. This approach can be used to intervene in contraceptive use among teenagers.
Because contraceptive action involves a preventive health decision followed by correct and consistent use, the model may have useful applications to both the prevention and compliance aspects of contraceptive behavior. Sex EducationThe subject of sex education remains a divisive one. On one side are those who argue that Americans should learn to accept adolescent sexuality and make guidance and birth control more easily available, as it is in parts of Europe. On the other side are those who contend that sex education is up to the parents, not the state, and that teaching children about birth control is tantamount to condoning promiscuity, or violating family religious beliefs and values. Sex Education in The Schools'Eight out of 10 Americans believe that sex education should be taught in schools, and seven out of 10 believe that such courses should include information about contraception' (Teenage Pregnancy, 1981, p.
38). Only a handful of states require or even encourage sex education, and fewer still encourage teaching about birth control or abortion. Most states leave the question of sex education up to the local school boards. Only a minority, however, provide such instruction. Parents and Sex EducationParents are a child's earliest models of sexuality; they communicate with their children about sex and sexual values nonverbally. However, most adolescents report that they have never been given any advice about sex by either parent, even though a majority of teenagers prefer their parents and counselors as sources of sex information.
Studies indicate that both parents and their children believe that they should be talking about sexuality, but that parents are extremely uncomfortable doing so (Sexuality Education, 1984). Organizations, including churches, schools, Planned Parenthood affiliates, and other agencies serving young people, offer programs designed to help parents teach their children about sexuality. Most would agree that sex education should start early, before a child's sexuality becomes an issue. Family Planning ServicesMost teenagers and adults approve of making contraceptives available to teenagers, and most parents favor family planning clinics providing birth control services to their children (Teenage Pregnancy, 1981). The clinics have had the expected result of improving the quality and consistency of contraceptive use among teenagers. They have also been credited with preventing an estimated 689,000 unintended births, and probably a higher number of abortions, among teenagers.
However, most teenagers are sexually active for many months before ever seeking birth control help from a family planning clinic or physician (Teenage Pregnancy, 1981). Very few come to a clinic in anticipation of initiating sexual intercourse, and many come because they fear-often correctly-that they are pregnant. The major reason teenagers give for the delay is concern that their parents will find out about the visit. Nevertheless, more than half of teenage patients have told their parents about their clinic visit, and only about one-quarter would not come if the clinic required parental notification. But most of these would continue to be sexually active, using less effective methods or no contraceptives and many thousands would get pregnant as a result.
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