Teen Pregnancy in the United

Teen Pregnancy in the United States: How it Impacts Maternity Nurses

Teen pregnancy is one of the United States' most significant public health problems. This is because, when compared to other similarly industrialized nations with similar health care systems, the United States has an embarrassingly high teen pregnancy rate. In fact, if judged solely by the teen pregnancy rate, one would assume that the United States was a non-industrialized, borderline third-world country, instead of the world's most significant superpower. However, teenage pregnancy remains the norm in many countries, which can lead people to wonder why teenage pregnancy is considered such a significant issue. After all, if teenage pregnancy is the worldwide norm, how can it be considered so negative in the United States? Does an anti-teen pregnancy attitude reflect an age bias and have more to do with concerns about emerging female sexuality than it does about actual consequences of teenage pregnancy? The risks associated with teenage pregnancy argue against that conclusion. Instead, they suggest that teen pregnancy is detrimental, not only for teenage mothers, but also for their babies.

Teen pregnancy is unequivocally negative for the vast majority of teenage mothers. Teen mothers are not only less likely to complete school, but also more likely to be single parents. The combination of these events makes it unlikely that they will be able to adequately provide for themselves or for their children. Moreover, while adolescent female bodies may be capable of procreation that does not mean that they are ideal for procreation. "Common medical problems among adolescent mothers include poor weight gain, pregnancy-induced hypertension, anemia, sexually transmitted diseases (STDs), and cephalopelvic disproportion. Later in life, adolescent mothers tend to be at greater risk for obesity and hypertension than women who were not teenagers when they had their first child" (Cape Fear Teen Health Council, 2006). When one views this evidence, it is impossible to conclude that teenage pregnancy is good for teenage mothers, as a whole.

Furthermore, teenage pregnancy can have serious negative consequences for the child. Teenage mothers are far less likely to get adequate prenatal care than older mothers, and this can have a detrimental impact on the baby. Combined with the other health issues that frequently co-exist in teenage mothers, the outlook for the child can be very negative. "Children born to teen mothers suffer from higher rates of low birth weight and related health problems. Low birth weight raises the probabilities of infant death, blindness, deafness, chronic respiratory problems, mental retardation, mental illness, and cerebral palsy" (Cape Fear Teen Health Council, 2006). Moreover, these problems do not end at birth. Due to lack of maternal resources, the children of teenage mothers often suffer lifelong consequences, including, but not limited to insufficient health care, inadequate parenting, child abuse, and neglect (Cape Fear Teen Health Council, 2006). These problems do not remain in the home either; "children of teens are 50% more likely to repeat a grade; they perform much worse on standardized tests; and ultimately they are less likely to complete high school than if their mothers had delayed childbearing"(Cape Fear Teen Health Council, 2006).

Moreover, all of society is impacted by teenage pregnancy. Every child that grows up in an inadequate home increases the risk of the burden on society. This is a particular problem in the United States, which has teen pregnancy rates that are far in excess of any other industrialized nation. U.S. teen pregnancy rates are "nearly double Great Britain's, at least four times those of France and Germany, and more than ten times that of Japan" (Cape Fear Teen Health Council, 2006). The result is that a huge amount of U.S. resources must be diverted to dealing with the impact of teen pregnancy, which places us in a weakened position when compared to competitor nations. Teen pregnancy literally costs taxpayers billions of dollars each year, and, given the cyclical nature of the problem, creates an enduring legacy of problems. "There are nearly half a million children born to teen mothers each year. Most of these mothers are unmarried, and many will end up poor and on welfare. Each year the federal government alone spends about $7 billion to help families that began with a teenage birth" (Cape Fear Teen Health Council).

Teen pregnancy rates

When examining the problem of teen pregnancy in the United States, it is critical to realize that the problem varies tremendously from state to state. In 2006, 750,000 women under the age of 20 became pregnant (Guttmacher, 2010). The pregnancy rate among 15 to 19-year-olds was 71.5 per 1000 (Guttmacher, 2010). Of course, these numbers do not reflect those under 15 who experienced pregnancy. Moreover, while there had been a downward trend in the U.S. teen pregnancy rate, with it reaching its lowest point of 69.5 pregnancies per 1000 teens in 2005, it increased in 2006 for the first time in more than a decade (Guttmacher, 2010).

One of the interesting things about teen pregnancy rates is that they are not related to teen sexual activity in the way one would imagine. In other words, the more sexually active a teenager is does not mean that teenager has an increased risk of becoming a teenage mother. In contrast, "the pregnancy rate among sexually experienced teenagers (those who had ever had intercourse) was 152.8 pregnancies per 1,000 women aged 15 -- 19, reflecting the fact that the overall teenage pregnancy rate includes a substantial proportion of young people who are not sexually active" (Guttmacher, 2010). However, while this may reflect the historic success of birth control usage in sexually active teenage mothers, there is alarming news; the three percent increase in teenage pregnancies in the period from 2005 and 2006 was correlated with the same increase in teenage pregnancies among sexually experienced teenagers (Guttmacher, 2010).

Teenage pregnancies do not always results in teenage parents. There are three main options for a pregnant teenager: raising the child, adoption, and abortion. All three options receive some consideration, though abortion and keeping the child are highly favored over adoption. In 2006, the teenage birthrate "was 41.9 births per 1,000 women. This was 32% lower than the peak rate of 61.8, reached in 1991, but 4% higher than in 2005" (Guttmacher, 2010). In 2006, the teenage abortion rate was 19.3 abortions per 1,000 women, which is half of the 1988 peak, but 1% higher than the 2005 rate (Guttmacher, 2010). If 71.5 in 1000 teenagers were pregnant and 19.3 received abortions, then that is an abortion rate greater than 25%. However, it is critical to note that teenage abortion has declined significantly over the past two decades. "From 1986 to 2006, the proportion of teenage pregnancies ending in abortion declined almost one-third, from 46% to 32% of pregnancies among 15-19-year-olds" (Guttmacher, 2010). This news could be both good and bad, depending on one's personal position on the abortion issue, but it has not led to a significant increase in adoptions. On the contrary, "there is an unmistakable and dramatic trend away from teenagers giving their children up for adoption" (Lachance, 2011). Combine that with the overall decrease in teen abortions, and the result is an increase in the number of teenagers parenting, even if there has been an overall decline in teen pregnancy rates over the last two decades.

Like most things in the United States, one sees racial and ethnic differences in teen pregnancy rates, as well. However, while minorities, particularly African-Americans and Hispanics have historically been far more likely to experience teen pregnancy than whites, the race gap does appear to be getting smaller. "Among black women aged 15 -- 19, the nationwide pregnancy rate fell by 45% (from 223.8 per 1,000 to 122.7) between 1990 and 2005, before increasing to 126.3 in 2006" (Guttmacher, 2010). "Among Hispanic teenagers (of any race), the pregnancy rate decreased by 26% (from 169.7 per 1,000 to 124.9) between 1992 and 2005, before rising to 126.6 in 2006" (Guttmacher, 2010). However, there are still dramatic racial differences in teenage pregnancy; "among non-Hispanic white teenagers, the pregnancy rate declined 50% in the same period (from 86.6 per 1,000 to 43.3), before increasing to 44.0 in 2006" (Guttmacher, 2010).

In addition to race or ethnicity, geographic location seemed to have an impact on teenage pregnancy rates, probably because community attitudes about teenage sexuality, birth control, and sex education vary widely across the United States. Every state except experienced declines in their teen pregnancy rates from 1988 to 2000, and every state but North Dakota experienced declines in those rates from 2000 to 2005 (Guttmacher, 2010). Generally, states with the greatest numbers of teenagers had the highest numbers of teenage pregnancies (Guttmacher, 2010). However, teenage pregnancy rates were much greater in the south and southwest than in the northeast and Midwest. For example, "New Mexico had the highest teenage pregnancy rate (93 per 1,000), followed by Nevada, Arizona, Texas and Mississippi. The lowest rates were in New Hampshire (33), Vermont, Maine, Minnesota and North Dakota" (Guttmacher, 2010). Generally those states with the highest teenage pregnancy rates had the highest teenage birth rates, with Texas, New Mexico, Mississippi, Arkansas, and Arizona having the highest teenage birthrates (Guttmacher, 2010). Abortion trends varied widely by state as well. "Teenage abortion rates were highest in New York (41 per 1,000), New Jersey, Nevada, Delaware and Connecticut. By contrast, teenagers in South Dakota (6 per 1,000), Utah, Kentucky, Nebraska and North

Dakota all had abortion rates of eight or fewer per 1,000 women aged 15 -- 19. More than half of teenage pregnancies ended in abortion in New Jersey, New York and Connecticut" (Guttmacher, 2010). It is important to keep in mind that teenage abortion rates may reflect multiple issues. First, they may reflect that teenager's own personal beliefs and desire to raise a baby. However, they may also reflect prevailing societal norms in that geographic area, which can make it difficult, and even practically impossible, for pregnant teenagers to obtain abortions.

Portrayal in popular culture

Perhaps one of the most alarming things about teen pregnancy is that it is receiving more and more attention in popular culture, but not necessarily negative attention. For years, the trend was to stigmatize teenage mothers, which could lead to them being ostracized from society. For example, pregnant teenagers were once prohibited from attending the same schools as other children. There has been a trend towards compassion, which cannot be critiques; ostracizing teenage mothers only served to increase the negative impact of teenage pregnancy. However, there has been a trend in recent years of popular culture focusing on teen pregnancy, and many believe that this has glamorized teenage pregnancy.

The movie Juno focused on a pregnant 16-year-old and her decision to have the baby and give it up for adoption. Because the character Juno was portrayed in a positive manner, many people felt as if the movie was promoting the idea of teen pregnancy. There are some aspects in the film that certainly do not mesh with the reality for most pregnant teens. For example, the character is very self-possessed and has the support of her family (Jayson, 2008). In reality, most pregnant teenagers are members of otherwise high-risk groups and unlikely to have the self-possession of the movie's title character. Moreover, while some parents are supportive of their pregnant teenagers, the reality is that many pregnant teens get little to no support from their families. That does not mean that the movie Juno is unrealistic, but that it portrays a reality for a very small percentage of pregnant teenagers.

Even more disconcerting than the movie Juno is the popular reality TV series Teen Mom and the series it has spawned. Following teenagers who get pregnant during high school, the series does portray some of the realities for teen parents. However, despite the fact that most of these teenagers are not exemplary parents and have done literally nothing to distinguish them from the rest of society, they have been welcomed into the ranks of celebrity. The result is that teenage parenting may be portrayed as glamorous, even if the details of the show do not actually glamorize teen pregnancy. Teen pregnancy could be seen as a pathway to fame and fortune. Moreover, while most adults might dismiss this notion because of the tremendous problems portrayed on the show and in the tabloids about the mothers that have been represented, the problem is that teenagers lack adult judgment. In fact, one of the problems with teen pregnancy is that teenagers lack the mental faculty of adults; expecting them to understand messages that are clear to parents may be beyond the abilities of many teenagers.

Other figures in pop culture experience teenage pregnancy with an apparent lack of consequences. For example, when Jamie Lynn Spears became pregnant, she was a teenager. However, her similarities to the average teenager may have ended with her biological age. She certainly had the financial resources to deal with a pregnancy. Moreover, she had a family that was willing to help her raise her child. Likewise, teenage mothers like Bristol Palin, who have made a career out of being an unwed teenage mother, do not demonstrate the reality of what it will mean for most teenagers to become pregnant. The fact is that almost anyone who is going to be a sufficiently public figure for her pregnancy to be part of popular culture is going to be so removed from the problems that plague most teenage parents that she simply will not be a realistic depiction of pregnancy for the average teenager.

Popular beliefs and opinions impact on the teen pregnancy rate

Although popular culture may be embracing unwed parenting in general and seemingly embracing teen parenting in general, it would be erroneous to assume that popular culture is the driving force behind current high teenage pregnancy rates. Instead, one must look at the belief systems that lead to the U.S.'s high rates of teen pregnancy. The biggest contributing factor to teenage pregnancy appears to be American attitudes towards sexuality, particularly female sexuality, which is compounded by American religious beliefs. It is no coincidence that teenage pregnancy rates are higher in those states that are also most highly identified as predominantly conservative and Christian. Children in those states do not have sex at lower rates than children in other areas, but they do not seem to seek access to birth control at the same rates.

In fact, the failure to use reliable and consistent contraception is the cause of the teenage pregnancy epidemic (CDC, 2012). "Nearly two-thirds of unwed teenage women report that they never practice contraception or that they use a method inconsistently" (Lachance, 2011). This is not because they are trying to get pregnant; only 9% of pregnant teenagers reported trying to get pregnant (Lachance, 2011). Instead, the girls seemed to have an embarrassing lack of knowledge about basic human reproduction. Almost half of them believed that they could not get pregnant, generally because it was the wrong time of the month for conception (Lachance, 2011). "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% 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" (Lachance, 2011). Understanding the circumstances that make teenage women feel as if they are unable to use contraception is a critical component of solving teen pregnancy.

What is being done to reduce teen pregnancy?

At this point, it seems ridiculous to suggest that anything is being done to reduce teen pregnancy rates in some areas. Many areas have abstinence-only-based sex education, which is an absurd approach. Only a single abstinence-only education program has been able to provide credible evidence that it has led to a reduction of teenage pregnancy rates in any age group (Kirby, 2002). There is some evidence that abstinence only education may delay initial age of sexual intercourse, but that evidence is interesting because it also shows an overall increase in teen pregnancy rates. In fact, "increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates" (Stanger-Hall & Hall, 2011). This suggests that abstinence-only approach is in many ways more concerned about the notion of preserving female virginity than in decreasing teenage pregnancy rates, which may or may not be a morally appropriate approach, but does nothing to combat the public health epidemic of teenage pregnancy.

In other areas, sex education that discusses contraception, including where to access contraception, has been shown to be effective in helping reduce teenage pregnancy rates, though it does not eliminate teenage pregnancy. This is not due simply to contraceptive failure. The problem is that, even when students are informed about contraceptives and have access to them, they may not use them. In fact, "most teenagers are sexually active for many months before ever seeking birth control help from a family planning clinic or physician (citingTeenage 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" (Lachance, 2010). What this suggests is that real change has to go beyond schools and formal sex education and tackle the societal and family level issues that contribute to teenage pregnancy.