Young, innocent and pregnant; teenagers get pregnant for a variety of reasons, from ambivalence and ignorance about sex to wanting to fill a void in their lives

Young, innocent and pregnant; teenagers get pregnant for a variety of reasons, from ambivalence and ignorance about sex to wanting to fill a void in their lives

Elizabeth Stark

Young, Innocent and Pregnant

One out of ten teenagegirls in the United States becomes pregnant every year and almost half of these pregnancies result in births– 30,000 of them to girls under the age of 15.

Part of the reason for the high rateof teenage pregnancy is obvious: Teenagers are becoming sexually active at younger ages. During the 1970s, the number of sexually active teenagers increased by two-thirds. Today, among 15- to 17-year-olds in this country, almost half of the boys and a third of the girls are sexually active.

Unfortunately, teenagers’ sense ofresponsibility and ability to plan for the future have not kept pace with their sexual sophistication. Only 14 percent of teenage girls use contraceptives the first time they have intercourse. Most wait until they have been sexually active for nine months or more before they visit a birth-control clinic. And a major reason for a visit to a clinic is for a pregnancy test.

Among teenagers who do use contraceptives,many depend on such unreliable methods as withdrawal or rhythm. All in all, nearly two-thirds of unwed sexually active teenage girls either never or inconsistently practice birth control. Why are teenagers so lax about using contraception?

“The first time, it was like totallyout of the blue. . . . I mean, you don’t know it’s coming, so how are you to be prepared?’ a 16-year-old girl told Ellen Kisker, a demographer at the Office of Population Research at Princeton University.

“If I did [use a contraceptive] thenI’d have sex more. Then it would be too easy. . . . I don’t feel it’s right. I haven’t been raised that way,’ said another teenager, reflecting a major reason for the delay in obtaining contraceptives –ambivalence. As Karen Pittman, a sociologist at the Children’s Defense Fund in Washington, D.C., explains it, “Many teenagers can reconcile their sexual activity if it’s spontaneous or unplanned.’

Studies that support this idea havebeen conducted by psychologists Donn Byrne, at the State University of New York in Albany, and William Fisher, at the University of Western Ontario in London, Ontario. In many cases, they find, a teenager’s desire for completely spontaneous sex is tied to the belief that being “swept off your feet’ or “carried away’ is forgivable, but having premeditated sex is not. According to Fisher, “many adolescents are comfortable enough to have intercourse, especially with the aid of lust, love or liquor, but they are not comfortable enough to plan for it in advance.’

Byrne and Fisher found that collegestudents with negative attitudes toward sex were less likely to use birth control than those with more positive attitudes. The reason those who have negative attitudes are more likely to risk unwanted pregnancy, Byrne and Fisher believe, is that their negative feelings, while not strong enough to inhibit them from having sex, prevent them from going through the steps necessary to use contraception. They deny the possibility that sex may occur, are too embarrassed to get birth control or to discuss it with their partners and are inhibited about using birth-control devices. “The more guilt and anxiety you have about sex, the less likely you are to use contraception,’ Byrne says.

Young teenagers are simply not capableof internalizing contraceptive information, according to Irma Hilton, a psychologist at the Ferkauf Graduate School of Psychology. She believes that young people just don’t have the psychological strength to recognize the consequences of their actions.’ Teenagers tend to be impulsive and have trouble deferring gratification and making long-range plans, Hilton says. She points out that the older teenagers are when they initiate sexual activity, the more likely they will be to use contraceptives.

Another reason, according to Hilton,is that “maybe deep down they want to get pregnant.’ For those who feel isolated, the prospect of a baby offers the possibility of someone to love. Pregnancy also brings attention to a girl who may be feeling neglected. The ploy of entrapping a reluctant suitor may motivate some teenagers. Others may see pregnancy as a way to assert their independence from their parents or to become their mothers’ equal. Some may want to keep up with their pregnant girlfriends. Unfortunately, says Hilton, most teenage girls who see someone else’s cute, cuddly baby are in for a rude awakening when their own baby cries through the night and interferes with their social life.

Gerard Kitzi, director of the AdolescentResources Corporation in Kansas City, Missouri, which runs three school-based health clinics, agrees that many teenage pregnancies are on some level deliberate. He says that they have teenagers who come in for a pregnancy test and “are disappointed when the test is negative.’

And it is not only teenage girls whomay desire a child. In one study Hilton found that teenage fathers were generally happy about their girlfriend’s pregnancy, whether or not they had any intention of caring for the child. They felt that the pregnancy affirmed their manhood.

Many of the motivations for a teenagepregnancy are born of hopelessness, the feeling that opportunities in life are few and limited and one might as well have a baby as do anything else, according to Fisher. These feelings, many experts believe, are most common among lower-income teenagers who see success in school or work as impossibilities for themselves. “They’re people who’ve fallen out of the system,’ Fisher says. Studies have shown that teenagers who are behind academically in school are three times more likely to become unwed parents.

“The bottom line is kids don’t feelgood about themselves, especially those in lower-socioeconomic groups, who have no feeling of the future,’ says Kitzi. “So they do something that for them seems “temporary’: go out and start a family.’

In addition, Hilton believes that lower-incometeenagers are more likely to become pregnant because of attitudes within the family. According to her studies, a tolerant family attitude toward early sexual activity and pregnancy predicts high rates of teenage pregnancy. But if a teenage girl has a good relationship with her mother and if her mother is opposed to teenage pregnancy, it is less likely.

The first step in combatting teenagepregnancy, many experts agree, is teaching children about sex and sexuality from an early age. Although some school administrators claim that parents are opposed to sex education, 85 percent of the people polled by Louis Harris in the summer of 1985 said they wanted sex education taught in the schools. In addition, 78 percent said that television should air messages about birth control, and 67 percent thought that schools should establish links with family-planning clinics so that teenagers can obtain and learn about contraceptives.

Between 60 and 75 percent of studentsin this country receive some type of sex education before they graduate from high school, but the effectiveness and quality of these classes are questionable, according to Douglas Kirby, director of the Center for Population Options. Many schools that claim to offer sex education just provide one biology or health class on basic reproduction and do not address the real questions teenagers have about sex. (See “What Kids Need to Know,’ this issue.) Not all programs discuss birth control, and even when they do, they are unlikely to affect teenagers’ use of contraception.

The most effective sex-educationclasses don’t just teach basic reproduction and contraception; they discuss dating and relationships, as well as beliefs and life goals, according to Kirby, who did an evaluation of 13 sex-education programs in the United States. The attempt in the past to teach sex education free of values may have been a mistake, Kirby says. He believes it is important to discuss basic values such as “all people should be treated with respect and dignity’ and “no one should use subtle pressure or physical force to get someone else to engage in unwanted sexual activity.’

Although these sorts of sex-educationclasses appear to help, they are most effective in reducing teenage pregnancies and births when combined with the resources of a clinic, according to Kirby’s report.

There are about 50 school-based clinicsin the country, and many of them show promise in reducing pregnancy rates and keeping teenage mothers from dropping out of school or becoming pregnant again. The prototype of such clinics, the St. Paul Maternal and Infant Care Program in St. Paul, Minnesota, began its school-based clinic more than a decade ago. It was originally set up to offer prenatal and post-partum care to pregnant teenagers at an inner-city high school. The focus soon shifted to preventing pregnancies by offering contraceptive counseling, but students were reluctant to attend since “there was no question why someone was going in there,’ says Ann Ricketts, program administrator. So the clinic quickly expanded to include more health services, such as athletic and college physicals, immunizations and weight-control programs, to broaden its appeal and to encourage more teenagers to visit.

There are now four school-basedclinics in St. Paul. Each has a core group made up of a nurse practitioner, social worker and technician. A nutritionist, pediatric nurse, pediatrician and obstetrician visit once a week. The clinics offer sex-education courses in the school, and participation in the clinics is completely voluntary, confidential and free for all students.

The clinics have helped reduce pregnanciesamong their students by more than 50 percent, have kept pregnant teenagers from dropping out of school (80 percent return to school and graduate after their delivery) and have increased teenagers’ use of contraceptives. Most impressive, the percentage of repeat pregnancies among students is less than 2 percent.

Laurie Schwab Zabin, director of theSocial Science Fertility Research Unit at the Johns Hopkins School of Medicine, and her colleagues recently completed an evaluation of an adolescent pregnancy prevention program that ran for three years in Baltimore’s inner city. The health program was based in two schools–a junior and senior high. A social worker and a nurse practitioner taught sex-education classes in the schools and provided birth-control information and devices at the nearby clinics. In addition, seven “peer resources’ students publicized the centers and acted as counselors. The program was extremely successful. Among high school students involved with the program for at least two years, the pregnancy rate decreased by 30 percent, while the rates rose 58 percent at similar schools in the area, according to Zabin.

Another encouraging finding wasthe high attendance at the clinic of boys, especially at the junior high school level. Various researchers have pointed out the importance of getting teenage boys motivated to use contraception since two of the most popular methods among teenagers, condoms and withdrawal, depend on male cooperation. Many have claimed that it’s impossible to get young men interested in practicing contraception, but Zabin says that this isn’t true “if you get them interested at young ages.’

One result of the program, whichsurprised some, was that those who participated in it became sexually active on average seven months later than did teenagers attending schools with no such programs. According to Zabin this “once and for all refutes the notion that these sorts of programs encourage sex.’

She explains that “the staff waswilling to tell kids that they thought sex was inappropriate at young ages. It was discussed in the context of future goals. We tried to develop values in these kids. The focus was “make a life for yourself before you make another life.”

Various programs around the countryencourage teenagers to “say no’ to sex. One called “Will Power/Won’t Power’ helps 12- to 14-year-olds deal with the pressures of becoming sexually active and increases their assertiveness and skills in saying “no.’ In other programs teenagers learn responses to come-ons and pressures to have sex by role-playing and following scripts. But a few researchers question the effectiveness of such programs.

“I’m not saying it’s a bad idea,’says Byrne. “Society might be a better place for it. But in our present society with movies, TV and magazines glamorizing sex, the idea of just telling kids to say no is not realistic.’

Pittman believes simply telling teenagersto say no is “naive as a single strategy, but can be important as one of many strategies, especially among younger teenagers. There are teens who didn’t want to do it but were pushed into it. We should support those teens who don’t want to be sexually active.’

Fisher suggests that teenagers whoaren’t ready for sexual activity should be encouraged to pursue “virginity with affection,’ in which they achieve orgasm without intercourse. Various other programs have promoted the same sort of idea, which is sometimes referred to as “outercourse.’

Fisher also believes that societyneeds to develop fantasies that involve birth control. Most of our fantasies don’t include contraception, he says, and if they do they’re often “bad’ fantasies, as in the awkwardness of buying condoms in Summer of ’42 or the horror of having a parent discover a diaphragm, as in Good-bye Columbus. “It’s possible to replace those bad fantasies with good ones,’ he says. But he admits that this is not the total solution, especially among lower-income teenagers. “They need the possibility of jobs and a future. No amount of pro-contraception fantasy can change that,’ he says.

Almost everyone who has looked atthe problem agrees that poverty-stricken teenagers need to know that opportunities await them before they can be motivated to avoid pregnancy. As Pittman puts it, “all kids don’t have equally compelling reasons to delay parenthood.’ She believes that programs that help increase teenagers’ self-esteem and their abilities to succeed in the working world will lower teen pregnancy rates. If they feel valued as human beings they will be less likely to get pregnant to fill a void in their lives.

According to Pittman, the movementto help these teenagers find positive alternative to pregnancy must go beyond the schools into churches, youth groups, summer camps, recreation centers, after-school centers and of course the home–any place where a teenager’s self-esteem can be bolstered and where he or she can be offered possibilities for the future.

“The more teens, male or female,think they have to lose with a pregnancy,’ says Pittman, “the more likely they will try to avoid parenthood.’

Photo: Few teenagers use contraceptivesthe first time they have sex, and when they do, they usually use an unreliable method.

Photo: In some cases, mothers of teenage mothers end up caring forthe babies.

Photo: Teenage girls sometimes become pregnant to please or impress girlfriends and boyfriends.

Photo: Pregnant teenagers sometimes find themselves lavished withattention and love for the first time.

COPYRIGHT 1986 Sussex Publishers, Inc.

COPYRIGHT 2004 Gale Group