young pregnancy essay

124 Teenage Pregnancy Essay Topics + Examples

Early motherhood is a very complicated social problem. Even though the number of teenage mothers globally has decreased since 1991, about 12 million teen girls in developing countries give birth every year.

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Globally, adolescent birth rate has decreased from 65.5 in 2000 to 41.3 in 2023.

If you need to write a paper on the issue of adolescent pregnancy and can’t find a good topic, this article by our custom-writing experts will help you. Here, you will find:

research topics about teenage pregnancy
great essay prompts
writing tips with examples.
🔝 Top-12 Teenage Pregnancy Topics
🚀 Research Topics about Teenage Pregnancy
🔮 Creative Essay Topics
💡 Essay Prompts
📑 Top 10 Examples
🤔 Writing Tips

🔗 References

🔝 top-12 teenage pregnancy essay topics.

Effect of early childbearing on society.
Risk factors for teenage fatherhood.
Teenage pregnancy in developing countries.
Risk of eclampsia in adolescent mothers.
Early childbearing in industrialized countries.
Low-income level and adolescent pregnancy.
Preterm birth problems in adolescent mothers.
Child neglect as a cause of teenage pregnancy.
Socioeconomic factors of adolescent pregnancy.
Psychological consequences of teenage pregnancy.
Lack of education as the leading cause of early childbearing.
Is lack of contraception the only cause of teenage pregnancy?

🚀 Research Topics about Teenage Pregnancy: Top Ideas for 2024

Discuss the hidden factors behind alarming teen pregnancy statistics.
Analyze the relationship between poverty and early pregnancy.
What is the impact of teen pregnancy on maternal health ?
Write about the impact of early pregnancy on a child’s development and well-being.
Explore the psychological challenges faced by teenage mothers.
The role of government policies in preventing teen pregnancy.
Teenage mothers in foster care : risk factors and outcomes for teens and their children.
The impact of early pregnancy on career opportunities for teenage mothers.
Discuss the impact of media on attitudes toward teen pregnancy .
Analyze the relationship between race and early pregnancy rates.
Study the issue of teen pregnancy and the mental health needs of young mothers.
What role can a healthcare provider play in preventing teenage pregnancy ?
Analyze family relationships in a teenage couple post-pregnancy.
Discuss the role of fathers in preventing teen pregnancy.
Study a number of teen pregnancy prevention programs and evaluate their effectiveness.
Young, pregnant, and incarcerated: the impact of teen pregnancy on the juvenile justice system .
What is the relationship between teenage pregnancy and substance abuse?
Write about the impact of abortion on teenage mothers as opposed to early motherhood.
What is the role of schools in preventing teen pregnancy?
Conduct a correlational analysis of teenage pregnancy and maternal mortality rates in the United States .
How do teen pregnancy and domestic violence impact the unborn baby?
Discuss the impact of teenage pregnancy on child abuse and neglect rates.
Write about a possible solution to the problem of teen pregnancy and healthcare disparities in marginalized communities.
What is the impact of teenage pregnancy on intergenerational poverty?
Is there a correlation between socioeconomic status and teen pregnancy rates in developed countries?
Analyze some of the factors that contribute to increased rates of teen pregnancy in Southern African countries.
Explore the impact of teenage pregnancy on high school completion rates in Texas, US.
What role do healthcare providers have in addressing the reproductive health needs of teenagers?
Elaborate on why easy access to contraception is pivotal in reducing teen pregnancy rates.
Discuss psychological and socioeconomic challenges faced by teenage fathers.
What is the impact of teen pregnancy on rates of child poverty ?
Explain the importance of family planning in preventing early pregnancy.
Critically evaluate the influence of peer pressure on teenage sexual behavior.
What is the psychological impact of the stigma associated with teenage pregnancy?
Suggest ways to address the impact of teenage pregnancy on young mothers’ ability to attain financial independence.
Discuss the importance of community support for teenage parents.
What is the role of government policies in addressing the root causes of teen pregnancy ?
Describe the impact of teenage pregnancy on young mothers’ self-esteem.
A possible solution found: parental involvement in preventing teenage pregnancy.
Speak about the impact of family, peer, and school context on teen pregnancy and childbearing.
What is the role of technology in teen pregnancy prevention and intervention?
Discuss the impact of parent-child communication on teen pregnancy prevention.
A comparative study of teen pregnancy rates in urban and rural areas.
Examine the relationship between teen pregnancy and risky sexual behavior .
Write about the effectiveness of long-term contraceptive methods for teen pregnancy prevention.
What impact do early childhood experiences have on teen pregnancy and childbearing?
To what extent does teen pregnancy and intimate partner violence correlate?
Explain the role of gender and sexuality in teen pregnancy rates and prevention.
Elaborate on the relationship between teen pregnancy and poverty.
What is the impact of early pregnancy on mental health outcomes for children?
Speak about the effects of social media on teenage pregnancy and parenting behaviors.
How does teenage pregnancy affect academic achievement and educational attainment?
How school-based health clinics can assist in reducing teenage pregnancy rates.
What is the relationship between teenage pregnancy and mental health outcomes for adolescent mothers ?
How can media portrayals of pregnancy affect the behaviors of young mothers?
Write about the effects of early childhood interventions on improving outcomes for children of teenage mothers.
Speak about the role of healthcare providers in promoting family planning and reducing teen pregnancy rates.
What effect can teenage pregnancy have on relationships between romantic partners?
Explain the correlation between the COVID-19 lockdown and teenage pregnancy rates.
Alarming statistics: sexual abuse as a contributing factor in teenage pregnancy.
Discuss the complications after having an unwanted teenage pregnancy .
What is the impact of gender roles and expectations on teenage pregnancy rates?
Speak about the effects of pregnancy prevention programs on reducing repeat teen pregnancies.
Analyze the relationship between early pregnancy and sexual and reproductive health outcomes.
What are the major economic effects of increased contraceptive access among young women?
Analyze the role of family dynamics and structure in teenage pregnancy prevention efforts.
Write about the impact of legal and policy interventions on reducing teenage pregnancy rates in the United States.
What are some cultural stereotypes regarding teen pregnancy?
How does stigma affect attitudes toward teenage pregnancy and parenting?
What are some of the determinant factors of the high adolescent pregnancy rate in Africa?

The US has the highest rates of teen pregnancies among developed nations.

Teenage Pregnancy Topics for Quantitative Research

Factors affecting teen pregnancy rate among African Americans.
Teen birth rate disparity in underrepresented groups.
Why has teen pregnancy been on the decline?
An international perspective on the teen pregnancy rate in the US.
Is sexual abstinence effective against early childbearing?
The median age of sexual activity: teen pregnancy implications.
How can we prevent adolescent pregnancies in catholic schools?
How does sex education impact Hispanic teen pregnancy rates?
The birth rate of American Indian and Alaska Native teens.
How does teen pregnancy affect the rate of graduation from high school?

Recent quantitative research shows us that the teenage pregnancy rate decreases every year. This tendency started in 1991 and it still continues. Quantitative studies use numbers and statistics, and they help estimate the problem’s scope. You can write a survey of your own using the topics above.

Qualitative Research Topics about Teenage Pregnancy

Educational factors affected by teen pregnancy.
Teen pregnancy in Nebraska: qualitative analysis.
Chicago African American teen pregnancies: insights from the community.
Community leadership and teen pregnancy: core preventers.
Teen pregnancy and sexually transmitted diseases: an interview-based study.
How to address the issue of access to sex education among Hispanic teen mothers.
Teen pregnancy risk factors: things we still need to address.
Sexual abuse and teen pregnancy: victim analysis.
Determine essential areas of assistance for teen mothers.

Qualitative research deals with personal perspectives and often uses methods such as questionnaires. It helps determine the causes that lead to teenage pregnancy. Unhealthy childhood environments, domestic violence, and inaccessibility of education are the major factors influencing the chances of early pregnancy that you can research in your paper.

🔮 Creative Teenage Pregnancy Essay Topics

Teen pregnancy among African Americans: a call for help.
Adolescent pregnancy rates in Catholic schools.
Sexual abstinence education and the Holy Bible.
Explore the role of influencers, peer pressure, and online communities on teen pregnancies.
Assistance for teen mothers: stopping the shaming.
Spotting a sexual abuse victim: do not ignore teens.
Compare different approaches to sex education and evaluate their effectiveness.
The median age of sexual activity: what our leaders must do.
God, adolescence, and motherhood: a catholic perspective.
Explore the intersectional issues of sexism, racism , and classism in early parenthood.

In your essay on teenage pregnancy, you may look at the problem of early motherhood from a more unusual angle. For example, study the threats to young mothers, such as the absence of proper healthcare, illegal abortion, and family abuse. Make sure to read plenty of scientific literature while writing your paper on one of our creative topics.

Causes of Teenage Pregnancy Essay Topics

Evaluate the role of proper sex education in reducing teenage pregnancies.
How do parental relationships impact the likelihood of teen pregnancy?
Assess the effect of substance abuse on adolescent pregnancy rates.
Cultural and religious influences on teenage pregnancy rates in the US.
Is academic pressure a contributing factor in teen pregnancy?
Different family structures and teen pregnancy: a comparison.
What mental disorders are likely to lead to an early pregnancy?
Evaluate the effects of early sexual activity on the likelihood of teen pregnancy.
Analyze various community programs and their impact on reducing teen pregnancy.
How do various parenting styles influence early pregnancy rates?
Psychological factors and emotional drivers of adolescent pregnancy.
Does lack of communication contribute to teen pregnancy?
How do disparities in education contribute to teenage pregnancy rates?

The causes of teenage pregnancy are numerous, and some are more studied than others. For example, the effect of social media on early motherhood is a relatively new phenomenon that you can research in your essay about teenage pregnancy.

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💡 Teenage Pregnancy Essay Prompts

Does access to condoms prevent teenage pregnancy: essay prompt.

Access to condoms might result in an even higher rate of teenage pregnancies. In your essay, you can analyze previous research about the increase in adolescent pregnancies due to widespread condom distribution in schools.
Access to condoms should come together with mandatory counseling. You might suggest this or other ways to make access to contraception methods more efficient in preventing teenage pregnancies.
Sex education should be offered in all schools. Teenagers should have access to birth control and know how to use it to prevent unintended teenage pregnancy. Do you agree with this idea?

Teenage Pregnancy Solution Essay Prompt

Ways in which parents and guardians can prevent early pregnancies. For example, parents can ask healthcare providers to educate their teenage children on the topic of contraception. Analyze these and other ways in which they may prevent adolescent pregnancies.
The role of governments in teenage pregnancy prevention. Governments should raise awareness of the issue by developing programs and providing affordable family planning services. You might suggest other ways for the governments to contribute.
What should teenagers do to avoid unwanted pregnancies? Some of the options are birth control methods and open conversations with their parents. What other options are there?

Teenage Pregnancy and Poverty Essay Prompt

The correlation between poverty rate, education level, and teenage pregnancy. Many adolescent mothers live in poverty and lack education due to their social status. Your essay can analyze how these factors interact and result in early pregnancies.
How does poverty lead to health issues in teenage mothers? Young mothers and children born in poverty have a high chance of developing health problems. Pregnancy is a vulnerable period in a woman’s life, and poverty only aggravates it. The risks include preterm birth and even infant death.

Causes and Effects of Teenage Pregnancy Essay Prompt

The effect of alcohol and drugs on teenage pregnancy rates. Due to frequent social gatherings, alcohol, and drugs might become a part of a teenager’s life. Your cause-and-effect essay may analyze how substance use may lead to early unwanted pregnancy.
How do TV shows influence teen pregnancy rates? The media often romanticizes this issue, which is why some teenagers may fail to understand the actual consequences of their decision to have children early. You may also analyze reality shows about teen pregnancy that take a more realistic approach, like 16 and Pregnant .
The effect of early pregnancy on the future child’s parenting approach. Research shows that a teen mother’s child has a high chance of also becoming a teen parent . You might analyze this phenomenon in your paper.

📑 Teenage Pregnancy Essay Examples: Top 10

Want some more inspiration? Check out these outstanding examples:

Teenage Pregnancy in Barking and Dagenham Borough
School Sex Education and Teenage Pregnancy in the United States
Teenage Pregnancy: Causes, Education, Prevention
Teenage Pregnancy, Its Health and Social Outcomes
Teenage Pregnancy and Its Negative Outcomes
Teenage Pregnancy in the United Kingdom

🤔 Teenage Pregnancy Essay Writing Tips

Now that you’ve chosen a topic, it’s time to write an excellent teenage pregnancy essay. But how do you do it? Follow our helpful tips!

Teenage Pregnancy Essay Introduction

When writing an introduction , use a traditional structure:

Present the problem you are addressing with some background info.
State your position and the main points of your argumentation in a thesis statement .

Teenage pregnancy is among the leading causes of maternal mortality. Complicated pregnancy or traumatic childbirth causes the death of almost 30,000 adolescent girls every year. These alarming statistics prove that it is crucial to search for more efficient ways of reducing the teenage pregnancy rate.

Steps to writing a teenage pregnancy essay introduction.

Teenage Pregnancy Essay Body

The body paragraphs help you develop your argumentation. A standard 5-paragraph essay includes three body paragraphs. Each one conveys a key idea supported by evidence, such as interviews, statistics, and journal articles.

Here’s what one such paragraph may look like:

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Research shows that proper sex education helps reduce the number of teenage pregnancies. According to a recent study by the University of Washington based on a national survey of 1,719 teenagers, comprehensive sex education more effectively reduces the early birth rate than the traditional abstinence-only approach.

Conclusion for an Essay About Teenage Pregnancy

An effective conclusion should draw attention to the problem and key points of the essay. Rephrase your thesis and give a short summary of your arguments:

Education is the key factor that leads to a reduction in teenage pregnancy. Statistical analysis shows that girls who do not get the proper education more often get pregnant before reaching adulthood. Literature analysis proves that adding comprehensive sex education to the school curriculum effectively reduces the teenage pregnancy rate. Thus, providing girls with proper education is an effective way to reduce the number of adolescent mothers.

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Teenage Pregnancy by Andrew L. Cherry , Mary E. Dillon LAST REVIEWED: 26 October 2015 LAST MODIFIED: 26 October 2015 DOI: 10.1093/obo/9780199791231-0111

Since the 1950s, teenage pregnancy has attracted a great deal of concern and attention from religious leaders, the general public, policymakers, and social scientists, particularly in the United States and other developed countries. The continuing apprehension about teenage pregnancy is based on the profound impact that teenage pregnancy can have on the lives of the girls and their children. Demographic studies continue to report that in developed countries such as the United States, teenage pregnancy results in lower educational attainment, increased rates of poverty, and worse “life outcomes” for children of teenage mothers compared to children of young adult women. Teenage pregnancy is defined as occurring between thirteen and nineteen years of age. There are, however, girls as young as ten who are sexually active and occasionally become pregnant and give birth. The vast majority of teenage births in the United States occurs among girls between fifteen and nineteen years of age. When being inclusive of all girls who can become pregnant and give birth, the term used is adolescent pregnancy , which describes the emotional and biological developmental stage called adolescence. The concern over the age at which a young woman should give birth has existed throughout human history. In general, however, there are two divergent views used to explain teenage pregnancy. Some authors and researchers argue that labeling teen pregnancy as a public health problem has little to do with public health and more to do with it being socially, culturally, and economically unacceptable. The bibliographic citations selected for this article will be extensive. The objective is to cover the major issues related to teenage pregnancy and childbearing, and adolescent pregnancy and childbearing. Childbirth to teenage mothers in the United States peaked in the mid-1950s at approximately 100 births per 1,000 teenage girls. In 2010, the rate of live births to teenage mothers in the United States dropped to a low of 34 births per 1,000. This was the lowest rate of teenage births in the United States since 1946. In 2012, the live births to teenage mothers continued to decline to 29.4 per 1,000. This was a drop of 13.5 percent from 2010. In 2012, some 305,388 babies were born to girls between fifteen and nineteen years of age. Among girls fourteen and younger the rate of pregnancy is about 7 per 1,000. About half of these pregnancies (3 per 1,000) resulted in live births. In spite of this decline in teenage pregnancy over the years, approximately 820,000 (34 percent) of teenage girls in the United States become pregnant each year. What’s more, some 85 percent of these pregnancies are unintended. These pregnancies and births suggest that the story of teenage pregnancy is not in the numbers of teen pregnancies and births but in the story of what causes the increase and decrease in the numbers. With the objective in mind to better understand teenage pregnancy, a general overview is provided as a broad background on teenage pregnancy. Citations are grouped under related topics that explicate the complexity of critical forces affecting teenage pregnancy. Topics that provide a global view of the variations in perception of and response to teenage pregnancy will also be covered in this article.

Adolescent pregnancy is a complex issue with many reasons for concern. Teenage pregnancy is a natural human occurrence that is a poor fit with modern society. In many ways it has become a proxy in what could be called the cultural wars. On one philosophical side of the debate, political and religious leaders use cultural and moral norms to shape public opinion and promote public policy with the stated purpose of preventing teen pregnancy. To begin, Martin, et al. 2012 provides national vital statistics on teen pregnancy. Leishman and Moir 2007 provides a good overview of these broader issues. Demographic studies by organizations like the Alan Guttmacher Institute ( Alan Guttmacher Institute 2010 ) give a statistical description of teenage pregnancy in the United States. The number of teen pregnancies and the pregnancy outcomes are often used to support claims that teenage pregnancy is a serious social problem. The other side of this debate presented in publications by groups like the World Health Organization ( World Health Organization 2004 ) reflects the medical professionals, public health professionals, and academicians who make a case for viewing teenage sexuality and pregnancy in terms of human development, health, and psychological needs. These two divergent views of teen pregnancy are represented in the United States by groups such as Children’s Aid Society; Healthy Teen Network; Center for Population Options; Advocates for Youth; National Campaign to Prevent Teen Pregnancy; National Organization on Adolescent Pregnancy, Parenting, and Prevention; state-level adolescent pregnancy prevention organizations; and other organizations that include teen pregnancy within their scope of interest and services. Mollborn, et al. 2011 delineates other important aspects of teenage pregnancy (race, poverty, and religious influences) that help explain why teenage pregnancy is considered a problem in some circles. The association between teenage pregnancy and social disadvantage, however, is not just found in the United States. Harden, et al. 2009 reports on the impact of poverty on teenage pregnancy rates in the United Kingdom. This phenomenon is not isolated to the United States and Great Britain; it is global. Holgate, et al. 2006 and the authors of Cherry and Dillon 2014 provide a comprehensive overview of global teenage pregnancy. To round out this general overview, the article Jiang, et al. 2011 is a description of a pragmatic national effort to improve the sexual and reproductive health of all adolescents and young adults. The best sources for research are professional journals and monographs from national and international health and development organizations focused on specific countries, regions, and global teenage pregnancy variations and trends.

Alan Guttmacher Institute. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity . New York: Alan Guttmacher Institute, 2010.

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This report describes trends in teenage pregnancy, childbearing, and abortion in the United States. The statistics reveal discernible variations in teen birth and abortions between states. There is also a wide variation in teen pregnancy between racial and ethnic groups. Since the slight increase in 2006 rates have continued to decline.

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Cherry, Andrew L. “Biological Determinants and Influences Affecting Adolescent Pregnancy.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 39–53. New York: Springer Science & Business Media, 2014.

This chapter highlights the biological determinants that influence adolescent sexuality and pregnancy. While our genes influence individual sexual development and behavior, the question is how much. Integrated biopsychosocial models are more accurate and give a richer picture of the determinants of adolescent sexuality.

Cherry, Andrew, and Mary Dillon. International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . New York: Springer Science & Business Media, 2014.

DOI: 10.1007/978-1-4899-8026-7 Save Citation » Export Citation » Share Citation »

In this edited volume, eight chapters deal with issues related to adolescent pregnancy, such as mental health; biological determinants; fatherhood; pregnancy among lesbian, gay, and bisexual teens; etc. Additionally, thirty-one chapters cover major variations in the way adolescent pregnancy is viewed from different countries around the world.

Harden, Angela, Ginny Brunton, Adam Fletcher, and Ann Oakley. “Teenage Pregnancy and Social Disadvantage: Systematic Review Integrating Controlled Trials and Qualitative Studies.” British Medical Journal 339 (2009): 1182–1185.

DOI: 10.1136/bmj.b4254 Save Citation » Export Citation » Share Citation »

This is a review of interventions addressing social disadvantages associated with adolescent pregnancy in the United Kingdom. Teenage pregnancy rates were 39 percent lower among teenagers receiving both early childhood intervention and youth development programs that address “dislike of school,” “poor material circumstances and unhappy childhood,” and “low expectations for the future.”

Holgate, Helen S., Roy Evans, and Francis K. O. Yuen. Teenage Pregnancy and Parenthood: Global Perspectives, Issues and Interventions . New York: Routledge, 2006.

Teenage pregnancy and parenting, especially at a young age, is typically viewed as personally and socially undesirable. Governments worldwide demonstrate concern about teenage pregnancy in their policies and programs. This book provides a broad range of international perspectives and cultural contexts, and looks at interventions and examples of best practices.

Jiang, Nan, Lloyd J. Kolbe, Dong-Chul Seo, Noy S. Kay, and Claire D. Brindis. “Health of Adolescents and Young Adults: Trends in Achieving the 21 Critical National Health Objectives by 2010.” Journal of Adolescent Health 49 (2011): 124–132.

DOI: 10.1016/j.jadohealth.2011.04.026 Save Citation » Export Citation » Share Citation »

This is a report on the 21 Critical National Health Objectives for Adolescents and Young Adults in the United States as described in Healthy People 2010 . Two of the twenty-one goals were reached, reduction in adolescents riding with a drunk driver, and reduced physical fighting. Progress varied by demographic variables.

Leishman, June, and James Moir. Pre-Teen and Teenage Pregnancy: A Twenty-First Century Reality . Keswick, UK: M&K Update, 2007.

This book is a good place to start. It provides a standard definition of adolescents. The premise is that the physical and emotional health of teenagers has always been a complex issue and continues to challenge modern societies. It offers insight into the social reality of sexually active adolescents.

Martin, J. A., B. E. Hamilton, S. J. Ventura, M. J. Osterman, E. C. Wilson, and T. J. Mathews. “National vital statistics reports.” National Vital Statistics Reports 61.1 (2012).

This brief report shows the latest available statistical on teenage pregnancy in the United States. The report shows that teenage pregnancy continued to fall for all groups. Nevertheless the disparity between the rate of live births is two times higher among non-Hispanic African American and Hispanic girls compared to non-Hispanic white girls.

Mollborn, Stefanie, Benjamin W. Domingue, and Jason D. Boardman. Racial, Socioeconomic, and Religious Influences on School-Level Teen Pregnancy Norms and Behaviors . Boulder: Institute of Behavioral Science, University of Colorado, 2011.

This report provides a broad overview of the influence and role of schools on teenage pregnancy. The impact of the school’s social, economic, and racial composition on teenage pregnancy rates among students is examined. Focusing on “age norms,” the authors answer the question, How do norms explain school pregnancy rates?

World Health Organization. Adolescent Pregnancy: Issues in Adolescent Health and Development . Geneva, Switzerland: World Health Organization, 2004.

This overview of global adolescent health, development, and pregnancy covers both developed and developing countries. Social indicators and statistics show the increase in teen pregnancy after World War II and the surprising decline in the 1990s. This occurred as social control by parents and family declined.

As of mid-year 2012, there were few books designed as textbooks to be used in college classes on teenage pregnancy. This lack of textbooks and chapters, however, does not mean that this topic is not addressed in academia. Research related to teenage pregnancy (not including demographic studies and comparisons) has been mainly limited to the medical, behavioral, and social sciences. An exception is the textbook Farber 2009 . Written for social workers and students in the helping professions, it covers the risk factors and prevention. There are other books that might be used as supplemental reading material: Goldstein 2011 has a medical orientation but it was not written to be a textbook. There are several chapters on teenage pregnancy written in textbooks, for example, Armstrong 2001 . Other chapters are included in volumes related to adolescent health. Wells 2006 would be useful as a supplemental text. It presents opposing viewpoints. Other volumes such as Cater and Coleman 2006 explore why teenage girls in Great Britain plan their pregnancies. Another publication, Romer 2003 , could stimulate class discussions about the perception of what is an integrated approach to reducing the risk of adolescent pregnancy. Two other books that could be used in a college class are Maynard 1996 , a classic that makes the case that teenage pregnancy is a problem that needs to be addressed, and Cocca 2006 , which provides a historical background.

Armstrong, Bruce. “Adolescent Pregnancy.” In Handbook of Social Work Practice with Vulnerable and Resilient Populations . Edited by Alex Gitterman, 305–341. New York: Columbia University Press, 2001.

This chapter provides students in the helping professions with a more in-depth discussion of the experience of teenagers who become pregnant and parent their children. Examining vulnerability and resilience, the chapter makes the point that pregnancy and parenting during adolescence is a contentious public issue and has resulted in perplexing policy.

Cater, Suzanne, and Lester Coleman. “Planned” Teenage Pregnancy: Perspectives of Young Parents from Disadvantaged Backgrounds . Bristol, UK: Policy, 2006.

This is a study of the reasons teenage girls facing poverty and disadvantage in the United Kingdom plan their pregnancies. Interviews with the teens are used to suggest policy implications for reducing teen pregnancy and how “planning” is viewed by policymakers.

Cocca, Carolyn. Adolescent Sexuality: A Historical Handbook and Guide . Westport, CT: Praeger, 2006.

This is a set of five essays dealing with adolescent sexuality, which includes adolescent pregnancy. It also includes a broad survey of the history of perceptions of adolescent sexuality and chapters on rape, pregnancy, sex education, and pop culture.

Farber, Naomi. Adolescent Pregnancy: Policy and Prevention Services . 2d ed. New York: Springer, 2009.

This textbook is primarily written for social workers and others in the helping professions who provide services to adolescents and teenagers. It covers the risk factors, child-family outcomes, and prevention. It addresses public policy and practice issues related to adolescent sexual health risks and the variation in teen pregnancy rates. Originally published in 2003.

Goldstein, Mark A. “Adolescent Pregnancy.” In The MassGeneral Hospital for Children: Adolescent Medicine Handbook . Edited by Mark A. Goldstein, 111–113. New York: Springer, 2011.

DOI: 10.1007/978-1-4419-6845-6_15 Save Citation » Export Citation » Share Citation »

This is a medical-oriented description of teenage pregnancy focusing on predictors. Listed causes are: early pubertal development, sexual abuse, poverty, lack of a nurturing family, substance abuse, low expectations or career goals, and poor school performance. “Just say no” and “virginity pledges” may decrease the likelihood of using contraception.

Maynard, Rebecca A., ed. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy . Washington, DC: Urban Institute, 1996.

During the early 1990s, four hundred thousand US girls under the age of eighteen gave birth. This was twice the rate of other developed countries. Estimated economic and social costs of teenage childbearing are presented and contrasted with the strengths and weaknesses of specific policies and programs to prevent teen pregnancy and childbirth.

Romer, Daniel. Reducing Adolescent Risk: Toward an Integrated Approach . Thousand Oaks, CA: SAGE, 2003.

This is a good source on the topic of adolescent risk-taking behaviors (such as unprotected sex resulting in teen pregnancy). Understanding the role that adolescent risk taking often plays in sexual behavior is important for understanding unplanned teen pregnancy. This volume provides prevention and programming resources.

Wells, Ken R., ed. Teenage Sexuality: Opposing Viewpoints . Farmington Hills, MI: Greenhaven, 2006.

This is the latest in an opposing viewpoint series that can be useful supplemental material in some educational settings. It approaches teenage pregnancy by providing expert opinions in a pro versus con format.

The following reference material covers many issues that mark teenage pregnancy as an important issue in modern society. The debate is over whether teenage pregnancy is a serious health problem that requires intervention and prevention programming or whether it is a constructed crisis perpetuated by a conservative segment of society trying to enforce moral standards in an effort to save the greater society. The more pragmatic, less moralistic assessments tend to equate teenage pregnancy with adolescent sexual and reproductive health. What is evident from the literature is that on an individual level, adolescent pregnancy can and does change the trajectory of the teen mother and her child’s future. Rayes 2010 does a good job showing how trends influence public policy that results from concern over teenage pregnancy. The edited book by Card and Benner 2008 is a good source of descriptions of model programs to improve adolescent sexual health. Vinovskis’s work ( Vinovskis 1988 ) began early to make the case that teenage pregnancy was inappropriately being characterized as a problem. It helps put the policy issue in perspective. Fraser 2004 portrays teen pregnancy in an ecological context. This is a view that does not blame the teenager for her pregnancy. Arai 2009 takes a similar position in explaining teenage pregnancy in Great Britain. Early negative life events have been studied by Felitti and Anda ( Felitti and Anda 2010 ); they discuss these effects on adolescent pregnancy and the on long-term psychosocial outcomes and fetal death. Lancaster and Hamburg 2008 is similar with a biosocial emphasis. Finally, Laser and Nicotera 2010 employs these ideas for practitioners who work with adolescents. Cherry, et al. 2009 shows that although the physical risk associated with biological immaturity is ever present when young girls become pregnant, this risk (supported by research worldwide) for the most part has been shown to be caused by the social context in which the girls live. What is clear in the literature is that assumptions and perspectives can either increase risk or modulate the risk associated with an adolescent pregnancy.

Arai, Lisa. Teenage Pregnancy: The Making and Unmaking of a Problem . Bristol, UK: Policy, 2009.

This book presents the findings of a longitudinal study of adolescent health that focuses on teenage pregnancy. The author identifies strategies to reduce teenage pregnancy, reframes teen pregnancy as a social exclusion issue rather than a moral issue, and promotes increasing the participation of teen mothers in education and employment.

Card, Josefina J., and Tabitha A. Benner, eds. Model Programs for Adolescent Sexual Health: Evidence-Based HIV, STI, and Pregnancy Prevention Interventions . New York: Springer, 2008.

This volume provides a directory of model programs for adolescent sexual health. Programs described are among the most promising and empirically tested sexual education and prevention programs in the United States. Programs included were selected for their demonstrated positive impact.

Cherry, Andrew L., Lisa Byers, and Mary E. Dillon. “A Global Perspective on Teen Pregnancy.” In Maternal and Child Health: Global Challenges, Programs, and Policies . Edited by John Ehiri, 375–397. New York: Springer, 2009.

DOI: 10.1007/b106524 Save Citation » Export Citation » Share Citation »

This chapter presents a global view of teenage pregnancy comparing developed and developing counties in terms of attitudes, perspectives, and approaches employed to deal with teen pregnancy. The primary conclusions: the more educational, occupational, and economic opportunity available to teenage girls, the more likely they are to postpone pregnancy and childbirth.

Felitti, Vincent J., and Robert F. Anda. “The Relationship of Adverse Childhood Experiences to Adult Medical Disease, Psychiatric Disorders and Sexual Behavior: Implications for Healthcare.” In The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic . Edited by Ruth A. Lanius, Eric Vermetten, and Clare Pain, 77–87. Cambridge, UK: Cambridge University Press, 2010.

DOI: 10.1017/CBO9780511777042 Save Citation » Export Citation » Share Citation »

Early negative life events are increasingly recognized as having serious and long-lasting effects. Emotional traumas during childhood impact neural and biological systems required for labile stability, general well-being, biomedical disorders, social function, and psychopathology. The effects of adolescent pregnancy on long-term psychosocial outcomes and fetal death are discussed.

Fraser, Mark W., ed. Risk and Resilience in Childhood: An Ecological Perspective . 2d ed. Washington, DC: NASW, 2004.

Each chapter deals with a different issue. Based on the ecological and multisystemic perspective, protective factors and risk factors for teenage pregnancy, school failure, and other childhood behaviors (i.e., disorders in childhood, drug use, and delinquency) are examined using an ethnocultural perspective.

Lancaster, Jane B., and Beatrix A. Hamburg. School-Age Pregnancy & Parenthood: Biosocial Dimensions . New Brunswick, NJ: Aldine Transaction, 2008.

In this biosocial perspective of teenage pregnancy both the biological substratum and the social environment are proposed as essential codeterminants of behavior. Culturally defined responses to the basic needs of pregnant and parenting girls is presented to explain the medical and social response and the challenge of teen pregnancy and childbearing.

Laser, Julie Anne, and Nicole Nicotera. Working with Adolescents: A Guide for Practitioners . Social Work Practice with Children and Families Series. New York: Guilford, 2010.

The authors take the position that teenage pregnancy is one of several adolescent problem behaviors. An ecological perspective is used to explain and address specific challenges faced by adolescents. The theoretical framework is followed by a section on the adolescent in context. It concludes with clinical interventions for problematic adolescent behaviors.

Rayes, Gilberto de la. Nonmarital Childbearing: Trends, Reasons and Policy . New York: Nova Science, 2010.

In 2006, 38.5 percent of all US births were among single mothers (single teenage girls and young women). Birth without marriage is viewed as a serious problem among social conservatives. Research cited suggests that children who grow up with only one biological parent often experience worse lifetime outcomes than peers.

Vinovskis, Maris A. An “Epidemic” of Adolescent Pregnancy? Some Historical and Policy Considerations . New York: Oxford University Press, 1988.

This book is a historical review of adolescent sexuality and pregnancy starting in colonial times. It includes background on the origins of federal programs and policies that produced unexpected outcomes that were frequently not in line with expectations. This book also includes perspectives on the role of the adolescent father.

The following reference matter covers some of the most important issues related to teenage pregnancy. Foremost, as Patton, et al. 2010 and Hagen, et al. 2012 , make the point; teenage pregnancy is a health issue that fundamentally affects the sexual and reproductive health of the girl who is pregnant. Yet, Jewell 2000 and others believe that teenage pregnancy is a social problem. It is also a public health concern and a concern for those specializing in family planning. Prevention is another area that is supported by both professionals and the public. The definition of prevention, however, may be very different. As such, sexual education, the centerpiece of any prevention program, is hotly debated in many countries, particularly in the United States. In part, it is because the question is framed as an effort to prevent teen pregnancy. This is unfortunate. In many cases, the consequences of the prevention efforts often result in increases in sexually transmitted disease, pregnancy, and abortions. Approaching the task of providing sexual education from a justice perspective is different. The reason for providing accurate age-graded sexual information from a justice perspective, as Catania and Dolcini 2012 and Secor-Turnera, et al. 2011 suggest, is that it is an inalienable right of all people, especially adolescents and in particular teenagers, to have accurate information about their sexual and reproductive health. Even so, as Kaye, et al. 2009 and Collins, et al. 2011 explain, this does not exclude the influence of family, parents, or the religious community. Parents and peers are very influential on adolescent sexual behavior. Religion can be significant in delaying sexual initiation but is also associated with a failure to use a condom at first sexual intercourse.

Catania, Joseph A., and M. Margaret Dolcini. “A Social-Ecological Perspective on Vulnerable Youth: Toward an Understanding of Sexual Development among Urban African American Adolescents.” Research in Human Development 9 (2012): 1–8.

DOI: 10.1080/15427609.2012.654428 Save Citation » Export Citation » Share Citation »

A social-ecological framework is used to explore the complex factors influencing adolescent sexual development among urban African American youth living in low-income neighborhoods. Using a multistage qualitative investigation, the researchers offer new data on the sexual development of urban African American adolescents.

Collins, Rebecca L., Steven C. Martino, Marc N. Elliott, and Angela Miu. “Relationships between Adolescent Sexual Outcomes and Exposure to Sex in Media: Robustness to Propensity-Based Analysis.” Developmental Psychology 47 (2011): 585–591.

DOI: 10.1037/a0022563 Save Citation » Export Citation » Share Citation »

The effect of exposure to sex in the media on adolescent initiation of sexual intercourse is still an open question. This article reviews research that has been conducted and finds a weak association between media exposure and sexual initiation. The authors suggest that youth exposure to sexual content be reduced.

Hagen, Janet W., Alice H. Skenandore, Beverly M. Scow, Jennifer G. Schanen, and Frieda Hugo Clary. “Adolescent Pregnancy Prevention in a Rural Native American Community.” Journal of Family Social Work 15 (2012): 19–33.

DOI: 10.1080/10522158.2012.640926 Save Citation » Export Citation » Share Citation »

Native American girls have a higher rate of teen pregnancy than the US national average. A five-year study of eighth graders who were taught the Discovery Dating curriculum resulted in fewer pregnancies and higher use of condoms than eighth graders in the control group.

Jewell, David. “Teenage Pregnancy: Whose Problem Is It?” Family Practice 17 (2000): 522–528.

DOI: 10.1093/fampra/17.6.522 Save Citation » Export Citation » Share Citation »

This qualitative study of thirty-four teenage mothers from the United Kingdom examines teenage mothers’ attitudes about sexual health, contraception, and pregnancy. Teens from less affluent families reported more problems accessing contraceptive services and dissatisfaction with sexual education in schools. Abortion was also less acceptable to the socially disadvantaged girls.

Kaye, Kelleen, Kristin Anderson Moore, Elizabeth C. Hair, Alena M. Hadley, Randal D. Day, and Dennis K. Orthner. “Parent Marital Quality and the Parent–Adolescent Relationship: Effects on Sexual Activity among Adolescents and Youth.” Marriage and Family Review 45 (2009): 270–288.

DOI: 10.1080/01494920902733641 Save Citation » Export Citation » Share Citation »

Teenagers growing up outside of an intact family are likely to engage in risky sexual behaviors. This study looks at characteristics within married-parent families to identify sources that influence adolescent sexual activity. Marital relationship, the youth–parent relationship, and the interaction of the two are identified and discussed.

Patton, George C., Russell M. Viner, Le Cu Linh, et al. “Mapping a Global Agenda for Adolescent Health.” Journal of Adolescent Health 47 (2010): 427–432.

DOI: 10.1016/j.jadohealth.2010.08.019 Save Citation » Export Citation » Share Citation »

Positive changes are taking place in health care in many developing countries that will benefit adolescents. This paper reports on a 2009 London meeting related to strategic data needed to monitor future global initiatives in adolescent health. Developing a core set of global adolescent health indicators would facilitate this process.

Secor-Turnera, Molly, Renee E. Sieving, Marla E. Eisenberg, and Carol Skay. “Associations between Sexually Experienced Adolescents’ Sources of Information about Sex and Sexual Risk Outcomes.” Sex Education: Sexuality, Society and Learning 11 (2011): 489–500.

DOI: 10.1080/14681811.2011.601137 Save Citation » Export Citation » Share Citation »

This secondary analysis reports on informal sources about sexual risk among a group ( N = 22,828) of sexually experienced teenagers aged thirteen to twenty. Friends and siblings were most often the source of information about sex. When accurate sexual information comes from friends and siblings, it reduces teenage sexual risk.

The citations presented in this section are for the most part literature reviews. Nevertheless, in several of these articles ( Coles, et al. 1997 and Jolly, et al. 2007 ), the authors and researchers provide information from the teenagers themselves that informs and provides insight into the reasons and circumstances associated with teenage sexual behavior. Teenage fathers are also introduced under this topic with the literature review Lohan, et al. 2010 . Although little attention has been paid to teenage fathers, they play a major role, whether involved with the mother and child or absent from that relationship. More research is needed to increase our understanding of how professionals and society can support the teenage father’s effort to become a responsible father, husband, and adult. School-based health clinics are another important program type. Strunk 2008 is a good source of descriptions of these model programs. Putting in perspective the need for adolescent pregnancy health services Sells and Blum 1996 shows that adolescent morbidity and mortality has declined since 1979 by 13 percent. Other conditions that are often overlooked are the effect of child abuse and child sexual abuse on the life trajectory of adolescent girls, delineated by Francisco, et al. 2008 , and the influence of the neighborhood context, explored by Lupton and Kneale 2010 , particularly, as Buhi and Goodson 2007 points out, in relationship to early pregnancy.

Buhi, Eric R., and Patricia Goodson. “Predictors of Adolescent Sexual Behavior and Intention: A Theory-Guided Systematic Review.” Journal of Adolescent Health 40 (2007): 4–21.

DOI: 10.1016/j.jadohealth.2006.09.027 Save Citation » Export Citation » Share Citation »

This systematic literature review was conducted to answer the question, “Why do adolescents initiate sexual activity at early ages?” Three conditions were identified that help explain the behavior: intention, perceived norms , and time home alone . Based on the literature, these variables were good predictors of adolescent initiation of sexual behavior.

Coles, Robert, Robert E Coles, Daniel A Coles, and Michael H. Coles. The Youngest Parents: Teenage Pregnancy as It Shapes Lives . New York: W. W. Norton, 1997.

The voices of teenage girls and boys who were soon to be parents are presented in an effort to challenge preconceived ideas about teenagers who become pregnant and parents. Their stories are unique and reveal much to respect.

Francisco, Melissa A., Kasey Hicks, Julianne Powell, Kristin Styles, Jessica L. Tabor, and Linda J. Hulton. “The Effect of Childhood Sexual Abuse on Adolescent Pregnancy: An Integrative Research Review.” Journal for Specialists in Pediatric Nursing 13 (2008): 237–248.

DOI: 10.1111/j.1744-6155.2008.00160.x Save Citation » Export Citation » Share Citation »

In 2008, during a brief period of time when adolescent pregnancies in the United States increased, there were renewed calls for research related to identifying risk factors involved in adolescent pregnancy. Based on a meta-analysis, the authors determined the existence and strength of the relationship between child sexual abuse and adolescent pregnancy.

Jolly, Kim, Josie A. Weiss, and Patricia Liehr. “Understanding Adolescent Voice as a Guide for Nursing Practice and Research.” Issues in Comprehensive Pediatric Nursing 30.1–2 (2007): 3–13.

DOI: 10.1080/01460860701366518 Save Citation » Export Citation » Share Citation »

This article focuses on adolescent attitudes about contraception and adolescent depression, taking into consideration the ethnocultural context. Giving voice to adolescents by listening to their stories is proposed as a way of improving health care provided to teenagers and as a basis for further research.

Lohan, Maria, Sharon Cruise, Peter O’Halloran, Fiona Alderdice, and Abbey Hyde. “Adolescent Men’s Attitudes in Relation to Pregnancy and Pregnancy Outcomes: A Systematic Review of the Literature from 1980–2009.” Journal of Adolescent Health 47 (2010): 327–345.

DOI: 10.1016/j.jadohealth.2010.05.005 Save Citation » Export Citation » Share Citation »

A review of the professional literature exposed a long-standing gender bias in academic and policy research on adolescent pregnancy, which has resulted in the lack of research on the perspectives of the adolescent male. This article sums up the literature related to adolescent boys and their attitude toward pregnancy and parenting.

Lupton, Ruth, and Dylan Kneale. Are There Neighbourhood Effects on Teenage Parenthood in the UK, and Does It Matter for Policy? A Review of Theory and Evidence . London School of Economics and Political Science CASE 141. London: Centre for Analysis of Social Exclusion, 2010.

This paper is a review of the evidence for considering “neighborhood effects” in relationship to teenage pregnancy. This review identifies three explanations for teen pregnancy (opportunity costs, differential values, and social networks). Although neighborhoods may influence the rate of teen pregnancy, the authors conclude that statistical evidence is mixed.

Sells, C. Wayne, and Robert W. Blum. “Morbidity and Mortality among US Adolescents: An Overview of Data and Trends.” American Journal of Public Health 86 (1996): 513–519.

DOI: 10.2105/AJPH.86.4.513 Save Citation » Export Citation » Share Citation »

This is an analysis of data about adolescent morbidity and mortality in the United States (1979–1994). Since the 1980s mortality declined 13 percent among fifteen- to twenty-four-year-olds. Messages related to the benefits of contraceptives and the prevention of sexually transmitted disease have had a positive impact on the rate of unwanted teen pregnancies and childbearing.

Strunk, Julie A. “The Effect of School-Based Health Clinics on Teenage Pregnancy and Parenting Outcomes: An Integrated Literature Review.” The Journal of School Nursing 24 (2008): 13–20.

DOI: 10.1177/10598405080240010301 Save Citation » Export Citation » Share Citation »

This review of the literature offers substantial research findings that suggest many of the problems associated with teenage pregnancy and parenting could be lessened if school-based programs offer counseling, health care, health education, and classes on childhood development.

There are no journals that are exclusively dedicated to teenage pregnancy issues; however, there are a number of journals focused on adolescent issues, such as the Journal of Adolescence , Journal of Adolescent Health , Journal of Research on Adolescence , and International Family Planning Perspectives , which tend to publish articles on teenage and adolescent pregnancy and childbirth. Pediatrics and the American Journal of Public Health have a propensity to cover many of the issues related to teenage pregnancy. The journals listed here such as the Journal of the American Academy of Child & Adolescent Psychiatry and the International Journal of Epidemiology are examples of professional publications that emphasize medical, psychological, or sociological perspectives. Of course, other journals similar to Journal of Family Planning and Reproductive Health Care will publish articles related to teen pregnancy depending on their area of clinical, medical, or social service interest.

American Journal of Public Health .

This journal focuses on research methods and program evaluation related to public health. In an effort to improve public health research, the journal publishes articles related to public health policy, best practices, and education. Epidemiologists, a broad range of social scientists, and medical and helping professionals access this journal.

International Family Planning Perspectives . 1995–2008.

This journal published studies conducted in the United States and other developed countries in the world. Articles published cover contraceptive practice; fertility levels, trends, and determinants; adolescent pregnancy; abortion; public policies and legal issues affecting childbearing; and other critical issues related broadly to family planning practice.

International Journal of Epidemiology .

This international journal publishes studies about epidemiological advances and new developments and changes in the global population. Articles and studies related to teenage pregnancy typically focus on effects of prevention programming, health services, and medical care.

Journal of Adolescence .

This is an international, multidisciplinary, broad-based journal that is concerned with the nature of adolescent development (i.e., emphasis is on personality, social, and emotional functioning). It publishes empirical studies, clinical studies, and literature reviews. A broad field of professionals specializing in services to adolescents read and publish in this journal.

Journal of Adolescent Health .

This is a multidisciplinary scientific journal. It publishes research in the field of adolescent medicine and health. Articles typically cover biological, behavioral, public health, and policy issues. Professionals involved in adolescent health access this journal. This is the official publication of the Society for Adolescent Health and Medicine.

Journal of Family Planning and Reproductive Health Care .

The journal emphasis reproductive and sexual health nationally and internationally. The articles are related to clinical care, service delivery, training, and education in the field of contraception and reproductive/sexual health.

Journal of Research on Adolescence .

This journal is research oriented. It presents methodological and theoretical articles using methods that include multivariate, longitudinal, etc. Studies include ethnographic, experimental, cross-national, and studies of gender, ethnic, and racial diversity.

Journal of the American Academy of Child & Adolescent Psychiatry .

The Journal of the American Academy of Child & Adolescent Psychiatry is the leading journal that focuses exclusively on the psychiatric research and treatment of the child and adolescent. The journal is committed to the advancement of research on pediatric mental health and promoting the mental health of adolescents and their families.

Pediatrics .

This journal addresses the broad needs of the whole child: that is, physiologic, mental, emotional, and social structures. It provides a platform for articles of interest to pediatricians, general medical professionals, and helping professionals.

There are basically two major views and explanations for teenage pregnancy and these views are at odds. One is that teenage pregnancy is a serious problem that requires prevention and intervention. The other is the view articulated by Upadhya and Ellen 2011 that teen pregnancy is an issue of social disparities. Johnson 2014 discusses the association between adolescent pregnancy and poverty. Banerjee, et al. 2009 argues that it is a socially inflicted health hazard. Rich-Edwards 2002 and Lawlor and Shaw 2002 made a similar point that teen pregnancy is not a public health crisis in the United States. Nonetheless, Chambers, et al. 2001 identifies sex, culture, and service needs to reduce the socially inflicted harm. A good example of the problems perspective is explained by Holgate 2012 . As a problem, teenage pregnancy is viewed as something to control and manage. As a health issue, safety is paramount, closely followed by adolescent developmental issues. Regardless of one’s explanation, Calvin, et al. 2009 discusses the rights of teen parents to be involved in decision-making that impacts their family and child or children. Of course, in Linders and Bogard 2014 and Duncan, et al. 2010 there is a real conflict over teenage parenthood. Even so, the reality is that teenage girls, especially young girls who become pregnant, are at risk of physical complications due to the immaturity of their bodies. This is especially problematic among child brides. Becoming pregnant at too young an age comes with many physical risks and problems. Given the social context, even older teens can face daunting-odds when attempting to parent their child or children. The challenge for professionals is to respect the human rights of the adolescent and support her or his physical and emotional needs as a teenager lunging toward adulthood. To improve the outcomes of adolescent pregnancy Montgomery, et al. 2014 addresses the issue through legislation. Macleod 2014 suggests the issues can be better understood and addressed as a feminist issue.

Banerjee, Bratati, G. K. Pandey, Debashis Dutt, Bhaswati Sengupta, Maitrayei Mondal, and Sila Deb. “Teenage Pregnancy: A Socially Inflicted Health Hazard.” Indian Journal of Community Medicine 34 (2009): 227–231.

DOI: 10.4103/0970-0218.55289 Save Citation » Export Citation » Share Citation »

Early marriages are considered a threat to the physical and emotional health of young girls. It is a major concern in rural India. Three steps instituted to enhance family welfare programs improved efforts to prevent pregnancy complications and perinatal outcomes.

Calvin, John, Manouchka Colon, and Kacey Houston. “Decision-Making Rights of Teen Parents.” Michigan Child Welfare Law Journal 12 (2009): 29–42.

The legal right of teenage parents to make autonomous decisions about their children’s care continues to be a concern. The debate over parental rights of minors is in sharp contrast to the limited rights of minors in other areas of the law.

Chambers, Ruth, Gill Wakely, and Steph Chambers. Tackling Teenage Pregnancy: Sex, Culture and Needs . Abingdon, UK: Radcliffe Medical, 2001.

This is an account of Britain dealing with the highest rate of teen pregnancy in Europe. The debate over how to respond to the high rates of teen pregnancy and minimize the risk of social exclusion is delineated. It outlines basic principles that improve services and reduce pregnancy and childbearing.

Duncan, Simon, Rosalind Edwards, and Claire Alexandrer, eds. Teenage Parenthood: What’s the Problem? London: Tufnell, 2010.

This is an examination of why policymakers and the media claim that teenage parenthood ruins a girl’s life and that of her children. It also addresses assertions that teenage pregnancy threatens the wider social and moral fabric of society. Research increasingly shows teenage parenthood does not have to be harmful.

Holgate, Helen. “Young Mothers Speak.” International Journal of Adolescence and Youth 17 (2012): 1–10.

DOI: 10.1080/02673843.2011.649400 Save Citation » Export Citation » Share Citation »

This overview is written from a problems perspective . The author compares problems associated with teen pregnancy from different countries worldwide to illustrate broad variation in causes and problems. The author concludes that many factors are involved in teen pregnancy and many strategies are needed to reduce teen pregnancy rates.

Johnson, Clara L. “ Adolescent Pregnancy and Poverty: Implications for Social Policy .” The Journal of Sociology & Social Welfare 1.1 (2014): 17.

This open access article presents research comparing wed and unwed teenage girls. The author concludes that the rate of poverty is the about the same. Both groups were very similar in terms of birth at a young age, incomplete education, low income level, psychological and developmental issues, and social dependency.

Lawlor, Debbie A., and Mary Shaw. “Too Much Too Young? Teenage Pregnancy Is Not a Public Health Problem.” International Journal of Epidemiology 31 (2002): 552–553.

DOI: 10.1093/ije/31.3.552 Save Citation » Export Citation » Share Citation »

The concern over the age at which a young woman should give birth has existed throughout human history. The authors argue that labeling teen pregnancy as a public health problem has little to do with public health and more to do with it being socially, culturally, and economically unacceptable.

Linders, Annulla, and Cynthia Bogard. “Teenage Pregnancy as a Social Problem: A Comparison of Sweden and the United States.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 147–157. New York: Springer Science & Business Media, 2014.

Adolescent pregnancy in the United States is treated as an urgent social problem. Scholars, politicians, interest groups, and media have contributed to this view. In sharp contrast, teenage pregnancy in Sweden is not considered a problem in its own right. The differences are explained and discussed.

Macleod, Catriona. “Adolescent Pregnancy: A Feminist Issue.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 129–145. New York: Springer Science & Business Media, 2014.

This chapter critically examines teen pregnancy from a feminist perspective. The author examines the power relations implicit in the technologies of representation and the technologies of intervention that cohere around the pregnant and parenting teenager.

Montgomery, Tiffany M., Lori Folken, and Melody A. Seitz. “Addressing Adolescent Pregnancy with Legislation.” Nursing for Women’s Health 18.4 (2014): 277–283.

DOI: 10.1111/1751-486X.12133 Save Citation » Export Citation » Share Citation »

This article is helpful in better understanding legislation that addresses adolescent pregnancy. The focus is on legislation related to prevention and education about adolescent pregnancy. Prevention legislation that affects health care clinics, schools, and adolescent-friendly community-based organizations is highlighted. Legislative efforts are viewed as helping address the issue on a macro level.

Rich-Edwards, Janet. “Teen Pregnancy Is Not a Public Health Crisis in the United States: It Is Time We Made It One.” International Journal of Epidemiology 31 (2002): 555–556.

DOI: 10.1093/ije/31.3.555 Save Citation » Export Citation » Share Citation »

The perception of opportunity is postulated as a major factor involved in adolescent pregnancy. The author submits that it is not simply poverty that increases teenage pregnancy it is low levels of optimism about their future among impoverished girls. Adolescent girls with expectations and perceived opportunity do not give birth.

Upadhya, Krishna K., and Jonathan M. Ellen. “Social Disadvantage as a Risk for First Pregnancy among Adolescent Females in the United States.” Journal of Adolescent Health 49 (2011): 538–541.

DOI: 10.1016/j.jadohealth.2011.04.011 Save Citation » Export Citation » Share Citation »

This study examines the underlying determinants of teenage pregnancy that are associated with social disparities that are different for older teens than younger teens. Authors make the case that prevention programs targeting social risk could be improved by addressing developmental stages related to sexuality.

To understand the extent of sexuality among teenagers is to begin to understand teenage pregnancy. Adding ethnic, economic, and global demographics into the calculus helps explain the complexity of what is referred to as teen pregnancy. As well, when teenage fertility is examined over time, in the United States and among the rest of the developed nations, it is clear that teenage pregnancy has been on the decline since the mid-1990s. A good example of the history of the numbers is Smith, et al. 1996 , which looks at trends in the United States from 1960 to 1992, and Abma, et al. 2010 and Ventura, et al. 2011 , which compile data from the National Survey of Family Growth (1991–2008). Dallas 2011 focuses on an area where little research has been conducted, the response by families to the pregnancy of an adolescent. Then again, as Kaufmann, et al. 1998 shows, the decline in teen pregnancy rates is the real story. The conditions that tend to increase and reduce teen pregnancy are more understandable when cross-national social differences are studied. This type of investigation can also benefit from comparing ethnic and racial groups within countries. It is also evident that many of the educational and economic problems identified and faced by pregnant and parenting teens have little or nothing to do with the pregnancy and everything to do with social sanctions and disapproval.

Abma, J. C., G. M. Martinez, and C. E. Copen. “Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, National Survey of Family Growth 2006–2008.” Vital and Health Statistics 23 (2010): 1–47.

Estimates on the sexual behavior of boys and girls fifteen to nineteen years old regarding sexual activity, contraceptive use, and births are presented from the 1988, 1995, and 2002 National Survey of Family Growth. Additional data are reported from two National Survey of Adolescent Males (1988 and 1995).

Dallas, Constance M. Redefining Family for Low-Income, Unmarried African American Adolescent Parents . In Virginia Henderson International Nursing Library’s Online Repository , 2011.

The response by families to the pregnancy of an adolescent is an area where little research has been conducted. In this study the challenges faced by families of unmarried pregnant and parenting girls are studied in light of culture influences and family systems.

Kaufmann, Rachel B., Alison M. Spitz, Lilo T. Strauss, et al. “The Decline in US Teen Pregnancy Rates, 1990–1995.” Pediatrics 102 (1998): 1141–1147.

DOI: 10.1542/peds.102.5.1141 Save Citation » Export Citation » Share Citation »

While teen pregnancies between 1985 and 1990 increased approximately 9 percent, starting in 1991 the rate began to decline. Between 1991 and 1995 teen pregnancies fell about 13 percent to 83.6 per 1,000 births. The conditions and statistics of a decline in pregnancies and abortions are also presented.

Smith, Herbert L., S. Philip Morgan, and Tanya Koropeckyj-Cox. “A Decomposition of Trends in the Nonmarital Fertility Ratios of Blacks and Whites in the United States, 1960–1992.” Demography 33 (1996): 141–151.

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Demographic factors believed to increase childbirth among non-married African American and white females in the United States is the subject of this monograph. The rate of the increase in childbearing for all women and teenagers over thirty years (1960–1992) is examined.

Ventura, Stephanie J., Centers for Disease Control and Prevention, T. J. Mathews, Brady E. Hamilton, Paul D. Sutton, and Joyce C. Abma. “Adolescent Pregnancy and Childbirth: United States, 1991–2008.” Morbidity and Mortality Weekly Report: Surveillance Summaries 60 (2011): 105–108.

Long-term adverse consequences for adolescent mothers and their children are often associated with poorer outcomes than for children of mothers in their early twenties. Fragile family structure, limited long-term resources, and poor social supports rather than age are contributors to poor outcomes. An estimated 82 percent of pregnancies in 2001 among adolescents were unintended.

The decreasing age of menarche (the first period) has influenced fertility rates. In current models used to explain teen pregnancy, as Aruda, et al. 2010 suggests, the earlier in age that girls experience a pregnancy the higher the adolescent fertility rates. Additionally, most of the medical problems that are linked with nulliparous adolescent pregnancy ( Hueston, et al. 2008 and Zeck, et al. 2008 ) are associated with the lack of health care or inadequate health care for this group of girls. This is especially problematic because studies also show that teen girls in large number fail to access prenatal care or start prenatal care late into their pregnancy even when prenatal care is readily available. This often results in subsequent physical complications for the mother and her child. This lack of health care for pregnant teens is a global concern; Wamala 2009 provides a global view of maternal and child health. Bearinger, et al. 2007 examines global efforts related to sexual and reproductive health patterns, prevention, and potential of adolescents. An important issue, postpartum depression, is discussed by Kleiber 2014 . Outcomes among adolescent girls enrolled in care programs are described by Haeri, et al. 2009 . As a point of reference, Usta, et al. 2008 compares obstetric outcome of teenage pregnancies with adult pregnancies. Another area that is often overlooked teen moms and their leisure experiences. An overview is provided by Clark and Anderson 2014 . An international perspective is provided by Kunaviktikul 1987 , which describes health care for pregnant teens in Thailand. Teenage girls who do not access prenatal care in a timely way are less likely to follow through with postpartum care. Furthermore, these teen moms (typically younger) are less likely to follow through with healthy baby clinics. Subsequently, these teenage mothers are at an elevated risk of a repeat pregnancy. Cortez, et al. 2014 addresses the challenges for adolescent sexual and reproductive health within the context of universal health coverage. To round out this section, Baltag and Chandra-Mouli 2014 describes the needs of adolescents as outlined in the WHO Global Reproductive Health Strategy; and Tahrir 2014 discusses strategies to sustain advances in global adolescent sexual and reproductive health through organizational capacity building.

Aruda, Mary M., Kathleen Waddicor, Liesl Frese, Joanna C. M. Cole, and Pamela Burke. “Early Pregnancy in Adolescents: Diagnosis, Assessment, Options Counseling, and Referral.” Journal of Pediatric Health Care 24 (2010): 4–13.

DOI: 10.1016/j.pedhc.2008.11.003 Save Citation » Export Citation » Share Citation »

Pregnant teens often present at medical facilities with physical complaints not necessarily related to pregnancy. Diagnosis assessment and referral are critical for prenatal, postnatal, and positive outcomes for the teen mother and her child.

Baltag, Valentina, and Venkatraman Chandra-Mouli. “Adolescent Pregnancy: Sexual and Reproductive Health.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 55–78. New York: Springer Science & Business Media, 2014.

In many parts of the world the sexual and reproductive health needs of adolescents are either poorly understood or not fully appreciated. This chapter discusses the sexual and reproductive health needs of adolescents as outlined in the WHO Global Reproductive Health Strategy.

Bearinger, Linda H., Renee E. Sieving, Jane Ferguson, and Vinit Sharma. “Global Perspectives on the Sexual and Reproductive Health of Adolescents: Patterns, Prevention, and Potential.” Lancet 369 (2007): 1220–1231.

DOI: 10.1016/S0140-6736(07)60367-5 Save Citation » Export Citation » Share Citation »

Global data are used to show the importance of investment in programs that are shown to be effective prevention and treatment interventions for reducing the risk to adolescents that threaten their reproductive and sexual health. Strategies based on the adolescent’s developmental stage and social contexts are emphasized.

Clark, Brianna S., and Denise M. Anderson. “Not Yet a Woman, Not Yet a Mom: The Leisure Experiences of Pregnant Adolescents.” Journal of Leisure Research 46 (2014): 509–524.

This article examines an issue that is often overlooked, the leisure experience of a teen mother from her point of view. The findings suggest that adolescents make the effort to change their leisure behavior towards behaviors that help the unborn child. They also tend to develop new forms of child-centered leisure activities.

Cortez, Rafael, Meaghen Quinlan-Davidson, and Seemeen Saadat. Challenges for Adolescents’ Sexual and Reproductive Health within the Context of Universal Health Coverage . No. 91292. The World Bank, 2014.

This report about young people (ten to twenty-four years of age) from around the world describes the tremendous challenges they face in their efforts to access sexual and reproductive health care. Inadequate health information and services, and inequitable gender norms, contribute to a lack of knowledge about sexuality and basic human rights.

Haeri, Sina, Isabelle Guichard, and Stephanie Saddlemire. “Maternal Characteristics and Outcomes Associated with Late Enrollment for Care in Teenage Pregnancies.” Southern Medical Journal 102 (2009): 265–268.

DOI: 10.1097/SMJ.0b013e318197e85d Save Citation » Export Citation » Share Citation »

Adolescent pregnancy is associated with adverse maternal and fetal outcomes including premature and low-weight births, pregnancy-induced hypertension, and anemia. Third trimester enrollment for prenatal care among adolescents is particularly associated with higher rates of adverse perinatal outcomes. Improved prenatal care and early enrollment is proposed to improve birth outcomes.

Hueston, William J., Mark E. Geesey, and Vanessa Diaz. “Prenatal Care Initiation among Pregnant Teens in the United States: An Analysis over 25 Years.” Journal of Adolescent Health 42 (2008): 243–248.

DOI: 10.1016/j.jadohealth.2007.08.027 Save Citation » Export Citation » Share Citation »

This twenty-five-year-long longitudinal study highlights changes in patterns of adolescent pregnancy. The reduction in pregnancies among adolescents, particularly high-risk adolescents, and differences in the use of abortion are examined to identify characteristics that contributed to these changing patterns.

Kleiber, Blair Vinson. “Postpartum Depression among Adolescent Mothers: Examining and Treating Low-Income Adolescents with Symptoms of Postpartum Depression.” PhD diss., University of Colorado at Boulder, 2014.

Because both depression and teenage pregnancy emerge during adolescence the author examines conditions correlated with adolescent postpartum depression among low-income adolescent mothers. Perceived stress and anxiety severity were the best predictors of adolescent postpartum depression symptom severity.

Kunaviktikul, Chairat. “ Outcome of Adolescent Pregnancy .” Chiang Mai Medical Journal 26 (1987): 87–97.

A yearlong study (1 January to 31 December 1985) of adolescent pregnancy at the obstetrical unit of Chiang Mai Hospital School in Thailand; some 4.84 percent or 5,336 were adolescent deliveries. Findings show that adolescents experienced more problems related to pregnancy and childbearing than women who were twenty years old or older.

Tahrir, Esther. “Sustaining Advances in Global Adolescent Sexual and Reproductive Health through Organizational Capacity Building.” In 142nd APHA (American Public Health Association) Annual Meeting and Exposition (15 November–19 November 2014) . APHA, 2014.

Building organizational capacity to improve adolescent sexual and reproductive health is an effective way to initiate and sustain advances in adolescent sexual and reproductive health globally. The role of a youth perspective and of participation in adolescent sexual and reproductive health program development and decision-making is emphasized.

Usta, Ihab M., Dani Zoorob, Antoine Abu-Musa, Georges Naassan, and Anwar H. Nassar. “Obstetric Outcome of Teenage Pregnancies Compared with Adult Pregnancies.” Acta Obstetricia et Gynecologica Scandinavica 87 (2008): 178–183.

DOI: 10.1080/00016340701803282 Save Citation » Export Citation » Share Citation »

In this study from Beirut, adolescent girls more often delivered preterm when compared to older women. Adolescent girls were more likely to experience anemia and pre-eclampsia. Nulliparous girls went into labor quicker than adolescents giving birth to their second child. Overall, teens had comparable maternal and perinatal morbidity.

Wamala, Sarah. “The Impact of Globalization on Maternal and Child Health.” In Maternal & Child Health: Global Challenges, Programs, and Policies . Edited by J. Ehiri, 135–150. Washington, DC: Springer, 2009.

This edited book for the most part addresses issues related to adult maternal and child health care. Several chapters (such as chapter eight) deal with health issues related to all women, including teenage pregnancy. Almost half of all births worldwide are among teens.

Zeck, Willibald, Wolfgang Walcher, Karl Tamussino, and Uwe Lang. “Adolescent Primiparas: Changes in Obstetrical Risk between 1983–1987 and 1999–2005.” Journal of Obstetrics and Gynaecology Research 34 (2008): 195–198.

DOI: 10.1111/j.1447-0756.2007.00688.x Save Citation » Export Citation » Share Citation »

The authors make the argument that adolescent pregnancy is more of a public health and social issue than it is a medical problem. Even so, socioeconomic issues have to be considered when planning and implementing programs to reduce the risks associated with teenage pregnancy.

One of the theoretical perspectives that inform practitioners in their efforts to prevent risky adolescent sexual behavior and pregnancy is the concept of resiliency. East, et al. 2006 identifies the risk and protective factors that differentiate girls who experience an early pregnancy and girls who delay their first pregnancy. This is the type of information that can contribute to the development of policy and services that support a girl’s decision to delay pregnancy and childbirth. Among the protective factors are parents and family. Parents, as Commendador 2010 , explains can be very important in shaping teenage sexual behavior, that is, if the teenager has a parent or surrogate parent who is a positive role model. Tang, et al. 2014 explores protective factors associated with intergenerational parenting. In the public mind, however, teenage pregnancy is a threat to the young mother’s health and has tremendous social costs. Dallas 2009 suggests that the often overlooked factor of whether health care professionals interact or fail to interact in a positive way with adolescent fathers is important in providing care to the adolescent mother. This is related to the review of factors associated with prenatal and postpartum care and health in Sagili, et al. 2012 . The results of this line of research, described by Vesely, et al. 2004 , have clearly shown that in the majority of countries, the outcomes of teenage pregnancy are less positive than the outcomes among young women. Finally, Lyra and Medrado 2014 addresses the positive role that adolescent fatherhood can play if supported. There are educational and health programs for both female and male adolescents that have been shown to increase adolescents’ assets and protective factors.

Commendador, Kathleen A. “Parental Influences on Adolescent Decision Making and Contraceptive Use.” Pediatric Nursing 36 (2010): 147–156.

The numbers of teenage pregnancies began to decline in the 1990s. Even so, the high rate of teenage pregnancy in the United States continues to generate public concern. Partly, this is because the public views adolescent pregnancy as a threat to the young mother’s health and as having serious social costs.

Dallas, Constance M. “Interactions between Adolescent Fathers and Health Care Professionals during Pregnancy, Labor, and Early Postpartum.” Journal of Obstetric, Gynecologic, & Neonatal Nursing 38 (2009): 290–299.

DOI: 10.1111/j.1552-6909.2009.01022.x Save Citation » Export Citation » Share Citation »

This is a view of how professionals in the health care community interact or fail to interact in a positive way with adolescent fathers. Based on interviews with families of adolescent fathers, the experiences of adolescent fathers during prenatal and postpartum care are examined.

East, Patricia L., Siek Toon Khoo, and Barbara T. Reyes. “Risk and Protective Factors Predictive of Adolescent Pregnancy: A Longitudinal, Prospective Study.” Applied Developmental Science 10 (2006): 188–199.

DOI: 10.1207/s1532480xads1004_3 Save Citation » Export Citation » Share Citation »

This longitudinal study identifies protective factors that reduce the likelihood of pregnancy among at-risk girls. A group of Latina and African American girls between the ages of thirteen and nineteen participated in the study. Strict parenting and low childbearing intentions during early adolescence reduced teenage pregnancy in this study.

Lyra, Jorge, and Benedito Medrado. “Pregnancy, Marriage, and Fatherhood in Adolescents: A Critical Review of the Literature.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 103–128. New York: Springer Science & Business Media, 2014.

There has been very little published on adolescent fathers. This chapter gives an overview of what is available. Given the desire and potential of adolescent parents, the authors advocate for policies and programs that provide a role for teen fathers.

Sagili, Haritha, N. Pramya, Karthiga Prabhu, Mariano Mascarenhas, and P. Reddi Rani. “Are Teenage Pregnancies at High Risk? A Comparison Study in a Developing Country.” Archives of Gynecology and Obstetrics 285 (2012): 573–577.

DOI: 10.1007/s00404-011-1987-6 Save Citation » Export Citation » Share Citation »

This is a comparison between obstetric and perinatal outcome among teen and non-teen pregnancies. Some of the obstetric risks identified in this study supported previous findings while others refuted several long held beliefs about the risks in teenage pregnancy. Early and adequate antenatal care and delivery should improve outcomes.

Tang, Sandra, Pamela E. Davis-Kean, Meichu Chen, and Holly R. Sexton. “Adolescent Pregnancy’s Intergenerational Effects: Does an Adolescent Mother’s Education Have Consequences for Her Children’s Achievement?” Journal of Research on Adolescence (2014).

DOI: 10.1111/jora.12182 Save Citation » Export Citation » Share Citation »

Using the adolescent mother’s level of educational attainment, the authors found that their children did not do as well on reading and math measures through the eighth grade when compared to children born to mothers who were not teen moms.

Vesely, Sara K., Vicki H. Wyatt, Roy F. Oman, et al. “The Potential Protective Effects of Youth Assets from Adolescent Sexual Risk Behaviors.” Journal of Adolescent Health 34 (2004): 356–365.

DOI: 10.1016/j.jadohealth.2003.08.008 Save Citation » Export Citation » Share Citation »

In this article, five sexual risk behaviors were examined. Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations reduced the risk of sexual initiation. Peer Role Model and Family Communication increased the use of birth control methods by sexually active youth. Examines the relationship among individual youth assets and adolescent sexual risk behaviors.

Those who view teenage pregnancy as a problem can provide a plethora of research that compares the teen mom to her peers and peers of her children. Studies such as Miller, et al. 2010 highlight the risk of teen pregnancy associated with intimate partner violence, while Chen, et al. 2008 identifies potential links between teenage pregnancy and neonatal and post neonatal mortality. Some of the differences are that the children of teen mothers are more likely to experience poorer health, emotional, and educational outcomes—outcomes that are strongly correlated with poverty, a lack of effective sexual education, experience with domestic violence, and childhood sexual assault. One group at risk of adolescent pregnancy, described by McCoy 2015 , are former foster youth with histories of sexual abuse. And, as Barnet, et al. 2008 shows, risk of a second teen birth adds to these risk factors, depression among teenage mothers. Sipsma, et al. 2010 adds another dimension of risk, a view of the adolescent father. These and other antecedents have been identified and are proposed by Kirby 2002 to be associated with adolescent sexual initiation, the use of contraception, and pregnancy. These and other risk factors result in increased risky sexual behavior and teenage pregnancy. These outcomes have been found in virtually all developed countries and can be observed in varying degrees in the majority of countries worldwide.

Barnet, Beth, Jiexin Liu, and Margo DeVoe. “Double Jeopardy: Depressive Symptoms and Rapid Subsequent Pregnancy in Adolescent Mothers.” Archives of Pediatrics & Adolescent Medicine 162 (2008): 246–252.

DOI: 10.1001/archpediatrics.2007.60 Save Citation » Export Citation » Share Citation »

This study examined the proposal that depression puts teenage moms at risk for a second pregnancy. Some 269 teenagers, mostly low-income African American girls, participated in the study. Girls who scored high on depression experienced more subsequent pregnancies than girls with lower depression scores.

Chen, Xi-Kuan, Shi Wu Wen, Nathalie Fleming, Qiuying Yang, and Mark C. Walker. “Increased Risks of Neonatal and Post Neonatal Mortality Associated with Teenage Pregnancy Had Different Explanations.” Journal of Clinical Epidemiology 61 (2008): 688–694.

DOI: 10.1016/j.jclinepi.2007.08.009 Save Citation » Export Citation » Share Citation »

This study identifies potential links between teenage pregnancy and neonatal and post neonatal mortality. It is a retrospective cohort study of 4,037,009 nulliparous pregnant girls and women under twenty-five years of age in the United States. Risk associated with neonatal death was for the most part caused by preterm births.

Kirby, Douglas. “Antecedents of Adolescent Initiation of Sex, Contraceptive Use, and Pregnancy.” American Journal of Health Behavior 26 (2002): 473–485.

DOI: 10.5993/AJHB.26.6.8 Save Citation » Export Citation » Share Citation »

The antecedents thought to be associated with adolescent sexual initiation, use of contraceptive, and pregnancy were examined in this study. Antecedents such as adolescent demographics, their partners, peers, families, schools, and communities were among one hundred possible antecedents examined.

McCoy, Jazmine J. “Maternal Perceptions and Pregnancy Experiences of Former Foster Youth with Histories of Sexual Abuse.” PhD diss., Alliant International University, 2015.

This study describes the pregnancy experiences and maternal perceptions of six former foster youth (African American and biracial) teenage mothers with histories of sexual abuse. The purpose was to describe their pregnancy experiences and social support.

Miller, Elizabeth, Michele R. Decker, Anita Raj, Elizabeth Reed, Danelle Marable, and Jay G. Silverman. “Intimate Partner Violence and Health Care-Seeking Patterns among Female Users of Urban Adolescent Clinics.” Maternal and Child Health Journal 14 (2010): 910–917.

DOI: 10.1007/s10995-009-0520-z Save Citation » Export Citation » Share Citation »

This study looked at the prevalence of intimate partner violence (IPV) and health care–seeking patterns found among female patients at several adolescent clinics. Recent IPV was found to be prevalent among the girls. Poor health status and lack of medical treatment was significantly higher for girls who experienced IPV.

Sipsma, Heather, Katie Brooks Biello, Heather Cole-Lewis, and Trace Kershaw. “Like Father, Like Son: The Intergenerational Cycle of Adolescent Fatherhood.” American Journal of Public Health 100 (2010): 517–524.

DOI: 10.2105/AJPH.2009.177600 Save Citation » Export Citation » Share Citation »

This study identified an intergenerational cycle of adolescent fatherhood. The participants were adolescent fathers nineteen years old or younger when their first child was born. Findings reveal that an intergenerational cycle of adolescent fatherhood is a contributing factor to the high rate of adolescent pregnancy in the United States.

Pregnancy prevention programs that have promoted abstinence have been shown to be ineffective. Sexual education starting early in primary school that provides age-appropriate and accurate information on sexuality and sexual behavior provides adolescents and teenagers options when making decisions about sexual behavior. A better term than “preventing teen pregnancy” would be “reduce the causes of teenage pregnancy.” Applying the least harm approach to reducing injury, parents are viewed as a viable resource. Examples of national policy for building state capacity to provide pregnancy prevention programs, as described by Rolleri, et al. 2008 , have been shown to be effective in delaying teenage pregnancy at the macro level. More at the micro level, Lederman, et al. 2008 reports on intervention programs designed to reduce risks at the individual level. On other issues related to pregnancy prevention programming, Daguerre and Nativel 2006 explains why it is in the common interest for the state to support programming for adolescent sexual and health care. One of the major impediments to a more pragmatic approach to pregnancy prevention programming, documented in Irvine 2002 , is the “battle” over sex education in the United States. Kohler, et al. 2008 looks at another strong influence and compares Abstinence-Only and Comprehensive Sex Education on the age of sexual initiation. Mollborn and Sennott 2014 suggests a unique approach to understanding what norms shape the messages that teens hear about teenage pregnancy. Repeat pregnancies, which need programming to reduce the rate, are described by Crittenden, et al. 2009 , which explores mental health issues; Omar, et al. 2008 examines the impact of comprehensive young parent programming, and Milne and Glasier 2008 describes medical programming. Teenagers are a known at-risk population. Teenage pregnancy is a known risk. It is a situation that should not be ignored or given less attention than other threats to sexual and reproductive health.

Crittenden, Colleen P., Neil W. Boris, Janet C. Rice, Catherine A. Taylor, and David L. Olds. “The Role of Mental Health Factors, Behavioral Factors, and Past Experiences in the Prediction of Rapid Repeat Pregnancy in Adolescence.” Journal of Adolescent Health 44 (2009): 25–32.

DOI: 10.1016/j.jadohealth.2008.06.003 Save Citation » Export Citation » Share Citation »

This study examined salient factors thought to be predictors of rapid repeat pregnancy among urban adolescent girls ( N = 354)—twelve to nineteen years of age. The findings suggest that adolescent sexual behavior and individual mental health issues related to aggression should be addressed in preventing adolescent repeat pregnancy.

Daguerre, Anne, and Corinne Nativel. When Children Become Parents: Welfare State Responses to Teenage Pregnancy . Bristol, UK: Policy, 2006.

Becoming a teen parent puts one at a considerable disadvantage. It is associated with lower educational attainment and less income over time. This book delineated welfare state services to sexual active teenagers. Countries described are: Denmark, France, United Kingdom, United States, Italy, New Zealand, Norway, Poland, Russia, and the province of Quebec.

Irvine, Janice M. Talk about Sex: The Battles over Sex Education in the United States . Berkeley: University of California Press, 2002.

This is a retrospective study on the sexual education debate. Based on a long history of regulating all talk about sex, antagonists have paralyzed sexual education in US public schools. Even in the face of national public support for sexual education, sex education is framed as dangerous and immoral.

Kohler, Pamela K., Lisa E. Manhart, and William E. Lafferty. “Abstinence-Only and Comprehensive Sex Education and the Initiation of Sexual Activity and Teen Pregnancy.” Journal of Adolescent Health 42 (2008): 344–351.

DOI: 10.1016/j.jadohealth.2007.08.026 Save Citation » Export Citation » Share Citation »

The effectiveness of sexual education in the United States continues to be questioned despite research supporting it. In part, the authors of this article suggest that questions about the contribution of sexual education to teenage pregnancy and sexually transmitted disease (STD) persist because there are few epidemiologic evaluations of sexual education.

Lederman, Regina P., Wenyaw Chan, and Cynthia Roberts-Gray. “Parent-Adolescent Relationship Education (PARE): Program Delivery to Reduce Risks for Adolescent Pregnancy and STDs.” Behavioral Medicine 33 (2008): 137–144.

DOI: 10.3200/BMED.33.4.137-144 Save Citation » Export Citation » Share Citation »

The participants in this study were parent-adolescent dyads ( n = 192) involved in an after-school prevention education program at several southeastern middle schools in Texas. The participants were in either an Interactive Program (IP) where resistance skills were practiced or in a treatment as usual group. Significant differences are discussed.

Milne, Dona, and Anna Glasier. “Preventing Repeat Pregnancy in Adolescents.” Current Opinion in Obstetrics and Gynecology 20 (2008): 442–446.

DOI: 10.1097/GCO.0b013e3283086708 Save Citation » Export Citation » Share Citation »

Girls who become pregnant are at a high risk for a repeat pregnancy. Preventing repeated pregnancies is one of the goals of virtually all pregnancy prevention programs. A number of interventions that could be useful in preventing a repeat pregnancy are examined in this article.

Mollborn, Stefanie, and Christie Sennott. “Bundles of Norms about Teen Sex and Pregnancy.” Qualitative Health Research (2014): 1049732314557086.

Using the concept of “norm bundles,” the authors suggest that norm bundles can be used as a succinct measure of related norms that shape the messages teens hear. The authors suggest that the norm bundles concept is relevant to teen pregnancy prevention and policy development.

Omar, Hatim A., A. Fowler, and Karen K. McClanahan. “Significant Reduction of Repeat Teen Pregnancy in a Comprehensive Young Parent Program.” Journal of Pediatric and Adolescent Gynecology 21 (2008): 283–287.

DOI: 10.1016/j.jpag.2007.08.003 Save Citation » Export Citation » Share Citation »

A comprehensive program designed to reduce repeat teenage pregnancy is described. The results were encouraging. Among participants, there was a significant reduction in repeat teen pregnancy over several years.

Rolleri, Lori A., Mary Martha Wilson, Patricia A. Paluzzi, and Valerie J. Sedivy. “Building Capacity of State Adolescent Pregnancy Prevention Coalitions to Implement Science-Based Approaches.” American Journal of Community Psychology 41 (2008): 225–234.

DOI: 10.1007/s10464-008-9177-9 Save Citation » Export Citation » Share Citation »

Science-based approaches to pregnancy prevention in adolescent reproductive health stand the best chance of reducing unwanted teenage pregnancies and improving adolescent reproductive health. This article explores effective ways for disseminating research to practitioners that will result in more effective pregnancy prevention programs.

Adolescent abortion is extremely controversial in the United States, as Ely and Dulmus 2008 shows, in part because abortion for all females is controversial. Although legal under federal law, individual state laws have been written and passed that restrict or reduce access to abortion for both adolescents and adult women. In relationship to teenage pregnancy a number of laws require parental involvement and consent before a minor female can receive an abortion. Such laws have resulted in what Tomal 2001 finds is an increase in unwanted childbirth and illegal abortions. A description of a group of girls who requested an abortion is found in Coleman 2006 . Moreover, Donohue, et al. 2009 finds that childbearing declined 20 percent with legal abortion, and Coles, et al. 2010 shows that unintended teen births increase when abortion is restricted. Restricting contraceptive options and abortion in the United States as a strategy to reduce teen pregnancy and childbearing has had the opposite effect. In comparison to countries like France, described by Boonstra 2000 , the United States has some of the most restrictive laws on abortion among developed countries; yet, the United States has among the highest rates of teenage pregnancy, childbearing, and abortion in the developed world. How these laws create circumstances that result in greater risk for the adolescents whom we are trying to protect from risk, educates us. The effect of laws and policies targeting abortion highlight the complexity of teenage pregnancy and childbearing and the possibility for greatly reducing the harm experienced by the teenage mother and her child or children. Yet, Klick and Stratmann 2008 argues that laws requiring parental involvement and consent reduce risky adolescent sexual behavior.

Boonstra, Heather. “Promoting Contraceptive Use and Choice: France’s Approach to Teen Pregnancy and Abortion.” The Guttmacher Report on Public Policy 3.3 (June 2000).

This article describes the French policy in 2000 that enabled nurses to offer emergency contraception in public high schools. Although reported in newspapers (for example the New York Times ) that the emergency contraception policy “unleashed a flurry” in France, this article suggests that the policy had strong public support.

Coleman, Priscilla K. “Resolution of Unwanted Pregnancy during Adolescence through Abortion Versus Childbirth: Individual and Family Predictors and Psychological Consequences.” Journal of Youth and Adolescence 35 (2006): 903–911.

DOI: 10.1007/s10964-006-9094-x Save Citation » Export Citation » Share Citation »

This study examined various demographic, educational, family, and psychological variables that were involved in adolescent abortion. Of seventeen variables only two (risk-taking and the desire to leave home) explained desire to terminate their pregnancy. These teens were more inclined to seek counseling, have problems sleeping, and used marijuana more frequently.

Coles, Mandy S., Kevin K. Makino, Nancy L. Stanwood, Ann Dozier, and Jonathan D. Klein. “How Are Restrictive Abortion Statutes Associated with Unintended Teen Birth?” Journal of Adolescent Health 47 (2010): 160–167.

DOI: 10.1016/j.jadohealth.2010.01.003 Save Citation » Export Citation » Share Citation »

This is a study of the impact of mandatory waiting statutes on the unintended births among teenage girls receiving Medicaid. Restrictions in Medicaid accounted for higher rates of unwanted births among African American teens. Among girls identified as white, parent involvement laws increased unwanted births.

Donohue, John J., III, Grogger, Jeffrey, and Steven D. Levitt. “The Impact of Legalized Abortion on Teen Childbearing.” American Law and Economic Review 11 (2009): 24–46.

DOI: 10.1093/aler/ahp006 Save Citation » Export Citation » Share Citation »

There have been many explanations for the 20 percent decline in teenage childbearing between 1991 and 2002. The authors in this article use birth certificates as data and concluded that legalized abortion for females who became teenagers in the 1990s was one of the reasons for the decline in teenage childbearing.

Ely, Gretchen E., and Catherine N. Dulmus. “A Psychosocial Profile of Adolescent Pregnancy Termination Patients.” Social Work in Health Care 46 (2008): 69–83.

DOI: 10.1300/J010v46n03_04 Save Citation » Export Citation » Share Citation »

This study of adolescents who requested an abortion investigated the psychosocial problems of a sample of 120 adolescent girls who requested an abortion from a family planning clinic in the southeastern United States. Scores on the Multidimensional Adolescent Assessment Scale suggest that overall the adolescents were stable and healthy.

Klick, Jonathan, and Thomas Stratmann. “Abortion Access and Risky Sex among Teens: Parental Involvement Laws and Sexually Transmitted Diseases.” Journal of Law, Economics, and Organization 24 (2008): 2–21.

DOI: 10.1093/jleo/ewm041 Save Citation » Export Citation » Share Citation »

This examination of teenage pregnancy from a legal perspective attempts to explain the impact of parental-involvement laws, which require a parent’s permission before a minor person can request a legal abortion. Based on the decline in gonorrhea rates, the authors concluded that the law did reduce risky sexual behavior.

Tomal, Annette. “The Effect of Religious Membership on Teen Abortion Rates.” Journal of Youth and Adolescence 30 (2001): 103–116.

DOI: 10.1023/A:1005229022799 Save Citation » Export Citation » Share Citation »

Religious membership has a restraining effect on teenage abortion rates. Where religiosity is strong the abortion rate is influenced both directly by antiabortion sentiment and indirectly by parental-involvement laws. These laws are enacted in states where there are large numbers of religious residents in the state.

Global Perspective

Teenage pregnancy is not a stagnant condition, nor is it the same issue worldwide. Knowledge of global issues and responses to teenage pregnancy can be extremely instructive. Cherry, et al. 2001 is a first effort to organize profiles of representative countries from different regions around the world and their response to teenage pregnancy. It is a cross-sectional view of countries worldwide that allows for a contextual comparison. Shared knowledge gained from an international perspective provides insight and direction. Catalano, et al. 2012 makes a case that prevention science in adolescent health has developed effective programs that should be implemented worldwide. Inadequate nutrition among girls in some of the developing and many of the least developed nations is a significant problem and is explored as a global gender issue by Wallace, et al. 2006 . In some cultures girls are still not as valued as boys. Haley, et al. 2004 provides an example of efforts to work with stigmatized adolescent girls who have a history of pregnancy. On other global issues, Lawlor and Shaw 2004 points to the sensationalizing of teen pregnancy as the cause of the “global crisis,” while Call, et al. 2002 lays out a practical plan for reaching a goal of global adolescent health and well-being in this century. All aspects of children’s sexual and reproductive health related to physical and emotional development can be effectively managed. Additionally, social trends have been identified and their impact isolated. Growing poverty and income disparities, government instability, changing health care systems, and excluding adolescents from social systems because of pregnancy threatens the future health of adolescents and their children. The inevitable conclusion is that in the 21st century we will need to find strategies and programs to reduce the risk of adolescent sexual experimentation and behavior.

Call, Kathleen T., Aylin A. Riedel, Karen Hein, Vonnie McLoyd, Anne Petersen, and Michele Kipke. “Adolescent Health and Well-Being in the Twenty-First Century: A Global Perspective.” Journal of Research on Adolescence 12 (2002): 69–98.

DOI: 10.1111/1532-7795.00025 Save Citation » Export Citation » Share Citation »

This article points out a number of societal trends such as growing poverty and income disparities, government instability, the changing health care system, alienating rather than integrating adolescents into society, and so on, that threaten the future health of adolescents and society as a whole. The impact in the 21st century is discussed.

Catalano, Richard F., Abigail A. Fagan, Loretta E. Gavin, et al. “Worldwide Application of Prevention Science in Adolescent Health.” Lancet 379 (2012): 1653–1664.

DOI: 10.1016/S0140-6736(12)60238-4 Save Citation » Export Citation » Share Citation »

This article describes the principles of prevention science and the role it can play in improving adolescent health. The authors describe effective preventive interventions, challenges, and possible solutions when implementing prevention policy and programming. The authors recommend preventive intervention to reduce the burden of adolescent mortality and morbidity worldwide.

Cherry, Andrew L., Mary E. Dillon, and Douglas Rugh, eds. Teenage Pregnancy: A Global View . Westport, CT: Greenwood, 2001.

Teenage pregnancy is a worldwide phenomenon. This book explores fifteen countries in different regions of the world to provide a history of teenage pregnancy and how it is viewed both socially and politically in each of the countries. It addresses the question of how different cultures deal with teenage pregnancy.

Haley, Nancy, E. Roy, P. Leclerc, J.-F. Boudreau, and J.-F. Boivin. “Characteristics of Adolescent Street Youth with a History of Pregnancy.” Journal of Pediatric and Adolescent Gynecology 17 (2004): 313–320.

DOI: 10.1016/j.jpag.2004.06.006 Save Citation » Export Citation » Share Citation »

The authors of this article ask the question: What is the best approach for providing health care for adolescent street girls with a history of pregnancy? Considering histories of sexual abuse and early-age drug injection, there is a critical need to address these issues when providing health services to this group of teen girls.

Lawlor, Debbie A., and Mary Shaw. “Teenage Pregnancy Rates: High Compared with Where and When?” Journal of the Royal Society of Medicine 97 (2004): 121–123.

DOI: 10.1258/jrsm.97.3.121 Save Citation » Export Citation » Share Citation »

Discusses when teenage pregnancy (among health concerns like cancer, cardiovascular disease, and mental health) was designated a problem requiring targeted interventions; in the case of teenage pregnancy, the reason for political and policy action in large part was because of the media sensationalizing pregnancy among adolescents. The authors explain their reasoning.

Wallace, J. M., J. S. Luther, J. S. Milne, et al. “Nutritional Modulation of Adolescent Pregnancy Outcome: A Review.” Placenta 27 (2006): 61–68.

DOI: 10.1016/j.placenta.2005.12.002 Save Citation » Export Citation » Share Citation »

This article presents data from research in veterinary science to make the point that there are biological reasons for the risks of miscarriage, prematurity, and low birth weight among adolescent girls who become pregnant. The assumptions are based on studies of young female sheep and the effects of early pregnancy.

Rates and programs related to teenage pregnancy from countries around the world are compared to teenage pregnancy in the United States. Not because the United States is an example of how to cope with teenage pregnancy but because the United States is an example of how to develop social policies and programs that often increase teenage pregnancy and the ancillary problems typically associated with a socially constructed problem. Compared to Canada and European countries, the United States has more in common with developing countries in terms of the rate of teenage pregnancy, childbirth, and abortion. In the United States, the response to teen pregnancy varies across states. On a continuum, the states employ programs that vary from programs based on conservative religious models to programs based on public health models. This conceptualization and approach for measuring the response to teen pregnancy allows for the grouping of interventions by the level of conservatism. This knowledge is useful for improving program planning and advocacy. This continuum also is evident among Central and South American countries. de Almeida and Aquino 2009 examines the patterns of pregnancy in Brazil with international trends. The authors make the case that the influence of tradition and religion is still instrumental in shaping teen sexual behavior in the Americas. Much like other developing countries that are evolving from a rural-based economy into urban economic centers, many countries in Central and South America are facing similar challenges faced by policymakers in developed countries. One of the consequences of a lack of adolescent sexual and reproductive health services can be psychological distress, and suicidal behavior. Wilson-Mitchell 2014 explores these behaviors among a group of adolescent Jamaicans. The impact of adolescent mortality during pregnancy is explained by Conde-Agudelo, et al. 2005 as a clash between tradition and modernization. This struggle is played out with all its nuances in how these countries respond to the increase in the rate of teen pregnancy or to the increase in moral outrage by ambitious politicians, conservatives, and religious leaders in their effort to impose a policy of obscurantism related to sexual information and sexual education. Even so, the rate of teenage pregnancy fell in the 1990s. Santelli, et al. 2007 tries to explain the decade-long decline in teenage pregnancy as resulting from abstinence and improved contraceptive use. Santelli and Melnikas 2010 covers “a teen’s fertility in transition.” Issues vary from country to country. Al-Sahab, et al. 2012 describes the characteristics of teen moms in Canada, while Saewyc, et al. 2008 and Saewyc 2014 provide a view of teen pregnancy among gay, lesbian, and bisexual students in British Columbia, Canada. In Mexico, the issues are very basic. Atienzo, et al. 2009 reports on a study there of parent-adolescent communication as a way to reduce unwanted sexual behavior. Perez-Brena, et al. 2015 describes coparenting (mothers and daughters) in Mexico. The quality of the relationship and the adjustment in the relationship are described. Gogna, et al. 2008 describes issues of service and health care needs that are a major focus in Argentina.

Al-Sahab, Ban, Marina Heifetz, Hala Tamim, Yvonne Bohr, and Jennifer Connolly. “Prevalence and Characteristics of Teen Motherhood in Canada.” Maternal and Child Health Journal 16 (2012): 228–234.

DOI: 10.1007/s10995-011-0750-8 Save Citation » Export Citation » Share Citation »

This study identified the prevalence and characteristics of adolescent mothers in Canadian provinces and territories. The data revealed that teen mothers compared to older mothers were more likely to have low socioeconomic status, be nonimmigrants, have no partner, reside in the Western Prairies, and have been physically or sexually abused.

de Almeida, Maria da Conceição Chagas, and Estela M. L. Aquino. “The Role of Education Level in the Intergenerational Pattern of Adolescent Pregnancy in Brazil.” International Perspectives on Sexual and Reproductive Health 35 (2009): 139–146.

DOI: 10.1363/3513909 Save Citation » Export Citation » Share Citation »

The findings reported from Brazil are similar to findings from other countries regarding the cause of intergenerational adolescent pregnancy and the effect of educational opportunity. This supports the assumption that while a daughter of a teenage mother is more likely to be a teen mother herself, educational opportunity reduces the chance of early childbearing.

Atienzo, Erika E., Dilys M. Walker, Lourdes Campero, Héctor Lamadrid-Figueroa, and Juan Pablo Gutiérrez. “Parent-Adolescent Communication About Sex in Morelos, Mexico: Does It Impact Sexual Behaviour?” European Journal of Contraception and Reproductive Health Care 14 (2009): 111–119.

DOI: 10.1080/13625180802691848 Save Citation » Export Citation » Share Citation »

The level of communication between adolescents and their parents about sexual matters has been shown to affect teenage sexual behavior in the United States. This study replicates the protective effect of parent and child communication in Mexico. Improving communication between family members on sexual matters was found to contribute to safer sex practices.

Conde-Agudelo, Agustin, José M. Belizán, and Cristina Lammers. “Maternal-Perinatal Morbidity and Mortality Associated with Adolescent Pregnancy in Latin America: Cross-Sectional Study.” American Journal of Obstetrics and Gynecology 192 (2005): 342–349.

DOI: 10.1016/j.ajog.2004.10.593 Save Citation » Export Citation » Share Citation »

This study looked at risk associated with adolescent pregnancy in Latin America (Montevideo, Uruguay). Among the findings based on a perinatal information system was that adolescent girls as opposed to young women twenty-five years of age or older were at higher risk of specific adverse pregnancy outcomes.

Gogna, Mónica, Georgina Binstock, Silvia Fernández, Inés Ibarlucía, and Nina Zamberlin. “Adolescent Pregnancy in Argentina: Evidence-Based Recommendations for Public Policies.” Reproductive Health Matters 16 (2008): 192–201.

DOI: 10.1016/S0968-8080(08)31358-5 Save Citation » Export Citation » Share Citation »

This study describes characteristics of pregnant and parenting teens in Argentina and their service and health care needs. Improving sexual education to address safer sex and issues related to power relationships was recommended. Best practices endorsed are information and access to contraceptive options and antenatal, postpartum, and postabortion care.

Perez-Brena, Norma J., Kimberly A. Updegraff, Adriana J. Umaña-Taylor, Laudan Jahromi, and Ami Guimond. “Coparenting Profiles in the Context of Mexican-Origin Teen Pregnancy: Links to Mother–Daughter Relationship Quality and Adjustment.” Family Process 54.2 (2015): 263–279.

DOI: 10.1111/famp.12115 Save Citation » Export Citation » Share Citation »

This study looks at the multifaceted nature of the relationship between the teen mother and her mother in terms of coparenting of the teen mother’s child. There were three profiles of mother–adolescent coparenting identified. They were “communication, involvement, and conflict.” Implications for these coparenting styles are discussed.

Saewyc, Elizabeth M. “Adolescent Pregnancy among Lesbian, Gay, and Bisexual Teens.” In International Handbook of Adolescent Pregnancy: Medical, Psychosocial, and Public Health Responses . By Andrew Cherry and Mary Dillon, 159–169. New York: Springer Science & Business Media, 2014.

This chapter focuses on a rarely explored issue, teen pregnancy among lesbian, gay, bisexual (LGB) youth. A growing body of evidence suggests that not only do some LGB adolescents become pregnant or get someone pregnant, they are actually at higher risk for pregnancy involvement than their heterosexual peers.

Saewyc, Elizabeth M., Colleen S. Poon, Yuko Homma, and Carol L. Skay. “Stigma Management? The Links between Enacted Stigma and Teen Pregnancy Trends among Gay, Lesbian, and Bisexual Students in British Columbia.” Canadian Journal of Human Sexuality 17 (2008): 123–139.

This study focuses on the context in which LGBT adolescent sexuality develops. LGBT youth in Canada and the United States have documented health disparities that have been linked to “enacted stigma.” Trends in teen pregnancy and related sexual behaviors related to stigma are discussed.

Santelli, John S., Laura Duberstein Lindberg, Lawrence B. Finer, and Susheela Singh. “Explaining Recent Declines in Adolescent Pregnancy in the United States: The Contribution of Abstinence and Improved Contraceptive Use.” American Journal of Public Health 97 (2007): 150–156.

DOI: 10.2105/AJPH.2006.089169 Save Citation » Export Citation » Share Citation »

This study is another effort to explain the decline in teen pregnancy rates in the United States. Declining sexual activity and improved contraceptive use were used to determine if they explained part of the decline in teen pregnancy rates. The authors attributed 86 percent of the decline to improved contraception.

Santelli, John S., and Andrea J. Melnikas. “Teen Fertility in Transition: Recent and Historic Trends in the United States.” Annual Review of Public Health 31 (2010): 371–383.

DOI: 10.1146/annurev.publhealth.29.020907.090830 Save Citation » Export Citation » Share Citation »

To explain the decline and then short period of increased teen pregnancy rates (2006–2007), the authors examined historical changes in sexuality, social forces, and public policies that may have influenced teenage fertility. Public policies related to HIV prevention and sexuality education may have also played a role in fertility rates.

Wilson-Mitchell, Karline. “Factors Associated with Adolescent Pregnancy, Psychological Distress, and Suicidal Behavior in Jamaica: An Exploratory Study.” Journal of Midwifery & Women’s Health 59.5 (2014): 552.

DOI: 10.1111/jmwh.12248 Save Citation » Export Citation » Share Citation »

The purpose of the Jamaican Global School-Based Health Survey (2010) was to develop a sociodemographic profile of pregnant Jamaican adolescents and explore the personal experiences of these teens. The survey covered maternal mortality, premature newborns, low birth weight, and low and poor utilization of antenatal health care.

Health targets that have profoundly affected teen pregnancy in a positive way are based on the World Health Organization’s strategies for Europe in 2001 and global strategies articulated in 2004. European countries, particularly those in the European Union, as Moore 2000 and Avery and Lazdane 2008 explain, tend to follow best practices in program development rather than develop programs outlined by Ferguson, et al. 2008 and Selman 2003 that are designed to impose moral, traditional, or religious values on a vulnerable segment of society. Heath care and women’s rights are codified and each country seeking to become a member of the EU is required to sign a treaty and enforce women’s rights. This is extremely important to the sexual and reproductive health of adolescent girls. In one study, Zapata, et al. 2011 reported that pregnancy rates were greater than 70 percent among girls who became sexually active at twelve years old or younger. Examples of programs that have been developed in EU member countries are described by Fronteira, et al. 2009 and Teva, et al. 2009 , which are often compared on effectiveness to US teen sexual behavior programs and outcomes.

Avery, Lisa, and Gunta Lazdane. “What Do We Know about Sexual and Reproductive Health of Adolescents in Europe?” European Journal of Contraception and Reproductive Health Care 13 (2008): 58–70.

DOI: 10.1080/13625180701617621 Save Citation » Export Citation » Share Citation »

Adolescent sexual and reproductive health is viewed as essential for sustainable development in both developed and developing countries. New reproductive health programs and policies have been developed based on the World Health Organization’s strategies for Europe in 2001 and globally in 2004. Regardless, adolescents still receive poor reproductive health care.

Ferguson, Rebecca M., Ine Vanwesenbeeck, and Trudie Knijn. “A Matter of Facts . . . and More: An Exploratory Analysis of the Content of Sexuality Education in the Netherlands.” Sex Education: Sexuality, Society and Learning 8 (2008): 93–106.

DOI: 10.1080/14681810701811878 Save Citation » Export Citation » Share Citation »

The authors compare sexual education in the Netherlands, which has one of the lowest rates of teen pregnancy and one of the highest of contraceptive use among adolescents with sexual education in the United States. A content analysis of sexuality education materials in the Netherlands and the United States is discussed.

Fronteira, Ines, Miguel Oliveira da Silva, Vit Unzeitig, Helle Karro, and Marleen Temmerman. “Sexual and Reproductive Health of Adolescents in Belgium, the Czech Republic, Estonia and Portugal.” Journal of Contraception and Reproductive Health Care 14 (2009): 215–220.

DOI: 10.1080/13625180902894524 Save Citation » Export Citation » Share Citation »

This study examined the sexual and reproductive health of adolescents in four countries in the European Union. Differences between countries indicate that common measurement tools and targets are needed to inform policymakers and service providers about the effectiveness of programs designed to reduce teenage pregnancy and STDs.

Moore, Mary Lou. “Adolescent Pregnancy Rates in Three European Countries: Lessons to Be Learned?” Journal of Obstetric, Gynecologic & Neonatal Nursing 29 (2000): 355–362.

DOI: 10.1111/j.1552-6909.2000.tb02057.x Save Citation » Export Citation » Share Citation »

This comparison between the Netherlands, France, and Germany and the United States examines factors associated with higher teen pregnancy and abortion rates in the United States. Factors that differentiated the countries were differences in perspective related to sexual education, the rights and responsibilities of adolescents, access to contraceptives, and mass media campaigns.

Selman, Peter. “Scapegoating and Moral Panics: Teenage Pregnancy in Britain and the United States.” In Families and the State: Changing Relationships . Edited by Sarah Cunningham-Burley and Lynn Jamieson, 159–186. New York: Palgrave Macmillan, 2003.

DOI: 10.1057/9780230522831 Save Citation » Export Citation » Share Citation »

This study highlights differences between the rates of teen pregnancy in Britain and the United States and in other mainland European countries. One difference was that in both countries teenage mothers were subjected to hostility from the media and politicians as symbolic of declining morality and the collapse of the traditional family.

Teva, Inmaculada, M. Paz Bermúdez, G. Buela-Casal. “Characteristics of Sexual Behavior in Spanish Adolescents.” Spanish Journal of Psychology 12 (2009): 471–484.

DOI: 10.1017/S1138741600001852 Save Citation » Export Citation » Share Citation »

This study describes adolescent sexual behavior in Spain. Among the findings, boys and girls differed regarding sexual partners. Some 63 percent of males compared to 90.5 percent of females had a steady sexual partner. The average number of sexual partners over the last twelve months was slightly higher for boys than girls.

Zapata, Lauren B., Dmitry M. Kissin, Cheryl L. Robbins, et al. “Multi-City Assessment of Lifetime Pregnancy Involvement among Street Youth, Ukraine.” Journal of Urban Health 88 (2011): 779–792.

DOI: 10.1007/s11524-011-9596-z Save Citation » Export Citation » Share Citation »

The prevalence of risk factors associated with pregnancy among street youth was studied in the Ukraine. Findings reported a significantly elevated pregnancy rate of greater than 70 percent among girls who were initiated into sexual activity at twelve years old or younger, girls who reported lifetime anal sex, and survival sex.

Africa faces some of the most daunting public health problems in the world. Jewkes, et al. 2009 makes the point that to meet the Millennium Development Goals African countries need to reduce teenage pregnancy. This will be difficult in some countries where traditional Muslim religious practices have great sway. In mid-continent African countries like Cameroon, health workers are faced with, as Kongnyuy, et al. 2008 explains, the task of improving fetal outcomes. It is not a question of what works but how to encourage teens to utilize services. Nigeria has a population that is about half Muslim and half Christian with small numbers of Nigerians who adhere to traditional African religions. Okonofua, et al. 2009 studies the problem of unsafe abortions in Africa that result from the unwillingness to address the abortion issue in the face of religious resistance. In another example, Turkey, as described by Canbaz, et al. 2005 , is a nation that has joined the European Union and is working to meet the EU health standards affecting adolescent pregnancy. In this religious context, African nations struggle with some of the most serious public health challenges in the world. Clark, et al. 2006 makes the point that HIV/AIDS has changed the structure of the family in large swaths across Africa. Another important issue in many African countries, reported by Roudi-Fahimi and Monem 2010 , is that for many adolescent girls, the risks of unintended pregnancy they face are often within marriage. Their sexual and reproductive health is threatened because they are child brides. Becoming pregnant before the adolescent is physically mature enough to give birth, vaginal mutilation, and other risks are far too common in many African countries where the political leaders, religious leaders, health professionals, and the public fail to act responsibly in providing for teenage reproductive and sexuality health. To better understand sexual behavior in this region, Plummer, et al. 2004 explains how accurate data help in the design of services to reduce sexually transmitted disease. Toska 2015 explores the pathway between age-disparate sexual relationships, condom use, and adolescent pregnancy in South Africa’. Finally, Macleod and Tracey 2010 delineate efforts in South Africa over ten years to improve the sexual and reproductive health of adolescents in the African context.

Canbaz, Sevgi, Ahmet T. Sunter, Cetin E. Cetinoglu, and Yildiz Peksen. “Obstetric Outcomes of Adolescent Pregnancies in Turkey.” Advances in Therapy 22 (2005): 636–641.

DOI: 10.1007/BF02849957 Save Citation » Export Citation » Share Citation »

This study examined obstetric outcomes among adolescents in Samsun, Turkey. Findings show that cesarean sections were about 55 percent. Some 12 percent gave birth to low birth weight infants. Preterm births made up 9.5 percent of deliveries, while 1.7 percent of infants were stillborn. No children were born with congenital deformity.

Clark, Shelley, Judith Bruce, and Annie Dude. “Protecting Young Women from HIV/AIDS: The Case against Child and Adolescent Marriage.” International Family Planning Perspectives 32 (2006): 79–88.

DOI: 10.1363/3207906 Save Citation » Export Citation » Share Citation »

In developed countries the majority of teenage sexual activity is between nonmarried adolescents. In developing countries the majority of teenage sexual activity is among married adolescent girls. The many HIV/AIDS risks faced by these girls, because of their youth and lack of power in the relationship, are described.

Jewkes, Rachel, Robert Morrell, and Nicola Christofides. “Empowering Teenagers to Prevent Pregnancy: Lessons from South Africa.” Culture, Health & Sexuality 11 (2009): 675–688.

DOI: 10.1080/13691050902846452 Save Citation » Export Citation » Share Citation »

To meet the Millennium Development Goals, every nation will need to reduce its rate of teenage pregnancy. South Africa has struggled with a high rate of teen pregnancy but has reduced the rate substantially since the late 1980s. The programming and interventions that proved effective are discussed.

Kongnyuy, Eugene J., Philip N. Nana, Nelson Fomulu, Shey C. Wiysonge, Luc Kouam, and Anderson S. Doh. “Adverse Perinatal Outcomes of Adolescent Pregnancies in Cameroon.” Maternal and Child Health Journal 12 (2008): 149–154.

DOI: 10.1007/s10995-007-0235-y Save Citation » Export Citation » Share Citation »

This study from Cameroon identifies adverse fetal outcomes associated with adolescent pregnancies. The findings are similar to the findings from other countries. Adolescent pregnancies are associated with both adverse fetal and maternal outcomes in Cameroon. Improving compliance with prenatal care could significantly reduce adverse outcomes in Cameroon.

Macleod, Catriona I., and Tiffany Tracey. “A Decade Later: Follow-Up Review of South African Research on the Consequences of and Contributory Factors in Teen-Aged Pregnancy.” South African Journal of Psychology 40 (2010): 18–31.

DOI: 10.1177/008124631004000103 Save Citation » Export Citation » Share Citation »

This article examines research conducted in South Africa on the consequences and factors contributing to teenage pregnancy over ten years. The authors reported that there was an improvement in the data available as a result of several representative national and local surveys. Changes in theoretical issues are also discussed.

Okonofua, Friday E., Afolabi Hammed, Emily Nzeribe, et al. “Perceptions of Policymakers in Nigeria toward Unsafe Abortion and Maternal Mortality.” International Perspectives on Sexual and Reproductive Health 35 (2009): 194–202.

DOI: 10.1363/3519409 Save Citation » Export Citation » Share Citation »

Nigeria like many other developing countries restricts abortion except to save the mother’s life. One consequence of this restrictive law in Nigeria is a high rate of unsafe abortions resulting in death and injury. A survey revealed that policymakers were guided by moral and religious forces not evidence-based approaches.

Plummer, M. L., D. A. Ross, D. Wight, et al. “‘A Bit More Truthful’: The Validity of Adolescent Sexual Behaviour Data Collected in Rural Northern Tanzania Using Five Methods.” Sexually Transmitted Infections 80 (2004): ii49–ii56.

DOI: 10.1136/sti.2004.011924 Save Citation » Export Citation » Share Citation »

This is a discussion of an effort to check the validity of self-reported sexual behavior data from African adolescents living in rural Tanzania. Participant observation was reported as the most successful approach for gathering and understanding the complexity and the extent of sexually transmitted infection.

Roudi-Fahimi, Farzaneh, and Ahmed Abdul Monem. Unintended Pregnancies in the Middle East and North Africa . Washington, DC: Population Reference Bureau, 2010.

In this report, circumstances and context of unintended pregnancies occurring in the Middle East and North Africa are described. An important finding, unintended pregnancies jeopardize the health of many girls and women who have little or no access to contraception or control over their own pregnancies.

Toska, Elona, Lucie D. Cluver, Mark Boyes, Marija Pantelic, and Caroline Kuo. “‘From “Sugar Daddies” to “Sugar Babies”: Exploring a Pathway between Age-Disparate Sexual Relationships, Condom Use, and Adolescent Pregnancy in South Africa’.” Sexual Health (2015).

DOI: 10.1071/sh14089 Save Citation » Export Citation » Share Citation »

This study identified factors in South Africa which were associated with adolescent pregnancy, in particular the pathway of risk when there is an age-disparate sexual relationships (having ever had a sexual partner more than five years older).

The Asian and Pacific region is primarily influenced by two different cultures. One culture is Western European, which is best represented by Australia and New Zealand. The more influential culture is Asian. Keep in mind, however, that there is a great deal of variation in culture and tradition within the broader assemblage of countries with Asian-based cultures. Lee, et al. 1997 and Wang, et al. 2007 provide a view of girls in Asian-based cultures who become pregnant. Abortion plays an important role in sexual health services in these cultures. In Vietnam, for example, wars, communist rule and the transition to a capitalistic economy have created numerous challenges for adolescents who become pregnant. Wolf, et al. 2010 outlines the history, culture, and politics of the struggle over abortion services in Vietnam. Japan is very different from the majority of other countries in the region with Asian-based cultures. Nagamatsu, et al. 2008 shows that issues related to teenage pregnancy in Japan are very different. Another country that is unique in the region is India. As Raj, et al. 2009 reports, knowledge about child marriage and its effect on fertility-control outcomes is viewed as essential to dealing with teen pregnancy. Typically, public opinion about sexual education evolves over time. Rawat 2014 provides a good example of a debate over providing basic sex education to students in India. In Australia and New Zealand, as described by Skinner, et al. 2008 , the response to teen pregnancy is more European than that in the United Kingdom or the United States. In the rest of the region, the issues are about contraception availability, delaying sexual initiation, and delaying the first birth. Serquina-Ramiro 2005 discusses the concern over unmarried Filipino adolescents and sexual coercion in adolescent intimate relationships. Finally, looking at this area of the world more broadly, Gubhaju 2002 provides an overview of the challenges to provide adequate adolescent sexual and reproductive health in the Asia and Pacific region.

Graham, Maxine. “Enabling Tertiary Education for Teen Mothers: Organisational Insights.” PhD diss., Auckland University of Technology, 2014.

This model of tertiary education symbolically represents the key themes of “self-attributes” of the teen mother, “stigma,” and “support.” Identification of these factors is used to enable teen mothers (all of whom were of Māori ethnicity) through the transition to tertiary education (New Zealand’s term for education at universities and/or polytechnic level). Gaining a university polytechnic education is closely linked to income and general well-being.

Gubhaju, Bhakta B. “Adolescent Reproductive Health in Asia.” Paper presented at the 2002 IUSSP Regional Population Conference, South-East Asia’s Population in a Changing Asian Context, Bangkok, Thailand, 10–13 June 2002.

This paper delineates reasons for concern about the state of adolescent sexual and reproductive health and reports on programs adopted at the International Conference on Population and Development, held in Cairo in 1994. Promoting responsible sexual and reproductive behavior among adolescents was endorsed.

Koranne, Prachi Sauarbh, and Aparna R. Wahane. “Pregnancy in Adolescence: Is It Really a Concern?” Journal of Evolution of Medical and Dental Sciences 13 (2014): 7659–7668.

DOI: 10.14260/jemds/2014/2952 Save Citation » Export Citation » Share Citation »

This is a report on a cross-sectional institution-based study undertaken at a government medical college, Akola in central India, from January 2011 to December 2013. The magnitude of teenage pregnancy, especially among very young and physically immature girls, is presented. Risks and complications faced by these young mothers are described.

Lee, Meng-Chih, Tsung-Hsueh Lu, and Ming-Chih Chou. “Characteristics of Adolescent Pregnancy in Taiwan.” International Journal of Adolescent Medicine and Health 9 (1997): 213–216.

DOI: 10.1515/IJAMH.1997.9.3.213 Save Citation » Export Citation » Share Citation »

In Taiwan, much like in the United States, adolescent pregnancy was a major concern in the 1990s. There was widespread concern among the public and professionals involved in policy development and the delivery of services. Birth rates among girls between fifteen and nineteen years of age were considered high at 17 percent.

Nagamatsu, Miyuki, Hisako Saito, and Takeshi Sato. “Factors Associated with Gender Differences in Parent-Adolescent Relationships That Delay First Intercourse in Japan.” Journal of School Health 78 (2008): 601–606.

DOI: 10.1111/j.1746-1561.2008.00352.x Save Citation » Export Citation » Share Citation »

In this study, gender differences in parent-adolescent relationships were examined to identify factors that delayed sexual initiation for both boys and girls. The authors report that parental monitoring, parental disapproval of the adolescent’s sexual behavior, parental control, and satisfaction with the parent-adolescent relationship was important in delaying first intercourse.

Raj, Anita, Niranjan Saggurti, Donta Balaiah, and Jay G. Silverman. “Prevalence of Child Marriage and Its Effect on Fertility and Fertility-Control Outcomes of Young Women in India: A Cross-Sectional, Observational Study.” Lancet 373 (2009): 1883–1889.

DOI: 10.1016/S0140-6736(09)60246-4 Save Citation » Export Citation » Share Citation »

In India, child marriage is viewed as a primary concern related to women’s health and, as such, a barrier to social and economic development in India. Associated with child marriage were no contraceptive use before first childbirth, high fertility, rapid repeat childbirth, multiple unwanted pregnancies, pregnancy terminations, and sterilization.

Raut, Dharmendra, and Amol Patil. “ Study of Comparison of Pregnancy and Foetal Outcome among the Pregnant Adolescent (13-19yrs) and Control (20-25yrs) Groups .” Journal of Evolution of Medical and Dental Sciences 3 (2014): 15374–15380.

DOI: 10.14260/jemds/2014/4072 Save Citation » Export Citation » Share Citation »

This study suggests the extent of the risk of adolescent pregnancy in India. Adverse outcomes because of an adolescent pregnancy varied by region and were associated with higher risk of adverse pregnancy and fetal outcomes. The authors suggest that comprehensive adolescent pregnancy programs could be effective.

Rawat, Seema. Is Youth of India Ready for Sex Education? A Study on Opinions towards Sex Education among Adolescent Students, their Parents and Teachers in Mumbai City . 2014.

This study is a good example of a debate over providing basic sex education to students in the state of Maharashtra in India. To determine the support of sexual education, the authors assessed the students’ knowledge of sex, and the attitudes of the adolescents, their parents, and teachers toward sexual education.

Serquina-Ramiro, Laurie. “Physical Intimacy and Sexual Coercion among Adolescent Intimate Partners in the Philippines.” Journal of Adolescent Research 20 (2005): 476–496.

DOI: 10.1177/0743558405275170 Save Citation » Export Citation » Share Citation »

Sexual coercion among unmarried Filipino adolescents was the focus of this study. The results suggest that sexual coercion was common in adolescent intimate relationships. Almost 65 percent reported that they had been involved in a coercive intimate relationship. Some 42 percent of victims were boys and 64.6 percent were girls.

Skinner, S. Rachel, Jennifer Smith, Jennifer Fenwick, Sue Fyfe, and Jacqueline Hendriks. “Perceptions and Experiences of First Sexual Intercourse in Australian Adolescent Females.” Journal of Adolescent Health 43 (2008): 593–599.

DOI: 10.1016/j.jadohealth.2008.04.017 Save Citation » Export Citation » Share Citation »

A better understanding of the influences on sexual initiation provides information that can help reduce adolescent risk taking behavior. Those who said they were “ready” were more likely to have delayed intercourse until they were ready. Peer norms and intoxication were typical reasons for unwanted sexual initiation.

Wang, Bo, Xiaoming Li, Bonita Stanton, et al. “ Sexual Attitudes, Pattern of Communication, and Sexual Behavior among Unmarried Out-of-School Youth in China .” BMC Public Health 7 (2007): 189.

DOI: 10.1186/1471-2458-7-189 Save Citation » Export Citation » Share Citation »

This study provides data for China’s prevention and intervention efforts related to reducing risk among out-of-school adolescents engaging in premarital sex. Approximately 60 percent of adolescents surveyed approved of premarital sex. Boys generally did not talk with either parent about sex. One-third of girls talked to their mothers about sexual matters.

Wolf, Merrill, Phan Bich Thuy, Alyson Hyman, and Amanda Huber. “Abortion in Vietnam History: Culture and Politics Collide in the Era of Doi Moi .” In Abortion in Asia: Local Dilemmas, Global Politics . Vol. 20. Edited by Andrea Whittaker, 149–174. New York: Berghahn, 2010.

Culture and politics collide in the era of Doi Moi (renovation). The Vietnamese government’s effort to reduce population growth began in the 1960s. The national family planning program limited families to two children. Contraceptive methods were in short supply. Abortion and IUD’s were the common methods available to most women.

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What Can Be Done to Reduce Teen Pregnancy and Out-of-Wedlock Births?

Subscribe to the center for economic security and opportunity newsletter, isabel v. sawhill isabel v. sawhill senior fellow emeritus - economic studies , center for economic security and opportunity @isawhill.

October 1, 2001

18 min read

Why Focus on Teen Pregnancy?

Virtually all of the growth of single-parent families in recent decades has been driven by an increase in births outside marriage. Divorce rates have leveled off or declined modestly since the early 1980s and thus have not contributed to the rising proportion of children being raised by only one parent nor to the increase in child poverty and welfare dependence associated with the rise in single-parent families.

Not all non-marital births are to teen-agers. In fact, 70 percent of all births outside marriage are to women over age 20. For this reason, some argue that a focus on teens fails to address the real problem and that much more attention needs to be given to preventing childbearing, or raising marriage rates, among single women who have already entered their adult years.

But there are at least four reasons to focus on teens:

First, although a large proportion of non-marital births is to adult women, half of first non-marital births are to teens. Thus, the pattern tends to start in the teenage years, and, once teens have had a first child outside marriage, many go on to have additional children out of wedlock at an older age. A number of programs aimed at preventing subsequent births to teen mothers have been launched but few have had much success. So, if we want to prevent out-of-wedlock childbearing and the growth of single-parent families, the teenage years are a good place to start

Second, teen childbearing is very costly. A 1997 study by Rebecca Maynard of Mathematica Policy Research in Princeton, New Jersey, found that, after controlling for differences between teen mothers and mothers aged 20 or 21 when they had their first child, teen childbearing costs taxpayers more than $7 billion a year or $3,200 a year for each teenage birth, conservatively estimated.

Third, although almost all single mothers face major challenges in raising their children alone, teen mothers are especially disadvantaged. They are more likely to have dropped out of school and are less likely to be able to support themselves. Only one out of every five teen mothers receives any support from their child’s father, and about 80 percent end up on welfare. Once on welfare, they are likely to remain there for a long time. In fact, half of all current welfare recipients had their first child as a teenager.

Some research suggests that women who have children at an early age are no worse off than comparable women who delay childbearing. According to this research, many of the disadvantages accruing to early childbearers are related to their own disadvantaged backgrounds. This research suggests that it would be unwise to attribute all of the problems faced by teen mothers to the timing of the birth per se. But even after taking background characteristics into account, other research documents that teen mothers are less likely to finish high school, less likely to ever marry, and more likely to have additional children outside marriage. Thus, an early birth is not just a marker of preexisting problems but a barrier to subsequent upward mobility. As Daniel Lichter of Ohio State University has shown, even those unwed mothers who eventually marry end up with less successful partners than those who delay childbearing. As a result, even if married, these women face much higher rates of poverty and dependence on government assistance than those who avoid an early birth. And early marriages are much more likely to end in divorce. So marriage, while helpful, is no panacea.

Fourth, the children of teen mothers face far greater problems than those born to older mothers. If the reason we care about stemming the growth of single-parent families is the consequences for children, and if the age of the mother is as important as her marital status, then focusing solely on marital status would be unwise. Not only are mothers who defer childbearing more likely to marry, but with or without marriage, their children will be better off. The children of teen mothers are more likely than the children of older mothers to be born prematurely at low birth weight and to suffer a variety of health problems as a consequence. They are more likely to do poorly in school, to suffer higher rates of abuse and neglect, and to end up in foster care with all its attendant costs.

How Does Current Welfare Law Address Teen Pregnancy and Non-Marital Births?

The welfare law enacted in 1996 contained numerous provisions designed to reduce teen or out-of-wedlock childbearing including:

A $50 million a year federal investment in abstinence education;
A requirement that teen mothers complete high school or the equivalent and live at home or in another supervised setting;
New measures to ensure that paternity is established and child support paid;
A $20 million bonus for each of the 5 states with the greatest success in reducing out-of-wedlock births and abortions;
A $1 billion performance bonus tied to the law’s goals, which include reducing out-of-wedlock pregnancies and encouraging the formation and maintenance of two-parent families;
The flexibility for states to deny benefits to teen mothers or to mothers who have additional children while on welfare (no state has adopted the first but 23 states have adopted the second); and
A requirement that states set goals and take actions to reduce out-of-wedlock pregnancies, with special emphasis on teen pregnancies.

Research attempting to establish a link between one or more of these provisions and teen out-of-wedlock childbearing has, for the most part, failed to find a clear relationship. One exception is child support enforcement, which appears to have had a significant effect in deterring unwed childbearing.

Are Teen Pregnancies and Births Declining?

Teen pregnancy and birthrates have both declined sharply in the 1990s (figure 1). The fact that these declines predated the enactment of federal welfare reform suggests that they were caused by other factors. However, it is worth noting that many states began to reform their welfare systems earlier in the decade under waivers from the federal government, so we cannot be sure. In addition, the declines appear to have accelerated in the second half of the decade after welfare reform was enacted. And finally, most of the decline in the early 1990s was the result of a decrease in second or higher order births to women who were already teen mothers. This decrease was related in part to the popularity of new and more effective methods of birth control among this group. It was not until the second half of the decade that a significant drop in first births to teens occurred.

Teen birthrates had also declined in the 1970s and early 1980s but in this earlier period all of the decline was due to increased abortion. Significantly, all of the teen birthrate decreases in the 1990s were due to fewer pregnancies, not more abortions.

Equally significant is the fact that teens are now having less sex. Up until the 1990s, despite some progress in convincing teens to use contraception, teen pregnancy rates continued to rise because an increasing number of teens were becoming sexually active at an early age, thereby putting themselves at risk of pregnancy. More recently, both better contraceptive use and less sex have contributed to the lowering of rates.

Given that four out of five teen births are to an unwed mother, this drop in the teen birthrate contributed to the leveling off of the proportion of children born outside marriage after 1994 (figure 2). More specifically, if teen birthrates had held at the levels reached in the early 1990s, by 1999 this proportion would have been more than a full percentage point higher. Thus, a focus on teenagers has a major role to play in future reductions of both out-of-wedlock childbearing and the growth of single-parent families.

What Caused the Decline in Teen Pregnancies and Births?

Although the immediate causes of the decline-less sex and more contraception-are relatively well established, it is less clear what might have motivated teens to choose either one. However, many experts believe it was some combination of greater public and private efforts to prevent teen pregnancy, the new messages about work and child support embedded in welfare reform, more conservative attitudes among the young, fear of AIDS and other sexually transmitted diseases, the availability of more effective forms of contraception, and perhaps the strong economy.

Some of these factors have undoubtedly interacted, making it difficult to ever sort out their separate effects. For example, fear of AIDS may have made teenagers-males in particular, for whom pregnancy has traditionally been of less concern-more cautious and willing to listen to new messages. Indeed, as shown by Leighton Ku and his colleagues at the Urban Institute in Washington, D.C., the proportion of adolescent males approving of premarital sex decreased from 80 percent in 1988 to 71 percent in 1995. The Ku study also linked this shift in adolescent male attitudes to a change in their behavior.

The growth of public and private efforts to combat teen pregnancy may have also played a role, as suggested by surveys conducted by the National Governors’ Association, the General Accounting Office, the American Public Human Services Association, and most recently and comprehensively, by Child Trends. The Child Trends study, conducted by Richard Wertheimer and his associates at the Urban Institute, surveyed all 50 states in both 1997 and 1999. The survey shows that states have dramatically increased their efforts to reduce teen pregnancy (figure 3). These efforts include everything from the formation of statewide task forces to more emphasis on sex education in the public schools and statewide media campaigns. Although such efforts have been greatly expanded in recent years, they are still relatively small. State spending on teen pregnancy prevention averages only about $8 a year per teenaged girl. In addition to being small, such efforts may or may not be effective in preventing pregnancy. Fortunately, we know more about this topic now than we did even a few years ago.

Do Teen Pregnancy Prevention Programs Work?

The short answer is “yes, some do.” Based on a careful review of the scholarly literature completed by Douglas Kirby of ETR Associates in Santa Cruz, California, a number of rigorously evaluated programs have been found to reduce pregnancy rates. Two of these programs have reduced rates by as much as one-half. One is a program that involves teens in community service with adult supervision and counseling. The other includes a range of services such as tutoring and career counseling along with sex education and reproductive health services. Both have been replicated in diverse communities and evaluated by randomly assigning teens to a program and control group. In addition, a number of less intensive and less costly sex education programs have also been found to be effective in persuading teens to delay sex and/or use contraception. Such programs typically provide clear messages about the importance of abstaining from sex and/or using contraception, teach teens how to deal with peer pressure to have sex, and provide practice in communicating and negotiating with partners.

“Abstinence only” programs are relatively new and have not yet been subject to careful evaluation, although what research exists has not been encouraging. More importantly, the line between abstinence only and more comprehensive sex education that advocates abstinence but also teaches about contraception is increasingly blurred. What matters is not so much the label but rather what a particular program includes, what the teacher believes, and how that plays out in the classroom. A strong abstinence message is totally consistent with public values, but the idea that the federal government can, or should, rigidly prescribe what goes on in the classroom through detailed curricular guidelines makes little sense. Family and community values, not a federal mandate, should prevail, especially in an area as sensitive as this one.

Do Media Campaigns Work?

Community-based programs are only part of the solution to teen pregnancy. Indeed, only 10 percent of teens report they have participated in such a program (outside of school), while on average teens spend more than 38 hours a week exposed to various forms of entertainment media. By themselves, teen pregnancy prevention programs cannot change prevailing social norms or attitudes that influence teen sexual behavior. The increase in teen pregnancy rates between the early 1970s and 1990 was largely the result of a change in attitudes about the appropriateness of early premarital sex, especially for young women. As more and more teen girls put themselves at risk of an early pregnancy, pregnancy rates rose. More recently, efforts to encourage teens to take a pledge not to have sex before marriage have had some success in delaying the onset of sex.

In an attempt to influence these attitudes and behaviors, several national organizations as well as numerous states have turned to the media for assistance. Between 1997 and 1999 alone, the number of states conducting media campaigns increased from 15 to 36. Typically, such campaigns use both print and electronic media to reach large numbers of young people with messages designed to change their behavior. Such messages can be delivered via public service announcements (PSAs) or by working with the media to incorporate more responsible content into their ongoing programming. Most state efforts rely on PSA campaigns but several national organizations are working with the entertainment industry to affect content.

Research assessing the effectiveness of media campaigns is less extensive and less widely known than research evaluating community-based programs, but it shows that they, too, can be effective. A meta-analysis of 48 different health-related media campaigns from smoking cessation to AIDS prevention by Leslie Snyder of the University of Connecticut found that, on average, such campaigns caused 7 to 10 percent of those exposed to the campaign to change their behavior (relative to those in a control group). As with community-based programs, media campaigns vary enormously in their effectiveness and need to be designed with care. But existing evidence suggests that they are a good way to reach large numbers of teens inexpensively.

Are Efforts to Reduce Teen Pregnancy Cost-Effective?

At first appearance, the finding by Rebecca Maynard that each teen mother costs the government an average of $3,200 per year suggests that government could spend as much as $3,200 per teen girl on teen pregnancy prevention and break even in the process. But, of course, not all girls become teen mothers and programs addressing this problem are not 100 percent effective so a lot of this money would be wasted on girls who do not need services and on programs that are less than fully effective.

Here is a simple but useful method to estimate how much money could be spent on teen pregnancy prevention programs and still realize benefits that exceed costs. If we accept Maynard’s estimate that reducing teen pregnancy saves $3,200 per birth prevented (in 2001 dollars), the question is how much should we spend to prevent such births? We first have to adjust the $3,200 estimate for the fact that not all teen girls will get pregnant and give birth without the intervention program. We know that about 40 percent of teen girls become pregnant and about half of these (or 20 percent) give birth. This adjustment yields the estimate that $640 (20 percent multiplied by $3,200) might be saved by a universal prevention program. (If we knew how to target the young people most at risk we could save even more than this.) However, a second adjustment is necessary because not all intervention programs are effective. Based on data reviewed by Douglas Kirby and by Leslie Snyder, a good estimate is that about one out of every ten girls enrolled in a program or reached by a media campaign might change her behavior in a way that delayed pregnancy beyond her teen years. This second adjustment yields the estimate that universal programs would produce a benefit of 10 percent of $640 or about $64 per participant. As the Wertheimer survey showed, actual spending on teen pregnancy prevention programs in the entire nation now averages about $8 per teenage girl. If the potential savings are $64 per teenage female while actual current spending is only $8 per teenage female, government is clearly missing an opportunity for productive investments in prevention programs. In fact, these calculations-while rough-suggest that government could spend up to eight times ($64 divided by $8) as much as is currently being spent and still break even.

Implications for Welfare Reform Reauthorization Research and experience over the last decade suggest several lessons for the administration and Congress as they consider reauthorization of the 1996 welfare reform legislation.

First, the emphasis in the current law on time limits, work, and child support enforcement should be maintained. The 1996 welfare reform law included a set of very important messages. To young women, it said “if you become a mother, this will not relieve you of an obligation to finish school and support yourself and your family through work or marriage. And any special assistance you receive will be time limited.” To young men, it said “if you father a child out-of-wedlock, you will be responsible for supporting that child.” Although opinions vary as to whether these messages have had an impact, in my view the decline in teen pregnancies and births together with the leveling off of the non-marital birth ratio and of the proportion of children living in single parent homes all suggest such an impact. These messages may be far more important than any specific provisions aimed at increasing marriage or reducing out-of-wedlock childbearing, and their effects are likely to cumulate over time.

Second, the federal government should fund a national resource center to collect and disseminate information about what works to prevent teen pregnancy. Until recently, little information was available about the best ways to prevent teen pregnancy. States and communities had no way of learning about each other’s efforts and teens themselves had no ready source of information about the risks of pregnancy and the consequences of early unprotected sex. Some private organizations have attempted to fill the gap without much help from public sources.

Third, Congress should send a strong abstinence message coupled with education about contraception. Surveys of both adults and teens reveal strong support for abstinence as the preferred standard of behavior for school-age youth, and they want teens to hear this message. At the same time, a majority is in favor of making birth control services and information available to teens who are sexually active. In addition, few expect all unmarried adults in their twenties to abstain from sex until marriage. And since a large proportion of non-marital births occurs in this age group, and a significant number of teens continue to be sexually active, education about and access to reproductive health services remains important through Title X of the Public Health Service Act, the Medicaid program, and other federal and state programs.

Fourth, adequate resources should be provided to states to prevent teen pregnancy, without specifying the means for achieving this goal. In addition, states that work successfully to reduce teen pregnancy should be rewarded for their efforts. A strong argument can be made that the federal government should specify the outcomes it wants to achieve but not prescribe the means for achieving them. This is especially important given some uncertainty about the effectiveness of different programs and strategies, and the diversity of opinion about the best way to proceed. It suggests the wisdom of retaining a block grant structure for TANF and avoiding earmarks for specific programs. This does not mean the federal government should not reward states that achieve certain objectives, such as an increase in the proportion of children living in two-parent families, a decline in the non-marital birth ratio, or a decline in the teen pregnancy or birth rate. Reducing early childbearing may be one of the most effective ways of increasing the proportion of children born to, and raised by, a married couple. But states should decide on the best way to achieve these outcomes, subject only to the caveat that they base their efforts on reliable evidence about what works. The evidence presented above suggests that states should be spending roughly eight times as much as they are now on teen pregnancy prevention.

Fifth, the federal government should fund a national media campaign. Too many public officials and community leaders have assumed that if they could just find the right program, teen pregnancy rates would be reduced. Although there are now a number of programs that have proved effective, the burden of reducing teen pregnancy should not rest on programs alone. Rather, we should build on the fledgling efforts undertaken at the state and national level over the past five years to fund a broad-based, sophisticated media campaign to reduce teen pregnancy. These funds should support not only public service ads but also various nongovernmental efforts to work in partnership with the entertainment industry to promote more responsible content. These media efforts can work in tandem with effective sex education and more expensive and intensive community level programs targeted to high-risk youth.

These steps have the potential to maintain the progress made over the past decade in reducing teen and out-of-wedlock pregnancies. There are only two solutions to the problem of childbearing outside marriage. One is to encourage early marriage. The other is to encourage delayed childbearing until marriage. Although commonplace as recently as the 1950s, early marriage is no longer a sensible strategy in a society where decent jobs increasingly require a high level of education and where half of teen marriages end in divorce. If we want to ensure that more children grow up in stable two-parent families, we must first ensure that more women reach adulthood before they have children.

Additional Reading

Henshaw, Stanley. 2001. U.S. Teenage Pregnancy Statistics. New York: Alan Guttmacher Institute.

Kirby, Douglas. 2001. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, D.C.: National Campaign to Prevent Teen Pregnancy.

Ku, Leighton, and others. 1998. “Understanding Changes in Sexual Activity Among Young Metropolitan Men: 1979-1995.” Family Planning Perspectives, 30(6): 256-262.

Lichter, Daniel T., Deborah Roempke Graefe, and J. Brian Brown. 2001. Is Marriage a Panacea? Union Formation Among Economically Disadvantaged Unwed Mothers. Columbus: Ohio State University.

Maynard, Rebecca A., ed. 1997. Kids Having Kids: Economic Costs and Social Consequences of Teen Pregnancy. Washington, D.C.: Urban Institute.

National Campaign to Prevent Teen Pregnancy. 2001. Halfway There: A Prescription for Continued Progress in Preventing Teen Pregnancy. Washington, D.C..

National Center for Health Statistics. 2000 and 2001. National Vital Statistics Reports, 48 and 49, various issues. Hyattsville, Md.: Department of Health and Human Services.

Sawhill, Isabel. Forthcoming. “Welfare Reform and the Marriage Movement.” Public Interest.

Snyder, Leslie B. 2000. “How Effective Are Mediated Health Campaigns?” In Public Communication Campaign, edited by Ronald E. Rice and Charles K. Atkin. Thousand Oaks, Calif.: Sage.

Wertheimer, Richard, Justin Jager, and Kristin Anderson Moore. 2000. “State Policy Initiatives for Reducing Teen and Adult Non-Marital Childbearing.” New Federalism: Issues and Options for States (No. A-43). Washington, D.C.: Urban Institute.

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Hardcopy Version at National Academies Press

CHAPTER 4 TEENAGE PREGNANCY AND ITS RESOLUTION

Sandra L.Hofferth

One major source of confusion in the literature dealing with teen pregnancy and childbearing is precisely the distinction between pregnancy and its outcomes. People often say they're referring to teenage pregnancy when they only have information on births . Pregnancy can be resolved in a number of ways, only one of which is a live birth kept by the mother. However, in talking about the problems of teen pregnancy, the problems that have been well-documented to date are those associated with that one outcome—bearing and raising a child as a teenager. Another set of confusions revolves around the process which leads ultimately to childbearing and its implications for policy and programs. For example, an agency may be interested in developing a profile of young women at risk of teen childbearing to target them for intervention. As discussed in earlier chapters, in order to become a teen mother, a young woman must first become sexually active, next, not use contraception or fail in its use in some way (including experiencing method failure), and, finally, once pregnant, decide to bear and raise the child herself. There are several points at which alternatives present themselves. Some teens choose one way, others choose another. Thus the agency has several possible points at which to target its interventions: at initiation of sexual activity, at contraceptive use, or, at the resolution of a pregnancy.

In this chapter some basic demographic description of the number and rates of teen pregnancies, births and abortions are first presented for the United States. Comparisons are drawn with Denmark, a country with registers of health events. Statistics showing the actual way pregnancies to U.S. teens are resolved are presented, followed by a discussion of research that sheds light on the factors associated with resolving a pregnancy one way rather than another. A summary and conclusions section closes the chapter.

In 1984 there were 469,682 births to teenagers 15 to 19, 9,965 births to teens under 15. This represents a considerable decline in births to teens over the decade, from a high of 656,000 in 1970. The number of pregnancies rose slightly until 1980 and has declined slightly since then. There were over a million pregnancies to teens in 1984 ( Table 3.1 ).

However, the change in the absolute numbers of births and pregnancies does not adequately indicate the incidence of teen pregnancy and childbearing because it does not take into account changes in the number of teen women. The number of teens rose during the 1970s, leveling off in the mid 1970s and declining since 1979. Nor does it take into consideration the number of women at risk, that is, the number of women who are sexually active (see Hofferth et al., 1986). This is especially important for teenagers, only a portion of whom are sexually active. Pregnancy rates 1 per 1000 women 15 to 19 rose 9 per- cent between 1974 and 1984; however, because the proportion who were sexually active also rose over the period, the pregnancy rates per 1000 sexually active women 15 to 19 actually fell 8.7 percent between 1974 and 1984.

What does this mean for individual women? The pregnancy rate in 1984 was 231 per 1000 sexually active women. This means that in 1984, 23 percent of sexually active teenagers would have become pregnant. This figure, however, only indicates the proportion of teens who would become pregnant in any one year. A more interesting figure is the proportion of young women who would ever become pregnant before reaching age 20. That is, what is the chance that a young woman would become pregnant as a teenager? Although this probability has been estimated using survey data, since abortions are underestimated in such data, the estimates of pregnancy will be low. Better estimates are obtained from reporting data such as those collected by the Centers for Disease Control and the Alan Guttmacher Institute. Based on such data it was estimated that in 1981 about 44 percent of young women will become pregnant before reaching age 20, 40 percent of white and 63 percent of black women (Forrest, 1986; Table 3.3 ).

Of course, this estimate, too, is rather crude, since among those young women are some who became sexually active very early in their teens, others who became sexually active very late and others who were still virgins at age 20. The data that are most helpful in showing what the actual risk of pregnancy is among those who are sexually active, breaks the probability down by the length of time since first intercourse and uses a life table methodology to estimate the risk of conception within the first two years after first intercourse (Zabin, 1979; Koenig and Zelnik, 1982). Data collected in 1976 (Zabin, 1979) indicate that within the first three months 9 percent of white and 14 percent of black teenage women will have experienced a first premarital pregnancy (Table 3.7). By the end of the first year that figure has risen to 17 percent for whites and 27 percent for blacks, and by the end of two years, 30 percent of whites and 37 percent of black teenagers will have experienced a first premarital pregnancy. Data from 1979 (Koenig and Zelnik, 1982) suggest a slight increase in the probability of pregnancy during the first two years after first intercourse between 1976 and 1979, with 33 percent of white teenagers and 43 percent of black teenagers experiencing a first premarital pregnancy within two years after first intercourse ( Table 3.5 ). The probability of a first pregnancy is strongly affected by two factors—the age at first intercourse and the use of contraception (Tables 4.6 and 4.8). Pregnancy rates are much for those older at first intercourse and for those who always used a contraceptive method. There was little difference in pregnancy between those who used a prescription and non-prescription methods, as long as they always used it (Koenig and Zelnik, 1982).

THE RESOLUTION OF TEEN PREGNANCIES

What happens to these one million teenage pregnancies? Many more young women under 20 become pregnant than bear a child, almost twice as many. In 1982 the total births to teenagers 15 to 19 represented 47 percent of the total number of pregnancies (abortions plus births plus miscarriages [ Table 3.1 ]).

Table 3.2 shows how pregnancies in 1982 were divided: 40 percent of the pregnancies were aborted, and 13 percent miscarried; thus slightly under half, 47 percent, resulted in a live birth. The 47 percent which were live births are divided as follows: 13 percent were postmaritally conceived births, 11 percent were premaritally conceived but born postmaritally, and 23 percent were born out-of-wedlock (estimates from Table 3.1 and O'Connell and Rogers, 1984).

The resolutions to a premarital pregnancy considered here are abortion versus having a live birth, marriage versus non-marriage, and adoption versus keeping the child.

Live Birth versus Abortion

The proportion of teenage pregnancies that ended in a live birth decreased over the past decade ( Table 3.1 ). The number of teen pregnancies has risen, but because the number of abortions has risen even faster, the number of births has been declining. Both the number of abortions and the abortion rate increased by 50 percent between 1974 and 1980. The percent of teenage pregnancies terminated by abortions climbed rapidly, increasing from 27 percent to 40 percent between 1974 and 1980. Since 1980, the abortion rate and ratio have remained level. Birth rates for all women have remained fairly level; rates for those sexually active have declined. ( Table 3.1 ).

Of course, it is difficult to interpret these figures without some comparison. What is a high level of pregnancy, of births, of abortions for teenagers? Unfortunately, there are only limited international data on abortions, especially by age of the woman. The United States has a high abortion rate for young women compared to western European countries (Jones et al., 1985; Henshaw and O'Reilly, 1983). The United States also leads in the percent of abortions to teenagers (Tietze, 1983; Bachu, 1983). In spite of the large number of abortions, births to United States teens are also high, relative to other countries (AGI, 1981; Jones et al., 1985).

Denmark is a good country with which to compare the United States. Levels of sexual activity among teenagers are actually higher in Denmark than in the U.S. (Rasmussen and David, 1981). Abortion laws were liberalized there about the same time as in the United States—the early 1970s. Most important, Denmark has an excellent abortion reporting system. With a unique identifying number for each person and a centralized information gathering system, the data on abortion in Denmark are among the most complete in any nation.

Pregnancy rates in the United States have been about twice the level of Denmark for the past decade (David et al., 1982; Table 3.1 ). In both countries the pregnancy rates increased initially after liberalization of abortion, but levels in Denmark returned to those prior to liberalization, while those in the United States continued to rise. As a result, rates of abortions and births in the U.S. in 1980 and 1981 are considerably higher than in 1970. Abortion rates in both countries rose. However, while they have leveled off in Denmark, they have continued to rise in the United States.

The rapid increase in pregnancy and abortion rates in the U.S. during the 1970s was due to the rapid increase in sexual activity over the same period. Apparently, levels of sexual activity rose dramatically in Denmark during the 1960s (Rasmussen and David, 1981); thus by the time abortion was legalized in both countries, sexual activity had begun to level off in Denmark at a higher level. In contrast, the major increase in sexual activity in the U.S. occurred during the 1970s, with a leveling off during the early 1980s (see discussion, Chapter 1 ). As Table 3.1 showed, pregnancy rates among those sexually active actually showed a decline between 1974 and 1984.

Two valuable lessons from these data and from a recent study of five western European nations (Jones et al., 1986) are that 1) high levels of sexual activity do not necessarily result in high pregnancy rates, given adequate use of contraception, and 2) low birth rates do not necessarily imply high abortion rates; they may simply imply low pregnancy rates. Low abortion rates and low birth rates are compatible.

Among teens, the proportion of pregnancies terminated by abortion is higher in Denmark than in the United States, primarily due to the high abortion ratio among 15 to 17 year old Danes (David et al., 1982). 15 to 17 year old United States teens are much more likely to bear their babies than Danish 15 to 17 year olds. Jones et al. (1985) also found that in each of 5 developed nations they investigated, that 15–17 year olds were much more likely to abort a pregnancy than 18–19 year olds: the difference was smallest in the U.S. This suggests substantial differences between United States and other countries in choice of resolution for unplanned pregnancies, differences which will be pursued a little later.

One way of resolving an out-of-wedlock teenage pregnancy is by marrying. So far all teenage pregnancies have been lumped together. In fact, some 13 percent of all teenage births are postmaritally conceived ( Table 3.2 ), and such births are not generally considered to be problematic. In 1980 only 5 percent of abortions to teens 15 to 19 (about 2 percent of all pregnancies) were to married women (Henshaw et al., 1985). Assuming that abortions indicate that a pregnancy was unintended, it can be inferred that most pregnancies to married women are intended. Zelnik (1979) found that 53 percent of first births to women who were married were unintended. If to the proportion of postmarital births are added a proportion of the miscarriages and a small proportion of the abortions, it can be seen that that between 15 and 20 percent of all pregnancies to women under 20 occur to married women. The remainder, 80 to 85 percent, are premarital pregnancies.

Earlier, it was pointed out that about 24 percent of sexually active teenagers age 14 become pregnant each year. However, this does not tell us how many teenagers age 14 become pregnant before they reach 20 or marry. According to 1979 survey data (Zelnik and Kantner, 1980), 16 percent of all metro teenage women 15 to 19 had ever experienced a premarital pregnancy, double that of 1971. Of those sexually active, 33 percent had ever experienced a premarital pregnancy, a small increase since 1971. Thus, when control is introduced for the increase in sexual activity over the decade of the 1970's, the incidence of premarital pregnancy has not changed very much. The major reason for the large apparent increase in premarital pregnancy is the increase in sexual activity. There was an increase in premarital pregnancy among sexually active white teens, but not among black teens. The lack of increase among blacks is probably due to underreporting of abortion. Thus premarital pregnancy has increased, but not as much among those sexually active as it appears from the increase in the population of teenagers. Data from the 1982 National Survey of Family Growth show a slight decline in premarital pregnancy among teenagers between 1979 and 1982, although the difference is probably not statistically significant. In 1982 14 percent of all teen women 15 to 19 had ever experienced a premarital pregnancy, compared with 16 percent in 1979. Of those premaritally sexually active, 30 percent experienced a premarital pregnancy.

These figures substantially underestimate the true proportion of teenagers who become pregnant before they reach age 20 or marry because abortions are substantially underreported in surveys—by as much as 50 percent. Some subgroups report more accurately than other subgroups (Mosher, 1985). Unmarried black teenage females are the least likely to accurately report their abortions, with unmarried white teenage females only slightly more accurate. Older married white females are the most accurate reporters of their own abortions. Since accurate pregnancy estimates depend on accurate abortion reports, the reports of pregnancy obtained from surveys will be lower than those estimated on the basis of nationally collected data from organizations such as the Centers for Disease Control and the Alan Guttmacher Institute. Recent calculations from the latter (Forrest, 1986; Table 3.3 ) suggest that based on 1981 data about 40 percent of white teenagers 15–19 and 63 percent of black teenagers would experience a first pregnancy before reaching age 20.

The increase in premarital pregnancy over the decade of the 1970s was not due to an increased wantedness of pregnancy. Table 3.6 shows that the proportion of premaritally pregnant teens who were unmarried at resolution who wanted the pregnancy actually declined between 1971 and 1979 for whites and blacks alike, and the proportion using contraception increased (Zelnik and Kantner, 1980; Table 4.4 ). Of course, premaritally conceived but marital births, which constitute about 11 percent of teen pregnancies, are excluded here. However, since the proportion who marry to resolve a premarital pregnancy also declined, the proportion who wanted a pregnancy probably also declined for all premaritally pregnant teen women.

Contraceptive use generally improved between 1971 and 1982. A smaller proportion reported never using contraception, a higher proportion reported always using it. A larger proportion used contraception at first intercourse and at last intercourse in 1982 than in 1971. Unfortunately, Table 3.4 shows that the percentage of premaritally sexually active teen women who ever experienced a premarital first pregnancy rose in all contraceptive use statuses 1976–79, except for those who used contraception at first intercourse but not always (Zelnik and Kantner, 1980). The largest increase was among never users, but increases also occurred among those who always used contraception. The authors attribute this increase in pregnancy, particularly among the youngest teens, to sharply increased frequency of intercourse and to decreased reliance on the most effective methods of contraception (Koenig and Zelnik, 1982). Data are not yet available from the 1982 NSFG to see whether pregnancy rates continued to increase among contraceptive users as well as non-users. We suspect they have not, since pregnancy rates have been declining.

Data from three surveys of young women (Bachrach, 1985) show that the proportion of teenage women whose first pregnancy ended in a first premarital birth and who gave their baby up for adoption declined in the 1970s between 1971 and 1976 and leveled off at a low level between 1976 and 1982 ( Table 8.1 ). Eighteen percent of white teenagers reported having terminated parental rights in 1971, 2 percent of blacks. By 1976 only 7.0 of whites and no blacks reported having given up a baby for adoption. By 1982 7.4 percent of whites and fewer than 1 percent of blacks reported having given up a child for adoption. Based on data from the National Survey of Family Growth, the estimated annual number of unrelated adoptions declined to a low in 1976 and has been gradually increasing since then.

Agency data support survey evidence which showed declining adoption placements from the early to the mid-1970s (Bachrach, 1985). Legal abortion became an alternative to adoption for many young women who had an unintended pregnancy and who would have adopted if abortion were not available. It has been argued that the reduced social stigma attached to unwed pregnancy caused a shift away from adoption as an alternative to childbirth. The subsequent apparent increase in adoption may be a response to the substantial demand for babies to adopt as well as a response to the many concerns about the ethics of abortion. This is just speculation, since there is no research that would allow us to shed light on these changes. Just documenting the changes that have occurred is a difficult task.

Factors Associated with Resolution of Premarital Teen Pregnancies: Delivering the Baby

Once a teenager is pregnant, what factors are associated with whether she has an abortion or carries the pregnancy to term and delivers the baby? One study found that the younger the teen at conception, the more likely she was to carry the pregnancy to term (Zelnik et al., 1981). In this study 13 to 16 year olds were more likely to have a live birth compared with 17 to 19 year olds comparable on other factors. This is supported by data from another study, which found that of those 13 to 19, the 16 to 17 year olds were most likely to have a live birth. However, national statistics on abortion ratios do not support these findings. The true explanation may be the underreporting of abortions in sample surveys of teenagers, which is likely to be most serious for the younger teens. An underreporting of abortions would increase the apparent proportion who carry pregnancies to term. Thus, due to underreporting of abortion, it is not clear whether factors are related to choice of abortion or birth or to whether abortion is reported. This is a serious problem for analytic study of abortion using sample surveys.

The birth year of the teenager is important. At a given age, earlier birth cohorts are more likely than more recent cohorts to have a live birth (Zelnik et al., 1981).

Young women are more likely than in the past to resolve a premarital pregnancy by abortion ( Table 4.5 ). White teenagers were 1.3 times and black teenagers 2.5 times more likely to have an induced abortion in 1978 than in 1972. Although in the early 1970s black teenagers had a lower likelihood of using abortion to resolve pregnancy, according to these abortion ratios, after 1974 the abortion ratios are similar or slightly higher for blacks than whites. Since abortion data appear to be underreported more for blacks (Zelnik and Kantner, 1980), the difference in levels between blacks and whites may be underestimated. The abortion ratio appears to have levelled off after 1980, according to national figures ( Table 3.1 ).

The black-white difference in likelihood of abortion varies by age. Among young teenagers the ratio of abortions to births is lower for blacks than whites ( Table 4.6 ). However, this difference declines such that ratios are similar for 19 year olds. Among older women, ratios are higher for blacks than for whites.

One source of difference is the age at which abortions and pregnancies are measured. The Ezzard et al. (1982) study ( Table 4.5 ) adjusted age to age at conception. This is particularly important at younger ages. Only a third of women who became pregnant before age 15 were still under 15 at delivery, while three-fourths of those obtaining abortion were still under 15 at the time of abortion (Henshaw et al., 1985). Thus differences between the figures will be sharpest at youngest ages.

Zelnik et al. (1981) found that the more religious a young women, the more likely she is, once pregnant, to bear the child. Another study using data from a small study of health providers in Ventura County California found white Catholics to be less likely to have a live birth, once pregnant than either white non-Catholics or Hispanic Catholics (Eisen et al., 1983). Thus the particular religious affiliation appears less important in the decision than the strength of religious conviction.

Teens living in the East or North central United States or in an urban area are more likely to have a live birth, once pregnant, than those in other regions or in non-urban areas (Zelnik et al., 1980).

The most important family factor associated with delivering a baby versus aborting a pregnancy is parental education. The higher the education of parents, the lower the likelihood that a teenager, once pregnant, will have a live birth (Zelnik et al., 1980). The mother's opinion of abortion is important, with girls whose mothers are more favorably disposed toward abortion less likely to have a live birth (Eisen et al., 1983).

Peer environment is important. The more positive a likely a young pregnant girl is to have a live birth (Eisen et al., 1983). In addition, girls who know a single teen mother are more likely to have a live birth (Eisen et al., 1983).

Among the most important factors affecting the outcome of the pregnancy was whether the pregnancy was wanted. Girls who said they wanted the pregnancy were much more likely to have a live birth than those who didn't (Zelnik et al., 1980). Of course, this measure of wantedness was obtained after the resolution of the pregnancy; ex-post facto rationalization may be measured here.

Beliefs about abortion and birth are important. Having favorable attitudes toward and beliefs about abortion prior to the event were associated with a lower probability of having a live birth (Eisen et al., 1983) and with a positive abortion intention (Smetana and Adler, 1979). Intention to have an abortion was associated with a lower probability of having a live birth (Smetana and Adler, 1979). Positive beliefs about having a child were associated with a low intention to have an abortion. Finally, women choosing either abortion or birth believed others wanted them to follow this alternative, with women intending abortion most motivated to comply with friends' expectations (Smetana and Adler, 1979).

Among the most important factors associated with choice of pregnancy resolution are expectations and academic achievement. High school dropouts and those not enrolled in school, those with a low grade point average, and those with low educational expectations have been found more likely, once pregnant, to have a live birth (Eisen et al., 1983; Leibowitz et al., 1980; Devaney and Hubley, 1981).

Two studies have looked at the relationship between receipt of AFDC and pregnancy resolution decision. Moore and Caldwell looked at the probability of abortion, marriage and out-of-wedlock birth among premaritally pregnant U.S. women aged 15 to 19 in 1971, data collected by Kantner and Zelnik in the National Survey of Young Women. Controlling for a number of individual characteristics, such as education of the father, wantedness of pregnancy, importance of religion and race, they found the probability of abortion to be significantly lower in states having relatively generous AFDC benefit levels (Moore and Caldwell, 1977).

Eisen et al. (1983) and Leibowitz et al. (1980) examined a group of 299 pregnant teenagers who went to health providers in Ventura County, California between 1972 and 1974 for assistance in terminating a pregnancy or for prenatal care. The teens were interviewed twice, once prior to abortion or delivery and a second time six months after the resolution of the pregnancy. The authors hypothesized that young women who received state support would be more likely to choose delivery than girls who were self-supporting. They found that both receiving financial aid from the family and receiving financial aid from the state (AFDC) were associated with choosing delivery (Eisen et al., 1983; Leibowitz et al., 1980). However, more young women than those currently living in welfare families would be eligible for welfare if they did give birth; thus the study really measures the effect of actual receipt of welfare benefits, rather than their availability.

Factors Associated with Marriage Before Birth (Legitimation)

Young women are less likely now than in the past to resolve a premarital pregnancy by marrying. The proportion of women pregnant before marriage who resolved a premarital pregnancy by marrying dropped by 50 percent between 1971 and 1979 for both whites and blacks (Zelnik and Kantner, 1980). The data show very little additional change between 1979 and 1982, although the data are not completely comparable, and the total number of pregnancies is underreported (Horn, 1985).

If we look only at pregnancies that end in a live birth, we see that of the total first births to white and black teenagers, the proportion conceived outside of marriage has risen, and the proportion premaritally conceived but legitimated before birth rose then declined to about the same initial level (O'Connell and Rogers, 1985). As a result, the proportion born out of wedlock rose sharply.

Two studies have examined factors associated with whether a premaritally pregnant teenager who subsequently had a birth married prior to that birth: Zelnik et al. (1981) used data from the National Survey of Young Women in 1971 and 1976. They found that (among those who were premaritally pregnant and gave birth) white teenagers, those from a higher socioeconomic status background and those who wanted the baby were more likely to marry before bearing the child. The second study used the data from Ventura County, California (Eisen et al., 1983). They found that (among those who carried to term) the only factor that discriminated between those who married before the birth and those who didn't was whether the family had been receiving financial aid from the state. Those girls whose families had been receiving financial aid from the state during pregnancy were less likely to marry than those who had not been receiving such assistance (Eisen et al., 1983).

Factors Associated with Bearing an Out-of-Wedlock Child

The resolution many people are interested in is that of bearing a child out-of-wedlock compared with all other options. The previous analyses have explored the decisions in temporal sequence: that is, they have looked at, first, the decision to abort or carry a premarital pregnancy to term, and, second, the decision to marry or not marry before birth among those who carry to term. Several analyses have studied this decision as a joint one with three choices: 1) abortion, 2) marriage and birth, and 3) bearing an out-of-wedlock child. The results of studies viewing the decision this way do not differ from the results of studies using paired comparisons only, but this approach allows simultaneous comparison among all alternative resolutions. Young women who are black, who live in a metropolitan area, whose parents are of low educational levels, who are young at first conception, and who live in a large family are more likely to bear a child out-of-wedlock than to either abort or marry (Eisen et al., 1983; Leibowitz et al., 1980; Devaney and Hubley, 1981; Zelnik et al., 1980). In addition, Leibowitz et al., 1980 and Eisen et al., 1983 found teens living in families receiving financial aid from the state to be more likely than their peers to bear an out-of-wedlock child. In contrast, using 1971 data from the National Survey of Young Women, Moore and Caldwell (1977) found no relationship between level of AFDC benefits and having an out-of-wedlock birth. The latter found a negative relationship between AFDC acceptance rates and the probability of having an out-of-wedlock birth. That is, young women in states with high acceptance rates were less likely to have an out-of-wedlock birth (Moore and Caldwell, 1977). There was no significant association between AFDC benefit levels and acceptance rates and the probability of marrying before the birth (Moore and Caldwell, 1977).

Only a few studies have compared teens who have made adoption plans with teens who have kept and parented their children. These are summarized in Resnick (1984). The results suggest that teenagers who make adoption plans are similar to those who have abortions but different from those who take on parenting responsibilities. The former tend to be older, to have more parental influence and less male partner influence, and to be of higher socioeconomic status. Parenting teens tend to be younger, to have less schooling, to not be attending school and to come from non-intact homes. Thus those who make adoption plans tend to have more prospects for the future. In addition, they were reared in smaller towns and cities and have more traditional attitudes about abortion and family life (Resnick, 1984).

Recent data from the 1982 National Survey of Family Growth (Bachrach, 1985) show that teenagers under 18, whose parents have had some college, whose baby was born before 1973, and who were living with both parents at age 14 were more likely than other teenagers to place the child for adoption if they had a premarital birth.

Two recent studies (Kallen, 1984; Resnick, 1984) are funded by the Office of Adolescent Pregnancy Programs to look more closely at the factors affecting the decision of unmarried pregnant teens to make an adoption plan. At this writing no results are yet available.

Factors Associated with Decision Satisfaction

It is obvious that no one decision is the “right” decision for all adolescents, since the circumstances differ among individuals. However, researchers have found some regularities in the extent to which individuals express satisfaction or dissatisfaction about the decisions they have made in resolving their pregnancies. A study of a Danish sample found that the degree of satisfaction with the decision depended on the firmness of the decision in the first place. Of those who had made a firm decision to abort soon after learning about pregnancy, 94 percent said that the decision was correct 6 months later. Of those who were not so certain, 72 percent said that the decision was correct 6 months later (David et al., 1982). Of those whose decision was firm, 59 percent experienced relief afterward, compared with 28 percent of the less firm. None of the Danish women expressed feeling of guilt over the decision.

A study of United States teen women (Rosen, 1983) found that the more alternatives considered, the greater the dissatisfaction with the decision. This probably reflects greater uncertainty as to what to do, and is consistent results from the Danish study (David et al., 1982).

The Eisen and Zellman (1984) study of pregnant teens in Ventura County, California found no significant difference in decision satisfaction 6 months after pregnancy resolution by type of decision made, age or ethnic group. Nearly all—80 percent—expressed satisfaction in their decision. There were some differences in degree of satisfaction depending on the decision made. Among teenagers who chose abortion, those with better educated mothers, who had advocated abortion for themselves, who were more approving of abortion in general and who used contraception more consistently following abortion were more satisfied (Eisen and Zellman, 1984). Among teens who chose single motherhood, those not enrolled in formal schooling during the six months after birth were more likely to be satisfied with the decision, as were those with maternal support for single parent status. Among teens who married, none of the variables utilized significantly differentiated those who were satisfied with their decision from those who weren't.

Interesting and Controversial Issues

Three issues are worth looking at further. The first issue is the relationship between age and pregnancy resolution. Young teenagers in the United States have a very high probability of bearing the child, once pregnant, compared to older teenagers or teenagers in other countries (Jones et al., 1985). Data from the Danish study (David et al., 1982) show abortion ratios (abortions divided by births plus abortions) to 15 to 17 year olds that are twice those of U.S. 15–17 year olds. Three-quarter of the pregnancies to young Danish teens are terminated by abortion, compared with 40 percent of those to young U.S. teens. Abortion ratios for 18 to 19 year olds are very similar in the U.S. and in Denmark. Results from the National Survey of Young women suggested that, net of other factors, girls younger at conception are more likely than older teens to carry a pregnancy to term. Although the differences are exaggerated because of the underreporting of abortion at younger ages, it could be expected that abortion would be higher at younger ages than at older ages, as shown by the Danish sample, since few young women wanted these pregnancies.

Thus the lack of difference by age in the United States is of interest. Why are 15 to 17 year old pregnant teens in the United States so much more likely to bear a child than comparable teens in a country such as Denmark and other countries? Why are they as likely to bear a child as their 18 to 19 year old peers in the U.S.?

The second important issue is that of race differences in pregnancy resolution. The chapter has emphasized differences between blacks and whites, but conclusions about race differences in pregnancy resolution based on analyses of survey data are of necessity weak because of differential reporting of abortion by race in those data sets. The best information on subgroup characteristics come from the Centers for Disease Control, AGI, and from the National Center for Health Statistics and they are good. However, such data do not provide the depth of information needed to explore causal factors in decision-making. Another problem is whether to use abortion rates or ratios. The abortion ratio is higher among blacks than whites for all ages except the teen years ( Table 4.6 ). During the teen years, the ratio of induced terminations of pregnancy to live births is higher for whites than for blacks. However, if you look at the abortion rate ( Table 4.4 ) the rate is higher for non-whites than for whites at all ages. This is because the pregnancy rate for non-whites is also higher. Thus, in this case, using the abortion rate would lead to a completely different and erroneous conclusion about black-white differences. Analysts need to choose the appropriate measure for their purposes.

One reason for the differences between blacks and whites in abortion is that blacks appear to use abortion for spacing or to end childbearing more than to postpone a first birth. Sixty-five percent of abortions to whites occurred to childless women, compared to 39 percent of abortions to blacks ( Table 4.7 ).

However, there is another problem with the data. Figures are often based on age of the woman at pregnancy outcome. Since birth occurs nine months and abortion approximately 3 months after a conception, a proportion of the young women who conceived (and who eventually bore a child) at the same time as those who conceived and who eventually terminated the pregnancy through abortion would be one year older at outcome. Thus the event (pregnancy) occurred at the same age, but this would not be reflected in the statistics. Adjusting the data to age at conception would take care of this problem, but would also alter the number of births and abortions, especially at younger ages. Thus the Ezzard et al. (1982) study ( Table 4.5 ) shows almost no black-white difference in abortion ratios when abortions and births are adjusted to age at conception. This raises an important issue of comparability of measures across studies. The Alan Guttmacher Institute has moved toward reporting ratios adjusted to age at conception. The other organizations that report abortion statistics do not yet do so (the Centers for Disease Control and the National Center for Health Statistics).

A third interesting issue is that of repeat abortion. In 1980 one-third of U.S. aborters had previously had an abortion (Tietze, 1978; Henshaw and O'Reilly, 1983: Table 7). The figure is smaller for teenagers, as could be expected, since they have not had as much time to have one, let alone two abortions. NCHS data suggest that 12 percent of abortions to 15 to 17 year olds, and 22 percent of abortions to 18 to 19 year olds are repeat abortions ( Table 4.7 ). There are two potential reasons for concern. First, there may be negative effects of abortion on later childbearing and subsequent pregnancies. Second, there may be (over)utilization of abortion as substitute for contraception.

Are there negative effects of abortion on later childbearing and subsequent pregnancies? This literature has been reviewed in Strobino (in this volume) and Hogue (1982); the reader is referred to those sources. After adjusting for the fact that abortions performed on teenagers are performed later in pregnancy, which is somewhat more risky, rates of mortality and morbidity from abortion are somewhat lower for teenagers than for adult women. There is only one instance in which teenagers appeared to be at higher risk of injury than adults. Teenagers appeared to be at higher risk of cervical damage than older women (Cates et al., 1983; Cates, 1981).

Although there is little evidence that having had one prior abortion increases a woman's risk of miscarriage, premature birth or bearing a low birth weight baby, there is some evidence that having had multiple abortions may increase this risk, although, again, the results of several different studies do not agree (Levin et al., 1980; Chung et al., 1982).

Is abortion over-utilized as a substitute for contraception? The concern that abortion is becoming a substitute for contraception does not seem founded. Although in 1971 the percentage of teen women who had a premarital second pregnancy was higher 2 years after the outcome of the first premarital pregnancy for those who had an abortion than for those who had a birth, by 1979 the figures were reversed. In 1979 teen women who had terminated their premarital first pregnancy by abortion were less likely to have a second pregnancy within two years than those who had carried the first pregnancy to term (Koenig and Zelnik, 1982). Tietze (1978) argued that the increasing number of repeat abortions reflects the increasing number of women who have had a first abortion and are, therefore, at risk of having a second abortion. This appears to be born out by a recent study that shows few differences between women obtaining a first and those obtaining a repeat abortion (Berger et al., 1984). Those obtaining a repeat abortion were older, less likely to be married and more tolerant of legal abortion than were women having a first abortion. They had intercourse more frequently and they were more likely to have been contracepting when they became pregnant. They did not differ on type of method used or on any other demographic, psychological or attitudinal measures. Finally, results from a 1982 national survey show that fewer than one half of 1 percent of women exposed to the risk of unintended pregnancy, who did not use contraception, mentioned the availlability of abortion as a reason for nonuse (Forrest and Henshaw, 1983).

SUMMARY AND CONCLUSIONS

How women choose to resolve their pregnancies has become one of the major factors determining the number and rate of births to teens. Only about half of all pregnancies to teens end in a live birth. Yet only a very small amount of research has been conducted on this important issue. One important issue that researchers have just begun to address is whether miscarriage and abortion have psychological, social, health, familial, educational, economic or other consequences for adolescents and for their families. A few studies have focused on short term psychological effects, but there are no long term studies. The many studies of health effects that have been conducted have found little negative impact on health (Hogue et al., 1982).

One major question that several researchers have addressed is why individual women choose one form of resolution to a pregnancy over another. The major studies in this area use two data sets: the National Surveys of Young Women (1971, 76, 79) and a study of 299 women in Ventura County, California in 1972–74. These are the only studies to provide multivariate evidence on the issue, and they are the only studies to have focused on the resolution of premarital teen pregnancies (as distinguished from postmarital teen pregnancies). It is important to make this distinction. Few people consider maritally conceived pregnancies problematic, although, among young teenagers, they may be. Research suggests that a premaritally pregnant teen is more likely to give birth rather than obtain an abortion if she wanted the pregnancy, is of lower socioeconomic status, is unfavorably disposed to abortion, has lower aspirations and educational expectations, receives parental financial assistance, currently lives in a family that receives public assistance, and lives in a state with higher AFDC benefit levels. These results are based on a very limited set of studies, however, and all these studies suffer from underreporting of abortion.

Among those who give birth, those who are of lower socioeconomic status, who are younger, and who are black are less likely to marry than their peers.

Two types of data are needed: 1) Vital statistics data that can provide national estimates of abortion (and, as a result, pregnancies) by age and, simultaneously, by race/ethnicity, and 2) Survey data that not only provide reasonable estimates of abortion but also contain variables that could be used to test hypotheses about relationships among variables both at one point and over time. At the present time there are no national reporting requirements for abortions. Abortion data are presently estimated from three sources: a national survey of providers by the Alan Guttmacher Institute, counts of characteristics of abortion patients obtained by the Centers for Disease Control and counts of abortions obtained in 12–13 reporting states by the National Center for Health Statistics. National estimates of abortions in survey data can be obtained from the National Survey of Young Women (1971, 1976) and the National Survey of Young Women and Young Men (1979), the National Survey of Family Growth, Cycle III (1982), and the National Longitudinal Survey of Youth, Ohio State University (1979–1985). Unfortunately, all these surveys have documented substantial underreporting of abortions, so they should be used cautiously until we have a better understanding of the bias this introduces into our analyses.

Pregnancies=Births and abortions plus miscarriages. Accurate abortion data are needed to calculate the number of pregnancies. Abortion was legalized in the U.S. in 1973. Prior to this year, the annual number of abortions in the U.S. could only be estimated. Therefore, 1974 was selected as a comparison year since it is probably the first full year with good abortion statistics.

Cite this Page National Research Council (US) Panel on Adolescent Pregnancy and Childbearing; Hofferth SL, Hayes CD, editors. Risking the Future: Adolescent Sexuality, Pregnancy, and Childbearing, Volume II: Working Papers and Statistical Appendices. Washington (DC): National Academies Press (US); 1987. CHAPTER 4, TEENAGE PREGNANCY AND ITS RESOLUTION.

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Preventing Pregnancies in Younger Teens

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More than 1 in 4 teens who gave birth were ages 15 to 17, before teens typically complete high school.

Nearly 1,700 teens ages 15 to 17 years give birth every week.

Only 1 in 4 (27%) teens ages 15 to 17 have ever had sex.

Teen births in the US have declined over the last 20 years to the lowest level ever recorded, but still more than 86,000 teens ages 15 to 17 gave birth in 2012. Giving birth during the teen years has been linked with increased medical risks and emotional, social, and financial costs to the mother and her children. Becoming a teen mom affects whether the mother finishes high school, goes to college, and the type of job she will get, especially for younger teens ages 15 to 17. More can be done to prevent younger teens from becoming pregnant, particularly in health care.

Doctors, nurses, and other health care professionals can

Provide confidential, respectful, and culturally appropriate services that meet the needs of teen clients.
Encourage teens who are not sexually active to continue to wait.
Offer sexually active teens a broad range of contraceptive methods and encourage them to use the most effective methods.
Counsel teens about the importance of condom use to prevent pregnancy and sexually transmitted diseases, including HIV/AIDS.

Many younger teens give birth at ages 15 to 17.

More than 1 in 4 teens who give birth are ages 15-17.

Hispanic, non-Hispanic black and American Indian/Alaska Native teens have higher rates of teen births.
Only 38% of teens who gave birth at age 17 or younger earned high school diplomas by their 22nd birthday versus 60% of teen who were 18 or older when they gave birth. Among teens not giving birth, 89% earned high school diplomas.

Sexually active teens need ready access to effective and affordable types of birth control.

Long-acting reversible contraception (LARC) including intrauterine devices (IUDs) and hormonal implants are the most effective reversible methods. These methods do not require taking a pill each day or doing something each time before having sex.
Nine in 10 (92%) younger teens ages 15 to 17 used birth control the last time they had sex, but only 1% used LARC. The most common methods used were condoms and birth control pills.

There are effective ways to prevent pregnancy among younger teens ages 15-17.

About 8 in 10 (83%) teens did not receive sex education before they first had sex. Earlier delivery of sex education may enhance prevention efforts.
More than 7 in 10 (76%) spoke to their parents about birth control or about not having sex. Parents play a powerful role in helping teens make healthy decisions about sex, sexuality, and relationships.
More than half (58%) of sexually active younger teens made a reproductive health visit for birth control services in the past year. Doctors and nurses could use this opportunity to discuss advantages and disadvantages of different contraceptive methods and the importance of condom use during every sexual encounter.

View large image and text description.

Infographic: Having youth-friendly reproductive health visits for teens

Top of Page

Federal government is

Developing and evaluating programs in communities where teen births are highest.
Supporting states in efforts to reduce pregnancies, births, and abortions among teens.
Working to improve the health and social well-being of teens to reach the Healthy People 2020 national objective to reduce pregnancy in teens ages 15-17.

Doctors, nurses, and other health care providers can

Encourage teens to delay sexual activity.
Encourage sexually active teens to consider the most effective reversible methods of birth control. Refer to CDC guidelines .
Make clinic visits suitable for teens by offering convenient office hours and confidential, respectful, and culturally appropriate services [PDF – 3.20MB] .
Talk about using condoms correctly every time during sex to prevent sexually transmitted diseases, including HIV/AIDS, even if another birth control method is used.
Discuss normal physical, emotional, and sexual development with teens and parents.

Parents, guardians, and caregivers can

Talk with teens about sex , including:
Normal sexual development, and how and when to say “no” to sex.
Having a mutually respectful and honest relationship.
Using birth control if they have sex and a condom every time.
Know where their teens are and what they are doing, particularly after school.
Be aware of their teen’s use of social media and digital technology (e.g., cell phones, computers, tablets).

Younger teens can

Know both they and their partner share responsibility for preventing pregnancy and resisting peer pressure to start having sex until they are older.
Talk openly about sexual health issues with parents, other adults they trust, and their friends.
See a health care provider to learn about the most effective types of birth control and use it and condoms correctly every time.
Science Clips
Vital Signs Issue details: Births to Teens Aged 15–17 Years — United States, 1991–2012, Morbidity and Mortality Weekly Report (MMWR)
CDC Feature – Breaking the Cycle of Teen Pregnancy
Vital Signs – Preventing Pregnancy in Younger Teens [PODCAST – 1:15 minutes]
Vital Signs – Preventing Pregnancy in Younger Teens PSA [PSA – 0:60 seconds]
Vital Signs – Preventing Repeat Teen Births [PODCAST – 1:15 minutes]
Vital Signs – Preventing Repeat Teen Births [PSA – 0:60 seconds]
Public Health Ground Rounds on Reducing Teen Pregnancy in the US

On Other Web Sites

Medline Plus: Birth Control
Medline Plus: Health Statistics
Medline Plus: Teenage Pregnancy

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CDC Digital Press Kit
Read the MMWR

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The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
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Teenage Pregnancy (Argumentative Essay Sample)

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Teen pregnancy is when a girl becomes pregnant at a very young age between 15-19 years. Going through this phase is not easy and in most countries being pregnant as a teen is highly discouraged. Well, it’s hard enough being a teenager, and pregnancy makes it even more challenging. Young women push through the trials of teen pregnancy every day. Life becomes hard for them as well as their child after they give birth. It also negatively impacts their emotional, physical, and mental well-being. In this essay, I will present arguments against teen pregnancy so that you will also start to agree with me.

Table of Contents

Argumentative Essay About Teenage Pregnancy – 700 Word Long Essay

Teenage pregnancy is understood as pregnancy among girls at a young age. Teen mothers are aged 18 years and below. Teen pregnancy has the highest incidences recorded in the USA apart from other issues such as abortion and childbirth. However, the teen pregnancy rate has significantly reduced since 1990. Most teens nowadays avoid unwanted pregnancies because of government sexual education campaigns. The reduction in birth rate is because most teenage girls use birth control methods and have education about sexual activity. A teen mom usually drops out of school and faces many hardships. In this argumentative essay, I will present arguments on why teen pregnancy should be avoided.

Teenage pregnancies should be discouraged since they put a strain on the parents of that teen. Teen moms usually face numerous problems during their early parenthood. Parents of the teen mother have to incur expenses regarding medication. Teen mothers also have to carry out parenthood activities besides making ends meet for other expenses. Therefore, adolescent pregnancy should be eliminated through awareness of these negative impacts. Every teenager should know about safe sex and sex education from a young age.

Teen pregnancies should be eradicated due to their impact on the rise of social responsibility. The current society is burdened with social responsibility due to increased birth rates. There is a high cost of living due to population growth, high medication costs, and loss of human capital. Teen parents should be counseled and allowed to stay in schools and colleges. There should be advertisements on sex education by the government to control teen pregnancy rates so that teen birth rates can be controlled. Pregnant teens should not be allowed to go to school or college so that these pregnant teenagers don’t have a bad influence on others.

https://www.pexels.com/photo/faceless-unhappy-woman-covering-face-6383282/

Teen pregnancy leads to increased poverty in society hence it should be abolished. The poverty status of teenage mothers is currently on the rise because they don’t have a source of income. This poverty situation is typically prolonged as the child is unable to get better education due to the limited resources. Poverty in children born to teen parents leads to health deterioration due to depression and low self-esteem.

Teenage pregnancies are responsible for high risks of health-related infections among teen mothers and their babies. Teen parents usually exhibit mental problems due to stress and depression as well as physical injuries. These problems sometimes lead to death at the time of delivery. Other health-related problems include anemia, hemorrhage, STD infections, and low birth weight. Teen mothers don’t know how to take care of themselves when they are pregnant which also leads to miscarriages. Even if there are no miscarriages, babies are prematurely born and have poor nutrition.

In conclusion, teen pregnancy even though it is reduced due to awareness, negatively impacts the mother, baby, and society. Teenage mothers, as well as their children, usually suffer for their whole life because of this mistake. Therefore, it is critical to educate teens on better methods of birth control while encouraging sexuality education.

Short Argumentative Essay About Teen Pregnancy – 300 Word Short Custom Essay

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Teenage pregnancy is defined as the occurrence of pregnancy among young girls aged 10 to 19 years old. Teen moms suffer their whole life due to a lack of information about safe sex and reproductive health. The tread in most schools as soon as the children hit puberty is towards having a relationship with the opposite sex and losing virginity. Most teens are not even aware of the consequences before they indulge in such relationships. They don’t realize how they have damaged their health, self-esteem, social stature, future of education, and most importantly the future of their offspring. In this essay, I will present arguments on why teenage pregnancies should always be discouraged.

Young people usually have very little or no sex education at all. Nowadays teenagers and adolescents are influenced by social media and tv shows that promote sexual interactions. These shows give these young minds a false idea about this world and life goals. Sexually explicit content on the internet and no sex education makes them take bad decisions in life. One of the worst outcomes of all this is teenage mothers having no idea of what to do. This leads to more and more problems in life and can even affect families.

Teen pregnancy should be discouraged because it negatively affects the social, physical, and mental wellbeing of the teen parent as well as their child. Teens are challenged to carry out early parenthood responsibilities, they drop out of school, they don’t even get enough money to afford these expenses. On top of all anxiety, stress, shame, and fear during teenage pregnancy may even cause death during childbirth. A child born after unwanted pregnancy also suffers all his/her life because of this mistake. The child never gets the deserved love, respect, and resources to fulfill his/her basic needs. These children fall easy prey to anxiety, depression, and emotional stress.

In conclusion, the government should take measures by promoting sex education among teenagers. premarital sex in teenagers should be discouraged. Problems that arise after becoming a teen parent should be highlighted so that everyone should be safe from health issues in this age bracket.

Like these argumentative essay samples about teenage pregnancy? Reach out to Essay Basics to get a professionally written plagiarism-free custom essay on any topic in less than 3 hours.

FAQ About Effects of Early Pregnancy in Teens

What is the main problem of teenage pregnancy.

The main problem of teen pregnancy is guilt and shame that makes you leave school or college. It also negatively affects the social, physical, and mental well-being of the teen mom.

What are the advantages and disadvantages of teenage pregnancy?

The disadvantage of teen pregnancy is that it destroys the social, physical, and mental well-being of the teen mother. The advantage of teen pregnancy is that teen mothers heal super fast after giving birth and are closer to their kids.

https://americanpregnancy.org/unplanned-pregnancy/teen-pregnancy-issues-challenges/

Watch CBS News

Mortality rate for babies, young mothers continues to grow in America

After Unexplained Infertility, Carli Lloyd Is Pregnant And Sharing Her Story For The First Time

“In times of struggle, we see what we are made of.”

Being a mom was always something I wanted, but it wasn’t necessarily something that was always on my mind. As a professional soccer player, I was on the sole mission of becoming the best in the world. In order to get there, I knew soccer had to be my number one priority. It would require a selfish mindset.

My husband, Brian, and I met in high school, so we’ve been together for 24 years. He supported me through every step of my career, and without his support, I never would have reached the heights I did.

When I retired in 2021 at age 39, I’d spent 34 years of my life playing soccer, 17 of them professionally. Having a baby was on our mind, and I thought putting it off for a little bit longer to enjoy life wouldn’t pose an issue. For the first time, soccer wasn’t my priority. I could actually choose what I wanted to do and spend time with Brian, my family, and my friends without soccer consuming my mind and body. (In retrospect, I wish I had been more educated about pregnancy and how to prepare for it, and that I looked years ago into the options I had for freezing my eggs.)

The only thing that changed when I retired was that I wasn’t training or playing. I was very grateful for the opportunities that continued to come my way. I was flying all over for appearances, shoots, speaking engagements, and filming for the Special Forces show, and I got to play in an amazing charity soccer match.

In the summer of 2022, Brian and I thought it was time to try to get pregnant and see where it would lead us. My whole life revolved around defying odds and proving people wrong. Soccer taught me how to work hard, persevere, be resilient, and never give up. I would do whatever it took to prepare, and usually when I prepared, I got results. But I found out that I didn’t know much about this world. I was very naive to think that we wouldn’t have any issues getting pregnant. And so it began. The casual whatever happens, happens turned into disappointment month after month. I was starting to feel like this was a race against the clock—my 40-year-old biological clock.

The journey began to eat me alive and consume me.

I kept saying to myself, “Why is my body failing me?” I had taken such good care of myself, was never a smoker, didn’t drink much. I started talking to a former teammate who had gone through similar struggles, and she helped guide me and encourage me. She suggested I start building a support team around me. I began doing acupuncture and going to a health and wellness center that could help with the process. Brian and I also decided to both get checked out to make sure there were no issues going on.

After getting all the necessary tests done, there was nothing standing in our way except my age. I left that visit with the doctor asking when I wanted to start in-vitro fertilization. I was taken aback, as we were in the early stages and I hadn’t even thought about IVF. I wasn’t ready to go down that road. In my mind, we could still get pregnant naturally and just needed to give it some time.

The months continued to pass, with the thought of trying to get pregnant constantly on my mind. I decided to schedule a consultation with another fertility doctor. I asked around about other doctors, and Dr. Louis Manara at the Center for Reproductive Medicine and Fertility in Voorhees, New Jersey, came highly recommended. At this point, my COBRA insurance that I had for a year after I retired was expiring. We didn’t have any insurance at the consult, but I didn’t care, as I wanted to hear what he had to say.

I met with Dr. Manara, who has been a fertility doctor since 1985. He gathered some information about myself and Brian. He was empathetic, knowledgeable, and honest. He said, “With your age and the timing, the best and most straightforward route is to do IVF.” I fought it so much up until this point. As a woman, I wanted to get pregnant naturally because that’s what our bodies are supposed to be capable of. I felt like my body let me down. But at that moment, I was ready to take the next steps.

The first time I sat in the waiting room, I remember feeling really ashamed and embarrassed. I wanted to put my head down, afraid that people would recognize me. I felt as if I shouldn’t be there. But as time went on, I realized that we’re all human and many women are going through similar struggles. There’s a stigma that comes with needing help or needing to go through fertility treatments. It isn’t talked about enough, but it’s just a different process to get to the same end goal: becoming a parent.

We began our first round of IVF in April 2023.

Our plan was to stash as many embryos as we could because we would love to have two children, and now was the time to retrieve my eggs at a younger age. So, again, being a bit naive, I’m thinking, We’ll get four on the first one. Totally. Not a problem .

During my career, I put myself through rigorous workouts, did ice baths every day, and had a very high pain tolerance. I was always “no pain, no gain.” So, for me, the injections were the easy bit, and I did all of them myself. The hardest thing was the emotional toll. The uncertainty. The waiting. The constant worrying about what if .

I had 20 eggs retrieved, but we expected those numbers to dwindle after they were fertilized by day five and six. Then the numbers are expected to dwindle even more when the embryos are sent for genetic testing. So it was a waiting game that we literally had no control over. And it’s hard. I felt all the emotions during my career—stress, worry, fear, anxiety—but I’d never felt all the emotions that IVF brought on. I felt completely out of control. It’s an indescribable roller coaster unless you go through it.

After my first egg retrieval, I was waiting for the call to find out how many embryos had made it after day six. I was in Washington, D.C., in the dining hall of the Capitol building, doing media and meeting with senators about the excitement of the upcoming 2023 Women’s World Cup with the team at Fox Sports.

When the nurse called, I had to excuse myself. She told me that three embryos had made it, which meant we would likely end up with even less than that after genetic testing. The nurse needed an answer on whether we wanted to hold off on genetic testing and do another retrieval. We could group the first and second rounds together to save money, or go ahead with sending these three off to get tested. Genetic testing results usually took one to two weeks.

.css-1cugboc{margin:0rem;font-size:2.125rem;line-height:1.2;font-family:Domaine,Domaine-roboto,Domaine-local,Georgia,Times,Serif;color:#f7623b;font-weight:bold;}.css-1cugboc em,.css-1cugboc i{font-style:italic;font-family:inherit;}.css-1cugboc b,.css-1cugboc strong{font-family:inherit;font-weight:bold;} “I felt all the emotions during my career—stress, worry, fear, anxiety—but I’d never felt all the emotions that IVF brought on. I felt completely out of control.”

I started tearing up. The emotion hit me like a ton of bricks, and all I wanted was to be alone in private. I hadn’t said anything to my colleagues at Fox. I felt incredibly rude and apologized profusely, and they supported me even though they had no idea what was going on. Meanwhile, we started our tour around the Capitol building.

I called Brian and shared the news with him and couldn’t control my emotions. But I had to pull it together. I called my other friend who had gone through the IVF journey and was supporting me every step of the way, asking her if we should do another cycle right away or wait for the genetic results.

I was just so gutted. My expectation was that we would get enough embryos this first round, we would do a transfer, I would get pregnant, and then I would go work at the World Cup in July, and everything would be absolutely perfect. But life is never perfect and never how you plan it. That was when I realized you cannot have any expectations going through this process.

We decided to try a second round of IVF the following month.

We chose to pay to send the embryos off for genetic testing. We wanted to know how many genetically normal ones we had before we started a second round. Two of our embryos came back genetically normal, so now we had a bit of a dilemma. If we wanted two kids, both embryos would have to work. We went back and forth about whether to do another cycle, and there’s never a right or wrong answer. You just make a decision that inevitably decides the path. It’s also a costly decision.

A lot of this was paid out of pocket, because our health insurance didn’t cover it. I know that many people struggle to even be able to consider fertility treatments, so we were very grateful that more rounds of IVF was an option for us.

My schedule was insanely packed throughout this process, but this cycle was particularly challenging. Anyone who has gone through IVF knows that you are at the mercy of your body and you don’t control the timing. It took a lot of patience and understanding when my agent would tell some of the brands I was working with that, confidentially, I was going through this and we may need to reschedule some events. Believe it or not, I was able to get through everything seamlessly. One shoot I had with Delta required stopping the shoot so I could do my injections. We were shooting all over D.C., and I had a 15-minute window to duck into a hotel bathroom, do my shots, and come back out.

My body responded well to the medication and there were no issues retrieving eggs. The issue I was faced with was finding quality eggs that would fertilize and become strong embryos. This time, three made it to day six, and next was the genetic testing process.

I was in Los Angeles, about to host my soccer clinic, when the nurse called. I was walking to get breakfast with my cousin Jaime and my coach and friend Shaun. The nurse told me that zero embryos had come back genetically normal. The entire cycle was a wash—a complete waste of time and money.

My clinic was starting 30 minutes later in front of 100 kids, and once again I had to wipe away tears and carry on. My cousin Kerrie, who lives in Los Angeles, met us for dinner that night. Thankfully I was not alone and had Kerrie, Jaime, and Shaun by my side. I cried to Kerrie and Jaime in my hotel room, explaining the journey. They both said to stay hopeful and that it will work out the way it is supposed to work out.

At this point, I didn’t have time to do another retrieval cycle. I was leaving for Australia for the Women’s World Cup with Fox Sports at the beginning of July. I also was so emotionally drained that I needed a break. My thoughts were consumed with this. It was time to get away, let loose, have a cocktail or two, and enjoy my experience. And that is exactly what I did. I was surrounded by an incredible team of people working the Women’s World Cup, and it was the exact break I needed.

But I was still left with the decision of what to do. I s two embryos enough? Do we take our chances? Do I go through another retrieval? Brian was ready to go through with a transfer, but I wasn’t quite sure, and he knew I wasn’t ready to make a decision. But I didn’t need to have an answer right away. I had plenty of time to think.

We went ahead with our first embryo transfer in October.

When I came home from Australia in August, I purposely waited to start the transfer process until I had adjusted back to the time zone and was feeling good. No matter how much you want to speed up this process, you can’t. It is very time consuming and unpredictable. We had two frozen embryos, and we decided to take the chance with one. We felt that maybe these two were meant to be our children.

The embryo transfer was quick and easy. You don’t have to be put under anesthesia like you do with an egg retrieval. I was still feeling as if I could somehow control this journey, so I went to the grocery store and purchased all I could to help allow my body to accept this embryo—pomegranate juice, pineapple, nuts, teas. I kept my socks on daily. I did a medicated transfer, which required daily progesterone shots on my butt, alternating sides every day. It was much easier having Brian do these for me while I lay on my stomach. He never liked having to do these. I didn’t like them either. I bled and had bruises and knots on each side of my butt.

a man in surgical scrubs looking at a baby

So now the waiting began. To be honest, it was torture. My life stopped completely, as I felt like I needed to control everything for this embryo to take. I was traveling around this time and needed to wait an extra few days to go to the doctor’s office to get blood work to see if I was pregnant. Usually I would have gone in nine days after the embryo transfer. In my case, it was 12 days later.

I was driving to our local dump to throw trash and cardboard out, which I do quite often, when I received a call from Dr. Manara right before I pulled in. My heart was beating so fast, and I was holding my breath.

He shared the bad news: I wasn’t pregnant. I felt sick to my stomach. He was heartbroken for us. He said that even when you take all these steps, there’s only a 60 percent chance of a successful transfer with genetically normal embryos, and sometimes it just doesn’t work out. He suggested we go ahead with another retrieval since now was the time to get as many embryos as we could for future children. That afternoon, I had to put a smile on my face, wipe away tears, and shoot some social media content. Life went on.

I wanted answers. I thought maybe there was something I did wrong. I felt hopeless. I didn’t see light at the end of the tunnel. I had never been this broken in my life, ever.

My life had been revolving around all of this, consuming me. Everything I ate or drank, anything I did, there would be guilt. Should I have this? Should I not have this? Should I work out? Should I not work out? I was literally driving myself crazy. Throughout this entire process, my schedule was busy and I was juggling so much. I’d have to leave my home, go speak or do a shoot, put on a happy face, and pretend that none of this was going on in my world when it was eating me up every single moment of the day.

I’ve felt every emotion throughout this process. When I look back at all the things I went through on the soccer field—whether it was a poor performance, getting benched, or missing a penalty kick in a World Cup final—there was always something I felt I could do to control the situation. I would go out and work 10 times harder. I was incredibly focused during my career. The majority of the time, the world saw me in competitor mode. A machine. I was often emotionless and numb because that’s the only way I felt I was able to survive and thrive.

But this situation hit me so differently. I wasn’t emotionless or numb. Some nights I would lie in bed crying uncontrollably to Brian. I cried and worried a lot. I leaned on Brian more than I ever had, as well as on my family and friends. For the first time in my life, I needed their support to keep going.

Ultimately, we chose to do a third round of IVF.

Growing up, my parents attended church and would take me and my sister and brother. We attended Sunday school and some youth group events, but it wasn’t something I necessarily enjoyed. Throughout my career, I had many teammates who would hold Bible study on the road, and I would occasionally join in. It wasn’t until after our failed transfer, where I felt lost and completely hopeless, that my faith kicked in. Former teammates of mine would send me prayers and encouragement. I truly believe that everything in our lives happens for a reason. You can’t always see it or feel it in the moment, but when you look back in time, you understand it.

When I called my parents to tell them our transfer didn’t work, they both said, “It just wasn’t meant to be. For whatever reason, God has other plans for you. Don’t lose hope.” And while hearing this was hard to process, it was the only thing I could hold on to. I had to believe that what is meant to be will be and to trust the process. It sounded familiar. Something I would constantly tell myself during my career.

At the start of our third cycle, my mindset was totally different. I finally surrendered. Whatever was meant to be would be, and I had to continue to live life. Life is short. I didn’t want time to pass on by and look back and say I didn’t enjoy my life while we were going through this. You don’t get time back. So I tried to stop thinking about the future and started living in the present, one day at a time. We have chickens, so I spent time outside in nature with them, and that was very therapeutic. I started to journal every day. I wrote down my fears and worries, I read, and I prayed. For once, I became vulnerable and leaned on all the support I had around me.

Brian and I had a vacation planned to the Bahamas in December, and of course, here we are on unplanned IVF cycle number three at the mercy of my body’s timing. We hoped it wouldn’t interfere with our trip, but we knew we couldn’t control that. Thankfully, our third retrieval ended up being a week prior to our departure. The nurse called and left a voicemail as we were flying to the Bahamas letting us know we had four embryos that made it to day six, which was great news for us. Those got shipped off for genetic testing—more waiting. Two of those four ended up being genetically normal. After three retrievals, we had three embryos, and we felt good about that. Dr. Manara felt good about it as well.

“I tried to stop thinking about the future and started living in the present, one day at a time.”

We started the transfer process at the beginning of January, and our transfer was at the end of the month. Of course we had another trip scheduled. This time, I was invited to play in the Waste Management Pro-Am in Phoenix. I was now worried whether it would be okay to play and swing a golf club while we waited to see if this embryo took. I consulted with Dr. Manara, and he said it would be okay. It was nice to be away and have a distraction. Since we were traveling, I wouldn’t be able to go into the office to get my blood drawn to see if I was pregnant. So, instead of having to wait until we got home, the office wrote me a script to go while in Scottsdale.

We got up early, took an Uber, and walked into a Labcorp. I expected the results to come back three days later, since it was a Friday. The next morning I woke up early and noticed an alert in my portal that I could view the results. Since this was a Saturday, no one was at Dr. Manara’s office, so I got the news before they could call to tell me. Without clicking on the downloaded version, I saw only my beta hCG level. I texted my friend—the one who had been supporting me throughout this journey—a screenshot of the number. She texted in all caps: “OMG CARLI!!!!! YOU ARE PREGNANT.” Brian was just waking up as I shared the news. We hugged and held each other and, for the first time in a long time, felt at peace.

I was finally pregnant, but we weren’t ready to celebrate just yet.

While I wanted to jump up and down and celebrate, we knew we weren’t out of the woods. We would have four more blood tests to make sure my hCG levels were rising, and the ultrasounds would follow. Every appointment brought anxiety. Our first ultrasound was to confirm that the gestational sac was inside the uterus and everything was looking good. Since we had a ski trip coming up the following week, we went back to the office two weeks later.

During our second ultrasound, we were thrown a curveball. The baby still had a heartbeat, but the measurement was calculated at five days behind, and Dr. Manara was concerned to see this in a genetically tested embryo for which we knew the exact date of the transfer. I immediately thought I did something wrong.

Dr. Manara assured me this had nothing to do with skiing or traveling. He did say, “I’m still hopeful, but I am concerned that this could potentially lead to a miscarriage.” We left that visit extremely uneasy and worried. And I was leaving for Mexico the next day. We now had to wait another week after I returned from my travels to go back and make sure that everything was okay. Again, we held on to that faith that God has a plan and it will work out the way it is supposed to work out. I continued to journal. But it was never off my mind. I feared I’d miscarry at any moment.

This next appointment couldn’t come any faster. To say we were anxious and worried was an understatement. I felt as if everyone in the office was anxiously waiting as well. The ultrasound tech was quick to get in and make sure there was a heartbeat. And we had a heartbeat! What a relief. And the baby had gained a day and was now measuring four days behind. Dr. Manara was feeling a lot better after this visit, but he still wanted to check again, so we came back four days later to do another ultrasound.

Each week we went back, we would go in holding our breath. The ultrasound tech would say, “Okay, there’s a heartbeat,” and we all could breathe again. We didn’t want to let ourselves get too excited. But with every appointment since then, the baby’s been steadily progressing each week.

After 10 weeks of monitoring this pregnancy, it was time to graduate. In the IVF world, you graduate from your fertility clinic and then start going to your ob-gyn. It was bittersweet, and I knew I would miss everyone in the office. The most exciting moment was when I was done with the daily progesterone shots. I had some serious scar tissue, knots, and bruises that I couldn’t wait to go away.

Dr. Manara’s office is a very small practice with very special people. They made me feel comfortable and truly cared about me as a patient. Dr. Manara is the best; I am so grateful for the way he handles his patients, the knowledge and expertise he provides, and the care and empathy he showed throughout our entire journey. At every visit he is face to face with his patients, going over everything and answering any questions. I couldn’t have been any happier with my experience there.

It is still hard to believe I am pregnant. It truly is a miracle, and we are so excited to be parents!

I want to show other women going through IVF that they are not alone, and that good can come from this.

I’ve conquered the soccer world and I consider myself to be really strong, but I was at my weakest during this entire process. I want to show other women that it’s okay to struggle. It’s okay to feel broken and to feel hopeless, but to never give up and to keep going. We don’t know the future chapters of our lives, and it is important to just keep putting one foot in front of the other.

I went from feeling embarrassed, ashamed, and afraid to tell people that I was going through IVF to now wanting to share my story to help others. In times of struggle, we see what we are made of. We grow. We learn. And most important, we have more appreciation for the things we do have in life.

Going through something like IVF also puts things into perspective. I’ve been blessed with many things in my life. It was not easy for Brian and me to navigate the journey from high school to attending different colleges, to a professional career, and then a long-distance relationship as I traveled the world. Our relationship continues to be tested and strengthened. This experience brought us closer than I had ever imagined. I couldn’t have gotten through it without him. He kept me going. He would say, “Just trust. Trust that it’s going to work out.” His strength and calmness was something I never realized I needed.

I always try to extract positive things or lessons that come out of struggle. And there are many things, but the one that is truly special is that it brought me closer to my parents, as well as my sister and my brother, after years of not speaking. We can never get back lost time, but we can soak up all the present and future times together, and I am grateful for that. We are truly blessed with the family and friends we have in our lives who were there for us when we needed them the most.

Since I retired, my heart has come alive. I have felt I can be more like myself. I am not in the pressure cooker anymore. I can let my guard down and be more vulnerable. For those who have never experienced the national team, it’s hard to truly understand how cutthroat it is. For 17 years, I was a machine. I was on a mission. And the only way I felt I could achieve my dreams was to be like this. The women’s national team either makes you or breaks you. Only the strong survive. And now for the first time in my life, I needed others to help carry me along.

“I want to show other women that it’s okay to struggle. It’s okay to feel broken and to feel hopeless, but to never give up and to keep going.”

I have been told that nothing I have accomplished or faced in my soccer life will ever be as great as being a mom. I know this will change me forever, and I am so excited for the journey. This was not an easy journey, but that’s true of most things in life that are worthwhile. Brian and I look forward to loving and raising a strong little one to be the best version of themselves.

My story is currently a happy one, but I know there are other women who are facing challenges in their pregnancy journey. I see you and I understand your pain. My hope is that more and more women will speak up about this topic, because their stories helped me. I also wish for more resources, funding, and education around fertility treatments. There is much to be done, and I hope I can play a role in helping.

—As told to Amanda Lucci

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Published: Mar 20, 2024

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Causes of teenage pregnancy, consequences of teenage pregnancy, prevention and intervention.

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Teen Pregnancy in the United States Essay

Introduction, assessment of teen pregnancy, applicable healthy people 2020 objectives, nursing intervention strategies, role of the advanced practice nurse.

This research paper will focus on the problem of teen pregnancy in the United States. Barcelos and Gubrium (2014) will be the research article. The article focused on the teen pregnancy in the United States. This article reports that although the rates of teen pregnancy have been reducing significantly in the past two decades, it remains a major concern in the health sector. The research by Males (2010) shows that teenage pregnancy remains one of the biggest challenges that the country faces as it seeks to achieve the objectives of Healthy People 2020.

This research estimates that in the American society, the teen pregnancy rate currently stands at about 5.74%. This means that the country still needs to find ways of dealing with this issue in a conclusive manner. Hoffman and Maynard (2008) say that teen pregnancy poses serious social and health problems to the affected children. Some teenagers become pregnant at very tender ages, which may be a threat to their lives if they were to carry the child to term.

In case they succeed to carry the pregnancy to term, they may face life-threatening processes of delivering the child because the organs are not properly developed for this role. When the teenager is subjected to abortion, cases of damage of the reproductive system may be experienced. The events related to the teen pregnancy may bring massive stress to the involved parties if proper counseling is not done. In fact, such events may redefine the lifestyle of such a teenager for the worse. Fistula is one of the most common health problems that such a young girl may acquire when her child is delivered normally.

According to Barcelos and Gubrium (2014), teen pregnancy is an issue of concern that stakeholders in the health sector in this country are still grappling with, especially because of its negative consequences on the affected individuals. The research by Malesa (2010) also notes that teen pregnancy remains an issue because teenagers are indulging in sex at a very tender age. However, the problem is that they do it without proper knowledge about sex, including some of the consequences associated with it. Malesa (2010) blames parents for their unwillingness to engage their children on sex education at tender ages.

The topic remains a taboo in many American families. Parents always hope that by being strict with their children, and the issues of morality learnt in school, their teenagers would avoid the vice. However, this is not always the case. Children would be driven by their curiosity and visit the internet to gain more knowledge about these issues. They are influenced heavily by the events happening in the social media, and this leads them into early indulgence in sex.

This can be explained using the Social Cognitive Theory. As Malesa (2010) observes, Social Cognitive Theory holds that “Portions of an individual’s knowledge acquisition can be directly related to observing others within the context of social interactions.” What these teenagers observe in the social media, television shows, and their society brings out the notion that ‘sex is cool’. The term ‘sexy’ is widely used to describe things that are perceived to be pretty. This defines the knowledge of these children, the fact that has contributed largely to teenage pregnancy.

Teen pregnancy is given an elaborate focus in the Healthy People 2020 vision. When developing the vision, teen pregnancy was one of the issues that needed immediate attention. Barcelos and Gubrium (2014) observe that some teenage girls had lost their lives while others developed serious health and psychological problems because it. For this reason, a number of objectives were set that were to be achieved in an effort to reduce cases of teen pregnancies. These objectives are outlined in the Sexual Heath section of Healthy People 2020 program. In this section, the researcher will highlight a number of the objectives, which are very relevant to this issue under investigation.

According to Healthy People 2020 (2014), objective numbered FP-6 states, “To increase the proportion of females at risk of unintended pregnancy or their partners who used contraception at most recent sexual intercourse.” It is estimated that about 77% of teen pregnancies in this country are unintended ( CDC , 2014). If this proportion can be eliminated, then the current rates of teen pregnancies will be reduced by this percentage. This objective advocates for the use of condom. It is a common knowledge that a number of teenagers above 16 years have become sexually active. This objective seeks to advocate for their use of protection.

According to Healthy People 2020 (2014), objective number FP-8.1 states, “Reduce pregnancies among adolescent females aged 15 to 17 years.” this objective directly focuses on the initiatives that can be used to fight teenage pregnancies, especially those who fall within the age bracket of 15-17 who are at the greatest risk of getting pregnant.

According to Healthy People 2020 (2014), objective number FP-9.1 states, “Increase the proportion of female adolescents aged 15 to 17 years who have never had sexual intercourse.” Inasmuch as the stakeholders in the health sector appreciates the fact that many adolescents have become sexually active, this objective still seeks to promote abstinence as the best option of avoiding teen pregnancies.

It may be necessary for the nurses to intervene in order to find a common solution to this problem that is affecting the lives of young Americans. According to Barcelos and Gubrium (2014), nurses have a central role in an effort to fight teen pregnancies, which are posing serious health problems to the future generations of this country. This is an important stage in their lives when teens experience serious changes in their physiological structure.

There should be a program where nurses get to speak directly to the adolescent at school on issues about their sexuality. They can give them practical evidences of some of the negative consequences of indulging in premarital sex, especially when one is at a tender age. This strategy will target the teenagers in selected schools and colleges. Nurses can find a way of engaging the parents and teachers so that they can actively engage their children in discussing their sexuality at this delicate stage. The adolescent boys and men who may be part of this web of teen pregnancy should also be involved in the debate because they are the reason for the frequent cases of teen pregnancies.

Family Theory supports the approach of engaging various stakeholders in this fight. According to Hoffman and Maynard (2008), Family Theory holds that “Individuals cannot be understood in isolation from one another, but rather as a part of their family.” Success can only be achieved when this problem is addressed from all the possible angles instead of being looked at as an isolated case. As suggested in this theory, it may not be easy to understand the teenage girls in isolation. It will be necessary to bring together all the relevant stakeholders in order to find a common solution.

When presented with a case of teen pregnancy, an advance practice nurse should know his or her role in order to enhance the well-being of the affected individual. The first thing will be counseling. It may be too late to start informing such a teenager about the dangers of early pregnancy at this stage. Barcelos and Gubrium (2014) suggest that a nurse should try to find a common solution that can be used by the affected individual.

When counseling the individual, care should be taken not to create fear. They should be informed that what happened was unexpected at that stage, but given that fact that it did happen, the only remedy would be to follow the guidelines of the doctor. The nurse will need to coordinate with the doctor to understand the best solution to the problem. If termination is the only solution, the teenage should be informed about all relevant issues about termination of the pregnancy before the procedure is undertaken (Hoffman & Maynard, 2008).

If the solution lies in carrying the pregnancy to term, a nurse will need to conduct a comprehensive counseling to help them overcome stigma and psychological torture they may be going through because of the pregnancy. The nurse will also need to offer the affected individuals medical care once they have given birth.

Barcelos, C. & Gubrium, A. (2014). Reproducing Stories: Strategic Narratives of Teen Pregnancy and Motherhood, International Journal of Sociology of the Family, 61 (3), 466-481.

CDC: About Teen Pregnancy . (2014). Web.

Healthy People 2020: Adolescent Health . (2014). Web.

Hoffman, S. D., & Maynard, R. A. (2008). Kids having kids: Economic costs & social consequences of teen pregnancy . Washington: Urban Institute Press.

Malesa, M. A. (2010). Teenage sex and pregnancy: Modern myths, unsexy realities . Santa Barbara: Praeger.

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Reproductive rights in America

What abortion politics has to do with new rights for pregnant workers.

Selena Simmons-Duffin

Employers are required to make accommodations for pregnant women and new moms like time off for doctor's appointments. Thomas Trutschel/Photothek via Getty Images hide caption

Employers are required to make accommodations for pregnant women and new moms like time off for doctor's appointments.

This week, attorneys general from 17 Republican-led states sued the Equal Employment Opportunity Commission over something they say is an "abortion accommodation mandate."

Here are four things to know about the latest battle in the war over abortion between Republican-led states and the Biden administration.

1. The law in question is about protections for pregnant workers.

First, a little background: In 2015, a survey found that nearly 1 in 4 women went back to work just two weeks after giving birth.

It took about ten years for a bill protecting pregnant workers to get through Congress, and in 2022, not long after Roe v. Wade was overturned, the Pregnant Workers Fairness Act passed with bipartisan support. The law requires employers with at least 15 employees to accommodate workers who are pregnant with things like extra bathroom breaks, time off for prenatal appointments, a chair for sitting during a shift. It also says employers have to accommodate workers after they give birth.

Even though lawmakers from both parties think pregnancy protections are a good thing, abortion politics have overshadowed the news of those new rights. It all comes down to one line in the law and the word "abortion" in the regulation.

The law says employers should make "reasonable accommodations" for pregnant workers during and after "pregnancy, childbirth and related medical conditions." The new rule EEOC put out to implement the law includes abortion in a lengthy list of "related medical conditions," along with everything from ectopic pregnancy to anxiety to varicose veins.

2. Abortion entered the chat and about 100,000 people chimed in on the regulations.

Political and religious groups that oppose abortion rights took notice of the inclusion of "abortion" in the list of related medical conditions, as did the lead Republican co-sponsor of the law , Sen. Bill Cassidy of Louisiana. Some 54,000 people commented on the proposed rule objecting to the inclusion of abortion, according to the EEOC's analysis in the final rule, while 40,000 people commented in support of abortion's inclusion. (The agency noted that most of these were nearly identical "form comments" driven by advocacy groups).

In the end, "abortion" remained on the list. In its analysis, the agency explained that abortion's inclusion is consistent with longstanding interpretation of civil rights laws and courts' rulings. In the final rule, the EEOC says the law "does not require any employee to have – or not to have – an abortion, does not require taxpayers to pay for any abortions, and does not compel health care providers to provide any abortions." The rule also notes that unpaid time off for appointments is the most likely accommodation that would be sought by workers having abortions.

3. The lawsuit + the politics of the lawsuit

Within days of the rule being published in the Federal Register , a coalition of 17 Republican-led states filed suit. "The implications of mandating abortion accommodations are immense: covered employers would be required to support and devote resources, including by providing extra leave time, to assist employees' decision to terminate fetal life," the lawsuit reads .

The lawsuit was filed on Thursday in federal court in Eastern Arkansas. The plaintiffs ask the court to put a hold on the effective date of the final rule pending judicial review, and to temporarily block the enforcement of – and ultimately vacate – the rule's "abortion-accommodation mandate."

Arkansas and Tennessee are the two states leading the lawsuit. In a statement , Arkansas Attorney General Tim Griffin said: "This is yet another attempt by the Biden administration to force through administrative fiat what it cannot get passed through Congress."

Griffin said the rule is a "radical interpretation" of the new pregnancy protection law that would leave employers subject to federal lawsuits if they don't give employees time off for abortions, even if abortions are illegal in those states. "The PWFA was meant to protect pregnancies, not end them," he said.

Women's advocates see the politics of the lawsuit as well. "It's no coincidence that this organized, partisan effort is occurring in states that have some of the highest maternal mortality rates in the country," Jocelyn Frye of the National Partnership for Women & Families wrote in a statement . "Any attempt to dismantle these protections will have serious consequences for women's health, working families, and the ability for women to thrive in the workplace."

Greer Donley is a law professor at the University of Pittsburgh who submitted a comment on the proposed regulation defending the inclusion of abortion. She points out that this is the latest in a string of legal challenges from anti-abortion groups fighting the Biden administration's efforts to protect abortion using federal agencies.

"You can really see this in a suite of [abortion] lawsuits – including the two that were heard in the Supreme Court this term, one involving the FDA's regulation of mifepristone and one involving the Biden administration's interpretation of EMTALA ," she observes, and guesses a legal challenge will also come in response to the newly announced privacy protections for patients who've had abortions. "You have a Supreme Court that is overwhelmingly anti-abortion and overwhelmingly anti-administrative state – those two things in tandem are not a good thing for the Biden administration."

4. In the meantime, pregnant workers have new rights.

At the moment, until a judge says otherwise, the new protections for pregnant workers are already in effect. The EEOC has a guide for pregnant workers about their new rights under the law and how to file charges against their employers. It's also holding trainings for human resource professionals on how to comply with the law.

Complaints have already started to roll in. In a statement to NPR, EEOC spokesperson Victor Chen wrote that in the first three months that the law was in effect, the agency received nearly 200 charges alleging a violation of the Pregnant Workers Fairness Act, which works out to nearly two a day.

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Guest Essay

A Huge Gender Gap Is Emerging Among Young Voters

Two young women sit on top of a car at a drive-in event, for which large Biden-Harris billboards have been erected.

By Thomas B. Edsall

Mr. Edsall contributes a weekly column from Washington, D.C., on politics, demographics and inequality.

It has become clear that one constituency — young voters, 18 to 29 years old — will play a key, if not pivotal, role in determining who will win the Biden-Trump rematch.

Four years ago, according to exit polls, voters in this age group kept Trump from winning re-election. They cast ballots decisively supporting Biden, 60 to 36, helping to give him a 4.46-point victory among all voters, 51.31 percent to 46.85 percent.

This year, Biden cannot count on winning Gen Z by such a large margin. There is substantial variance in poll data reported for the youth vote, but to take one example, the NBC News national survey from April found Trump leading 43 to 42.

Young voters’ loyalty to the Democratic Party has been frayed by two distinct factors: opposition to the intensity of the Israeli attack on Hamas in Gaza and frustration with an economy many see as stacked against them.

Equally important, a large gender gap has emerged, with young men far less likely to support Biden than young women.

Bill McInturff , a co-founder of the Republican polling firm Public Opinion Strategies — which conducts surveys for NBC along with the Democratic firm Hart Research — provided The Times with data covering a broad range of recent political and demographic trends.

Tracking the partisan identification and ideology of 18-to-34-year-olds, the McInturff analyses show that from 2012 to 2023, women became increasingly Democratic, going from 55 percent identifying as Democratic and 29 percent Republican in 2012 to 60 and 22 in 2023. The shift was even more striking in the case of ideology, going from 32 percent liberal and 29 percent conservative to 51 percent liberal and 17 percent conservative in 2023.

Among young men, the Democratic advantage in partisan identification fell from nine points in 2012 to five points in 2023.

What gives?

I asked the Democratic pollster Celinda Lake , who recently joined the Biden campaign’s polling team, a job she also held in 2020. She sent a detailed reply by email:

Three reasons. First and foremost is the abortion issue and all the aspects of reproductive health, including medication abortion, I.V.F., birth control and criminalizing abortion. Young men are very pro-abortion and birth control, but young women really vote the issue. Second is style and respect. Young men are not as troubled by the chaotic and divisive style of Trump, while young women want people to be respected, including themselves, want stability and are very concerned about division and the potential for violence. Young women think Trump’s style is an embarrassment abroad, a poor role model for their children and dangerous for the country. Younger men, especially blue-collar, have a grudging respect for his strength and “tell it like it is” attitude. Third is the economy. Young men, especially blue-collar and people of color, feel left behind in this economy. They do not feel things have been delivered to them. They do not know anything about what this administration has done. Younger women are much more committed to a role for government to help people like themselves as a foundational view. They don’t know much more about the economic programs than young men, but they tend to respond more favorably to Democrats in general on the economy. Younger men also feel more left behind on the economy and more sense of grievance than young women do who are also increasingly dominating college and higher education.

The Times/Siena poll conducted April 7 to 11 asked voters “How much do you think Donald Trump respects women?” A majority of men, 54 percent, replied that Trump does respect women (23 percent “a lot” and 31 percent “some”), while 42 percent said he does not (14 percent “not much” and 28 percent “not at all”).

Women replied quite differently, with 68 percent saying Trump does not respect women (24 percent “not much,” 44 percent “not at all”) and 31 percent saying Trump does respect women (15 percent “a lot” and 16 percent “some”).

Jean Twenge , a professor of psychology at San Diego State University and the author of “ Generations : The Real Differences Between Gen Z, Millennials, Gen X, Boomers and Silents and What They Mean for America’s Future,” wrote by email that the question of why there is such a gender divide “is tough to answer,” but she made some suggestions: “It could be that the changes on the left have driven young men away from the Democratic Party. For example, the idea that identities can be divided into ‘oppressor’ and ‘oppressed’ may have alienated some young men.”

Another likely factor, according to Twenge, is:

Fewer young men get college degrees than young women, and in the last 10 to 15 years the parties have split by education, with more of those without a college degree conservative and Republican. This appears even among high school seniors, where young men who do not plan to attend a four-year college are 30 percent more likely to identify as conservative than young men who are planning to get a college degree.

Richard Reeves , who wrote the book “ Of Boys and Men : Why the Modern Male Is Struggling, Why It Matters and What to Do about It,” argued in a January essay posted on his Substack :

In the centrifugal dynamic of culture-war politics, the more the right goes to one extreme, the more the left must go to the other, and vice versa. The left dismisses biology; the right leans too heavily on it. The left see a war on girls and women; the right see a war on boys and men. The left pathologizes masculinity; the right pathologizes feminism.

In this context, Reeves wrote, “Young men see feminism as having metastasized from a movement for equality for women into a movement against men, or at least against masculinity.”

In an article published in January on the Business Insider website, “ The War Within Gen Z ,” Daniel A. Cox, the director of the Survey Center on American Life at the American Enterprise Institute , wrote:

Something strange is happening between Gen Z men and women. Over the past decade, poll after poll has found that young people are growing more and more divided by gender on a host of political issues. Since 2014, women between the ages of 18 and 29 have steadily become more liberal each year, while young men have not. Today, female Gen Zers are more likely than their male counterparts to vote, care more about political issues and participate in social movements and protests.

Cox noted that “at no time in the past quarter-century has there been such a rapid divergence between the views of young men and women,” suggesting that “something more significant is going on than just new demographic patterns, such as rising rates of education or declining adherence to a religion — the change points to some kind of cataclysmal event.”

After interviewing young voters, Cox and his colleagues at the A.E.I. survey center concluded:

Among women, no event was more influential to their political development than the #MeToo movement. In 2017, women around the world began speaking out about their experiences with sexual assault and harassment. Gen Zers were then in high school and college, and for them, the movement came at a formative moment.

But, Cox continued:

while women were rallying together, many Gen Z men began to feel like society was turning against them. As recently as 2019, less than one-third of young men said that they faced discrimination, according to Pew, but today, close to half of young men believe they face at least some discrimination. In a 2020 survey by the research organization P.R.R.I., half of men agreed with the statement: “These days society seems to punish men just for acting like men.”

For a growing percentage of young men, Cox wrote:

Feminism has less to do with promoting gender equality and more to do with simply attacking men. A 2022 survey by the Southern Poverty Law Center found that 46 percent of Democratic men under 50 agreed that feminism has done more harm than good, and even more Republican men agreed.

More young men, he added, “are adopting a zero-sum view of gender equality — if women gain, men will inevitably lose.”

How does this translate into politics?

According to Cox:

While women have turned to the left for answers to their problems, men are finding support on the right. Trump helped redefine conservatism as a distinctly masculine ideology, stoking grievances and directing young men’s frustration toward liberals and feminists. There are signs the message is resonating: Republican affiliation among white men aged 18 to 24 jumped from 28 percent in 2019 to 41 percent in 2023, according to a Harvard Youth Poll .

On April 8, McInturff published a report, “ Key Data by Generation ,” on his firm’s website:

“We are witnessing a profound generational break,” he wrote, “between Generation Z versus the baby boomers that is already reshaping our country, its values, media habits and its politics.”

At the outset, McInturff compared the values of Gen Z respondents ages 18 to 26 with those of the baby boomers, now 59 to 77.

Some 76 percent of baby boomers placed a high value on patriotism; for Gen Z, it was 32 percent. Nearly two-thirds of baby boomers, 65 percent, highly valued religion and their belief in God; Gen Z, 26 percent. Having kids: baby boomers, 52 percent; Gen Z, 23 percent. Asked if they agreed that “America is the best place to live,” 66 percent of boomers said yes, double the 33 percent of 18-to-26-year-olds.

In other words, the youngest voters are, at least for the moment, disaffected from traditional notions of family, country and religion.

Even so, young voters as a whole are decidedly more liberal on specific policies and issues than their elders.

On gay marriage, according to McInturff’s data, 84 percent of voters 18 to 34 were in favor, compared with 51 percent of voters 65 and over. Ending transgender discrimination: young, 55 percent; old, 24 percent. Climate change: 64 to 39. Cutting the defense budget, 48 to 24.

One particular issue is currently working against Biden and Democrats among young voters.

“The Israel/Hamas war in Gaza reflects one of the sharpest policy differences by age we have seen over a 40-year period,” McInturff wrote. “President Biden’s support for Israel has collapsed his standing with one of his key and previously most supportive subgroups, 18-to-29-year-old voters.”

McInturff compared data on voters 18 to 34 in two categories: surveys conducted from January to September 2023, before the war began, and surveys conducted after it started, from November 2023 to January 2024.

The shift among these young voters is terrible news for the Biden campaign. In the pre-Gaza polling, young voters backed Biden by 29 points, 61 to 32. In the post-Gaza surveys, Biden’s advantage over Trump fell to four points, 45 to 41.

If the decline in young people’s support for Democrats holds through Election Day, it will be a major setback for Democratic strategists who, before the outbreak of the Israel-Hamas war, were banking on what appeared to be a secure partisan commitment by Gen Zers and millennials to the Democratic Party.

One of the key findings in the Harvard Youth Poll of 2,010 18-to-29-year-olds, conducted March 14 to 21, is that support for Biden among young voters fell far short of his support four years ago:

If the presidential election were held today, President Biden would outperform former President Trump among both registered (50 percent Biden, 37 percent Trump) and likely young voters under 30 (56 percent Biden, 37 percent Trump). When there is no voter screen (i.e., all young adults 18 to 29), the race narrows to single digits, 45 percent for President Biden, 37 percent for Trump, with 16 percent undecided.

At the same point in 2020, the Harvard Youth Poll “showed Biden leading Trump by 23 points among all young adults (51 percent to 28 percent),” compared with an eight-point lead in 2024. Among “likely” young voters in 2020, Biden led Trump by 33 points (60 percent to 27 percent), compared with 19 points in the current survey.

Young men account for virtually all the drop in support for Biden.

Joe Biden leads among both men (+6) and women (+33). Compared with this stage in the 2020 campaign, Biden’s lead among women is nearly identical (was +35 in 2020), but his lead among likely male voters has been dramatically reduced from +26 in 2020 to +6 today.

The same pattern emerged in partisan identification:

In 2020, 42 percent of young men in our poll identified as Democrats, and 20 percent were Republicans (+22 Democratic advantage); in this wave, 32 percent are Democrats, and 29 percent are Republicans (+3 Democratic advantage). Over the same period, the Democratic advantage among women expanded by six points. In 2020, 43 percent of young women in our poll identified as Democrats, and 23 percent were Republicans (+20 Democratic advantage); in this wave, 44 percent are Democrats, and 18 percent are Republicans (+26 Democratic advantage).

The Harvard survey corroborates McInturff’s analysis of the damage inflicted on the Biden campaign by the Israel-Hamas war. The Harvard study found that anger over the conflict has produced a substantial bloc of young voters — although not a majority — opposed to Israel’s attacks in Gaza.

The Harvard Youth Survey found that when asked if the Oct. 7 attack on Israel by Hamas justified Israel’s continuing response, “a plurality indicates that they don’t know (45 percent). About a fifth (21 percent) report that Israel’s response was justified, with 32 percent believing it was not justified.”

According to the Harvard survey, “Young Americans support a permanent cease-fire in Gaza by a five-to-one margin (51 percent support, 10 percent oppose). No major subgroup of young voters opposes such action.”

If Biden is struggling to restore his majorities among young voters, how is it that he remains competitive with Trump, running behind by 1.4 percentage points , according to the RealClearPolitics average of recent polls?

One reason is that the share of the electorate made up of the white working class, the core of Trump’s support, is steadily declining, while the number of college-educated white people, an increasingly strong source of Democratic support, is growing.

A second factor is that defections to the Republican Party that had been emerging among a small percentage of Black and Hispanic voters appear to have stopped, if not reversed. Matthew Blackwell , a political scientist at Harvard who tracks polling trends, posted graphics on X last month, noting, “Biden mildly trending better among Black and Hispanic subgroups in the last few weeks of polling.”

In an email, Blackwell expanded on his post: “The big takeaways are that Biden has been polling worse with Black and Latino voters compared to 2016 and 2020, but over the course of April, we did see some movement of these groups back to the 2020 levels, even if they haven’t quite gotten there yet.”

Blackwell predicted that “we can probably expect many prior Biden voters to ‘return to the fold’ as the campaign goes on,” before adding that many surveys may underestimate support for Biden:

Most of the polls are of registered voters without likely- voter screens . Many pollsters have found that regular voters are more supportive of Biden than nonregular voters. As we get closer to Election Day, we will probably see more likely-voter polls that may be more accurate.

Biden has improved on his 2020 margins with several very large blocs of voters: white people with college degrees (plus 1.3 points), white people without degrees (plus 0.6 points), 50-to-64-year-olds (plus 4 points) and voters 65 and older (plus 1.8 points). While the percentages are small, the groups are huge, making even a half a percentage point shift significant.

The closeness of the contest between Trump and Biden puts especially heavy pressure on Biden to negotiate a cease-fire, if not a conclusion to hostilities in Gaza. Nothing would do more to restore at least some of the crucial support he received from young men and women four years ago.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here's our email: [email protected] .

Follow the New York Times Opinion section on Facebook , Instagram , TikTok , WhatsApp , X and Threads .

Thomas B. Edsall has been a contributor to the Times Opinion section since 2011. His column on strategic and demographic trends in American politics appears every Wednesday. He previously covered politics for The Washington Post. @ edsall

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Teen Pregnancy: Causes, Effects and Prevention Essay
Social stigma and stress negatively affects the self-esteem of a pregnant teenage. When a teenage becomes pregnant, she develops fears about unplanned pregnancy, becomes frustrated, and begins to lose self-esteem and hope, as it seems to her that she has reached a premature destiny of her life. The pregnant teen has fears of disclosing her ...
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112 Teenage Pregnancy Essay Topics + Examples. (1 votes) Early motherhood is a very complicated social problem. Even though the number of teenage mothers globally has decreased since 1991, about 12 million teen girls in developing countries give birth every year.
Teenage Pregnancy Essay
10 Lines on Teenage Pregnancy Essay in English. 1. Teenage pregnancy is the occurrence of pregnancy in females below the age of 20. 2. On a global scale, each year, 16 million girls of age between 15-19 years give birth. 3. In the USA, around 77% of teenage pregnancies are unintended. 4.
PDF REDUCING TEENAGE PREGNANCY
old (Potts, 1990), and because six out of 10 young women have sex as teenagers (Martinez et al., 2011), most teenage girls are at risk of becoming pregnant. The consequences of adolescent pregnancy and childbearing are serious and numerous: • Pregnant teenagers are more likely than women who delay childbearing to experience maternal
Teenage Pregnancy Causes and Effects
Teenage pregnancy can be defined as a pregnancy that occurs in young girls below the age of twenty, regardless of whether they are married or of adult age (Christensen and Rosen 1). Teenage pregnancy has been increasing at an alarming rate, especially in the United States, Africa, and the United Kingdom.
Teenage Pregnancy Essay Examples
3. "Teenage pregnancy is a topic that often sparks debate and controversy. But beyond the debates, there are real stories of teenagers facing parenthood at a young age. This essay is a platform to explore the factors driving teenage pregnancy and the experiences of those directly affected." 🔚 Teenage Pregnancy Essay Conclusion Paragraph ...
Teenage Pregnancy
This is a set of five essays dealing with adolescent sexuality, which includes adolescent pregnancy. It also includes a broad survey of the history of perceptions of adolescent sexuality and chapters on rape, pregnancy, sex education, and pop culture. ... "Teen Pregnancy Is Not a Public Health Crisis in the United States: It Is Time We Made ...
What Can Be Done to Reduce Teen Pregnancy and Out-of ...
New measures to ensure that paternity is established and child support paid; A $20 million bonus for each of the 5 states with the greatest success in reducing out-of-wedlock births and abortions ...
Teenage Pregnancy: Causes and Preventive Measures
This essay aims to offer a comprehensive exploration of the causes of teenage pregnancy and delve into strategies to address and prevent it. Factors such as limited access to contraception, poverty, and inadequate sex education are pivotal in the prevalence of teenage pregnancy and necessitate in-depth analysis and proactive solutions.
TEENAGE PREGNANCY AND ITS RESOLUTION
Pregnancy can be resolved in a number of ways, only one of which is a live birth kept by the mother. However, in talking about the problems of teen pregnancy, the problems that have been well-documented to date are those associated with that one outcome—bearing and raising a child as a teenager.
Adolescent pregnancy
Adolescent pregnancy is a global phenomenon with clearly known causes and serious health, social and economic consequences to individuals, families and communities. There is consensus on the evidence-based actions needed to prevent it. There is growing global, regional and national commitment to preventing child marriage and adolescent ...
Teenage Pregnancy: Causes, Consequences, and Initiatives: [Essay
There are several causes of teenage pregnancy in many African countries which are; Poverty has been the biggest driver for the increase in the number of early pregnancies among young girls, especially in African countries. Poverty is a condition where people's basic needs for food, clothing, shelter, and others like education, health, and ...
Preventing Pregnancies in Younger Teens
The most common methods used were condoms and birth control pills. There are effective ways to prevent pregnancy among younger teens ages 15-17. About 8 in 10 (83%) teens did not receive sex education before they first had sex. Earlier delivery of sex education may enhance prevention efforts. More than 7 in 10 (76%) spoke to their parents about ...
The Adverse Effects of Teen Pregnancy
Teen pregnancy costs U.S. taxpayers about $11 billion per year due to increased health care and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers. 6 Some recent cost studies estimate that the cost may be as high as $28 billion per ...
Teen Pregnancy Essays: Examples, Topics, & Outlines
A Look at Teen Pregnancy Introduction. Teen pregnancy is a global issue that affects girls (ages 13-19) in every culture and nation around the world. 33% of American teenage girls will become pregnant before they reach their 20s, which equates to approximately 745,000 teen pregnancies each year.
Full article: Teen pregnancy
In the USA, '7.2% received no care at all' (Weiss, 2011 ). Some reasons for lack of care are teen denial of the pregnancy and fear of telling parents. Very young teens have a higher chance of pregnancy and birth complications. So do teens who smoke, since birth weights are lower for smoking mothers.
Teenage Pregnancy (Argumentative Essay Sample)
Short Argumentative Essay About Teen Pregnancy - 300 Word Short Custom Essay. Teenage pregnancy is defined as the occurrence of pregnancy among young girls aged 10 to 19 years old. Teen moms suffer their whole life due to a lack of information about safe sex and reproductive health. The tread in most schools as soon as the children hit ...
Essay About Teenage Pregnancy
Essay About Teenage Pregnancy. 1917 Words8 Pages. Teenage Pregnancy Many students suffer from the burden brought by being a parent at a very young age. Teenage Pregnancy is the bearing of child without the full awareness of responsibility. According to Bodeeb (2017), teenage pregnancy is a controversial topic that may affect the life of a student.
Teenage Pregnancy: Persuasive Essay
This essay sample was donated by a student to help the academic community. Papers provided by EduBirdie writers usually outdo students' samples. Nowadays teenage pregnancy has been an international issue, it is also recognized as adolescent pregnancy under the age of 20. It typically refers to teenagers between the ages of 15-19.
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In an exclusive essay, Carli Lloyd, former pro soccer player and Fox Sports analyst, shares her detailed infertility journey and announces that she's pregnant.
Teenage Pregnancy Speech: [Essay Example], 541 words
Teenage pregnancy is a complex issue with far-reaching implications for the individuals involved, their families, and society at large. According to the Centers for Disease Control and Prevention, the United States has one of the highest rates of teenage pregnancy among developed countries, with approximately 194,377 babies born to women aged 15-19 in 2017.
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Re "Why We Need to Talk About Teen Sex," by Peggy Orenstein (Opinion guest essay, April 14): As a psychotherapist and psychoanalyst who has worked for decades with teens and college-age ...
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The research by Males (2010) shows that teenage pregnancy remains one of the biggest challenges that the country faces as it seeks to achieve the objectives of Healthy People 2020. This research estimates that in the American society, the teen pregnancy rate currently stands at about 5.74%.
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