Teenage pregnancy

Teenage pregnancy
A US Government poster on Teen Pregnancy. Over 1100 teenagers, mostly aged 18 or 19,[1] give birth every day in the United States.
Classification and external resources
Specialty	Obstetrics
ICD-10	Z33
ICD-9-CM	650

Teenage pregnancy is pregnancy in human females under the age of 20. A girl can become pregnant from sexual intercourse after she has began to ovulate which can be before her first menstrual period (menarche), but usually occurs after the onset of her periods.^[2] In well-nourished girls, menarche usually takes place around the age of 12 or 13.^[3]

Pregnant teenagers face many of the same obstetrics issues as other women. There are, however, additional medical concerns for pregnant girls aged under 15, who are less likely to have become physically developed enough to sustain a healthy pregnancy or to give birth.^[4] For girls aged 15–19 risks are associated more with socioeconomic factors than with the biological effects of age.^[5] Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilization of antenatal care etc.).^[6][7] Every day in developing countries, 20,000 girls under age 18 give birth.^[8] This amounts to 7.3 million births a year.^[8] And if all pregnancies are included, the number of adolescent pregnancies is much higher.

In developed countries, teenage pregnancies are often associated with social issues, including lower educational levels, higher rates of poverty, and other poorer life outcomes in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures.^[9] By contrast, teenage parents in developing countries are often married, and their pregnancies welcomed by family and society. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems.

Teenage pregnancies appear to be preventable by comprehensive sex education and access to birth control.^[10] Abstinence-only sex education does not appear to be effective.^[11]

Definition

The age of the mother is determined by the easily verified date when the pregnancy ends, not by the estimated date of conception.^[12] Consequently, the statistics do not include pregnancies that began in women aged 19 if they did not end until on or after the woman's 20th birthday.^[12] Similarly, statistics on the mother's marital status are determined by whether she is married at the end of the pregnancy, not at the time of conception.

Effects

According to the United Nations Population Fund (UNFPA), “Pregnancies among girls less than 18 years of age have irreparable consequences. It violates the rights of girls, with life-threatening consequences in terms of sexual and reproductive health, and poses high development costs for communities, particularly in perpetuating the cycle of poverty.”^[13] Health consequences include not yet being physically ready for pregnancy and childbirth leading to complications and malnutrition as the majority of adolescents tend to come from lower-income households. The risk of maternal death for girls under age 15 in low- and middle-income countries is higher than for women in their twenties.^[13] Teenage pregnancy also affects girls’ education and income potential as many are forced to drop out of school which ultimately threatens future opportunities and economic prospects.^[8]

Several studies have examined the socioeconomic, medical, and psychological impact of pregnancy and parenthood in teens. Life outcomes for teenage mothers and their children vary; other factors, such as poverty or social support, may be more important than the age of the mother at the birth. Many solutions to counteract the more negative findings have been proposed. Teenage parents who can rely on family and community support, social services and child-care support are more likely to continue their education and get higher paying jobs as they progress with their education.^[14]

A holistic approach is required in order to address teenage pregnancy. This means not focusing on changing the behaviour of girls but addressing the underlying reasons of adolescent pregnancy such as poverty, gender inequality, social pressures and coercion. This approach should include “providing age-appropriate comprehensive sexuality education for all young people, investing in girls’ education, preventing child marriage, sexual violence and coercion, building gender-equitable societies by empowering girls and engaging men and boys and ensuring adolescents’ access to sexual and reproductive health information as well as services that welcome them and facilitate their choices.”^[8]

Mother

Being a young mother in a first world country can affect one's education. Teen mothers are more likely to drop out of high school.^[15] However, recent studies have found that many of these mothers had already dropped out of school before becoming pregnant, but those in school at the time of their pregnancy were as likely to graduate as their peers.^[16] One study in 2001 found that women who gave birth during their teens completed secondary-level schooling 10–12% as often and pursued post-secondary education 14–29% as often as women who waited until age 30.^[17] Young motherhood in an industrialized country can affect employment and social class. Less than one third of teenage mothers receive any form of child support, vastly increasing the likelihood of turning to the government for assistance.^[18] The correlation between earlier childbearing and failure to complete high school reduces career opportunities for many young women.^[15] One study found that, in 1988, 60% of teenage mothers were impoverished at the time of giving birth.^[19] Additional research found that nearly 50% of all adolescent mothers sought social assistance within the first five years of their child's life.^[15] A study of 100 teenaged mothers in the United Kingdom found that only 11% received a salary, while the remaining 89% were unemployed.^[20] Most British teenage mothers live in poverty, with nearly half in the bottom fifth of the income distribution.^[21] Teenage women who are pregnant or mothers are seven times more likely to commit suicide than other teenagers.^[22] Professor John Ermisch at the institute of social and economic research at Essex University and Dr Roger Ingham, director of the centre of sexual health at Southampton University – found that comparing teenage mothers with other girls with similarly deprived social-economic profiles, bad school experiences and low educational aspirations, the difference in their respective life chances was negligible.^[23]

Teenage motherhood may actually make economic sense for young women with less money, some research suggests. For instance, long-term studies by Duke University economist V. Joseph Hotz and colleagues, published in 2005, found that by age 35, former teen moms had earned more in income, paid more in taxes, were substantially less likely to live in poverty and collected less in public assistance than similarly poor women who waited until their 20s to have babies. Women who became mothers in their teens — freed from child-raising duties by their late 20s and early 30s to pursue employment while poorer women who waited to become moms were still stuck at home watching their young children — wound up paying more in taxes than they had collected in welfare.^[24] Eight years earlier, the federally commissioned report "Kids Having Kids" also contained a similar finding, though it was buried: "Adolescent childbearers fare slightly better than later-childbearing counterparts in terms of their overall economic welfare.".^[24]

According to the National Campaign to Prevent Teen Pregnancy, nearly 1 in 4 teen mothers will experience another pregnancy within two years of having their first.^[25] Pregnancy and giving birth significantly increases the chance that these mothers will become high school dropouts and as many as half have to go on welfare. Many teen parents do not have the intellectual or emotional maturity that is needed to provide for another life. Often, these pregnancies are hidden for months resulting in a lack of adequate prenatal care and dangerous outcomes for the babies.^[26] Factors that determine which mothers are more likely to have a closely spaced repeat birth include marriage and education: the likelihood decreases with the level of education of the young woman – or her parents – and increases if she gets married.^[27]

Child

Early motherhood can affect the psychosocial development of the infant. The children of teen mothers are more likely to be born prematurely with a low birth weight, predisposing them to many other lifelong conditions.^[28] Children of teen mothers are at higher risk of intellectual, language, and socio-emotional delays.^[26] Developmental disabilities and behavioral issues are increased in children born to teen mothers.^[29][30] One study suggested that adolescent mothers are less likely to stimulate their infant through affectionate behaviors such as touch, smiling, and verbal communication, or to be sensitive and accepting toward his or her needs.^[29] Another found that those who had more social support were less likely to show anger toward their children or to rely upon punishment.^[31]

Poor academic performance in the children of teenage mothers has also been noted, with many of the children being held back a grade level, scoring lower on standardized tests, and/or failing to graduate from secondary school.^[15] Daughters born to adolescent parents are more likely to become teen mothers themselves.^[15][32] Sons born to teenage mothers are three times more likely to serve time in prison.^[33]

Medical

Maternal and prenatal health is of particular concern among teens who are pregnant or parenting. The worldwide incidence of premature birth and low birth weight is higher among adolescent mothers.^[5][15][34] In a rural hospital in West Bengal, teenage mothers between 15 and 19 years old were more likely to have anemia, preterm delivery, and a baby with a lower birth weight than mothers between 20 and 24 years old.^[35]

Research indicates that pregnant teens are less likely to receive prenatal care, often seeking it in the third trimester, if at all.^[5] The Guttmacher Institute reports that one-third of pregnant teens receive insufficient prenatal care and that their children are more likely to have health issues in childhood or be hospitalized than those born to older women.^[36]

Young mothers who are given high-quality maternity care have significantly healthier babies than those who do not. Many of the health-issues associated with teenage mothers appear to result from lack of access to adequate medical care.^[37]

Many pregnant teens are at risk of nutritional deficiencies from poor eating habits common in adolescence, including attempts to lose weight through dieting, skipping meals, food faddism, snacking, and consumption of fast food.^[38]

Inadequate nutrition during pregnancy is an even more marked problem among teenagers in developing countries.^[39][40] Complications of pregnancy result in the deaths of an estimated 70,000 teen girls in developing countries each year. Young mothers and their babies are also at greater risk of contracting HIV.^[4] The World Health Organization estimates that the risk of death following pregnancy is twice as high for women aged 15–19 than for those aged 20–24. The maternal mortality rate can be up to five times higher for girls aged 10–14 than for women aged 20–24. Illegal abortion also holds many risks for teenage girls in areas such as sub-Saharan Africa.^[41]

Risks for medical complications are greater for girls aged under 15, as an underdeveloped pelvis can lead to difficulties in childbirth. Obstructed labour is normally dealt with by Caesarean section in industrialized nations; however, in developing regions where medical services might be unavailable, it can lead to eclampsia, obstetric fistula, infant mortality, or maternal death.^[4][8] For mothers who are older than fifteen, age in itself is not a risk factor, and poor outcomes are associated more with socioeconomic factors rather than with biology.^[5]

Causes

Culture

Rates of teenage pregnancies are higher in societies where it is traditional for girls to marry young and where they are encouraged to bear children as soon as they are able. For example, in some sub-Saharan African countries, early pregnancy is often seen as a blessing because it is proof of the young woman's fertility.^[41] Countries where teenage marriages are common experience higher levels of teenage pregnancies. In the Indian subcontinent, early marriage and pregnancy is more common in traditional rural communities than in cities.^[42] The lack of education on safe sex, whether it is from parents, schools, or otherwise, is a cause of teenage pregnancy. Many teenagers are not taught about methods of birth control and how to deal with peers who pressure them into having sex before they are ready. Many pregnant teenagers do not have any cognition of the central facts of sexuality.^[43]

Economic incentives also influence the decision to have children. In societies where children are set to work at an early age it is economically attractive to have many children.^[44]

In societies where adolescent marriage is less common, such as many developed countries, young age at first intercourse and lack of use of contraceptive methods (or their inconsistent and/or incorrect use; the use of a method with a high failure rate is also a problem) may be factors in teen pregnancy.^[45][46] Most teenage pregnancies in the developed world appear to be unplanned.^[46][47] Many Western countries have instituted sex education programs, the main objective of which is to reduce unplanned pregnancies and STDs. Countries with low levels of teenagers giving birth accept sexual relationships among teenagers and provide comprehensive and balanced information about sexuality.^[48]

Other family members

Teen pregnancy and motherhood can influence younger siblings. One study found that the younger sisters of teen mothers were less likely to emphasize the importance of education and employment and more likely to accept human sexual behavior, parenting, and marriage at younger ages; younger brothers, too, were found to be more tolerant of non-marital and early births, in addition to being more susceptible to high-risk behaviors.^[49] If the younger sisters of teenage parents babysit the children, they have an increased risk of getting pregnant themselves.^[50] Once an older daughter has a child, parents often become more accepting as time goes by.^[51] The probability of the younger sister having a teenage pregnancy went from one in five to two in five if the elder sister had a baby as a teenager.^[52]

Sexuality

In most countries, most men experience sexual intercourse for the first time before their 20th birthdays.^[53] Men in Western developed countries have sex for the first time sooner than in undeveloped and culturally conservative countries such as Sub-Saharan Africa and much of Asia.^[53]

In a 2005 Kaiser Family Foundation study of US teenagers, 29% of teens reported feeling pressure to have sex, 33% of sexually active teens reported "being in a relationship where they felt things were moving too fast sexually", and 24% had "done something sexual they didn’t really want to do".^[54] Several polls have indicated peer pressure as a factor in encouraging both girls and boys to have sex.^[55][56] The increased sexual activity among adolescents is manifested in increased teenage pregnancies and an increase in sexually transmitted diseases.

Role of drug and alcohol use

Inhibition-reducing drugs and alcohol may possibly encourage unintended sexual activity. If so, it is unknown if the drugs themselves directly influence teenagers to engage in riskier behavior, or whether teenagers who engage in drug use are more likely to engage in sex. Correlation does not imply causation. The drugs with the strongest evidence linking them to teenage pregnancy are alcohol, cannabis, "ecstasy" and other substituted amphetamines. The drugs with the least evidence to support a link to early pregnancy are opioids, such as heroin, morphine, and oxycodone, of which a well-known effect is the significant reduction of libido – it appears that teenage opioid users have significantly reduced rates of conception compared to their non-using, and alcohol, "ecstasy", cannabis, and amphetamine using peers.^{[45][54][57][58]}

Early puberty

Girls who mature early are more likely to engage in sexual intercourse at a younger age, which in turn puts them at greater risk of teenage pregnancy.^[59]

Lack of contraception

Adolescents may lack knowledge of, or access to, conventional methods of preventing pregnancy, as they may be too embarrassed or frightened to seek such information.^[55][60] Contraception for teenagers presents a huge challenge for the clinician. In 1998, the government of the United Kingdom set a target to halve the under-18 pregnancy rate by 2010. The Teenage Pregnancy Strategy (TPS) was established to achieve this. The pregnancy rate in this group, although falling, rose slightly in 2007, to 41.7 per 1000 women. Young women often think of contraception either as 'the pill' or condoms and have little knowledge about other methods. They are heavily influenced by negative, second-hand stories about methods of contraception from their friends and the media. Prejudices are extremely difficult to overcome. Over concern about side-effects, for example weight gain and acne, often affect choice. Missing up to three pills a month is common, and in this age group the figure is likely to be higher. Restarting after the pill-free week, having to hide pills, drug interactions and difficulty getting repeat prescriptions can all lead to method failure.^[61]

In the United States, according to the 2002 National Surveys of Family Growth, sexually active adolescent women wishing to avoid pregnancy were less likely than older women to use contraceptives (18% of 15–19-year-olds used no contraceptives, versus 10.7% for women aged 15–44).^[62] More than 80% of teen pregnancies are unintended.^[63] Over half of unintended pregnancies were to women not using contraceptives,^[62] most of the rest are due to inconsistent or incorrect use.^[63] 23% of sexually active young women in a 1996 Seventeen magazine poll admitted to having had unprotected sex with a partner who did not use a condom, while 70% of girls in a 1997 PARADE poll claimed it was embarrassing to buy birth control or request information from a doctor.^[55]

In a 2012 study, over 1,000 females were surveyed to find out factors contributing to not using contraception. Of those surveyed, almost half had been involved in unprotected sex within the previous three months. These women gave three main reasons for not using contraceptives: trouble obtaining birth control (the most frequent reason), lack of intention to have sex, and the misconception that they "could not get pregnant."^[64]

In a study for The Guttmacher Institute, researchers found that from a comparative perspective, however, teenage pregnancy rates in the United States are less nuanced than one might initially assume. “Since timing and levels of sexual activity are quite similar across [Sweden, France, Canada, Great Britain, and the U.S.], the high U.S. rates arise primarily because of less, and possibly less-effective, contraceptive use by sexually active teenagers.”^[65] Thus, the cause for the discrepancy between rich nations can be traced largely to contraceptive-based issues.

Among teens in the UK seeking an abortion, a study found that the rate of contraceptive use was roughly the same for teens as for older women.^[66]

In other cases, contraception is used, but proves to be inadequate. Inexperienced adolescents may use condoms incorrectly, forget to take oral contraceptives, or fail to use the contraceptives they had previously chosen. Contraceptive failure rates are higher for teenagers, particularly poor ones, than for older users.^[57] Long-acting contraceptives such as intrauterine devices, subcutaneous contraceptive implants, and contraceptive injections (such as Depo-Provera and Combined injectable contraceptive), which prevent pregnancy for months or years at a time, are more effective in women who have trouble remembering to take pills or using barrier methods consistently.

According to The Encyclopedia of Women's Health, published in 2004, there has been an increased effort to provide contraception to adolescents via family planning services and school-based health, such as HIV prevention education.^[67]

Age gap in relationships

According to the Family Research Council, a conservative lobbying organization, studies in the US indicate that the age gap between teenage girls and the men who impregnate them is an important contributing factor. Teenage girls in relationships with older males, are more likely to become pregnant than those in relationships with boys their own age. They are also more likely to carry the baby to term rather than have an abortion. A review of California's 1990 vital statistics found that men aged over 19 fathered 77% of all births to girls aged 16–18, and 51% of births to girls aged under 16. Men aged over 25 fathered twice as many children of teenage mothers as boys aged under 18, and men aged over 20 fathered five times as many children of girls aged under 16 as boys aged under 16. A 1992 Washington state study of 535 adolescent mothers found that 62% of the mothers had a history of being raped or sexually molested by men whose ages averaged 27 years. This study found that, compared with nonabused mothers, abused adolescent mothers initiated sex earlier, had sex with much older partners, and engaged in riskier, more frequent, and promiscuous sex. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of children born to teenage girls in the United States are fathered by adult men age 20 or older.^[68]

Sexual abuse

Studies from South Africa have found that 11–20% of pregnancies in teenagers are a direct result of rape, while about 60% of teenage mothers had unwanted sexual experiences preceding their pregnancy. Before age 15, a majority of first-intercourse experiences among females are reported to be non-voluntary; the Guttmacher Institute found that 60% of girls who had sex before age 15 were coerced by males who on average were six years their senior.^[69] One in five teenage fathers admitted to forcing girls to have sex with them.^[70]

Multiple studies have indicated a strong link between early childhood sexual abuse and subsequent teenage pregnancy in industrialized countries. Up to 70% of women who gave birth in their teens were molested as young girls; by contrast, 25% of women who did not give birth as teens were molested.^[71][72][73]

In some countries, sexual intercourse between a minor and an adult is not considered consensual under the law because a minor is believed to lack the maturity and competence to make an informed decision to engage in fully consensual sex with an adult. In those countries, sex with a minor is therefore considered statutory rape. In most European countries, by contrast, once an adolescent has reached the age of consent, he or she can legally have sexual relations with adults because it is held that in general (although certain limitations may still apply), reaching the age of consent enables a juvenile to consent to sex with any partner who has also reached that age. Therefore, the definition of statutory rape is limited to sex with a person under the minimum age of consent. What constitutes statutory rape ultimately differs by jurisdiction (see age of consent).

Dating violence

Studies have indicated that adolescent girls are often in abusive relationships at the time of their conceiving.^[74][74][75] They have also reported that knowledge of their pregnancy has often intensified violent and controlling behaviors on part of their boyfriends. Girls under age 18 are twice as likely to be beaten by their child's father than women over age 18. A UK study found that 70% of women who gave birth in their teens had experienced adolescent domestic violence. Similar results have been found in studies in the United States. A Washington State study found 70% of teenage mothers had been beaten by their boyfriends, 51% had experienced attempts of birth control sabotage within the last year, and 21% experienced school or work sabotage.

In a study of 379 pregnant or parenting teens and 95 teenage girls without children, 62% of girls aged 11–15 and 56% of girls aged 16–19 reported experiencing domestic violence at the hands of their partners. Moreover, 51% of the girls reported experiencing at least one instance where their boyfriend attempted to sabotage their efforts to use birth control.^[76]

Socioeconomic factors

Teenage pregnancy has been defined predominantly within the research field and among social agencies as a social problem. Poverty is associated with increased rates of teenage pregnancy.^[57] Economically poor countries such as Niger and Bangladesh have far more teenage mothers compared with economically rich countries such as Switzerland and Japan.^[77]

In the UK, around half of all pregnancies to under 18s are concentrated among the 30% most deprived population, with only 14% occurring among the 30% least deprived.^[78] For example, in Italy, the teenage birth rate in the well-off central regions is only 3.3 per 1,000, while in the poorer Mezzogiorno it is 10.0 per 1,000.^[45] Similarly, in the United States, sociologist Mike A. Males noted that teenage birth rates closely mapped poverty rates in California:^[79]

County	Poverty rate	Birth rate*
Marin County	5%	5
Tulare County (Caucasians)	18%	50
Tulare County (Hispanics)	40%	100

* per 1000 women aged 15–19

Teen pregnancy cost the United States over $9.1 billion in 2004, including $1.9 billion for health care, $2.3 billion for child welfare, $2.1 billion for incarceration, and $2.9 billion in lower tax revenue.^[80]

There is little evidence to support the common belief that teenage mothers become pregnant to get benefits, welfare, and council housing. Most knew little about housing or financial aid before they got pregnant and what they thought they knew often turned out to be wrong.^[47]

Childhood environment

Women exposed to abuse, domestic violence, and family strife in childhood are more likely to become pregnant as teenagers, and the risk of becoming pregnant as a teenager increases with the number of adverse childhood experiences.^[81] According to a 2004 study, one-third of teenage pregnancies could be prevented by eliminating exposure to abuse, violence, and family strife. The researchers note that "family dysfunction has enduring and unfavorable health consequences for women during the adolescent years, the childbearing years, and beyond." When the family environment does not include adverse childhood experiences, becoming pregnant as an adolescent does not appear to raise the likelihood of long-term, negative psychosocial consequences.^[82] Studies have also found that boys raised in homes with a battered mother, or who experienced physical violence directly, were significantly more likely to impregnate a girl.^[83]

Studies have also found that girls whose fathers left the family early in their lives had the highest rates of early sexual activity and adolescent pregnancy. Girls whose fathers left them at a later age had a lower rate of early sexual activity, and the lowest rates are found in girls whose fathers were present throughout their childhood. Even when the researchers took into account other factors that could have contributed to early sexual activity and pregnancy, such as behavioral problems and life adversity, early father-absent girls were still about five times more likely in the United States and three times more likely in New Zealand to become pregnant as adolescents than were father-present girls.^[84][85]

Low educational expectations have been pinpointed as a risk factor.^[86] A girl is also more likely to become a teenage parent if her mother or older sister gave birth in her teens.^[32][50] A majority of respondents in a 1988 Joint Center for Political and Economic Studies survey attributed the occurrence of adolescent pregnancy to a breakdown of communication between parents and child and also to inadequate parental supervision.^[55]

Foster care youth are more likely than their peers to become pregnant as teenagers. The National Casey Alumni Study, which surveyed foster care alumni from 23 communities across the United States, found the birth rate for girls in foster care was more than double the rate of their peers outside the foster care system. A University of Chicago study of youth transitioning out of foster care in Illinois, Iowa, and Wisconsin found that nearly half of the females had been pregnant by age 19. The Utah Department of Human Services found that girls who had left the foster care system between 1999 and 2004 had a birth rate nearly 3 times the rate for girls in the general population.^[87]

Media influence

A study conducted in 2006 found that adolescents who were more exposed to sexuality in the media were also more likely to engage in sexual activity themselves.^[88]

According to Time, "teens exposed to the most sexual content on TV are twice as likely as teens watching less of this material to become pregnant before they reach age 20".^[89]

Prevention

Comprehensive sex education and access to birth control appear to reduce unplanned teenage pregnancy.^[10] It is unclear if a single intervention is most effective.^[10]

In the United States free access to a long acting form of reversible birth control along with education decreased the rates of teen pregnancies by around 80% and the rate of abortions by more than 75%.^[90]

Education

The Dutch approach to preventing teenage pregnancy has often been seen as a model by other countries. The curriculum focuses on values, attitudes, communication and negotiation skills, as well as biological aspects of reproduction. The media has encouraged open dialogue and the health-care system guarantees confidentiality and a non-judgmental approach.^[91]

Abstinence only education

Some schools provide abstinence-only sex education. Evidence does not support the effectiveness of abstinence-only sex education.^[11] It has been found to be ineffective in decreasing HIV risk in the developed world,^[92] and does not decrease rates of unplanned pregnancy when compared to comprehensive sex education.^[11] It does not decrease the sexual activity rates of students, when compared to students who undertake comprehensive sexual education classes.^[93]

Public policy

In the U.S., one policy initiative that has been used to increase rates of contraceptive use is Title X: Title X of the 1970 Public Health Service act provides family planning services for those who do not qualify for Medicaid by distributing "funding to a network of public, private, and nonprofit entities [to provide] services on a sliding scale based on income."^[94] Studies indicate that, internationally, success in reducing teen pregnancy rates is directly correlated with the kind of access that Title X provides: “What appears crucial to success is that adolescents know where they can go to obtain information and services, can get there easily and are assured of receiving confidential, nonjudgmental care, and that these services and contraceptive supplies are free or cost very little.”^[65] In addressing high rates of unplanned teen pregnancies, scholars agree that the problem must be confronted from both the biological and cultural contexts.

On September 30, 2010, The U.S. Department of Health and Human Services approved $155 million in new funding for comprehensive sex education programs designed to prevent teenage pregnancy. The money is being awarded "to states, non-profit organizations, school districts, universities and others. These grants will support the replication of teen pregnancy prevention programs that have been shown to be effective through rigorous research as well as the testing of new, innovative approaches to combating teen pregnancy."^[95] Of the total of $150 million, $55 million is funded by Affordable Care Act through the Personal Responsibility Education Program, which requires states receiving funding to incorporate lessons about both abstinence and contraception.

In the developing world, programs of reproductive health aimed at teenagers are often small scale and not centrally coordinated, although some countries such as Sri Lanka have a systematic policy framework for teaching about sex within schools.^[42] Non-governmental agencies such as the International Planned Parenthood Federation and Marie Stopes International provide contraceptive advice for young women worldwide. Laws against child marriage have reduced but not eliminated the practice. Improved female literacy and educational prospects have led to an increase in the age at first birth in areas such as Iran, Indonesia, and the Indian state of Kerala.

Other

A team of researchers and educators in California have published a list of "best practices" in the prevention of teen pregnancy, which includes, in addition to the previously mentioned concepts, working to "instill a belief in a successful future", male involvement in the prevention process, and designing interventions that are culturally relevant.^[96]

Prevalence

Worldwide

In reporting teenage pregnancy rates, the number of pregnancies per 1,000 females aged 15 to 19 when the pregnancy ends is generally used.^[98]

Worldwide, teenage pregnancy rates range from 143 per 1000 in some sub-Saharan African countries to 2.9 per 1000 in South Korea.^[45][99] In the United States, 82% of pregnancies in those between 15 and 19 are unplanned.^[100] Among OECD developed countries, the United States, United Kingdom and New Zealand have the highest level of teenage pregnancy, while Japan and South Korea have the lowest in 2001.^[101] According to UNFPA, “In every region of the world - including high-income countries - girls who are poor, poorly educated or living in rural areas are at greater risk of becoming pregnant than those who are wealthier, well-educated or urban. This is true on a global level, as well: 95 per cent of the world’s births to adolescents (aged 15-19) take place in developing countries. Every year, some 3 million girls in this age bracket resort to unsafe abortions, risking their lives and health.” ^[13]

According to a 2001 UNICEF survey, in 10 out of 12 developed nations with available data, more than two thirds of young people have had sexual intercourse while still in their teens. In Denmark, Finland, Germany, Iceland, Norway, the United Kingdom and the United States, the proportion is over 80%. In Australia, the United Kingdom and the United States, approximately 25% of 15-year-olds and 50% of 17-year-olds have had sex.^[45] According to The Encyclopedia of Women's Health, published in 2004, approximately 15 million girls under the age of 20 in the world have a child each year. Estimates were that 20–60% of these pregnancies in developing countries are mistimed or unwanted.^[67]

Save the Children found that, annually, 13 million children are born to women aged under 20 worldwide, more than 90% in developing countries. Complications of pregnancy and childbirth are the leading cause of mortality among women aged 15–19 in such areas.^[4]

Sub-Saharan Africa

The highest rate of teenage pregnancy in the world is in sub-Saharan Africa, where women tend to marry at an early age.^[99] In Niger, for example, 87% of women surveyed were married and 53% had given birth to a child before the age of 18.^[41]

India

In the Indian subcontinent, early marriage sometimes results in adolescent pregnancy, particularly in rural regions where the rate is much higher than it is in urbanized areas. Latest data suggests that teen pregnancy in India is high with 62 pregnant teens out of every 1,000 women.^[102] India is fast approaching to be the most populous country in the world, and increasing teenage pregnancy, an important factor for the population rise, is likely to aggravate the problem.^[103]

Asia

The rates of early marriage and pregnancy in some Asian countries are high. In recent years, the rates have decreased sharply in Indonesia and Malaysia, although it remains relatively high in the former. However, in the industrialized Asian nations such as South Korea and Singapore, teenage birth rates remain among the lowest in the world.^[42]

Europe

The overall trend in Europe since 1970 has been a decreasing total fertility rate, an increase in the age at which women experience their first birth, and a decrease in the number of births among teenagers.^[104] Most continental Western European countries have very low teenage birth rates. This is varyingly attributed to good sex education and high levels of contraceptive use (in the case of the Netherlands and Scandinavia), traditional values and social stigmatization (in the case of Spain and Italy) or both (in the case of Switzerland).^[9]

United Kingdom

The teen pregnancy rate in England and Wales was 23.3 per 1,000 women aged 15 to 17. There were 5,740 pregnancies in girls aged under 18 in the three months to June 2014, data from the Office for National Statistics shows. This compares with 6,279 in the same period in 2013 and 7,083 for the June quarter the year before that. Historically, the UK has had one of the highest teenage pregnancy and abortion rates in Western Europe.

There are no comparable rates for conceptions across Europe, but the under-18 birth rate suggests England is closing the gap. The under-18 birth rate in 2012 in England and Wales was 9.2, compared with an EU average of 6.9. However, the UK birth rate has fallen by almost a third (32.3%) since 2004 compared with a fall of 15.6% in the EU. In 2004, the UK rate was 13.6 births per 1,000 women aged 15–17 compared with an EU average rate of 7.7.

A spokeswoman for the British Pregnancy Advisory Service said: "Contrary to popular perception, this data shows that the teenage pregnancy rate is falling dramatically in England and Wales. While the UK has historically had a high teenage conception rate, it is now at its lowest level on record and not significantly out of step with other European countries.

"We have seen a huge decline in the number of babies born to teenage mothers over the last decade, in part due to the improvements we've seen in contraception advice and services for younger women, with straightforward access to abortion services when their chosen method lets them down. But it also reflects broader societal shifts, with younger women quite rightly expecting and able to pursue educational and professional ambitions." ^[105]

United States

The teenage birth rate in the United States is the highest in the developed world, and the teenage abortion rate is also high.^[45] In 2005 in the U.S., the majority (57%) of teen pregnancies resulted in a live birth, 27% ended in an induced abortion, and 16% in a fetal loss.^[106] The U.S. teenage pregnancy rate was at a high in the 1950s and has decreased since then, although there has been an increase in births out of wedlock.^[107] The teenage pregnancy rate decreased significantly in the 1990s; this decline manifested across all racial groups, although teenagers of African-American and Hispanic descent retain a higher rate, in comparison to that of European-Americans and Asian-Americans. The Guttmacher Institute attributed about 25% of the decline to abstinence and 75% to the effective use of contraceptives.^[108] While in 2006 the U.S. teen birth rate rose for the first time in fourteen years,^[109] it reached a historic low in 2010: 34.3 births per 1,000 women aged 15–19.^[1]

The latest data from the United States shows that the states with the highest teenage birthrate are Mississippi, New Mexico and Arkansas while the states with the lowest teenage birthrate are New Hampshire, Massachusetts and Vermont.^[110]

Canada

The Canadian teenage birth has also trended towards a steady decline for both younger (15–17) and older (18–19) teens in the period between 1992 and 2002.^[111] However, teen pregnancy has been on the rise since 2013.^[112]

Teenage fatherhood

In some cases, the father of the child is the husband of the teenage girl. The conception may occur within wedlock, or the pregnancy itself may precipitate the marriage (the so-called shotgun wedding). In countries such as India the majority of teenage births occur within marriage.^[42][45]

In other countries, such as the United States and the Republic of Ireland, the majority of teenage mothers are not married to the fathers of their children.^[45][113] In the UK, half of all teenagers with children are lone parents, 40% are cohabitating as a couple and 10% are married.^[114] Teenage parents are frequently in a romantic relationship at the time of birth, but many adolescent fathers do not stay with the mother and this often disrupts their relationship with the child. U.S. surveys tend to under-report the prevalence of teen fatherhood.^[115] In many cases, "teenage father" may be a misnomer. Studies by the Population Reference Bureau and the National Center for Health Statistics found that about two-thirds of births to teenage girls in the United States are fathered by adult men aged over 20.^[116][117] The Guttmacher Institute reports that over 40% of mothers aged 15–17 had sexual partners three to five years older and almost one in five had partners six or more years older.^[118] A 1990 study of births to California teens reported that the younger the mother, the greater the age gap with her male partner.^[119] In the UK 72% of jointly registered births to women aged under 20, the father is over 20, with almost 1 in 4 being over 25.^[120]

History

Teenage pregnancy was normal in previous centuries, and common in developed countries in the 20th century. Among Norwegian women born in the early 1950s, nearly a quarter became teenage mothers by the early 1970s. However, the rates have steadily declined throughout the developed world since that 20th century peak. Among those born in Norway in the late 1970s, less than 10% became teenage mothers, and rates have fallen since then.^[121][122]

Pre-20th century

• It is often said that Mary, the mother of Jesus, was aged 12 to 14 when she became pregnant with Him.^[123]
• Hildegard of Vinzgouw, the second wife of Charlemagne, was about 14 years old when she gave birth to her first son in 772 CE.^[124]
• In 1187 Isabella of Hainault was aged 17 when she gave birth to Louis VIII of France, but she died in 1190 aged 19 the day after giving birth to twin boys who lived for 4 days.^[125]
• Isabel de Clare and all five of her daughters were teenage mothers.^[126]
• Violant of Aragon queen consort of Castile and León gave birth to her first three children before she was 20 in 1256.^[127]
• In 1230 Isabel Bigod, daughter of Hugh Bigod, 3rd Earl of Norfolk and Maud Marshal, became a widow aged 18 with 3 children. She went on to have at least six more children with her second husband John FitzGeoffrey.^[128][129]
• Margaret Beaufort, the mother of Henry VII of England, was 13 years old when she gave birth to him in 1457. The birth was particularly difficult due to her physical immaturity and small size and she would never give birth again.^[130] She feared for her eldest granddaughter, Margaret Tudor, and would not allow her to be sent to her husband James IV in Scotland until she was grown enough. Even so, the younger Margaret gave birth to her first three children before she was 20 in 1509; all three died in infancy.^[131]

20th century

• Singer Bobby Darin was born to a teenage mother in 1936, whom he believed to be his sister for most of his life, until she revealed to him as being his actual mother in his adult life. He was never told the identity of his true father.^[132]
• Child actress turned diplomat Shirley Temple was 19 when she gave birth to her first child, Linda Susan, in 1948.^{[133][134][135]}
• Ann Dunham was 18 when in 1961 she gave birth to her son, Barack Obama, the future 44th President of the United States.^[136]
• Naomi Judd gave birth to Wynonna Judd on May 30, 1964, the same day her high school diploma was mailed to her. Wynnona was born Christina Claire Ciminella; Michael Ciminella was not the biological father but married Naomi to give Christina his surname.^[137]
• Oprah Winfrey was 14 when she gave birth to a boy, who died shortly after birth.^[138]
• Dimple Kapadia was 17 when she gave birth to her first daughter and 19 when she gave birth to her second one.^[139]
• Tamara Beckwith dropped out of Cheltenham Ladies' College in order to have her daughter, Anouska Poppy Pearl in 1987. The father was an American Marine. Anouska is now studying acting in Los Angeles.^[140]
• Dwayne Michael Carter Jr.(Lil Wayne) had his baby, Reginae, with his now ex-wife Antonia "Toya" Johnson when he was 15 and she 14.^[141][142]

21st century

• Pop singer Fantasia Barrino, winner of American Idol 2004, was 16 when she gave birth to a daughter named Zion Quari' in 2001; in 2005 she released a controversial song about single motherhood titled Baby Mama.^[143]
• Taylor Hanson, a member of the pop band Hanson, was 19 when his 18-year-old wife Natalie gave birth to their first child, a son named Jordan Ezra, in 2002.^[144]
• Yulia Volkova, of the controversial Russian pop band t.A.T.u., was 19 when she gave birth to her daughter Viktoria Pavlovna Volkova in September 2004; she had spoken publicly about having an abortion the year before.^[145]
• Singer and actress Solange Knowles, the younger sister of singer Beyoncé Knowles, was 18 when she gave birth to her first child, Daniel Julez Smith Junior, in October, 2004.^[146][147]
• Asia Nitollano, who joined the pop group The Pussycat Dolls after winning a reality TV show, was 17 when she gave birth to her daughter in 2005.^{[148][149][150]}
• Oscar-nominated actress Keisha Castle-Hughes was 17 when she gave birth to her first child, a girl named Felicity-Amore, in 2007.^[151]
• Actress and singer Jamie Lynn Spears, younger sister of pop singer Britney Spears, gave birth to a daughter in 2008 when she was 17.^[152]
• Bristol Palin, 18, the teenage daughter of John McCain's 2008 vice presidential candidate former^[153] Alaskan Governor Sarah Palin, gave birth on December 27, 2008 to a son named Tripp.^[154]
• Lou Doillon, French actress and daughter of Jane Birkin, gave birth to son Marlowe Jack Tiger Mitchell in 2002 at age 19.^[155]

Society and culture

Politics

Some politicians condemn pregnancy in unmarried teenagers as a drain on taxpayers, if the mothers and children receive welfare payments from the government.^[156][157]

See also

References

Further reading

External links

• Teen Pregnancy at DMOZ
• Teen Pregnancy Prevention at DMOZ
• Teenage pregnancies and obstetric outcome
• Teen Pregnancy, a special issue from the Journal of Applied Research on Children (2011)

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