the_not-so-good_news_about_teenage_pregnancy.docx
SOCIAL SCIENCE AND PUBLIC POLICY The Not-So-Good News about Teenage Pregnancy Naomi Farber Published online: 25 April 2014 # Springer Science+Business Media New York 2014 “I didn’t want to have my virginity taken by my father so I slept with X instead…I do remember thinking I didn’t want my dad to be the first person. I didn’t want to have sex (at 14), but that was something I was thinking about.” (Low income, white, single teen mother in S.C.) Over the past few decades there has been a significant reduction overall in both pregnancy and childbearing among adolescents in the United States. Since the most recent peak of the early 1990s, the rate of pregnancy per 1,000 girls aged 15– 19 dropped from about 116.9 to 67.8 and the birthrate from 61.8 to 31.3 (the exact rates reported depending upon the data source). These dramatic declines of 42 and 49 % respectively occurred more or less steadily, and represent unequivocally good news. The downward trends occurred among teens in all racial and ethnic groups, of all ages, and in all states, to their current historic lows. Though the overall teen birth rate in the U.S. is nearly twice that of the next highest among developed nations, the U.K., the consistency of these positive trends over time and across various socio-demographic groups suggests that the tide of increased high-risk sexual activity among everyounger girls and boys has been stemmed. However, not all the news is good. Despite within-group declines, about half of all Latinas and black girls will become pregnant at least once before age 20, compared to 19 % of whites. Births to teens in rural counties are now almost 30 % higher than in urban or suburban communities and account for about 20 % of all births to teens. There also has been recent recognition of high levels of risky sexual activity among girls in foster care, who are twice as likely to give birth as those in the general population of teens. Preventing pregnancy among many of these adolescents—such as the young woman above whose early sexual initiation and motherhood resulted from fear of incest– and for whom the costs to the larger society are the highest, may prove to be extraordinarily difficult. In other words, as Sarah Brown, the Director of the National Campaign to Prevent Teen and Unplanned Pregnancy observed, we may already have achieved the “easy wins” in bringing down rates of pregnancy and childbearing among American youth. Historical Background It is only fairly recently that pregnancy among adolescents became defined as a social problem requiring public intervention. Historical evidence suggests that American young people have long been sexually active outside of marriage. Though we do not have direct measures, ebbs and flows in sexual activity and pregnancy among adolescents are evident in the proxy indicators of rates of premarital conception, ranging from under 10 % of first births in the 17th century to nearly 30 % in the late 1800 s. It was not until the last few decades of the 20th century that teenage pregnancy was branded an “epidemic,” ironically some years after the highest rates in modern times occurred in 1957, at 97.3 births per 1,000 girls aged 15–19. Although the actual rates of pregnancy and childbearing among adolescents have been consistently lower since 1957, widespread social changes profoundly altered the consequences of teenagers conceiving. Only a few decades ago, the unplanned result of early unprotected sex might simply hasten the expected outcome for most young women, marriage and motherhood. That scenario has changed drastically. Since the 1960s, the availability of more effective methods of birth control contributed to the possibility of disconnecting sex from pregnancy. However, sex and childbearing have also become disconnected from marriage. Over one-third of all N. Farber (*) College of Social Work, University of South Carolina, Columbia, SC 29208, USA e-mail: [email protected] Soc (2014) 51:282–287 DOI 10.1007/s12115-014-9777-y births in the U.S. are outside of marriage, and about 88 % of all childbearing teens are unmarried. Thus the problem of teen pregnancy over the last several decades was in many respects fundamentally a problem of young unwed motherhood. However, as the numbers and rates of conception and childbirth among teens and the stigma of single motherhood have all decreased, a proper understanding of what the “problem” of teen pregnancy is today requires more focused attention to the intensely difficult lives of those teens who currently are most likely to have children outside of marriage. In its simplest formulation, there is little mystery in what has occurred over the past few decades contributing to the decrease in pregnancies and births among American teenagers: more teens are delaying sexual initiation; fewer teens are sexually active; more of those teens who do have sex use contraception effectively; and many of those teens who become pregnant have abortions. Finally, although frequently ignored within the deeply contentious, ideologically-charged public debates over the impact of abstinence-only interventions and comprehensive sex education, research shows that some teenage pregnancy prevention programs are more effective for certain teens than others. Probably the most realistic conclusion is that the broad effect of greater access to contraception combined with attention to the various risks of unprotected sex have made many young people more mindful and cautious in their sexual behavior. Although this reversal followed widespread and substantial outlay of financial resources for intervention by “experts” in social welfare, medical, educational and other professions, as well as vigorous responses from local communities across the country, the fact is that not all adolescents were or are at equal risk of becoming pregnant or having children outside of marriage. Quite to the contrary, there are profound differences among adolescents in how likely they are to gamble with the life-altering consequences of unplanned pregnancy. That is, there is a clear continuum of risk of early parenthood that depends upon their individual life experiences, characteristics, and social context. In general, it is those youth at the lowest risk that have benefitted most from the last decades’ intensive wave of pregnancy prevention efforts, while those at highest risk continue to frustrate diverse professionals and others. At a recent presentation I gave on sources of risk for low-income rural white young women, a South Carolina state prevention program evaluator admitted that that he was looking for any insight that might guide his organization in reaching “that remaining 40 % we can’t seem to help.” He was, of course, referring to those youth outside of the category of “easy wins.” Beyond the Easy Wins The majority of American adolescents are not likely to become pregnant or young parents because they are not burdened with the multiple environmental and individual risk factors associated with engaging in unprotected sex. Perhaps the most pervasive sources of risk among teens result from a mismatch between contemporary cultural expectations for decision-making in important behavioral arenas such as sexuality, and limitations in typical adolescents’ cognitive capacities and the emotional maturity that are necessary to meet those expectations wisely. Many behaviors such as sexual intercourse that once explicitly were considered appropriate for adults only have been defined “downward” chronologically. At the same time, adolescence as a stage of social development has been extended, with the age of marriage rising and more youths remaining in school longer. In addition to the typical developmental context of each stage of adolescence, many teens actually feel ambivalent about becoming sexually active. Young people’s mixed feelings—of wanting to fit in, to be accepted and liked but not being ready for the actual experience, or feeling guilty— can decrease their effective use of birth control. So that, while the cognitive capacity to prevent pregnancy in a planned way increases over the course of adolescence, even older teens ostensibly not at high risk of pregnancy may face barriers to prevention if they become sexually active. Many of the most frequently-named reasons for having unprotected intercourse such as not planning to have sex or allowing it to “just happen” reflect some teens’ reluctance to take conscious responsibility for their sexual activity. The problematic impacts of both this normal ambivalence and developmental cognitive capacity are exacerbated in the contemporary cultural context that places high value on an open-ended conception of personal freedom. When the intense developmental pressures combine with weak direction from parents and other close adults, teenagers are left, as David Elkind observed, to find their own way to adulthood. This often means that teenagers of all ages take momentous actions often without being adequately equipped to handle the potential consequences. Simply, teenagers are not adults. Still, low-risk youths generally possess sufficient motivation to make decisions that will help them attain educational and occupational success, including avoiding young parenthood. They have an idea of the opportunities that await them later in life. For this reason, the predominant approaches to pregnancy prevention often are effective. When these types of educational experiences are joined with clear guidance from parents and other adults, most adolescents are able to act on their best interests even in the face of difficult decisions about their sexuality and do not become teen parents. It is primarily these young people who we count as the so-called “easy wins.” But what about the others who remain at higher risk? Beyond the generalized pressures to behave as sexually mature adults, some young people face greater susceptibility to early pregnancy and childbearing because family and personal characteristics lead them to engage in a variety of high-risk Soc (2014) 51:282–287 283 behaviors including, though not limited to unprotected sexual intercourse. Like other American youths, they grow up in a highly sexualized society that demands greater emotional and cognitive maturity than many adolescents possess. However, unlike teens at lower risk, these young people often do not have strong immediate environmental support to nurture positive and healthful personal decisions that would help them to avoid pregnancy. Several individual characteristics of adolescents who are at higher risk of conceiving include: 1) early age of initiation of sexual activity; 2) low expectations for, weak attachment to, and poor performance in school; 3) engagement in problem behaviors such as various forms of acting out, antisocial behavior and other conduct disorders; 4) being easily influenced by peers who participate in problem behaviors, and 5) weak parental bonding. These sources of risk of early, unprotected sexual activity are also part of those conditions that contribute to participating in delinquent acts, using drugs and alcohol and/or doing poorly in school. Engaging in high-risk sexual activity thus often reflects a different developmental context for these youths than it does for those at lower risk of pregnancy. As earlier and greater sexual activity among teens generally has become more common and social science more relativistic, traditional theories of adolescents’ sexual risk-taking in terms of syndromes of deviant behavior (e.g., Jessor and Jessor 1977) or weak social control have given way to the more value-neutral emphasis on social learning (Bandura 1977). Based on the assumption that much of adolescents’ risky sexual and other potentially harmful behavior reflects the models they encounter in their family, peer, school and community contexts and not personal or social pathology, prevention programs typically attempt to create strong “alternative” peer group norms. For young women and men who are either more likely to have early sex because they possess multiple characteristics associated with general high-risk behavior or are already engaging in unsafe behavior, providing knowledge about how to prevent pregnancy is necessary but usually not sufficient. When adolescents’ high-risk sexual activity expresses low commitment to conventional achievement their motivation to avoid unprotected sex or even pregnancy may not be strong enough to overcome emotional vulnerability and social norms that condone high levels of risk-taking. Thus, the wins are considerably harder to achieve among what might be considered troubled youth. Among those adolescents at even higher risk, those whose futures are already in jeopardy and who contribute most to the gaping group disparities in rates of teen pregnancy and childbearing, are individuals such as the teen mother I met not long ago at a regular meeting of the Foster Care Review Board of South Carolina on which I serve. The charge of this organization is to provide community oversight to the Department of Social Services in meeting their responsibility to achieve “permanency planning” for children in foster care. Present at this meeting were the young mother (who had her first of 3 children at age 16), the different fathers of two of these children, and assorted professionals responsible for providing services to her and her children, and ultimately making recommendations regarding family reunification or termination of all parental rights. During heated discussion about the best interests of her children, everyone spoke—except for the young mother. Not only was she silent as the fate of her children was debated, she barely looked up from the cell phone on which she was continuously texting. Certainly there are many reasonable explanations for her ostensible indifference, such as not feeling comfortable expressing feelings of intimidation, confusion, or anger. However true this might be, there was another important fact: the young mother herself had been raised in foster care, the result of severe neglect by her poor, single mother. Like many other youth in foster care, this young woman had experienced trauma, mental health and behavioral problems associated with elevated risk of adolescent pregnancy (Svoboda et al. 2012). Thus, in addition to feeling worried for the wellbeing of this emotionally flat young woman, her own children in foster care, and their fathers, I was absolutely unsurprised by how her apparent emotional destitution left her unable even to attempt to overcome the challenges required to regain the custody of her children then, or, most probably, in the future. Although many foster children live with caring families, too often they yearn for more meaningful and stable relationships with adults (Love, McIntosh, Rosst, and Tertzakian, 2005). Some teenagers in foster care explicitly regard having a child as a way to meet their need for reliable and unconditional love. However, childbearing motivated primarily by such a deep emotional void and without strong environmental support from committed adults can be a recipe for disaster: Indeed, there was little doubt that the children of the young mother I met that day would soon become permanent wards of the State of South Carolina. And so it goes. Though one must always guard against confusing generalized behavioral patterns with expectations of any individual’s experience, the logic of the trajectory of this young mother’s life is clear. In many of the particulars of her young and mainly unhappy life thus far she is similar to that worrisome minority of American adolescents who remain far outside of the category of easy wins in pregnancy prevention. Whether these vulnerable young people grow up in impoverished deteriorated urban or isolated rural communities or, move from foster family to foster family because of severe family chaos usually in the context of poverty, too many face dismayingly high odds of bearing another generation of children whose futures are severely compromised in their prospects for educational achievement, economic independence, vigorous physical and mental health, and satisfying social and emotional relationships. Certainly many such young parents are 284 Soc (2014) 51:282–287 competent and their children thrive; but they face steep uphill battles, and too often do not prevail. Different Explanations Since teen pregnancy became defined as a serious social problem, a great deal of research has examined why nonmarital teen pregnancy is so closely associated with minority youth status and urban poverty. Predominant theories have emphasized the overwhelming negative impact of economic and social structures on the motivation of disadvantaged youth to avoid early sex, pregnancy and out-of-wedlock parenthood. The seminal work of economist Gary Becker and colleagues in the 1970s on “utility maximization and the marriage market” (Becker et al. 1977) spawned several mid-range theories assuming that individuals act “rationally” in calculating the costs and benefits of their decisions, including marriage and childbearing. This economic perspective informed the popular “opportunity cost” analysis of teen pregnancy, suggesting that teens who allow themselves to become pregnant and choose motherhood perceive less “cost” to their futures than do teens who avoid pregnancy. Why do these youths feel they have so little to lose in future educational and occupational achievement by becoming single teen parents? One popular view attributes the previous rising rate of teenage illegitimacy to increased availability of public assistance beginning during the 1960s. Charles Murray, whose once-controversial views have since largely prevailed in the form of the 1996 welfare reform, argued that increasing illegitimacy among poor youth resulted from perverse incentives of welfare programs like AFDC that rewarded nonmarital childbearing and discouraged marriage (Murray 1984). A leading alternative view was proffered by William J. Wilson (1987), who posited that changes in the structure of urban economies diminished legitimate employment opportunities and contributed to high rates of incarceration and violent death among black men in inner cities—the result being a reduction in the “male marriageable pool” for black women. With no realistic expectation of either upward mobility or marriage, women thus sacrifice little by having children as unmarried teenagers. Despite bitter academic and policy-centered debates about the relative impact of welfare benefits and economic structure on adolescent childbearing, from the perspective of youth growing up in persistent poverty, the theories are neither mutually exclusive nor fully adequate. Certainly there has been a general decline in economic opportunity for individuals with low levels of education and skill that has also diminished the capacity of many men to provide financially for families. Ethnographic research documents convincingly how the ability of many young men and women to form stable and lasting marital unions has eroded in economically deteriorated communities. Recent studies of low-income women in general, including those in impoverished rural communities, finds similar reluctance of women to marry men who are not economically stable. Consequently, in the context of few other options, we now alarmingly see two, three and even more generations of women who bore children young, remained unmarried and relied upon public assistance to support their children. Although a growing body of research examines the many ways unmarried fathers may be present in the lives of their children, there is not compelling evidence that such typically tenuous ties mitigate the frequently negative consequences of growing up in a long-term poor singlemother family. While there are clear associations between lack of economic opportunity and non-marital adolescent childbearing, it is difficult to disentangle meaningfully the effects of poverty, public policies and cultural changes wrought over years of increasing social and economic decay when a teenager has a child. There has been insufficient research exploring the temporal dimension of deep poverty, lack of engagement with work, and relying on public assistance; how these experiences have shaped individuals’ expectations and habits over time, and across generations, and why it is so difficult to change these seemingly entrenched behavior patterns of family formation. Perhaps there would be more research into these seemingly intractable problems, if what they may imply—a culture of poverty—were not taboo in the academy. After many years of working with teen mothers in innercity Chicago, psychologist Judith Musick, concluded that frustratingly few disadvantaged young mothers and those at risk of teen pregnancy benefitted from social programs. Musick acknowledged the “cumulative effects of poverty on the family,” (1993, p. 61), but sought a deeper understanding of the relationship between the environmental stresses of poverty and the intrapsychic processes of adaptation. Describing how the development of girls raised in severe poverty is compromised, Musick observed: These girls frequently have grown up in damaged and damaging family situations where the basic developmental foundation has been poorly laid or is lacking altogether. In addition, the environment in which they live—at home, in school, and in the community—is often highly threatening. Surely more of these teens, when compared with their more advantaged counterparts, are highly stressed if not deeply troubled. At the same time, their external supports and their opportunities to find alternative models of coping are few and far less adequate (Musick 1993, p. 59). Mature development requires resolving common identityrelated issues through stages of adolescence. Many poor girls who do not experience consistent parental nurturing because Soc (2014) 51:282–287 285 of environmental deficiency, violence and other threats to emotional and physical security remain fixed on issues more characteristic of early adolescence. Sexual acting out then often results in pregnancy and motherhood: If an adolescent’s psychological energies are too strongly focused on defensive and security measures, much of her time and effort will be focused on trying to resolve her unmet dependency needs, searching for and trying to maintain attachments. When this occurs, her attention and energies are diverted from the critical developmental tasks that undergird adolescent and, later, adult competence in our society. Girls for whom basic acceptance and love are the primary motivating forces have little interest or emotional energy to invest in school or workrelated activities unless they are exceptionally bright or talented. Even then, the pull of unmet affiliative or dependency needs may be more powerful than anything the worlds of school or work have to offer, particularly when these offerings are as inadequate and inconsistent as those typically found in poverty communities (Musick 1993, p. 61). Musick based her analysis on the experiences of urban teens, but the dynamics she describes are also accurate among many young people in chronically impoverished rural communities, where rates of early and unprotected sex, pregnancy and childbearing among teens across race and ethnicity are considerably higher than national averages. Even in states that have seen significant decreases in teen pregnancy and childbearing, some of the highest rates are found in the most rural and poorest counties. For example, while New Jersey had one of the largest statewide declines in teen pregnancy between 2005 and 2008, the county currently with the highest rate by far, Cumberland, is primarily rural with poverty rates well above the state average. Though teen childbearing overall among Native American youth has declined consistent with national trends, on reservations and in other rural locales, young men and women continue to suffer the developmental disadvantages of persistent poverty and family dysfunction. In Montana, which ranks close to New Jersey in statewide rates of teen pregnancy, the highest incidence occurs in Roosevelt County which is almost 60 % Native American, predominantly rural, and poor. Despite the historically specific context of the problems faced by Native American youth in reservation and other rural communities, many underlying barriers to healthy youth development are hauntingly similar to youth in other disadvantaged circumstances, summed up thus: “Increasingly, the damage from that early abuse, loneliness and lack of love is being seen as a major factor in ills that plague tribes today, passed from one generation to the next and manifesting in high rates of poverty, substance abuse, depression and suicide” (King, 2008, p. 1 in Hagen et al. 2012). Consistent with other research, intensive life history interviews that a colleague and I conducted with young, poor, white, single mothers in rural southeastern communities reveal what we call “stacked vulnerabilities” beginning in childhood and leading to early childbearing and economic disadvantage by early adulthood (Farber and Miller-Cribbs 2014). Like poor urban and other disadvantaged rural youth, these young women are disproportionately likely to grow up in unmarried or divorced families characterized by domestic violence, sexual abuse, and substance abuse. The impact of this developmental milieu frequently includes early and unprotected sexual activity, dropping out of school, and use of drugs and alcohol, and teenage childbearing. The young woman quoted at the beginning who feared incestuous intercourse followed a path to motherhood that echoes the lives of many of other teen parents we encountered. She dropped out of school in 10th grade after becoming pregnant. Soon after, she followed an older man, a drug dealer, to another state, and began several years of drug use and involvement with a variety of abusive men, and multiple incarcerations that very nearly caused her son to be removed from her custody. When I met her, this young mother was working part-time as a waitress. Although she dreamed of becoming a nurse, without a high school diploma or GED, her prospects for economic security for her young son and herself were grimly limited. Another teen mother in our study also left an unsafe home early and never completed high school recalled that: My momma was a heroin addict and I didn’t have a lot of things kids had. You know, I couldn’t have kids over and stuff. My mom did the best she could for who she was. Which was an addict…. I was molested from 9 to 13…my uncle. These types of developmental disadvantages, indeed traumas, obviously have cumulative emotional and psychological—and, recent research suggests, biochemical– effects over time that are not easily compensated for by typical pregnancy interventions or a narrow focus on educational or employment opportunities. In one of the few explorations of the internal life of southern poor rural teen mothers, Anne Dean (1997) found differences between teen mothers and other teens in their personal and cultural “schemas” that defined “hierarchies of goals and means of achieving them” (Dean 1997, p. 192). These schemas, or systems of personal meaning, led the young women in divergent directions, either toward marriage and work and away from their impoverished community; or, inward to their own mothers with limited resources and the lives that were familiar and required little personal change. These choices limit the future of the young mothers and their children: 286 Soc (2014) 51:282–287 The point is not that children growing up in singleparent households cannot develop favorably…The point is, rather, that mothers in downwardly mobile environments lack the support of extended families, lack the emotional and economic support of a husband, lack sufficient and reliable resources for caring for themselves and for their children, and are likely themselves to have constructed deprived working models of their own attachment relationships…In this kind of social and psychological environment, the difficulties for the mother-child dyad of negotiating a path toward psychological maturity are greatly increased. The consequences of failing to do so include among others the increased likelihood of adolescent pregnancy for children who become adolescents, greater difficulty forming and maintaining a stable relationship with a partner, and greater difficulties taking advantage of increased opportunities for social and economic advancement. These outcomes then feed back into the system and the downward spiral continues (Dean 1997, p. 195). The psychological and relational dynamics described by Musick and Dean not only make these young people more likely to become teen parents, they also exacerbate the many negative consequences that so often follow adolescent motherhood in the context of poverty. The Difficult Truth If teen mothers in more affluent families suffer from unmet emotional needs, their greater resources and environmental supports can mitigate the worst long-term results in their own and their children’s development and well-being. In contrast, poorer girls are less likely to recover from the emotional distress and the educational and occupational losses that may accompany an early pregnancy. In essence, then, the most disadvantaged youth are most susceptible to early parenthood and then to the worst consequences of teen parenthood because of their prior disadvantage. It is a cycle that has been repeated and repeated, preoccupying that state evaluator and others who are willing to acknowledge the critical state of the unhelped “40 %.” The ongoing fundamental differences in values that exist in American society regarding sex, contraception and certainly abortion among unmarried young people suggest that we will continue to provide teens tools for preventing unplanned pregnancy both through encouraging abstinence and making available contraception, with a common agreement that early parenthood is undesirable. As the knowledge, skills and attitudes that contributed to the recent steady decline in teen pregnancy become more widely and deeply entrenched in young people’s various educational experiences, it is also likely the positive trend in the overall decline of teen pregnancy will continue. However, for that significant minority of American youth whose lives are filled with trauma, turmoil and unmet needs, it is unlikely that they will benefit much from the educational curricula, role plays, values clarification, exhortations, and condom demonstrations and distribution that constitute typical prevention programs. Insofar as the meaning of early sexual relations and having a child are far more complex than temporary errors of judgment or lack of knowledge or impulse control, their underlying motivations must be addressed, the intergenerational patterns of disadvantage interrupted. In order to avoid teenage motherhood in the context of such severe environmental deficiencies, be it urban or rural, a girl requires “not just average but above-average psychological resources and strengths, self-concepts and competencies” (Musick 1993, p. 3). Unless we accept this difficult truth, we will make very little progress in moving beyond our easy wins.
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