OBJECTIVE: We evaluated the factors associated with attitudes toward pregnancy among girls presenting to an adolescent health clinic to better predict which girls are at the highest risk of pregnancy.
STUDY DESIGN: We used a cross-sectional provider-administered survey design.
POPULATION: A total 202 girls aged 13 to 18 years presenting consecutively for reproductive health services to an adolescent care clinic were interviewed about their desire for pregnancy. Girls found to be already pregnant at the initial visit (n=54) were removed from analysis.
OUTCOMES MEASURED: The main outcome measured was desire for pregnancy. Subjects were grouped by those desiring pregnancy (n=16), those desiring to avoid pregnancy (n=107), and those ambivalent about pregnancy (n=25).
RESULTS: The girls who were ambivalent about pregnancy were not significantly different from the girls desiring pregnancy. In unadjusted analysis, girls desiring pregnancy or who were ambivalent about it were more likely to be Hispanic, unemployed, to not attend school, to live with neither natural parent, and to have lived away from home for more than 2 weeks. In adjusted analysis, the reported attitude of the boyfriend toward having a child was the only significant predictor of adolescent girls’ attitude toward pregnancy.
CONCLUSIONS: The best predictor of an adolescent girl’s attitude toward pregnancy is her perception of her boyfriends’ desire for a baby. Primary care providers should include boyfriends in any efforts to delay pregnancy in at-risk adolescent girls. Teenagers who are ambivalent about whether they want to be pregnant do not differ significantly from those desiring pregnancy, and should be considered just as high risk.
Early adolescent childbearing is associated with a wide range of adverse consequences and restricted life opportunities for young girls and the children they bear.1-5 Helping adolescents delay early childbearing has long been a goal of healthcare providers, researchers, and policymakers.6,7 Although the adolescent pregnancy rate in the United States is decreasing in most groups,8 it is still disturbingly high, particularly among Hispanic girls.
Most efforts to prevent or delay adolescent pregnancy have been directed at providing birth control, but this intervention is likely to fail if teens are not interested in preventing pregnancy. Although several studies have examined the factors and motivations underlying adolescent contraceptive behavior,9-13 teen attitudes toward pregnancy are still poorly understood.14 Adolescents may not share the same negative view of their childbearing as do adults concerned with preventing it. Retrospective studies suggest that as many as 60% to 80% of teenaged pregnancies are “unintended.”15,16 Other studies examining pregnant and parenting adolescents’ attitudes toward childbearing suggest that the percentage of pregnancies that are truly unintended may be lower than commonly believed.10,17-19 A significant percentage of never-pregnant adolescents harbor either highly ambivalent or positive attitudes toward early childbearing.19-21 A better understanding of the factors associated with a desire for pregnancy among adolescents may help health care providers better predict the most at-risk adolescents.
Our study investigated factors associated with adolescent desire for pregnancy among girls seeking reproductive health services at an adolescent clinic. Earlier studies have examined the attitudes of girls presenting for pregnancy testing, or who were already enrolled in prenatal care.9 No other studies have specifically looked at the factors associated with nonpregnant adolescents’ attitudes toward pregnancy, or the role of the boyfriend in influencing those attitudes.
Methods
Setting
This study was conducted in an adolescent health clinic within a migrant/community health center in a town with a population of 10,000, 25 miles from a major midwestern city. The clinic was staffed by a nurse practitioner and an adolescent health educator. The full spectrum of adolescent problems are dealt with in this clinic, but most visits are for pregnancy testing, birth control counseling, and checks for sexually transmitted diseases (STDs). Ninety-eight percent of visits are by females. The clinic serves patients aged 12 through 20 years, and has been operating in its current location for 20 years. The clinic offers completely confidential services to those who request it, with no parental notification or consent required.
Subjects
Girls aged 13 to18 years presenting consecutively for reproductive health services were eligible for this study. Girls were excluded if they had delivered a baby in the previous 12 months, had a miscarriage or a therapeutic abortion in the previous 6 months, or were currently using a hormonal method of contraception. A total of 202 girls were initially eligible and all agreed to participate. Because studies have shown that a woman’s attitude toward pregnancy changes once she is aware of being pregnant, we subsequently decided to also exclude those girls already pregnant at the initial visit (n=54), leaving 148 subjects in the final data analysis. All subjects spoke either Spanish or English.