Data Collection
After obtaining informed consent, each girl underwent an extensive, semistructured interview exploring her attitude toward pregnancy, childbearing, and contraceptive use. All interviews were done by 1 of the 2 clinicians working in the adolescent clinic (a 35-year-old adolescent health educator and a 40-year-old obstetric nurse practitioner). Both clinicians were white women who had been working in this clinic for more than 15 years. The health educator was fluent in Spanish. A girl’s attitude toward pregnancy was determined by a series of questions. Other information elicited included ethnicity, age, school attendance, employment status, social habits (alcohol and tobacco use, current dating, current sexual activity), family structure, whether the subject had ever lived away from home for more than 2 weeks, age of her boyfriend, boyfriend’s attitude about pregnancy, and confidentiality of the initial visit. Obstetric and gynecologic histories of each girl were also obtained. After the interview, pregnancy testing was done, if indicated.
Data Analysis
Based on the interview, each girl was categorized as desiring pregnancy, wishing to avoid pregnancy, or being ambivalent about pregnancy. Girls desiring pregnancy were so similar to girls who felt ambivalent about pregnancy that these girls were grouped together in the final analysis and compared against those girls wishing to avoid pregnancy.
Data were analyzed using the SAS statistical program (version 8.0). We used chi-squared testing for unadjusted analysis of factors associated with adolescent attitudes toward pregnancy. Unadjusted associations with a P value greater than .2 were included in multiple logistic regression analysis to adjust for multiple variables, and to calculate odds ratios and 95% confidence intervals. The final multiple logistic regression model included only those variables found to retain significance at P less than .05.
Results
Demographic characteristics of the participants are shown in Table 1. Of the 148 girls, almost all (92%) were currently dating, and most (88%) were sexually active with their partner. Ninety-six percent had never been pregnant previously, 86% had never used hormonal contraception, and 84% had never had a Papanicolaou test or an STD screening.
The mean age of subjects’ boyfriends was 18.4 years, with an age range of 13 to 30 years. One third of the girls lived with both of their biological parents, and 78% lived with at least one biological parent. Three were already married at the time of initial visit. Almost half (46%) described their enrollment visit as confidential.
One hundred seven (56.4%) of the girls were categorized as wishing to avoid pregnancy, 16 girls (19.8%) as desiring pregnancy, and 25 girls (23.7%) as ambivalent about whether they wanted to be pregnant. Unadjusted analysis comparing girls desiring pregnancy with those feeling ambivalent revealed only 1 significant difference: girls desiring pregnancy were more likely to report that their boyfriends wanted a baby. So, in the final analysis, these girls were grouped together, and compared with the girls wishing to avoid pregnancy (Table 1w.
Unadjusted analysis of the 148 subjects is shown in Table 2. Girls wishing to avoid pregnancy differed from girls desiring or ambivalent about pregnancy in 6 different parameters: ethnicity, school attendance, employment status, family structure, time spent away from home, and desire of boyfriend to have a baby. There was no significant association between a girl’s age and her attitude toward pregnancy (P=.48). Notably, the mean age difference between girls and their boyfriends was not significantly associated with desire for pregnancy.
In multivariate analysis of characteristics of the girls themselves, factors significantly associated with a positive attitude toward pregnancy were Hispanic ethnicity, having lived away from home for more than 2 weeks, and having left school Table 3.
When boyfriend characteristics and attitudes were added to the analysis, all subject characteristics ceased to be significant, leaving the perception of the boyfriends’ desire for pregnancy as the only significant variable.
Discussion
We found the strongest predictor of an adolescent girl’s attitude toward pregnancy was her stated belief about whether her boyfriend wanted a baby. In light of the powerful influence of the girl’s perception of her boyfriend’s attitude toward pregnancy, no other factors are significantly associated with her own attitude toward pregnancy. This finding suggests that family physicians and other health care providers working with teenaged girls should include the boyfriend in any discussions aimed at delaying pregnancy.
Girls ambivalent about pregnancy are markedly similar to those desiring it, differing only in the degree to which they believe their boyfriends want a baby. It may be that some of the ambivalence about pregnancy arises from a difference of opinion between the girl and her boyfriend. Girls ambivalent about pregnancy were least likely to know their boyfriend’s opinion on the subject. It may be that young girls who are ambivalent about pregnancy are also those with more limited interpersonal communication skills, making it difficult for them to discuss critical reproductive health issues with their partners. Health care providers may have a role in facilitating improved communication between girls and their partners by specifically addressing partner communication when seeing girls individually, as well as by inviting their partners to be present and more actively involved in clinic visits. Interventions focused solely on providing information about and access to contraception are unlikely to be sufficient in strengthening a girl’s motivation to delay pregnancy. More appropriate and effective interventions may be those that explore the extent to which her partner’s attitudes shape her own critical reproductive health decisions, and encourage greater dialogue between a girl and her partner with respect to contraceptive and childbearing decisions.