Social and psychological correlates of pregnancy resolution among adolescent women: a review

Are pregnant adolescents stigmatized by pregnancy?

PURPOSE

To identify prevalence and correlates, including substance use and exposure to violence, of feeling stigmatized by being pregnant as an adolescent.

METHODS

A total of 925 low-income African-American, Mexican-American, and Caucasian pregnant adolescents aged </= 18 years were interviewed on the postpartum ward of a university hospital within 48 hours of delivery. Correlates of stigma were identified among self-reported behaviors such as substance use, exposure to violence, family support and criticism, as well as reproductive and sociodemographic characteristics.

RESULTS

Two out of five adolescents (39.1%) reported feeling stigmatized by their pregnancy. As compared with their nonstigmatized peers, stigmatized adolescents were more likely to report having seriously considered abortion, being afraid to tell parents about pregnancy, feeling that parents/teachers thought pregnancy a mistake, and feeling abandoned by the fathers of their babies. Stepwise logistic regression revealed the following correlates independently associated with feeling stigmatized: white race/ethnicity, not being legally/common-law married or engaged to the baby's father, feelings of social isolation, aspirations to complete college, experiencing verbal abuse or being fearful of being hurt by other teenagers, and experiencing family criticism. In contrast, greater self-esteem and having dropped out of school before conception were protective of reporting feelings of stigma.

CONCLUSIONS

Significant proportions of pregnant adolescents feel stigmatized by pregnancy and are at increased risk of social isolation and abuse. These young women may need special attention during and after pregnancy to develop concrete strategies to care for themselves and their children to complete their education and avoid becoming clinically depressed.

The importance of the health education program environment for pregnant and parenting teens

Teenage Pregnancy is recognized as one of this country's most critical social issues. Each year, one out of ten females aged 15 to 19 becomes pregnant. In addition, there are a number of documented complications and consequences for the pregnant teenagers, their children, families and society. In response a number of health education programs have been developed to meet the myriad needs of this aggregate. Unfortunately, most of this cohort do not participate in these health education programs. This study, a part of a larger study, was conducted to identify the health education program elements most important to attract and sustain the participation of pregnant and parenting teens in a health education program. The sociodemographics of the pregnant and parenting teens were identified and linked to program elements. Since sociodemographics are often the first information known about a target group, linking these demographics to health education program elements has implications for program development and marketing. An exploratory survey methodology was used in this study and data were analyzed by measures of central tendency, dispersion, and analysis of variance to understand better the relationship between sociodemographic characteristics and importance of the health education program environment for pregnant and parenting teens.

The impact of sexual activity and fertility timing on African American high school graduates' later life experiences

Results from this study of 1,666 African American high school graduates' life experiences showed that a significant proportion of adolescent mothers were more successful than conventional stereotypes suggest Several had obtained professional jobs, had middle-income status, and were pursuing additional educational training. The author used data from the National Survey of Family Growth Cycle IV to examine a sample stratified by sexual activity and fertility timing: 474 virgins (28.5%), 570 never-pregnants (34.1%), 65 ever-pregnants (4%), and 557 adolescent mothers (33.4%). Across groups, most of the women had never married, with virgins and adolescent mothers the least likely to be in marital relationships. Of the four groups, virgins reported higher educational, financial, and occupational advancement. Implications for future research, education, and policy are discussed.

An ecological analysis of pregnancy resolution decisions among African American and Hispanic adolescent females

Using data from the 1988 National Family Growth Cycle, IV, this study sought to identify specific individual, family, sociocultural, and social structure factors that influence pregnancy resolution decisions of first conception among African American and Hispanic adolescents aged 15 to 21 years. A hierarchical discriminant function analysis was used to determine the extent to which selected variables could distinguish those who terminated their first pregnancy from those who decided to carry their first pregnancies to full term. Three individual factors (age at conception, contraceptive behavior pattern, degree of self-disclosure about the pregnancy), two family-level variables (family sexuality socialization, family income), and each of the selected social structure (access to sexual health care facilities) and sociocultural factors (religious affiliation and church attendance) were found to discriminate between the two groups. However, the discriminating power of these variables differed depending on race/ethnicity.

Drug use as a risk factor for premarital teen pregnancy and abortion in a National Sample of Young White Women

The relationship between adolescent drug use and premarital teen pregnancy and abortion as a pregnancy outcome among sexually active women is investigated in a sample of white women from the National Longitudinal Survey of Youth. Event history analysis is used to explore whether prior drug use has a unique effect on premarital teen pregnancy, with controls for personality, lifestyle, and biological factors. Logistic regression is used to estimate whether drug use affects the decision to terminate a premarital teen pregnancy. The results show that the risk of premarital teen pregnancy is nearly four times as high for those who have used illicit drugs other than marijuana as for those with no history of any prior substance involvement. Furthermore, illicit drug use increases the likelihood of an abortion by a factor of 5. Policy implications of the findings are discussed.

Emotional sequelae of abortion: implications for clinical practice

The literature is summarized on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Four areas of inquiry for identifying psychotherapeutic issues in regard to abortion are elaborated, including: (a) characteristics of the woman prior to and at the time of the abortion, (b) the nature of social support and the cultural milieu around the abortion, (c) characteristics of the medical environment and abortion procedure, and (d) events subsequent to the abortion which may have aroused post-decisional conflict. The implications of the research literature for psychotherapeutic treatment of women who have had abortions are discussed.

Psychological sequelae of induced abortion

This article reviews the scientific literature on the psychological sequelae of induced abortion. The methodology and results of studies carried out over the last twenty-two years are examined critically. The unanimous consensus is that abortion does not cause deleterious psychological effects. Women most likely to show subsequent problems are those who were pressured into the operation against their own wishes, either by relatives or because their pregnancy had medical or foetal contraindications. Legislation which restricts abortion causes problems for women with unwanted pregnancies and their doctors. It is also unjust, as it adversely most affects lower socio-economic class women.

Psychological impact of abortion: methodological and outcomes summary of empirical research between 1966 and 1988

A systematic "roadmap" through the medical literature that empirically examines the incidence of psychological sequelae of induced abortion is presented. Because outcome incidence rates and methodological profiles vary substantially across studies, selective use of articles from this literature without an accompanying rationale for that selectivity could foster erroneous conclusions. Information compiled here can facilitate a rapid methodological critique of citations in abortion-related materials. Investigations published in English between January 1966 and April 1988 that quantitatively examined psychological sequelae using prospective, retrospective, or comparative methodologies are summarized in tables to produce a synopsis of the demographics, methodological limitations, and gross statistical features of each article. This quantitative guide is designed to facilitate appropriate use of the current literature, provide needed background to assess positions arising from the currently available data, and provide methodological focus for planning better studies in the future.

Locus of control and decision to abort

The relationship of locus of control to deciding on an abortion was investigated. Rotter's Scale was given to 118 women immediately prior to abortion, 2 wk., and 3 mo. following the abortion. Subjects' locus of control scores were compared across the three times, and the abortion group's pretest scores were compared with those of a nonpregnant control group. As hypothesized, the aborting group scored significantly more internal than the general population but no differences in locus of control were found across the three times. The length of delay in deciding to abort an unwanted pregnancy following confirmation was also assessed. Women seeking first-trimester abortions were divided into internal and external groups on the Rotter Locus of Control Scale and the lengths of delay were compared. The hypothesis that external scorers would delay the decision longer than internal ones was confirmed. The results confirm characteristics of the locus of control construct and add information about personality characteristics of women undergoing abortion.

Relative body weight as a factor in the decision to abort

Abortion referral data of 692 pregnant women visiting a large urban planned parenthood clinic were analyzed to determine whether relative weight, as measured by an adiposity index, as well as other variables, were associated with a decision to terminate or not terminate a pregnancy. Relative weight, length of pregnancy, education, age, ethnicity, and marital status were found to be associated with the decision to abort. While most of these variables have previously been shown to be related to the decision to terminate or not terminate a pregnancy, a relationship between relative weight and abortion has not previously been reported. In the analyses of all the women in this study and of a subsample consisting only of those in the early stages of their pregnancies, increased relative weight was associated with a decrease in the likelihood of termination of pregnancy. Possible reasons for this relationship and the evolutionary implications are discussed.